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Monday, November 15, 2010

How salt is associated with stroke and heart disease risk-KevinMD.com

Sodium intake has a direct and independent impact on the risk of stroke and cardiovascular disease, according to a meta-analysis published online ahead of print in the British Medical Journal.
According to the American Heart Association, you can help patients reduce salt intake by recommending that they:
• Compare the sodium content of similar products (e.g., different brands of tomato sauce) and choose products with less salt
• Choose versions of processed foods, including cereals and baked goods, that are reduced in salt
• Limit condiments (e.g., soy sauce, ketchup).
Researchers out of the University of Naples conducted a meta-analysis of 19 independent cohort samples taken from 13 studies exploring the relationship between salt intake and cardiovascular disease. The cohorts comprised 177,025 participants who were followed-up for 3.5 to 19 years and who experienced over 11,000 vascular events.
Higher salt intake was associated with a greater risk of stroke, with a pooled relative risk (RR) of 1.23, as well as a greater risk of cardiovascular disease, with a pooled RR of 1.14. The observed associations increased with larger differences in sodium intake and a longer duration of follow-up. The authors estimate that reducing daily salt intake by as little as 5 g at the population level could avert 1.25 million deaths from stroke and nearly three million deaths from cardiovascular disease annually.
Today’s research provides strong evidence for worldwide efforts to reduce sodium intake.

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Top 10 Pocket-Essentials for Nursing and Clinicals - Nursing Link

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Scrubs Magazine

Scrubs Magazine is the lifestyle website for and about nurses. Here you’ll find weekly giveaways, “best of” lists, and both the lighter side and the serious side of nursing with cartoons, scrubs style DOs and DON’Ts, beauty, health and wellness. Scrubsmag.com also features revealing stories from nurse bloggers ranging from a newly minted nurse to a seasoned RN to a misunderstood male nurse. Follow us on Twitter and join our conversation on Facebook.

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Ani Burr | Scrubs Magazine

Every nurse (and student nurse!) carries around the essentials, here’s my “Top Ten” pocket-essentials for nursing and clinicals!
1. Pens – There’s something magical about nursing – nurses can make pens disappear into thin air! Make sure you keep extras near by, but always have a black ink pen on hand. Even if your hospital has gone paper-less, you’ll need it to mark something, sign something, or make a note of something. Highlighters for your own use – marking up your papers, and a dry erase marker for your patient boards.
2. Stethoscope – I guess this one is a given, but you want to make sure you get a stethoscope you can use effectively (i.e. the ear pieces aren’t poking your brain so hard you can’t concentrate on the sound), and also make sure you have a type specific to your patient population (adult, cardio, peds, neonates, etc).
3. Bandage scissors – There’s always a use for these, even when you’re not cutting bandages or tape. No sense wasting time fumbling around trying to open packaging for a pulse ox, keeping a (good) pair of bandage scissors on you will save you time. Just make sure you keep an eye on them, don’t let them wander off with those pens!
4. Penlight – A penlight is an essential for a good neuro check, and to me, this is the part of the nursing assessment that is most often glazed over in non-neuro patients. Having my own pen light in my pocket is a reminder to me that I need to use it, complete my assessment, and make sure that I don’t skip it even if the patient is alert and oriented X4!
5. Alcohol prep pads – I know for clinical I stock my pockets full of these. You need them for IVs, you need them to clean off your pens – you need them. A lot of them. On hand, all the time.
6. Saline flushes – I’ll never forget the instructor who would check meds with us in the morning, and then as we were leaving the med room would grab a hand full of saline flushes and shove them in my pockets saying, “you’re going to need these!” and I always thought there was no way I would need all of these flushes. But sure enough, she was right! You probably don’t need a handful (especially since they’re bulky and their packaging makes a lot of noise in your already-full pockets) but having a spare has never hurt!
7. Tape – Taping and re-taping IV’s, taping a sign on a door, taping around a pulse-ox to keep it secure, tape is essential. Paper, plastic, satin, whatever you prefer, it will always come in handy
8. Chapstick/lotion – I always carry a chapstick, since my lips chap easily, if you need it, keep it on hand so you’re not running back to your locker/bag to grab it. Lotion can be too bulky for your pocket, but if you can find a small tub of it, and your hands dry out (especially with constant sanitizer use and hand washing), it’s important to maintain your own skin integrity.
9. Brain – Not the one in your head, but whatever it is that keeps you organized throughout the day. A change of shift sheet, a hospital-provided “brain” to keep track of everything that goes on is how you’re going to stay on top of it. Students, if you don’t have one, make your own! Check out this blog to find out what to add!
10. Cash – Last but not least, carry a few dollars on you in case you need a mid-morning or mid-afternoon snack or a quick cup of coffee. I know I always need my morning coffee with breakfast, and maybe something sweet in the afternoon!
Every nurse carries their supplies out of experience. These are what I’ve found to be practical and necessary when I am in the clinical setting and at work.

