Saturday, March 5, 2011

How can I stop being hungry? – The Chart - CNN.com Blogs

Losing weight has always been tough for me. It's even tougher for me now that I'm in my 40s. However, I made a resolution for 2010, and with diet and exercise, I've managed to lose 35 pounds.

I've managed to lose weight through grit and determination. The problem is, I am always hungry and my appetite is ravenous, difficult to satisfy. I want to eat until I'm full EVERY TIME I eat. If it wasn't for force of will, I would continue to eat and pack the pounds back on.

Is there anything I can do to fight the hunger?

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Patients use Facebook, Twitter, to get health information – The Chart - CNN.com Blogs

More and more patients are turning to social networks such Twitter and Facebook for health information, according to a survey by the National Research Corporation.

In the survey of nearly 23,000 people in the United States, 41% said they use social media as a source of health care information. For nearly all of them – 94% - Facebook was their site of choice, with YouTube coming in a distant second at 32%. Eighteen percent of the respondents said they turned to MySpace or Twitter for health information.

One in four respondents said what they learned on these sites was “very likely” or “likely” to impact their future health decisions.

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HITLab Projects : VR Pain Control (Virtual Reality, Distraction Techniques)

The University of Washington Harborview Burn Center, directed by Dr. Nicole Gibran, is a regional burn center. Patients with severe burns from 5 surrounding states are sent to Harborview for special care. Harborview has pioneered a number of advanced treatments (e.g., early skin grafting). As a result of advances here and elsewhere, the chances of surviving a bad burn, and quality of living for survivors has improved dramatically over the past 20 years.

Unfortunately, the amount of pain and suffering experienced by patients during wound care remains a worldwide problem for burn victims as well as a number of other patient populations.

When patients are resting (most of the time), opioids (morphine and morphine-related chemicals) are adequate for controlling their burn pain.

In sharp contrast, during wound care such as daily bandage changes, wound cleaning, staple removals etc., opioids are not enough, not even close. As shown in the figure on the right above, over 86% of the burn patients reported having severe to excruciating pain during wound care (shown in red), even when standard levels of opioids were used. The pain management techniques in use are not good enough. Patients are suffering, a fact particularly disturbing when the patients are children.

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Friday, March 4, 2011

The Skin Cancer Foundation - Self Examination

WHY SELF-EXAMS ARE SO IMPORTANT

woman-with-mirror_200Skin cancer is the most common of all cancers, afflicting more than two million Americans each year, a number that is rising rapidly. It is also the easiest to cure, if diagnosed and treated early. When allowed to progress, however, skin cancer can result in disfigurement and even death.

Who Should Do It

You should! And if you have children, begin teaching them how to at an early age so they can do it themselves by the time they are teens. Coupled with yearly skin exams by a doctor, self-exams are the best way to ensure that you don’t become a statistic in the battle against skin cancer.

When To Do It

Performed regularly, self-examination can alert you to changes in your skin and aid in the early detection of skin cancer. It should be done often enough to become a habit, but not so often as to feel like a bother. For most people, once a month is ideal, but ask your doctor if you should do more frequent checks.

You may find it helpful to have a doctor do a fullbody exam first, to assure you that any existing spots, freckles, or moles are normal or treat any that may not be. After the first few times, self-examination should take no more than 10 minutes – a small investment in what could be a life-saving procedure.

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The Skin Cancer Foundation - American Academy of Pediatrics Calls for Ban on Youth Tanning | Tanning

The American Academy of Pediatrics (AAP), a group of 60,000 pediatricians, today called for all US tanning salons to bar minors. With this new policy statement, the AAP joins health groups such as the American Medical Association, the World Health Organization (WHO), the Academy of Dermatology, and The Skin Cancer Foundation in demanding a ban on indoor tanning for young people.

“We strongly commend the AAP for this definitive statement pushing for prohibition of indoor tanning for young people,” said Perry Robins, MD, President of The Skin Cancer Foundation. “The damage caused by the UV radiation from tanning beds and the sun is cumulative and often irreversible, and the earlier people start to tan, the higher their risk of developing skin cancer in their lifetimes.”

