This looks at a story on blood pressure medications and why do I bring this is up? We don’t prescribe medications, at least general nurses don’t, nurse practitioners do but why do we need to know the differences between generic and brand name medications? This is an ongoing issue and as every nation in the world struggles with dealing with the increased cost of providing high quality medical care to our patients. Why aren’t we looking more closely at previous treatment modalities? Medications that are very inexpensive and are inexpensive to duplicate, to replicate, to provides, easy for the patients to manage with a well-known profile of side effects and issues that we can document and keep track of very easily rather than new medications that have a less proven track record that may or may not cause and extended life of the patient.
So, why do we- we need to look at those kinds of studies and do that kind of research and this particular study that I found here over at medicine net.com looks at dealing with patients with a history of hypertension and dividing that patient group up and giving some of them a standard, easily available generic diuretic medication that has been used for years to treat high blood pressure and also another group of patients giving them a rather new ACE inhibitor or rather new calcium channel blocker and looking at how that high blood pressure is being treated using those particular medications.
So, they had 33,000 people in this study and they looked at these patients and how they responded overtime. This study came out- began in 2002 and they followed up with these patients over 4 and 8 years and discovered that the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing onsets of stroke, heart failure and overall cardiovascular disease and that’s significant. We’re talking about a 20% higher death rate for tyhe ACE inhibitor group and a 12% higher rate of hospitalization and death in the calcium channel blocker group. Significant changes are differences in how these patients were managed when they were put on just a diuretic versus the more expensive, newer, brand-name medications.
So, we should be doing more studies like this because if the old medication is working fine, either similar effect in this or in this caase had a better patient morbidity and mortality profile then we should probably be doing more studies like this much more frequently because it just doesn’t make sense to go ahead and continually make new drugs that overtime were shown not to be that effective in treating the patients and yet caused increased expense to the entire health care system.
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This article has been featured in the news segment of the Nursing Show podcast episode Psychological Assessment and Episode 145.
Filed under nursing news by on Sep 3rd, 2010. Comment. 
Now, stem cells have been out there for a while in research. Most recently, people have been holding stem cells as the eventual cure for many problems including spinal cord injury, neurological disorders, patients with any kind of permanent damage to their bodies; we could regrow portions or segments of organs, whatever the case may be. Well, a study that was recently done undertaken by the Mayo clinic and also researchers in Belgium concurrently, they used a mouse study to study mice with cardiac- induced cardiac problems. They then used the mouse’s own stem cells to change them using a recombinant DNA technique to go ahead and change those stem cells. They were targeted to become cardiac cells. The goal of course was to see if they can regrow dead cardiac muscle.
Now, this is a problem. If you have a patient with a heart attack, they have cardiac ischemia and then eventually death of the cardiac cells; they have that portion of their heart as non-functioning and it will not be getting any better. Patients that begin the downward slide of heart failure because of cardiac events or a series of cardiac events over time causing deaths of portions of the cardiac muscle, how do you regrow that cardiac muscle? You can’t, it won’t regenerate itself. But, if we are able to target stem cells to actually go in there- you have a patient with a significant cardiac event, you could put them on a cardiac bypass device to hold them momentarily to keep them on that bypass device, allowing the heart time to heal itself and regenerate cardiac tissue.
That’s a long way off. This type of study is still on the animal study stages so we’re looking at 10-15 years ‘til something like this might reach the patient population but it does hold out hope that stem cells do seem to be providing the tools needed to take care of patients with a whole host of injuries, whether it’s a medically related injury such as a cardiac event or if its perhaps a spinal cord injury because if we can regrow and regenerate cardiac cells, we should be able to do something similar for other types of cells and eventually perhaps even neurological cells. You may have patients coming in asking you questions because they see news headlines about things like this occurring and you should be able to talk to them about it and let them know that there’s a lot of great research going on out there. In may not help in the immediate near term but down the road, it could save a patient from otherwise be neither a life of disability or a life that would be extremely shortened and death following closely along.
