June 10th, 2015 | The Blog
Remembering to take daily medication can be difficult for some patients. Which pill do I take when? This becomes a consummate question, not only in younger years but especially when a patient is elderly. It holds true for everyone.
Patients who take multiple medications every day are impacted, as are elderly parents for whom many people provide care. Many patients take their medications directly out of the prescription bottle while others choose to fill a daily or weekly medication holder. Either way, there is a chance for error.
There are many medications ordered on a regular basis in the US. Here are a few interesting facts about the general population and prescription drugs:
The Medication Dilemma Solution
An innovative start-up pharmacy, PillPack, has come up with a solution to the confusion about taking medication correctly. All prescribed pills are packaged according to the dosing time, not individually by separate prescription.
What is New About It?
What is the Same?
This system takes the guesswork out of wondering if the patient took each prescribed pill or which prescribed pills were actually taken.
A study was conducted by Walter Reed Army Medical Center in Washington, D.C. to determine the accuracy of taking prescribed medications. The study found that by individualizing medication doses NOT individual meds, the compliance for regularly and accurately taking medications rose from 67% to 97%.
First and foremost, everyone can relax. The patient, the caregiver and concerned family members can be assured that the prescribed dose of each medication is sealed in the PillPack. The guesswork is gone.
The PillPack system eliminates:
PillPack is an independent company started by a pharmacist who wanted to innovate the way prescriptions are dispensed. The Company is licensed in 47 states. Oklahoma, Louisiana and Oregon have not yet approved PillPack usage.
There are 66 employees. Interestingly, 15 of those employees work exclusively on helping new patients transfer their existing prescriptions from traditional pharmacies to the PillPack system.
PillPack’s filling system is similar to one used in hospital pharmacies. The system holds 400 of the most popularly prescribed medications. A pharmacist loads less popular drugs into the PillPack by hand. Both the machine and a pharmacist check each drug.
Up and Coming
This system seems to be worth a try. Will it catch on? There will be more pop-up pharmacies offering the same service in the future. It will be up to the patient to choose the best option to fill their medication needs. Traditional retail pharmacies will need to step up their game in this competitive market.
June 3rd, 2015 | The Blog
A non-invasive test for marijuana detection would be a valuable tool in the work environment and for drug-related driving tests. Researchers are also working to develop a saliva test to detect marijuana in a person’s system.
With regard to drug usage, marijuana smokers fall into two categories. “Frequent smokers” are those who imbibe more than three times per week. “Occasional smokers” use marijuana less than twice per week. These guidelines were the basic foundation and participant criteria for the research.
The Need for Testing
Marijuana can be detected in the saliva almost immediately after smoking and for 12 to 24 hours after drug use.
Currently, urine tests are the most common means by which to screen for the drug. Obtaining a urine sample has drawbacks including privacy and the validity of the specimen sample. For obvious reasons, no one observes the collection of a urine sample. Guilty parties have been known to submit urine samples, other than their own, in order to pass the drug test.
On the other hand, collecting a saliva sample for analysis allows direct observation while the specimen sample is collected. Therefore, the sample cannot be altered or submitted for another person, which happens more commonly with a urine sample collection.
The Test Itself
Researchers have only screened marijuana smokers, not those who ingest the drug by other means. Users in the study were monitored and tested for 22 hours after smoking marijuana.
There are currently three saliva collection options. The tests include StatSure, Oral-Eze and DrugTest 5000. The first two options require in-laboratory validation while the DrugTest 5000 gives a quick, on-site result.
The tests measure delta-9-tetrahydrocannabinol (TCH), 11-nor-9-carboxy-tetrahyrdocannabinol (THCCOOH), cannabidiol and cannabinol.
For legal and professional testing purposes, an in-laboratory confirmed positive drug test result is necessary. The DrugTest 5000 does give a quick reading, which is needed in some cases. Researcher found that the results of each test vary according to each specific ingredient.
