Archive for the ‘children's health’ Category

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Drunk on Water, Drug Shortages, Understanding Health Care News, Plus Nursing Blog Posts of Note

July 15, 2011

by LeeBrimelow/via Flickr

The water myth: A physician, writing in the British Medical Journal (abstract only), has looked at the evidence for drinking eight glasses of water a day and says the oft-recommended practice is “debunked nonsense,” a myth the bottled water companies have been only too happy to exploit and that many respected health care organizations and experts continue to support. Maybe common sense reasoning is also partly to blame—after all, the idea seems to make sense. And all that water certainly conjures images of purification, which is inevitably appealing in a world of pervasive toxins, chemicals, food additives, and the like, and in a time when fewer people in any given Western country practice the same or similar religious sacraments or rituals, practices that may—among other functions—have once served a similar “purifying” psychologic purpose.

Drug shortages: The Wall Street Journal Health Blog has reported on two surveys that suggest that “unprecedented” drug shortages are being experienced by most hospitals. The reasons are multiple: shortage rumors that prompt hoarding, FDA actions that halt production, lack of a crucial ingredient, poor inventory management, and others:

All treatment categories were affected, hospitals said, with 80% or more respondents experiencing shortages of surgery/anesthesia, emergency care, cardiovascular, gastrointestinal/nutrition, pain or infectious disease drugs. And 66% of hospitals reported shortages of cancer drugs. Some 47% of hospitals reported experiencing a shortage of at least one drug on a daily basis.

What the study really said: The following resource isn’t new, but with more and more people getting health care news from the Internet, network television, newspapers, or from TV personalities like Oprah and Dr. Oz, it’s more important than ever for us all, whether health care journalists or nurses, to know a bit more about judging the quality of the evidence out there for certain treatments, tests, and drugs. HealthNewsReview.org offers some excellent tools for understanding what’s true, possibly true, and a complete distortion of the facts, with short primers on everything from causation vs. association, absolute vs. relative risk, and phases of drug studies to commercialism and much more.

Nursing blog sampler: Emergiblog had a nice post about a week ago about the practical challenges involved in treating the increasing numbers of children whose parents are unable to control them (or, as she puts it, “kids seem to be the adults in some families”). For something on the light side, Nurse Ratched’s Place has a post called “Treadmills, Hot Guys, and Nurses.” The gist is that everyone needs a little motivation, whether in the gym or while working a long nursing shift, and maybe a little old-fashioned objectification is just the thing (but not, of course, underwritten or endorsed by AJN!). Notes of a Nurse-To-Be has a post (ok, a couple weeks old now) on the particular kind of mental fatigue she experienced during her first mental health rotation. Read the rest of this entry ?

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Making Homes Safer

June 20, 2011

By Shawn Kennedy, AJN editor-in-chiefThe Canadian Partnership for Children’s Health and Environment suggests five actions for parents to follow to reduce their children’s exposure to environmental hazards at home. While the recommendations are not really new, it’s worth reminding parents of young children and women who are pregnant or contemplating pregnancy to be mindful of potential hazards from common household substances. Here are the recommendations (you can download the free brochure):

  1. Minimize dust in the air (which may contain minute lead particles) by frequent vacuuming and by using a damp cloth when cleaning.
  1. Use nontoxic cleaners (baking soda or vinegar and water are recommended as ‘green’ cleaners, and a number of commercial products without harmful chemicals are now available) and avoid antibacterial soap and items with added fragrances to minimize exposure to chemicals.
  1. Seal off areas undergoing renovation to avoid dust and fumes. Caution women who are pregnant and young children to avoid the area.
  1. Minimize exposure to plastic to avoid exposures to bisphenol A (BPA) and polyvinyl chloride (PVC). Avoid storing food in plastic (glass or ceramics are recommended) or microwaving food that’s in plastic containers or covered with plastic wrap; discard soft plastic toys that contain vinyl or PVC that might be used by or come into contact with infants and children.
  1. To minimize exposure to mercury, be mindful of the kind of fish you eat and how often you eat it.

Also, see “Best Practices in Environmental Health” in our June 2009 issue.

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Saving ‘Mimi’: How Nurses Can Combat Human Trafficking in the USA

February 1, 2011

By Sylvia Foley, AJN senior editor

Never to lie . . . by flickrohit, via Flickr

Picture this: “Mimi,” an 18-year-old Brazilian girl who speaks little English, arrives in your ED with injuries sustained in a beating. She’s accompanied by an older man who refuses to leave her side and who intercepts and answers questions directed at Mimi. The ED physicians and nurses treat Mimi’s injuries and release her back to this man’s care. Maybe you feel uneasy, but what can you do? Maybe the man really is her uncle; maybe he’s just being overprotective.