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This article has been featured in the news segment of the Nursing Show podcast episode Psychological Assessment and Episode 145.
Filed under nursing news by on Sep 2nd, 2010. Comment.
This news story is looking at treatment of atrial fibrillation and its associated risk factors. Now, we’ve covered a-fib here on the show before. You can look back in past episodes and find those episode links and listen to that show or watc h that episode. In any case, a-fib comes associated with some risk factors including increased risk for stroke, pulmonary embolism, cardiac events and heart failure. So, what do we do when we have patients with atrial fibrillation to assess their risk for those events?
Well, there are all kinds of scoring and screening scales out there. We use them to assess patients’ fall risk, we use them to assess patients for many different things and there is an assessment scale for atrial fibrillation called the CHADS 2 score and its used to assess patients and see whether or not they have an increased risk for things like stroke. So if you use this score and you assess your atrial fibrillation patient, it was found in this recent study coming out of Sweden that patients with a higher CHADS 2 score were found to be at increased risk for stroke, other cardiac events and actually, the CHADS 2 score was found to score well for other cardiac issues. So not even patients with atrial fibrillation but patients with any onset of acute coronary syndrome using the CHDS 2 score was predictive of their risk other problems to occur such as stroke and other associated issues.
That’s what this particular news item I found over at medical news today is talking about and you should keep in mind that there are a host of assessment tools available for taking care of our patients and we should utilize those tools, we should also continually assess those tools for their effectiveness in predicting problems with our patients. Just because we’ve used a tool forever in a day doesn’t mean that it can’t be tweaked or made a little bit better to better cause us to look more carefully at our patients and predict future outcomes and try to avoid negative outcomes. So, I like studies like this and I’ll continue to bring those out as I find them.
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This article has been featured in the news segment of the Nursing Show podcast episode Psychological Assessment and Episode 145.
Filed under nursing news by on Sep 2nd, 2010. Comment.
An article study that recently came out, showing that Acetaminophen may be a trigger for teen asthma attacks. Now, why do I bring this up? Anytime I see an article like this that gets out into the public I am constantly reminded that as medical professionals, we need to understand what these studies are saying and we need to be able to speak intelligently about them should we receive a question from one of our patients. It’s important because the news media will go out there and put something like this out on the internet or out on the websites or on their health pages in the newspapers and what happens is that patients hear this and change the way that they’re medicating themselves. We should always always be educating our patients that if you read some article, you need to check with you healthcare professional. The person who told you to take a certain medication, to use a certain nutritional supplement, whatever the case may be, don’t just stop taking something until you’ve contacted the medical professional who told you to take it.
This is true for something as inane as Tylenol. It is not a dangerous drug when used appropriately and even though this study showed that there was an increased asthma risk for some patients, that asthmas risk is still not that great. I mean, it’s an increased risk for an existing patient that has asthma but it may not be necessarily an indication that you should stop taking Tylenol. So, we need to be able to educate our patients whenever studies that talk about medications come out and reach news headlines because ultimately, a lot of our patient just go “Oh, we can’t use Tylenol anymore”, and they might switch to something else that is not as appropriate to treat the problem at hand that may cause other side effects and switching from one analgesic to another over the counter, probably not too much of an issue but if you have patients that were put on Tylenol because they have GI issues and the family of NSAIDs, the anti inflammatories out there cause these patients typically to have more risk of GI bleeds, well an isolated lower risk of a possible asthma attack might be just the less significant problem to deal with than a patient developing a slow GI bleed by taking too much of an Ibuprofen or some other over the counter anti inflammatory medication for pain management.
So we need to be able to speak intelligently about what we’re seeing and be able to educate our patients about “hey, when you read something, don’t just read the headline, read the whole article”, because as for instance, and I’ll just slide down here at the very bottom of this article, the authors of the study say that it is a safe drug and there’s no imminent threat to patients but for some people at high risk, it might be important for their prescribers to advise them appropriately about whether this drug would be a good choice for them. This is the standard disclaimer but it’s all the way at the bottom of the article so we need to go ahead and educate our patients that don’t just read the headlines. The headlines are out there to freak you out, they are used to cause a little bit of a fear reaction so you’ll read the article, that’s how headlines are written. patients should understand that and not have a knee-jerk reaction to just reading a headline because of course the headline doesn’t tell the whole story and you need to have the whole story and then talk to a medical professional like your nurse to go ahead and find out what exactly this particular article means.