The Results of the Test
The drug detection window is shorter for the occasional smoker than it is for the frequent smoker. Also, the drug concentration levels were higher for frequent smokers than those noted for occasional smokers.
Random drug testing in the workplace is the best indicator of marijuana use. The saliva or oral fluid based tests are a useful to detect marijuana usage in the past few days. This type of drug test is used for pre-employment, random, post-accident, reasonable suspicion or return to duty testing.
Studies are still being conducted to validate the accuracy and proper usage of the marijuana detection saliva tests.
Moving forward, it is still to be determined if urine, blood or saliva drug testing is the most accurate, appropriate and timely when assessing marijuana usage.
May 26th, 2015 | The Blog
Is your patient just tired or do they have chronic fatigue syndrome? Think again because chronic fatigue syndrome has been renamed, according to the Institute of Medicine (IOM). The IOM is an independent, nonprofit organization that works to offer medical advice to government authorities and the general public.
The renaming came about because patients felt that their medical condition, chronic fatigue syndrome, was mocked by the former name. This disease is now called systemic exertion intolerance disease (SEID). Either way, whether it is called chronic fatigue syndrome or systemic exertion intolerance disease, has the same troubling symptoms for the patient.
Systemic Exertion Intolerance Disease (SEID) Explained
This disease affects the daily quality of life of those who suffer from it. The level of affect varies from patient to patient, depending upon their symptom list and the severity of their symptoms.
Here are a few facts about the disease:
Causes of the disease include, but are not limited to:
Symptoms of the disease include, but are not limited to:
Many patients with SEID are either housebound or bedridden. Many more are unable to attend school or go to work. It interferes with normal daily life. The symptoms of SEID do not improve with bedrest.
Diagnosing the disease is not an easy task nor is it clear-cut. There is no blood test or body scan to confirm it. The usual diagnostic course includes:
Patients must have at least four of the above listed symptoms for at least 6 months, before they are specifically diagnosed with chronic fatigue syndrome or SEID.
The Stigma of the Disease
In renaming SEID as disease, not a disorder, a bold statement is made. The intended message is that affected patients are not just lazy or unmotivated; they have a real medical condition. The disease entity focuses on the post-exertional malaise, which is the main symptom and primary patient complaint.
There is no cure for the disease. The varying symptoms are closely monitored and treated as needed. There is tremendous emotional and physical support and effect from the well-planned treatment by rehabilitation specialists, mental health counselors and physical therapists as needed. Each patient diagnosed with SEID needs an individualized treatment plan moving forward with daily life.
May 22nd, 2015 | The Blog
Atrial fibrillation can be a life-changing diagnosis but not usually a life-ending diagnosis.
About 1% of the American population has been diagnosed with atrial fib. Some patients are in atrial fibrillation full-time while others bounce in and out of the irregular cardiac rhythm.
The Facts About Atrial Fibrillation
Atrial fibrillation is commonly referred to as A Fib, AF or atrial fib. This cardiac condition is an electrical defect in the heart. AF causes an irregular heartbeat or rhythm. It is a cardiac arrhythmia.
When this irregular heart rhythm occurs, the heart is unable to effectively pump enough blood.There are some interesting facts about atrial fib, which include:
The common symptoms of AF are:
Most, but not all, patients can feel when they are in atrial fib. About 15% of patients are asymptomatic before diagnosis, which is usually found on an electrocardiogram (EKG or ECG).
Some patients complain about vague symptoms like a change in exercise tolerance, which leads to the diagnosis.
Being in A fib does not increase the risk of a heart attack.
Being in atrial fib does increase the risk of having a stroke. The risk is five times higher than it is for someone who has never been in atrial fib.
Patients in AF are prescribed blood thinners like Coumadin or Warfarin to prevent blood clots. This lowers the patient’s risk of stroke.
Other AF treatments include medications to control the heart rate because patients with the arrhythmia have a high pulse rate.
It is important to control high blood pressure and/or diabetes when in atrial fib because both of these underlying conditions also increase the risk of stroke.