What’s in your pockets?
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• In New Nurse: Oh Organization!
• In Male Nurse: Nursing Gear List
• In Student Nurse: What’s in Your Pockets

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The Australasian Board Of Cardiovascular Perfusion was established pursuant to the Rules of the Australasian Society of Cardio-Vascular Perfusionists Incorporated, now ANZCP. The Board therefore forms part of the incorporated association and has no separate legal existence outside the College. The Board is required to establish and support the credentialing process

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Perfusion Line is the largest directory of Perfusion resources available to professionals and students involved with extracorporeal technology. We offer several special features to our registered members. Signup for a membership and enjoy all the exclusive sections. Our members support a website that offers scientific material for fundamental and continuing education to the international perfusion community. Join Perfusion Line Today.

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JAMA -- Abstract: Fall Prevention in Acute Care Hospitals: A Randomized Trial, November 3, 2010, Dykes et al. 304 (17): 1912

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Fall Prevention in Acute Care Hospitals
A Randomized Trial
Patricia C. Dykes, RN, DNSc; Diane L. Carroll, RN, PhD, BC; Ann Hurley, RN, DNSc; Stuart Lipsitz, ScD; Angela Benoit, BComm; Frank Chang, MSE; Seth Meltzer; Ruslana Tsurikova, MSc, MA; Lyubov Zuyov, MA; Blackford Middleton, MD, MPH, MSc

JAMA. 2010;304(17):1912-1918. doi:10.1001/jama.2010.1567
Context Falls cause injury and death for persons of allages, but risk of falls increases markedly with age. Hospitalizationfurther increases risk, yet no evidence exists to support short-stayhospital-based fall prevention strategies to reduce patientfalls.
Objective To investigate whether a fall prevention toolkit (FPTK) using health information technology (HIT) decreasespatient falls in hospitals.
Design, Setting, and Patients Cluster randomized studyconducted January 1, 2009, through June 30, 2009, comparingpatient fall rates in 4 urban US hospitals in units that receivedusual care (4 units and 5104 patients) or the intervention (4units and 5160 patients).
Intervention The FPTK integrated existing communicationand workflow patterns into the HIT application. Based on a validfall risk assessment scale completed by a nurse, the FPTK softwaretailored fall prevention interventions to address patients'specific determinants of fall risk. The FPTK produced bed posterscomposed of brief text with an accompanying icon, patient educationhandouts, and plans of care, all communicating patient-specificalerts to key stakeholders.
Main Outcome Measures The primary outcome was patientfalls per 1000 patient-days adjusted for site and patient careunit. A secondary outcome was fall-related injuries.
Results During the 6-month intervention period, the numberof patients with falls differed between control (n = 87)and intervention (n = 67) units (P=.02). Site-adjustedfall rates were significantly higher in control units (4.18[95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days)than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000patient-days; P = .04). The FPTK was found to be particularlyeffective with patients aged 65 years or older (adjusted ratedifference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days;P = .003). No significant effect was noted in fall-relatedinjuries.
Conclusion The use of a fall prevention tool kit in hospitalunits compared with usual care significantly reduced rate offalls.
Trial Registration clinicaltrials.gov Identifier: NCT00675935

Author Affiliations: Partners HealthCare System (Drs Dykes and Middleton, Ms Benoit, and Messrs Chang and Meltzer), Brigham and Women's Hospital (Drs Dykes, Hurley, Lipsitz, and Middleton, and Ms Tsurikova), Harvard Medical School (Drs Dykes, Lipsitz, and Middleton), and Massachusetts General Hospital (Dr Carroll and Ms Zuyov), Boston.

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Themes of Aging: Preserving Function, Improving Care
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JAMA 2010;304:1954-1955.
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Cardiovascular Perfusion:College of Health Professions:SUNY Upstate Medical University

Cardiovascular Perfusion—Bachelor of Science

Perfusionists are operating room specialists who conduct cardiopulmonary bypass. That is, they pump and oxygenate the blood of patients whose hearts or lungs are stopped, usually during open heary surgery.

The cardiovascular perfusion program accepts six students each year. Graduates are eligible to take the American Board of Cardiovascular Perfusion's National Certification Examination.

A Cardiovascular Perfusionist's work is a matter of life or death. People who succeed in this field thrive on excitement and stressful situations. More >

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Should tobacco companies pay for smokers' CT scans to screen for lung cancer?