In fact, Mimi is a victim of human trafficking, and the man who brought her to the hospital is both her pimp and her trafficker. And you and your colleagues just missed a chance to intervene on her behalf. Unfortunately, you’re not alone. In “The Role of the Nurse in Combating Human Trafficking,” a February CE feature, author Donna Sabella notes that clinicians who encounter victims of human trafficking often don’t realize it, and many such chances to intervene are lost. Sabella, a nursing professor active in helping such victims, hopes to change this. Read the rest of this entry ?

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Year-End Reindeer Dreams

December 29, 2010

By Peggy McDaniel, BSN, RN, infusion practice manager

As a long-time pediatric nurse who’s spent many a Christmas at the hospital, I have special memories, many of which still make me smile years later. Some of these are bittersweet, as suffering and pain do not stop for such days. One of my favorite shifts involved a little boy and some reindeer antlers. 

I was working a 12-hour night shift as a traveler in a small community hospital. We got a call from the ED to admit a four-year-old boy who was extremely anemic due to unknown causes. When this child arrived, I realized he was very ill and probably would only spend Christmas Eve night with us. He needed to be stabilized, then would move on to a regional children’s hospital for further diagnosis and treatment. Read the rest of this entry ?

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‘The Birthplace’: Showcasing a Collaborative Practice Model

December 21, 2010

By Sylvia Foley, AJN senior editor

Megan Tudryn, RN and expectant mother, undergoes a contraction. Photo by Alice E. Proujansky; all rights reserved.

Photojournalist Alice E. Proujansky reports in AJN this month on The Birthplace, a collaborative care practice model at Baystate Franklin Medical Center in Greenfield, Massachusetts, where a team of five nurse midwives, three obstetricians, and 35 nurses attend some 400 to 500 births annually. Except for preterm and other higher-risk deliveries, the nurse midwives manage all deliveries and monitor fetal and maternal health. Patients complete detailed birth plans that afford them various care options. Physicians are called in only when necessary; as one nurse midwife told the author, “There’s an awful lot that we can do on our own.”

How well does the model work? The Birthplace has lower-than-usual rates of medical interventions such as episiotomy, epidoral anesthesia, and cesarean section. The patients have greater autonomy and decision-making capabilities. And the practitioners “relish the collaborative approach,” says Proujansky, who interviewed several clinicians and patients for the article; her photographs appear alongside the text and on the December cover. Proujansky’s last piece for AJN, a photo essay on a Dominican maternity ward, appeared in our December 2008 issue; read it here.


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Fighting Malaria with Public Health Billboards and Mosquito Nets

December 2, 2010

By Dawn Starin

Metal billboard with an antimalarial public health message, Bubaque, Guinea-Bissau, 2010. Photo by Dawn Starin.

The metal billboard in the photo stands in the main marketplace on the island of Bubaque, the second largest in Guinea-Bissau’s Bijagós Archipelago. It depicts a mother and child sleeping under an insecticide-treated mosquito net. Translated into English, the text reads, “Malaria kills more pregnant women and children. Always sleep underneath the mosquito net.” But it’s not clear whether it gets its crucial message across effectively.

Half the global population—about 3.3 billion people—is at risk for contracting malaria, a parasitic infection transmitted by mosquitoes. The disease kills close to one million people each year; 91% of these deaths occur in Africa. A major global campaign, Roll Back Malaria (RBM), was launched in 1998 with a mandate “to implement coordinated action to combat malaria” worldwide; some 500 organizations now take part.

One RBM effort in sub-Saharan Africa (an area that includes Guinea-Bissau) is aimed at getting more people to use insecticide-treated bed nets, since the parasite-carrying mosquitoes are reportedly only active at night. In Africa malaria accounts for one in five deaths in children. 

Pregnant women are also at high risk, as they’re bitten by the mosquitoes twice as often as nonpregnant women. Why? According to a study published in 2000 in the Lancet, pregnant women have a higher body temperature and warmer skin and produce more sweat than do nonpregnant women; those in the last trimester also exhale greater volumes of air. (Read the abstract here.) All of these physiological differences give pregnant women a “larger host signature” and probably aid mosquitoes in detecting them as targets.

According to the RBM Partnership’s latest report, ”Every US $1,025 spent on insecticide-treated nets will protect 380 children and save one child’s life each year.” Is the message getting across?

(Editor’s note: For more on Guinea-Bissau’s public health billboards, see this earlier post.)

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Time to Pause and Commit to Act

November 24, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Of all the holidays, Thanksgiving seems to me to be the most pure—it began way before the greeting card folks thought of it and commercialized it. And it was born out of something that often gets lost during the course of our busy days—connecting with others and saying thank you for what they do or what they mean to us.