Sophie J. Balk, MD, coauthor of the policy statement and a pediatrician at Children’s Hospital at Montefiore in Bronx, NY, explained that the AAP wanted to make a “clear statement” supporting the other groups in recognizing the dangers of indoor ultraviolet (UV) tanning. Since 2009, she pointed out, the International Agency for Research on Cancer, affiliated with WHO, has classified tanning beds as cancer-causing, and studies show that those who first use tanning beds before age 35 have a 75 percent increase in their lifetime risk of developing melanoma, the deadliest form of skin cancer. On average, indoor tanners are 74 percent more likely to develop melanoma, 2.5 times more likely to develop squamous cell carcinoma, and 1.5 times more likely to develop basal cell carcinoma.

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Wednesday, March 2, 2011

A To Z List of Inspirational Poems, Touching Stories, 4Nursing.com, Nursing & Healthcare Resources

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20 Things I've Learned From Nursing by by Sally P. Karioth, RN, Ph.D:"1. When you're 92, you shouldn't have to beg for the salt shaker, even if you do have congestive heart failure. 2. Our profession has no room for bullies or whiners."
http://www.nursefriendly.com/nursing/inspiration/nursing.stories.20.things.ive.learned.from.nursing.htm

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A Nurse's Prayer, Inspirational Poems, Touching Stories:"Dear Lord, Please give me strength, to face the day ahead. Dear Lord, Please give me courage, as I approach each hurting bed."
http://www.nursefriendly.com/nursing/inspiration/a.nurses.prayer.htm

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An Everyday Survival Kit:"Toothpick, Rubber band, Band aid, Pencil, Eraser, Chewing gum, Mint, Candy Kisses, Tea Bag Here's why: Toothpick - to remind you to pick out the good qualities in others...Matt 7:1 Rubber band - to remind you to be flexible, things might not always go the way you want, but it will work out.Romans 8."
http://www.nursefriendly.com/nursing/inspiration/an.everyday.survival.kit.htm

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Angels of Mercy, Inspirational Poems, Touching Stories:"Sorry if we woke you in the middle of the night But someone in your neighborhood is fighting for his life. Sorry if we block the road and make you turn around, But there's been a bad wreck with dying children on the ground."
http://www.4nursing.com/inspirational-poems-touching-stories-angels-of-mercy.html

Inspirational Categories: Death, Dying, End of Life, Hospice Poems, Emergency Medical Services (EMS)

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Angels Unaware, Inspirational, Touching Stories:"It was a rainy night in New Orleans; at a bus station in the town, I watched a young girl weeping As her baggage was taken down. It seems she'd lost her ticket Changing buses in the night. She begged them not to leave her there With no sign of help in sight."
http://www.nursefriendly.com/nursing/inspiration/angels.unaware.htm

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Tanning Bed Exposure Can Be Deadly When Complicated By Medication Reactions

The researchers said that a recent random study of 1,200 individuals indicated that nearly 10 percent of those who frequented tanning salons did so in response to treatment of skin disease and only 5 percent were doing so on the advice of a physician.

"There is an increasing trend for patients to seek tanning bed radiation exposure as a means of self-treatment because, among much of the general public, the perceived benefits of tanning bed radiation include its ability to treat rashes," the study noted.

This research was funded in part by grants from the Riley Memorial Association, the National Institutes of Health and a Veterans Administration Merit Award.

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Texas Senate panel advances bill to protect nurses | AP Texas News | Chron.com - Houston Chronicle

A Texas Senate committee approved legislation Tuesday aimed at strengthening protection for nurses who report abuse by doctors.

The bill filed by state Sen. Jane Nelson, R-Flower Mound, protects nurses from being fired, discriminated against or punished. Nurses would be immune from criminal prosecution under the bill.

The bill now goes to the full Senate. If enacted, doctors would be fined up to $25,000 if convicted of retaliation.

Lawmakers saw a need for a more stringent law after two West Texas nurses were fired and criminally charged after reporting a doctor for allegedly practicing bad medicine.

The charges were dropped against Winkler County nurse Vicki Galle, but Anne Mitchell was prosecuted for "misuse of official information" and threatened with 10 years in prison.

Galle and Mitchell anonymously filed their complaint against Dr. Rolando Arafiles with the Texas Medical Board in 2009. But with help from the sheriff, Arafiles found out who the nurses were.

Despite Mitchell's acquittal, the case stirred outrage from medical communities nationwide. Nursing advocates want to ensure nurses can report malpractice without fear of retaliation.