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This article has been featured in the news segment of the Nursing Show podcast episode Acetaminophen Medication Review for Nurses and Episode 144.
Filed under nursing news by on Aug 26th, 2010. Comment.
There’s been continual evidence that violence in the workplace for healthcare professionals at all levels is under reported. If a patient combative because of a head injury, because of sedation and they take a swing at you, it’s violence but does that mean- does that get reported necessarily? If a patient’s combative and you have to wrestle him, technically that’s violence but its not- you know, it doesn’t get reported very frequently.
So there is going to be some new guidance for the UK on how violence is recorded in the workplace and this is part of the National Health Service security and management service and they have launched a guidance on different ways to mark patient records so that if a patient has been violent with health care professionals in the past or there’s some indication that they tend to lash out and become combative under certain situations, wouldn’t it be nice if there was something in the chart to warn you about this? So there are going to be procedures in place, that are going to be put in place by the National Health Service in the UK to pt violence markers on electronic and paper records.
Is this something we’re already doing here? Again, it’s under reported, how often do you place in the chart that the patient was combative and it took three of us to hold him down? You may have put something in there but did it get marked anywhere else? Did a flag get put on that when a patient is found to be repeatedly combative whenever they’re sedated? This is something that we need to look at in our facilities. It’s easy for the UK to do this kind of thing; they have a National Health Service so they can have a national standard. It’s more difficult here in the United States and I think this is one of those things that different nursing organizations, professional organizations, perhaps the emergency nurses, the critical care nurses, the American Nursing Association should look into and propose a series of standardized language, standardized ways of noting potentially patient in the care record so that future professionals dealing with them will be forewarned and be able to be on the lookout, be extra prepared.
In my other line as a paramedic, in my other show the MedicCast, I end every episode with the words Scene Safety, BSI, scene safety and body substance isolation. Its something that new emergency medical services professionals have to learn about because we’re going into the field so frequently and having to protect ourselves and be aware of our surroundings. Situational awareness is just as important in the hospital setting especially because you might often let your guard down, thinking that “hey, I’m at work, I’ve got my friends and co-workers around me, I’m not necessarily a potential victim of violence in the workplace”, and yet we find that’s really not the case and different levels and aspects of violence are inflicted upon healthcare professionals in facilities all the time. So, hopefully we can come up with a way to document this and do so more appropriately and I’m looking forward to finding out more about what’s going on in the UK and how they’re going to be doing this and perhaps we can bring some of those procedures and policies here at the United States.
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This article has been featured in the news segment of the Nursing Show podcast episode Acetaminophen Medication Review for Nurses and Episode 144.
Filed under nursing news by on Aug 25th, 2010. Comment.
This is a recent story I found over at medicalnewstoday.com and this is a study from the University Of Maryland School Of Nursing and they were looking at workplace conditions in magnet hospitals. Now, those of you that know probably already know this but magnet hospitals are facilities that have raised certain departments or perhaps the whole facility to a certain level of care expectation. Most often, they require nurses that work there to have BSNs in those departments that have the magnet status and they are constantly reviewing and raising educational concerns and information for increased and better patient care and patient outcomes. Great for the patients, but by just working at a magnet hospital, does that mean that your work conditions as a nurse are better? Is nurse staffing better? You’re working with a higher educated caliber of nurse, I want to say higher caliber in general because a Bachelor’s degree does not a fantastic nurse make automatically, but certainly a nurse with a higher level of education, higher understanding and perhaps a higher base of critical thinking. So, you have good patient care outcomes but what about good work environment?