Weight control is an important component of AF treatment. While there is no formal literature at this time about weight control and AF control, physicians are finding that there is a positive correlation.
A heart healthy diet is advised, which includes a diet low in:
By eating healthy, atrial fib patients also help control their blood sugar, cholesterol and blood pressure.
Quitting smoking is a key component of AF treatment. Smokers have an increased risk of developing the arrhythmia and also a higher risk of stroke.
Alcohol and other stimulants like decongestants with pseudo-ephedrine also increase the risk of A fib. Caffeine should also be kept to a minimum, although recent studies do not suggest that coffee be totally avoided.
Regular exercise, not vigorous exercise, is encouraged for good heart health. Walking for ? hour every day is a great form of exercise.
Stress reduction is important. Acute stress can trigger episodes of AF. Yoga can help manage stress, which can reduce atrial fib episodes by 50%.
Atrial fibrillation is a common cardiac arrhythmia. Lifestyle changes can help to control the symptoms.
May 15th, 2015 | The Blog
Summer is fast approaching and so is the urge to get to the beach and get a tan. Skin cancer is the greatest risk created by over-exposure to the sun.
Skin cancer is the most often diagnosed cancer for Americans. Over the past thirty years, the skin cancer incidence in the US has been higher than all other cancers combined. The number of skin cancer cases is estimated to be about 5 million. Again, most of these cases are preventable.
The cost to treat skin cancer is in the US is estimated to be $8.1 million per year. About $3.3 million of that total is attributed to the treatment of melanoma.
Deaths from skin cancer are directly related to melanoma cases. There are about 63,000 cases and 9,000 deaths every year from melanoma. Unfortunately, melanoma is the most common skin cancer diagnosed among the younger population in the US, adolescents and young adults.
Risks of Tanning
Healthcare providers repeatedly warn patients about the dangers of sun tanning. The US Surgeon General, Vice Admiral (VADM) Vivek H. Murthy, M.D., M.B.A, from the US Department of Health and Human Services, delivers regular warnings to the public.
Some of the risks of tanning include:
More than one in every three Americans gets sunburned every year. Sunburns signify over-exposure to UV rays. Over-exposure to UV rays causes skin cancer.
The Best Risk Reduction
It is important to note that anyone can get skin cancer. Lighter skinned people have a higher risk of developing skin cancer than those with darker skin. Skin cancer on darker skinned patients is often diagnosed at a more advanced stage, making it more challenging to treat.
Most skin cancer can be prevented. Prevention is the best way to reduce the risks associated with tanning. That is, prevent over exposure to UV rays.
Simple steps can be taken to prevent exposure:
Reducing the risk of exposure everyday of the year is the very best protection.
What to Eliminate
Tanning bed use increases the risk of developing skin cancer. There are ten states that currently prohibit tanning bed use for those under 18 years old.
Indoor tanning is just as delinquent in causing skin cancer as outside sun exposure. One in every three young white women engages in indoor tanning. Indoor tanning causes 400,000 cases of skin cancer every year. About 6,000 of those indoor exposure cases are melanoma.
The Surgeon General has released a Call to Action to Prevent Skin Cancer. The purpose of this document is to heighten the public awareness of the dangers of skin cancer. There are four sections to this document:
There are simple and effective ways to prevent overexposure to UV rays. They include:
Combining several strategies to reduce sun exposure is the best defense to prevent skin cancer.
May 4th, 2015 | The Blog
Continuing along the same topic as last week’s article on weight loss without dieting, here are a few more ways of losing weight without dieting. By incorporating some (or all) of these tips into everyday life, a person can lose at least 10 pounds in a year. So, what are you waiting for??
1. Try yoga
Yoga followers reportedly have a “mindful” approach to eating. They eat until full, not until their plate is empty. Self-awareness is a by-product of yoga and helps people avoid overeating.
2. Eat at home as much as possible
Eating home-prepared meals at least five days per week, according to Consumer Reports, is the “top habit of successful losers [weight loss]”. Using washed lettuce, pre-cut veggies, cooked chicken strips and other shortcuts can reduce preparation time and compliance.