"Patients are best served when nurses can advocate on their behalf," Nelson said. "The case of the Winkler County nurses highlighted the need for additional protection for nurses."

Mitchell said the decision to report Arafiles was carefully considered, and one she felt she had to make on behalf of her patients.

But the price she paid was high. She said her nursing career is over, her income has been cut in half and she continues to endure the effects of being labeled a whistleblower.

"That label basically reads 'don't hire me'," she said. "Nurses are frequently the last safety net for patients. If our voices are stifled, our patients will suffer. My hope is that the passage of this bill will prevent other nurses from having to go through what we went through."

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e-Autopsy: Kaiser Hospitals Dig In to Data to Assess Mortality

You've heard the macabre joke that hospitals and doctors "bury their mistakes." Well, here's an interesting twist: At Kaiser Permanente hospitals in Southern California, doctors are doing precisely the opposite. They're rolling back time in the death process – exhuming their unknown mistakes so to speak – to see what, if anything, they can learn in order to save similar patients the next time around.

But they're not doing it the old way through invasive autopsies. Those are expensive, increasingly unpopular with families, forbidden by some religions, and often don't reveal that much about errors in the process of hospital care.

Kaiser has a new concept, the e-Autopsy.

Kaiser's hybrid manual and electronic mortality review uses storytelling and specialists' scrutiny to study medical charts of patients who died in the hospital. The process builds a precise timeline of what happened. The goal is to prevent death and/or improve end-of-life care by looking for places to improve—from ambulatory settings prior to admission to the inpatient bedside.

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Patient Left Unrestrained, Patient Injured. Nurses Judgement Call

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Summary: The decision to use or not use restraints must be made with caution and good judgement. Their intended purpose must be to protect either the patient or others who may be injured by the patient including the staff caring for the client. The ultimate determination of necessity is left with the physician. Often, the moment to moment necessity is determined by the nurse. In this case a nurse did not feel restraining the patient was necessary. When an injury occurred, the patient sued.

The patient was involved in a motor vehicle accident. A head injury was suffered leaving him in a state of confusion and prone to agitation.

"Each year, an estimated 2 million people sustain a head injury. About 500,000 to 750,000 head injuries each year are severe enough to require hospitalization. Head injury is most common among males between the ages of 15-24, but can strike, unexpectedly, at any age. Many head injuries are mild, and symptoms usually disappear over time with proper attention. Others are more severe and may result in permanent disability." 2

Following the head injury, the patient was visibly confused and frequently became agitated. During the course of his admission, an order for "soft" wrist restraints was obtained and implemented to protect the patient from injury related to mental status (personality) changes.

"Personality Changes-Apathy and decreased motivation. Emotional lability, irritability, depression. Disinhibition which may result in temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behavior."2

On the day of the incident, the nurse on duty had assessed the patient. In her professional opinion restraints were not needed.

"What Is Restraint?

"Restraint" is physical force, mechanical devices, chemicals, seclusion, or any other means which unreasonably limit freedom of movement. hospital staff may use four types of restraint to restrict patients who are acting, or threatening to act, in a violent way towards themselves or others.

Physical restraint--holding a patient for over five minutes in order to prevent freedom of movement.

Mechanical restraint--using a device, such as 4-point or full sheet restraint, to restrict a patient's movement (excludes devices prescribed for medical purposes).

Chemical restraint--medicating a patient against her will for the purpose of restraint rather than treatment.

Seclusion--placing a patient alone in a room so that she cannot see or speak with patients or staff and the patient cannot leave or believes she cannot leave."3

She based this decision on her observation of the patient's mental, physical state and level of consciousness. It is common procedure and protocol in facilities for patient's to be released from restraints when the danger of violence is felt to have passed.

"How Long May Restraint Continue?

When an emergency no longer exists, the patient should be released. Thus, staff should release a patient who, upon examination, appears calm. The total time which a patient may be restrained is limited:"3

Later in the shift, the same nurse was helping the patient get up. In the course of this maneuver, the patient fell and claimed that an injury was sustained.

A lawsuit would be filed against the facility alleging negligence on the part of the nurse. The patient contended that the removal of the restraints breached standards of care.

In the initial trial, the jury was instructed to view the nurse's role as an "error in judgement." Based on this and on testimony on the proper use of restraints, standards of care, the court found for the facility.