What this study found was that just coz you work in a magnet hospital doesn’t mean that your working conditions are necessarily better, that this is really a separate management concern. Focusing on patient outcomes is all well and good but there are other things, other factors that contribute to workplace satisfaction and that’s what this particular article found out. Really, actually when you think about under those concerns, it’s not really that much of a surprise. Yes, you have a higher requirement for the nursing staff educationally but that doesn’t necessarily mean that you will also have better workplace conditions or better staffing. It doesn’t mean that its worse, doesn’t mean it’s better but definitely is not an indicator that if you work in a magnet facility that you’re going to enjoy your job better. You should look at all aspects of any employer. as we run into the beginning of the new fall semester, we have a lot of new nursing students coming in here and perhaps this is their final year, they’re going to be looking at jobs, perhaps you just passed your nursing boards, you’re a recent graduate and you’re looking at different facilities and where you’d like to work.
You should always ask some questions. I’ve done this in the past, you check over at nursingshow.com and search for nurse interview tips or tips for new nurses. You will find some articles and other segments over there that I’ve put together in the past, talking about the fact that no matter where you are in your nursing career when you go to interview for a job, one of the things you should bring with you is your list of questions that you have for your perspective employer. You know, it doesn’t hurt you to ask good questions about the workplace. It shows you’re interested, it shows you’re engaged and it lets them know that those types of questions are on the minds of their prospective applicants and so you should ask questions about other services available to the facility. Go online, look at you hospital’s websites, look at your perspective employer’s website and find out a little bit more about their background and jot down a few questions to bring to the interview yourself and this will help you find the right fit for you. What is a good fit for some people in some facilities is not necessarily true for everyone and so you need to find the right job that’s going to fit your perspective style in workplace, style in patient care and so magnet hospitals may not be the perfect job for you.
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This article has been featured in the news segment of the Nursing Show podcast episode Acetaminophen Medication Review for Nurses and Episode 144.
Filed under nursing news by on Aug 25th, 2010. Comment.
Up til now, insurance companies have been reluctant to get into the technology game where we have something that maybe can provide an option for our patients but their insurance company isn’t going to cover it and so they end up falling into the same-old, same-old whereas we could have a patient that could be safely and effectively managed much less expensively in the long term, but because of the upfront cost of putting in some kind of technological solution in the near-term, the insurance companies have bulked. That seems to be shifting according to this article I found over at medical news today.com, there is a shift and they’re starting to look at some monitoring technologies that will wirelessly let a monitoring center, physician’s office, a telenurisng program, hospital center, whatever the case may be, let them know about daily updates for for instance Congestive Heart Failure patients, COPD patients, patients that are at risk for being hospitalized with complications related to their medications, management of their disease.
Think about it, if we can monitor I’s and O’s remotely, we could catch an early weight gain that shows signs of Congestive Heart Failure exacerbation,. The benefit of that of course is we can adjust the patient’s diuretic medication, we can adjust the patient’s beta blockers and other cardiac meds and by doing that remotely by having a nurse- because it’ll be a nurse that calls, by having a nurse call in and verify the information, talk with the patient a little bit, get the assessment and then provide the update and information from their prescriber, we could give this patient an opportunity to not have a long-term hospital visit with all of the concurrent issues, risk for infection and other illnesses and expense and time away from home and all of those things that come into play when we have to hospitalize a patient. Managing this patient remotely, keeping them at home, keeping them from having and exacerbated situation occur is of course part of what nurses do and part of our focus on health management and return to optimal health and so I think that this is just right up nursing’s alley. This is what we do, it’s what we do really really well. So I’m looking forward to opportunities to do more of this. Imagine that at risk diabetes patient, that patient who for whatever reason is having difficulty managing their illness. If we could monitor their diabetes with them and catch some early shifts and some changes; maybe their diet is not where it needs to be, maybe they need some encouragement, all of these things can be done remotely and we provide this patient upfront care that staves off years of complications simply by making a quick phone call. So I’m looking forward to really having some of our insurers be more forward thinking about the uses of technology and actually reducing health care cost.