3. Chew strong mint flavored gum
Strong-flavored sugarless gum can help to derail a snack attack. Chewing a strong-flavored gum while preparing dinner, socializing or watching TV can make the tempting snack food not taste great.
4. Take pause while eating
Put down the fork for a few minutes after each bite. Engage in conversation rather than quickly moving onto another bite. This allows the stomach to alert the brain that it is full and helps to avoid overeating.
5. Use smaller plates
Using a 10-inch luncheon plate, not a 12-inch dinner plate, will reduce the average intake by 100-200 calories a day. This can translate into a 10 to 20 pound weight loss in a year.
6. Alter food portions
Eat modest portion, not a full portion at every meal. Typically, Americans overeat at every meal. Make snack-sized portions for in-between treats. Do not keep full portion bags of snacks accessible, which increase the temptation to overeat.
7. Follow the 80/20% rule
This tip works both ways. Dole out 20% less food at every meal or stop eating when you are 80% full, not stuffed. Americans need to work on this because they are known to traditionally eat until they are overfull.
8. Change the rules when eating out
It is okay to place a special, less fattening order at a restaurant. Ask for salad dressing on the side, broil fish of meat, do not pan fry and skip the butter, when possible. Other “out-to-eat” tips include: split an entr?e with whomever you are dining with, order an appetizer as a meal, order from the children’s menu or have half of the meal placed in a take home container before it is delivered to the table.
9. Use red sauce
More important than using marinara sauce, avoid cream sauces like Alfredo. Tomato-based sauce has less calories and less fat. Keep the pasta under the sauce to an appropriate portion, about one cup or the size of a tennis ball.
10. Eat less meat
Vegetarian-based meals have fewer calories than meat-based meals. The high fiber content of veggie-filled meals helps to keep the calorie count down. Try bean burgers, sweet potato burgers or portabella mushroom burgers.
11. Burn an extra 100 calories every day
If you burn an extra 100 calories everyday, you will lose about 10 pounds without dieting. What activities burn 100 calories?
12. Reward yourself
Do not reward good and healthy activity with food. Instead, call a friend to chat, get a pedicure or buy a new outfit. Yes, every once in a great while, indulge in a very small piece of cheesecake or a home-baked cookie.
Make it easy, make it part of your daily life. Make it simple for the best success.
April 27th, 2015 | The Blog
Summer is fast approaching. Most everyone has packed on a few extra pounds over the long winter months. Bariatric surgery is not the answer for everyone. The need to work on losing those extra inches of padding is certainly paramount.
There are simple and effective ways to lose weight without dieting or undergoing bariatric surgery. Here are a few ideas to work on the slim and trim body everyone wants before summer arrives:
If necessary, set a 20-minute timer to slow down the cadence of eating. Why eat slower? The body triggers hormones, which make a patient feel full as they eat. Smaller portions are consumed when sufficient time allows the stomach to alert the brain that it is full.
Sleeping one extra hour every night can help a person lose 14 pounds in one year. There are two explanations: sleeping eliminates the idle time during which a patient unnecessarily snacks?and sleeping less than 7 hours per night naturally increases the appetite.
Eat lots of fruit and vegetables
High fiber and high water content in fruits and vegetables help to satisfy the appetite with fewer calories. Serve more veggies everyday. Eat fruit for a midday snack. One other weight loss enhancer, avoid calorie-laden sauces and dressings. Instead, season the veggies with lemon juice and herbs.
Avoid cream-based soups, which are high in fat and calories. Serve broth-based soup at the beginning of a meal to reduce overall calorie intake. Low sodium broth is a good base with which to start. Try minestrone, tortilla, or wonton soup.
Whole grains are best
What are whole grains? Brown rice, barley, oats, buckwheat and whole wheat are the main whole grains. They help a patient to fill up on fewer calories. An additional benefit is that whole grains can reduce cholesterol.