Christine Moffa, AJN’s clinical editor, and I were discussing the holiday at a staff meeting, saying how we had never minded working on Thanksgiving. Patients, visitors, and colleagues—everyone was in a friendly, appreciative mode. Most hospital cafeterias served turkey dinners to the staff, so everyone was happy about that—and everyone got to have a real dinner break for a change!

It also seems that at Thanksgiving we’re still in the “giving” mode, maybe because it’s early in the holiday season. My first request-for-your-support e-mail this season came from photographer Ed Kashi; it’s one I’m glad he sent. Ed is an incredibly talented megastar of documentary photography (in my humble opinion); we’ve been fortunate to have some of his work grace our covers (July 2007 and our 2008 Family Caregiver supplement, as examples) and articles. His e-mail was about an online auction of photographs called Commit to Action, a collaborative project by VII Photo (a photo agency) and Doctors Without Borders/Médecins Sans Frontières (MSF) to generate funds for MSF work around the world.

The e-mail contained images from another one of their projects, Starved for Attention, in which VII Photo members documented child malnutrition around the world. These images are sobering, especially on the day before Thanksgiving when most of us are consumed with food preparations.

I encourage you to visit these sites. While bidding on the photographs may be out of reach for many, there are two beautiful posters available for a nominal donation. You can at least sign the petition urging world leaders to provide more food aid.

Somehow, in this time when we pay farmers not to grow food, no one, least of all a child, should die from lack of food.

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In Her Own Words: Pakistani Flood Victim Focuses on Providing Essential Medical Help to Others

September 30, 2010

Yesterday we posted here on the threats facing medical aid workers in unstable countries, with a special focus on the work of the international aid organization Merlin in Pakistan following this summer’s catastrophic flooding. Today we publish a first-person account by Azra Habib, a Lady Health Worker who has been working for Merlin’s diarrhea treatment unit (DTU) in the flood-affected Charsadda district of Khyber Pakthunkhwa. She, like many health workers, has opted not to focus on the potential risk she faces or her own family’s losses, but instead on the immediate need for basic health care services.—Jacob Molyneux, senior editor/blog editor

Azra Habib at a Merlin Diarrhea Treatment Unit in Pakistan

I’ve recently taken a new post as a Lady Health Worker for a diarrhea treatment unit (DTU) at the Charsadda District Hopital in KPK. After the floods there were many villages in the district with no clean water, and the demands on this specialized ward can be extreme. Having lost everything, many people don’t have the resources to get transport to the hospital. Often, by the time they get here, patients are moderately or severely dehydrated and need to be admitted. There are 40 beds but we’ve had as many as 189 patients arrive on the ward in a day.

A toddler recovering from dehydration brought on by acute watery diarrhea

Early one morning, not long after I started my position here, I was about to sign off from my night shift duty. A woman came in, crying out with a child not yet three years old in her arms. She was screaming, “He is not moving, he is not responding.” He had been suffering from diarrhea for two days. When the doctor saw him, he noted that his condition was grave and we started immediate treatment: an IV line to restore his fluid loss and antibiotics to treat his infection.

The boy had lost his father and 5-year-old sister in the flood. This meant that his mother had no one else left. I asked if I could take care of the child and continue my shift rather than sign out, and the doctor allowed me to do so. So I put in all my efforts to his recovery and the child started to respond in the evening. He remained in the DTU for five full days, and when he fully recovered he was discharged.

Noshad Ali holds his 2-year-old grandson, Mohammad Faizan, who is recovering from severe dehydration brought on by acute watery diarrhea

A very personal catastrophe. I wanted to make sure he survived because I know what it means to lose everything and to be left with heavy responsibilities. Prior to the floods in Pakistan, I worked for five years in my village, Banda Malahar, as a health worker. At the same time, I was close to finishing my nursing and midwifery studies. I was in the process of taking my third-year nursing exams when the floods hit and destroyed the area where I live. That day, I was on my way to the city to take exams when I saw water was fast approaching on the motorway. As the bus driver backtracked, I saw all the bee boxes from the nearby farms, floating in the water. I suddenly forgot about my exams and started to worry about my home.

I couldn’t reach my family by phone, but I’d heard on the radio that all of Khyber Pakhtunkhwa had been affected by flash floods. When I finally reached my elder brother by phone the next day, he told me that the whole village had been swept was away by water and there was nothing left. He told me that my sisters-in-law and their children found refuge in a school, while my three brothers were living in a tent on the motorway. He told me that our parents refused to leave the house. So we had no idea if they had survived. I was horrified by the news and felt very restless.

Only silence. Eight days after the flooding started, I finally found my parents. They had found shelter in a school. A week later we returned to Banda Malahar, which was washed away. There was nothing left, only silence. I was standing in ankle-high muddy water and debris. We took the household items we could salvage and what we could find to pitch up a tent to live in. Neighboring families began returning, pitching tents in the footprint of where their homes had once been.