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This article has been featured in the news segment of the Nursing Show episode Johnson & Johnson Campaign for Nursing’s Future Campaign and Episode 143
Filed under nursing news by on Aug 13th, 2010. Comment.
Compression only CPR has been discussed and bantied about for several years now but we are raping up to that next set of updates from the cardiac symposium, the American Heart Association and others who will come up with the next round of recommendations for what CPR should be. For bystanders, some places have started moving towards compression only CPR. 911 centers are often now promoting compression only CPR when they educate bystanders over the phone on how to perform CPR in the field before rescuers arrive.
What does this really mean for us in the health care arena? Is this is going to change the way we perform CPR? I doubt it, I think that we will not be moving away from supporting and managing an open airway and supporting an appropriately providing ventilations for our patients and I have to conditionally say that because that appropriate ventilations seem to be the source of some of the issues for the health care arena. For bystanders,a lot of them don’t want to do mouth to mouth ventilations on their patients and rather than trying to educate patients and educate bystanders about that over a phone call in 911 or dealing with the fact that they just aren’t going to do anything, bystander CPR with compressions only is probably a good thing rather than have no CPR at all.
Numerous studies seem to bare this out that there is a significant difference between CPR performed with ventilations versus CPR by bystanders performed without ventilations and so that’s where those recommendations come from from the several studies both in the United States and the other parts of the world. What does this mean for health care providers? We’re still going to be providing and managing airways and expected to do so. We need to understand some of the physiological reasons why we need to manage an airway appropriately, not over ventilate our patients, we need to maintain that negative chest pressure gradient within the thoracic cavity to facilitate return of blood flow to the heart but we need to provide oxygen to our patients as well. So we’re going to be probably still continuing to ventilate our patients and as this article pointed out, there is no change for pediatric patients. Pediatric patients often are in cardiac arrest because of an airway issue, they have choked on something, they have somehow stopped breathing and so their problem is related to a problem with their oxygenation and airway management is going to be key to getting cardiac arrest reversed if possible. So we need to of course apply our medical knowledge to what’s going on with these patients and that’s why I don’t suspect there’s going to be any difference or major changes for the way we perform CPR. We may have a larger compression to ventilation ratio, I think it might go up to 50 to 2 and so be expecting an increase in that regard but I don’t think we’re going to see compression only CPR coming into the hospital space or the health care provider space anytime soon. But I wanted to point this out to you,t his is an article that is- we’re likely to see more articles like this as time nears for the updates. I think later this year, we’re going to have that meeting and the American Heart Association will come out with a response and recommendation for the next round of what CPR classes are gonna look like, so be prepared for that but I wanted to provide this update to you.
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This article has been featured in the news segment of the Nursing Show episode Johnson & Johnson’s Campaign for Nursing’s Future and Episode 143
Filed under nursing news by on Aug 11th, 2010. Comment.
This story had just been released over at CNN health.com however, it’s showing up everywhere and it’s a study that recently came out looking at people who take calcium supplements. Do people really need to be taking that extra calcium? Primarily, we see this in a lot of our patients who are taking additional calcium supplements because of risks for osteoporosis trying to improve calcium density in the bone and there have been a number of different studies looking at whether that’s actually effective or not. Unfortunately, a lot of patients take it upon themselves to take additional calcium supplements in a variety of different forms, but do they really need it? There’s a study out recently showing that the millions of people who take calcium supplements may actually be increasing their risk for a heart attack by as much as a third over patients who don’t take calcium supplements and that’s a very scary prospect. The risk for cardiac arrest is still very low or heart attack is still very low according to this study but when you look at it compared to the control group, it is a significant increase and should be a cause for concern.