Keep “skinny” clothes around
Keep a favorite piece of clothing that is “just a bit too snug” in plain view for the incentive to lose those extra few pounds.
Skipping bacon on a sandwich saves about 100 calories per serving. Replace the bacon with other flavorful fillers like tomato slices, roasted red bell peppers or another personal favorite.
Reduce sugar intake
Stop drinking sugary soda. Switch to water or zero calorie seltzer. Each switch avoids 10 teaspoons of sugar intake. Need more flavor? Add in some fresh lemon, mint or frozen strawberries.
Eat meatless pizza
Thin crust pizza reduces calories more than the thick-crust choice. Veggie pizza toppings, instead of a fat-laden meat choice, can take 100 calories off of a traditional pizza meal. Also, use less cheese or a reduced-fat cheese.
Change the shape of the glass
Everyone tends to overfill a short, wide tumbler. Instead, use a tall, skinny glass. Studies report that 25% to 30% less juice, wine or soda is consumed with the tall, skinny glass.
Limit alcohol intake
Go ahead, have an alcoholic drink. Then, follow it with a non-alcoholic, low-calorie beverage like sparkling water. This will help to reduce a patient’s overall calorie intake and fill up the consumer so snacking on chips, dips and nuts is also reduced.
Drink green tea
Green tea increases the body’s calorie burning capacity. This is a result of catechins, which are phytochemicals.
There are a few more diet-free weight loss tips and tricks to share in next week’s nursingjobs.org blog. Patients will appreciate any tips that you share with them as you travel this journey beside them. Please be sure to check next week’s blog for Weight Loss Without Dieting Part II.
April 24th, 2015 | The Blog
Concussions are caused by impacts or sudden forces, which affect the head.
According to the American Academy of Neurology (AAN), a concussion is any injury to the brain that results in temporary loss of normal function.
The Greatest Affects
Younger, developing brains take longer to recover from a concussion, physically and cognitively, than a mature adult brain. This trend was documented in a study that involved high school, college and professional athletes who sustained head injuries.
When a head injury and potential concussion happens, the brain is affected and so is the person?s balance, judgment and/or reaction time. These factors place the person at a greater risk for further injury.
As soon as a concussion is suspected, athletes should immediately stop playing their sport.
It is important that anyone with a suspected head injury be evaluated by a healthcare professional as soon as possible after the impact, even if they “feel okay”.
Symptoms of a Concussion
There are many different symptoms of a concussion. They can occur immediately after a head injury or in the hours or days following the head impact. The include, but are not limited to:
Every concussion is managed individually, based upon a patient’s history and previous concussions.
Rest is the key component of concussion management. This holds true until the patient’s symptoms have completely cleared.
Important points in the management of a concussion:
In essence, the best treatment is to shut the brain down and let it rest.
Getting Back Into the Swing
Slow progression back into a routine and schoolwork should start when symptoms subside. Many students start with a half-day at school and then go home to rest. Some students sit in on classes but do not participate, do homework or take any tests until they are symptom-free.
While recovering from a concussion, the brain is very susceptible to further injury, if the head is impacted again. This is true for the ensuing weeks and months after an initial head injury.
Second Impact Syndrome makes the athlete at greater risk of developing long-lasting symptoms. A second concussion in rapid succession can cause severe and permanent neurological disabilities and even death, in some cases. While such situations are rare, it almost always involves a young, high school athlete who returned to play too soon, while still symptomatic.
Having a baseline cognitive test, as in an ImPACT test, on file before an athletic season begins is invaluable during the concussion recovery phase. It is important to know how someone?s healthy brain functions in comparison to his or her concussed brain function. When the brain function returns to the healthy baseline, it is an indicator that the person is healthy enough to segue back into their routine.
While the term concussion is sometimes used too frequently and often too loosely, it is a serious brain injury that demands immediate medical attention and follow through.
April 13th, 2015 | The Blog
Cesarean sections represent 1 in 3 births in the US. C-sections are the most common surgery performed in the United States.