According to a potential ruling in Massachusetts, tobacco companies will have to pay for smokers’ screening CT scans.
The Boston Globe (via Doug Farrago) writes that the decision “would allow thousands of other Massachusetts smokers to join the lawsuit, which covers people 50 or older who have smoked at least one pack a day of Marlboro cigarettes for at least 20 years,” and, “if a jury sides with the smokers, Philip Morris could be required to pay for each patient’s low-dose computed tomography scan, which can detect early-stage lung cancer.”
Now, I’m all for penalizing tobacco companies, but there some unintended consequences here.
First, there is no evidence that CT scans for early detection of lung cancer saves lives. In fact, the USPSTF doesn’t recommend it.
Second, what happens if the CT scan detects all sorts incidental findings, like benign masses that necessitate further workup? Indeed, a lung biopsy may be needed to definitively exclude cancer, which itself can lead to bleeding, infection, or other complications.
Would the tobacco companies pay for the additional tests that stem from the screening CT scan? If not, this decision will only further fiscally burden our health system.
Similar Posts:
CT scans for lung cancer screening may not save lives
Screening for lung cancer with a CT scan: What the NLST results mean
Lung cancer CT screening produces false positives and isn’t ready for prime time
Cancer screening and treatment cannot focus on mortality alone
Radiation from CT scans increases the risk of cancer

Tagged as: Cancer, Patient, Primary care, Radiology, Specialist

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Uninsured Americans cannot afford many medications-KevinMD.com

I went to the doctor recently and got a new prescription.
The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn’t have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a month’s supply. For those of you doing the math, yes, that’s $6,000 a year. Suffice it to say that I wouldn’t be filling the prescription. And that’s exactly what many Americans do.
For many low-income uninsured Americans, a number of important medications are out of reach because they are simply unaffordable. These are medications that treat chronic diseases like hypertension, high cholesterol, and other common illnesses. They are effective medications that can make a huge difference in a person’s quality of life–including whether or not they die an avoidable death. In a show of good faith, most pharmaceutical manufacturers provide access to no-cost or reduced-cost brand name medications (the ones they manufacture, of course) to this “gap” population. The trouble is, few people know about these programs, which offer tremendous assistance, but require people to jump through a number of application hoops to qualify for the cheap or, in some cases, free meds.
Dr. Heather Whitley has an article out in the latest issue of The Journal of Rural Health, which attempts to quantify the value of these prescription assistance programs (PAPs) at a clinic in Alabama. Head south from Tuscaloosa, and you’ll find yourself in Hale County–one of the 50 poorest counties in America with an average annual income of $14,927 per person. In Hale County, is a town called Moundville, and it is here that the Moundville Medical Clinic operates with a single physician, a nurse practitioner and a couple of nurses. This is one of those places that most Americans don’t know–or at least really don’t like to acknowledge–exists in the United States. If ever anyone needed help obtaining prescription medication, the patients of the Moundville Medical Clinic would be first in line.
The clinic has a pharmacist who works two days a week to help patients navigate the PAP application process. Costs are offset by charging patients $5 per completed and mailed application. In most cases, that is a small price to pay. Dr. Whitley looked at the data collected by the clinic to assess the value of the program–that is, how much free or reduced-cost medicine were patients getting?–and found that across a two-year period (2007 and 2008), the PAP program at the Moundville Medical Clinic brought in more than $138,000 in free medications.
That’s a lot, yes, but what is even more striking is when you consider that that was only for a total of 31 patients. In other words, each patient received about $4,500 in free medication on average during the study period. That’s a pretty remarkable benefit in return for filling out some complicated paperwork, and it suggests that — until real health reform and cost-control is achieved — clinics that see a number of PAP-eligible patients should strongly consider investing in such programs, even if it means having someone volunteer their time one day a week. The benefits far outweigh the costs, but there are administrative hurdles that must be cleared before the benefits can be accessed.
Brad Wright is a health policy doctoral student who blogs at Wright on Health.

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Monday, November 15, 2010

How salt is associated with stroke and heart disease risk-KevinMD.com

Top 10 Pocket-Essentials for Nursing and Clinicals - Nursing Link

Top 10 Pocket-Essentials for Nursing and Clinicals

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What’s in your pockets?
Next: Top Nursing Gear Must-Haves >>

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Australian and New Zealand College of Perfusionists

Perfusion Line

OHSU Healthcare: OHSU Healthcare

OHSU — Oregon Health & Science University

JAMA -- Abstract: Fall Prevention in Acute Care Hospitals: A Randomized Trial, November 3, 2010, Dykes et al. 304 (17): 1912

Cardiovascular Perfusion:College of Health Professions:SUNY Upstate Medical University

Cardiovascular Perfusion—Bachelor of Science

h2u.com : H2U : Health To You

Should tobacco companies pay for smokers' CT scans to screen for lung cancer?

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Uninsured Americans cannot afford many medications-KevinMD.com

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Monday, November 15, 2010

Top 10 Pocket-Essentials for Nursing and Clinicals

Featured Author:

More articles from this author:

What’s in your pockets?Next: Top Nursing Gear Must-Haves >>

More on ScrubsMag.com:

Cardiovascular Perfusion—Bachelor of Science

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Blog Archive

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About Andrew Lopez, RN, Nursefriendly.com

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What’s in your pockets?
Next: Top Nursing Gear Must-Haves >>