Of course, remember that calcium is one of those electrolytes, one of those ions that has a great impact on cardiac contractility, on the effectiveness of the cardiac push on contraction and of course having too much of that can cause hyper excited states in the cardiac muscle and of course deficiencies of calcium can cause other issues. the problem is that most people don’t seem to have a calcium deficiency and it seems to be extremely rare. So why are people taking all of these extra calcium if they have enough calcium in their diet,? Is their body really able to process and do anything with that extra calcium? It seems to be that the effects are not as strongly recommended as they might have been in the past. Of course in women, who are at increased risk for osteoporosis as well as increased risk for heart disease, how do you weigh those factors? Some of the studies and some of the people talking about this study and commenting in this article had comments basically saying if you don’t have a calcium deficiency and you have adequate calcium in your dietary intake, there should be no reason for you to take additional supplements on top of a normal calcium fortified diet which a lot of our foods are.
So, I think it’s important for us as nurses to be aware of some of these key studies when they come out and really talk to our patients. Don’t forget when you’re asking about medications to ask them about vitamins and supplements because a lot of patients don’t consider vitamins or supplements and things they get at your local nutritional store or in that other aisle at the grocery store, they don’t consider it to be medications and yet in many cases, this could be considered a harmful substance for some of our patients and we should make sure that they’re taking these medications appropriately. Now of course, don’t forget to tell those patients that have been tole to take calcium supplements to not stop taking their calcium supplements so we need to make that we’re getting all of our patients the correct information and we should be looking at this very carefully and making sure that our patients have the best possible information and we are a great source of good information, high quality information.
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This article has been featured in the news segment of the Nursing Show episode Johnson & Johnson Campaign for Nursing’s Future Campaign and Episode 143
Filed under nursing news by on Aug 9th, 2010. Comment.
Another quick look at home-based births and this is a study that recently came out that a lot of people had been quoting earlier in the month and it was looking at the fact that while it was claiming that there were fewer interventions affecting the mother in a planned home birth, it was also stating that it was not as safe for the infants, that the infant mortality rate for the newborns was higher.
This was the study that was brought up in a recent Insights in Nursing episode where we had Amy Romano on from the Science and Sensibility blog to talk to us about reading science effectively and understanding methodology and she pointed out some major flaws in this particular study. It is a combined meta analysis study where several different research pieces are put together and analyzed as a group and of course that is meant to alleviate issues with the study of small patient populations in a lot of research and medical and nursing field. However, if you pull a giant study such as this one did and pool it with a bunch of smaller studies, you can really end up with skewed numbers and if you have a large, well-designed study, you don’t need to provide a meta analysis of multiple studies because you have a large patient population study involved.
You can look at the numbers there in that study and extrapolate appropriately. Then when you use different criteria from different studies and don’t boil down to a similar criteria point such as when is neonatal mortality measured? At 7 days? At 30 days? Well, if you have a study that measures neonatal mortality all the way out to 30 days, infants past a certain point, is it really related to a birth trauma or related to a birth-related problem? So obviously, there can be a lot of issues when you start combining studies that are using different criteria for examining their data. So I just wanted to point out this article that has been talked about quite a bit and yet there’s a lot of issues with it follow up on the link to the Insights in Nursing episode so you can listen to Amy’s great analysis of this study and her confusion about why this is used as a better representation of infant mortality rates in planned home birth when there is at least one other well designed study that stands on its own and doesn’t need to be combined in a meta analysis situation.
Research can boggle many of us and we often don’t read the information appropriately. So we just kind of read the author’s conclusions and assume that their methodology is good. I think that it is incumbent upon us as nurses to be able to critically read some of this research and understand what’s going on there so that we can provide correct information when people ask us about that latest headline they heard about. That maybe it’s not safe to have a home birth, and these can be medical professionals asking this question as well as the lay public. So I urge you to really follow up and stay on top of the researches that come out. I’ll try to do my best to talk a little bit about the research itself and tell you what’s coming along but it is incumbent upon you to follow up on these articles and if you have a different point of view, if you think there’s a problem with that research, get back in touch with me. Again always, you can leave a comment and you can also reach me of course by sending in an email in to nursingshow@gmail.com.
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This article has been featured in the news segment of the Nursing Show podcast episode Patient Communication and Episode 142
Filed under nursing news by on Aug 6th, 2010. Comment.
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