Now everyone is developing severe skin infections, or coming down with diarrhea and malaria, which my sister has also contracted. Living conditions prior to the flood were very poor and now they’ve gone from bad to worse. The floodwaters took everything we had; even my elder brother’s beekeeping business is finished. Read the rest of this entry ?

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The Grave Dangers Facing Medical Aid Workers in ‘Insecure’ Regions

September 29, 2010

I recently heard from Jacqueline Koch, a senior communications officer with the global medical aid group, Merlin. As described in a recent AJN photo-essay on Merlin’s work in Gaza (for the best view, click through to the PDF version), the organization partners with local health organizations and trains health workers to provide care in response to natural and man-made disasters. Ms. Koch has now shared with AJN a first-person account of one Pakistani woman’s experiences working with flood victims, which includes a description of that worker’s own family’s suffering as a result of the flood. This account, which will appear tomorrow along with several photos, is prefaced below by Ms. Koch, who provides context for Azra Habib’s story. The security issues raised by Ms. Koch are frightening, in that we now see an already taxing kind of health care work becoming even more perilous because of the threat of physical attacks like the murder of 10 medical aid workers in Afghanistan back in August.—Jacob Molyneux, senior editor/blog editor

A toddler recovering from dehydration brought on by acute watery diarrhea in Merlin's DTU in Charsadda.

‘Senseless but simple.’ In Pakistan, alongside a breadth of man-made and natural disasters, there are many occupational hazards and cruel ironies, especially for aid and health workers. It’s senseless but simple: delivering aid, providing medical care, and saving lives can potentially make you a target.

For any Pakistani national health worker who is working for an international nongovernmental organization (INGO), the danger multiplies. Not only can they themselves be threatened, but so can their parents, siblings, spouses, children, and extended families. They face armed attacks, death threats, robbery, kidnapping for high ransom, and the very real possibility of murder.

Many must navigate these dangers by refraining from visiting nearby family, living in close proximity of their offices, and hiring guards to escort their children to and from school. When working in the field, many opt to leave hats and jackets with INGO logos and ID cards behind, alongside their BlackBerries and anything else that might identify them. They have little choice but to dramatically alter the rhythm of their lives in order to save lives—including their own. But these measures are not always foolproof.

Not just in Pakistan. Merlin, an international medical aid organization, recently published a report outlining the impact of violence, conflict, and insecure environments on health workers, who are central to achieving the United Nations Millennium Development Goals. For those delivering essential health care in fragile or conflict-affected states, it is “A Grave New World.”

As one female health worker in Pakistan in conflict-affected Swat Valley (and who asked for anonymity) noted:

“The militants were against family planning, saying women must stay in the home. As a Lady Health Visitor, I was suspected of providing family planning and therefore at risk. During the militant regime, I could not reach women, I couldn’t meet my patients. If someone knew what my job was, they would have cut me to pieces. I often think about it, I think about my children, because my job is something my family needs. My family needs my job to survive. But I had to stop working here during the regime. I left. While I was away, I thought about my patients, I thought about those who I left behind and who didn’t have anyone to care for their health.” Read the rest of this entry ?

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Back to School: Team Sports and Concussions

September 1, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Concussions among young athletes are on the rise—are parents and coaches taking them too lightly?

Photo by Dick Rochester, via Flickr

My sons played ice hockey and football in their high school years, what my husband and I referred to as “collision sports.” The unmistakable sound of helmet-hitting-helmet always made me cringe, especially in hockey where a good skater can generate considerable speed (and therefore force) before impact. I’ve witnessed many players being helped off the ice. The coach, who knew I was a nurse, would sometimes signal to me to come to the bench and check out a player. Most of the time, the player was fine; but there were a few times when it was clear that the player was a bit more than just shaken up.

I recall one 12-year-old who had nystagmus and ringing in his ears and kept asking the same question in a slow, sleepy voice. The coach wanted to put him back out on the ice (“He just saw a few stars, right?”), but instead I sent him with his parents to the ED for evaluation. After an overnight stay in the hospital he was released, but was cautioned not to play hockey for two weeks because he’d suffered a concussion. So he waited two weeks and went back to playing, even though he still had frequent headaches. I also remember a girl who was an excellent high school soccer player. She was hoping to play in college, but by the end of her senior year she’d sustained three concussions and was having cognitive issues—she had trouble working with numbers and suffered headaches. Her neurologist told her she shouldn’t play competitively for at least a year, and perhaps permanently. She was resistant, but her parents enforced the neurologist’s ban. Good for them. Read the rest of this entry ?

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