The patient appealed.

Questions to be answered:

1. Was the nurse in error to remove the restraints from a patient when she felt they were no longer needed.

2. Did the removal of the restraints directly contribute to the "injury" that the patient claimed to sustain?

3. Were the standards of care governing restraint use adequately maintained?

The plaintiff's arguments sought to convince the jury that poor judgement was exercised by the nurse. It was contended that removal of the restraints and ambulation of the patient put him in harm's way.

With the patient assessed to be calm, the purpose of the restraints, "to prevent the patient from harming himself or others," had been achieved.

The purpose of the restraints had not been to "keep the patient from falling out of bed." The removal of the restraints then, could not be deemed as negligent. There was no duty of care breached in allowing the calm patient to remain unrestrained.

The order was in place to ambulate the patient when stable. In the nurse's opinion, the patient was ready. Another nurse may not have agreed with her actions. The patient under a different nurse's care might have been kept in restraints. A nurse could have "held off" on the order to ambulate.

There was no causative relationship between removing the restraints and the patient's fall. In carrying out orders for ambulation, the nurse was providing proper nursing care.

It's not difficult to picture a lone nurse with an unsteady patient losing control and having the patient slip away. Would this be a breach of duty owed to the patient?

One could argue that the nurse had no business trying to move a patient by herself. One might also observe the staffing patterns at the time and realize the nurse was doing "the best she could."

The decision to remove the restraints was clearly a nursing decision. Often the decision to use them in the first place lies with the nurse too.

This illustrates the leeway and discretion given nurses when carrying out physician's orders. It also shows the typical catch 22 situation some nurses may find themselves in regarding restraint use.

"Historically, conventional wisdom supported using physical restraints, including bed side rails, to "protect and safeguard" residents. Ironically, little documented evidence exists that restraints prevent falls and risk of injury from falls. Clinical studies demonstrate that restraints, conversely, in some instances, precipitate or exacerbate fall risk."4

Both nurses in the above situation would be acting within their scope of practice. Each would be adhering to standards of care.

For the plaintiff to have a case, it would need to proven that either the removal of the restraints or the ambulation of the patient was premature.

This was clearly not the case. The actions of the nurse were in good faith and exercised reasonable concern for the well being of the patient. The fact that the patient suffered a fall is unfortunate, and reasonably unforseeable.

It can be compared to the actions of a physician when dealing with an acute patient. Depending on which course of treatment that physician chooses, the patient might or might not have a favorable outcome.

In either case, as long as the physician exercises reasonable judgement based on established principles of practice, a finding of negligence is unlikely.

It has been well established that Medicine is not an exact science. Outcomes are not guaranteed when prescribing courses of treatment.

They are the result of standard medical practices and individual patient responses. These responses are not always predictable. Basically, the caregiver can only hope for the best.

The same principle applies to Nursing care. Regardless of how accurate assessments are and how diligently orders are carried out, patients may or may not experience favorable outcomes.

When outcomes are unfavorable, it is the constitutional right of the patient or patient's estate to sue anyone felt to be involved.

The court reviewed the facts of the case and a nursing expert's testimony on restraint use. The appeals court agreed that standards of care had been maintained.

There exists today intense pressure from family members, governmental agencies and regulatory agencies to limit restraint use to "only when absolutely necessary." As soon as they are put in use, the plan of care must include provisions for their removal.

Link Sections:

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm

Sources:

1. RRNL 2 (July 1997)

2. Family Caregivers Alliance Clearinghouse. Revised November 1996. Fact Sheet: Head Injury. Retrieved May 30, 1999 from the World Wide Web: http://www.caregiver.org/factsheets/head_injury.html

3. Mental Health Legal Advisors Committee. No date given. Your Rights in Hospitals Regarding Restraining and Seclusion. Retrieved May 30, 1999 from the World Wide Web: http://www.psychiatry.com/mhlac/basicrights/restraintandseclusion.html

4. Braun, Julie A. & Quish, Clare J. 11/10/98. Illinois Institute for Continuing Legal Education. Physical Restraints And Fall-Related Injuries. Retrieved May 30, 1999 from the World Wide Web: http://www.iicle.com/articles/braun11_10_98b.html

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Created on Saturday May 23, 1999

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

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