Some new moms that have delivered via C-section feel as though they have missed out on a very important moment in their pregnancy and have somehow failed because they could not experience a vaginal delivery. In an effort to personalize and lessen the harshness of a C-section, there is a new trend afoot to create a gentle cesarean experience.
Why Have a C-Section?
There are many reasons that a woman needs to deliver a baby via C-section instead of a vaginal delivery. Some of them include, but are not limited to:
The decision about a C-section versus a vaginal delivery is one that is made with the guidance and expertise of a healthcare professional. The safety and wellness of both the baby and mother are taken into consideration.
Sedation is often administered to the mom, who is actually undergoing major abdominal surgery. Most women doze on and off into a twilight sleep during a traditional C-section.
New C-section moms often feel as if they have missed the birth of their baby due to their more medical entrance into the world.
Traditionally, a sterile drape blocks the mom’s view of the operating field. She does not see the actual birth and then the newborn is whisked away at least one-half hour (30 minutes) for medical care.
The Gentle Cesarean
The changes in cesarean delivery practice are somewhat minor but they are significant for the new mom and baby. The focus is on making a C-section feel more like a birth than a major surgical procedure.
Here are some changes:
The gentle C-section allows moms, if they choose to, to watch the birth. A clear sterile drape is often used so the mom can see the baby being born.
The newborn is then immediately, before the umbilical cord is cut, placed on the mom’s chest for skin-to-skin contact. This helps to stimulate immediate bonding and breast-feeding. This is a standard procedure in most vaginal births.
The newborns often remain on the mom?s chest during the remainder of the C-section, when the wound is being closed. She can talk and bond with the newborn.
Simple changes like moving an EKG monitor from the mom’s chest to the side helps her to visualize the birth. Moms are not strapped onto the operating table. Intravenous lines are specifically placed in the non-dominant hand so the dominant hand is free to hold the baby.
Will It Catch On?
The trend towards gentle cesarean is slowly evolving. Cost is not a factor in its popularity as only minor logistical adjustments are made. The basic procedure remains the same.
Clinical studies and scientific outcomes will be the driving force for the transition from the traditional cesarean to the gentle cesarean.
It is important to note that a gentle cesarean is not a new replacement for a vaginal birth. It is a means by which a traditional and necessary cesarean section birth can be an enhanced surgical experience.
April 6th, 2015 | The Blog
Organ donation is truly the gift of life. This gift bypasses 18 people in the US everyday. These 18 people die while waiting for an available organ.
The Controversial Question
When should organs for donation be removed or harvested from a dying patient? There is an ongoing debate about when it is too soon to remove them versus when it is too late, rendering the organs at risk of being too damaged for successful use.
Brain Death Defined
A group of neurologists, public health clinicians, biochemists, transplant surgeons, a medical historian and an ethicist convened at Harvard University in 1968 to define brain death or a permanently nonfunctioning brain.
These points, according to the Harvard University group, define brain death:
It is important to note that brain death is not synonymous with cardiac arrest.
The group developed criteria for irreversible coma, which later became the new criteria for death. Harvard University’s criteria and definition for death remain the standard in today’s healthcare field.
Dead Donor Rule
The definition of the Dead Donor Rule, which is the standard rule of ethics in the medical world, “forbids organs from being harvested from those who are still living”. Therefore, a patient must be brain dead in order for their organs to be harvested.
Time Limit on Harvesting Organs
Once a heart stops and there is no longer perfusion to the organs. Time is of the essence to remove the organs designated for transplant before irreversible damage is done and they are rendered useless.
A living donor is a healthy person who gives their consent to donate a kidney or a lobe of the liver while they are alive. This is an elective donation. Life, for the donor and recipient, continues forward after the organ donation and transplant.
A donation by a dying patient carries more guidelines and further discussion. A donation by a dying patient is guided by two main principles:
According to multiple studies, there is no uniformity about organ donation from institution to institution. What are some of the differences?
Organ donors, living and dying, absolutely save lives. It is a personal decision about whether or not to partake in this circle of life.