About Jacob Molyneux, senior editor/blog editor

Senior editor, American Journal of Nursing; editor of AJN Off the Charts.

On the Web: A Tragic Choice, Wasting Berwick, Cost Control, A Nurse’s Comfort Zone

President Barack Obama speaks to a joint sessi...

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

Read the rest of this troubling post at The Health Care Blog by surgeon John Maa if you doubt that we need health care reform in this country.

A measure of how unserious we are about fixing the problem of health care quality and costs in the U.S. can be found in reports that Don Berwick, President Obama’s choice to run the Centers for Medicare and Medicaid Services (CMS), continues to have an uphill battle for confirmation, despite being widely acknowledged within the medical community as the best choice for the challenging job.

Since we’re talking policy, there’s an incisive post at the Health Affairs Blog on where our energies should—and should not—be going in controlling costs. Here’s an excerpt:

The current cry to reduce Federal deficits and debt growth by reducing Medicare and Medicaid entitlements is totally missing the key issue: the need to moderate all health care inflation. This should be the time for a national debate on how to best tackle the underlying cost problem, for the sake of our future, the economy, and access to health care.

The June 13-19, 2009 Economist editorialized: “America has the most wasteful […]

2016-11-21T13:13:54-05:00March 8th, 2011|Nursing|1 Comment
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Psychiatrists as Therapists: A Vanishing Breed

By Maureen Shawn Kennedy, AJN editor-in-chief

In an article in the New York Times on Sunday, writer Gardiner Harris described how many psychiatrists have abandoned psychotherapy in favor of short consultations and pharmacotherapy; if patients want to discuss their problems, they are referred to a therapist. The main driver of this trend is money—with other, cheaper professionals available to provide therapy with comparable results, insurance companies won’t pay the higher fees most psychiatrists charge. So, instead of seeing 50 to 60 patients a week for the traditional 45-minute session on the psychiatrist’s couch, the psychiatrist can see 1,000 or more patients in a 15-minute, “what’s happening? do you need a medication adjustment? see you next week” check-up. As the wife and business manager of the psychiatrist profiled in the article says, “It’s all about volume.” One only hopes that most of the patients take his advice to see a therapist.

In fact, there is a growing body of evidence favoring psychotherapy over medications in mental health, notably in depression. In a recent meta-analysis in the Journal of Nervous and Mental Disease comparing psychotherapy with second-generation antidepressants (SGAs), researchers found that “ [b]ona fide psychotherapy appears as effective as SGAs in the short-term treatment of depression, and likely somewhat more effective than SGAs in the longer-term management of depressive symptoms.” 

And in the March issue of AJN, we report on a study published in the Archives of General Psychiatry, which found that “cognitive therapy combined with […]

2016-11-21T13:13:55-05:00March 7th, 2011|Nursing|1 Comment
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Alone, Isolated, At Risk


By Shawn Kennedy, AJN editor-in-chief

I saw the following headline this week: “LA woman dies in her cubicle at work; body is not discovered until the following day.” The article said it was unclear how she had died. I hope it was at the end of the day after everyone had left; I really hope they don’t find out that she died midday, amidst coworkers who were going about their business. Maybe they were so busy that they never noticed the silence from her cubicle.

This story reminded me of two articles I read recently. One was an article that will be published in the Emerging Infections department in our March issue, which goes live at the end of next week on ajnonline.com. “The Contact Precautions Controversy” examines the issues around placing patients on contact precautions and in isolation—an approach that many hospitals use almost routinely for some patients. (We covered this issue in a news piece last July as well.) Recent studies are raising questions about this practice and the risks to these patients, who often have fewer interactions, get less care, and may feel neglected because health care providers limit contact.

The other article is one that’s in the headlines now.  The Boston Globe ran a story about […]

2016-11-21T13:14:00-05:00February 17th, 2011|nursing perspective, nursing research, patient engagement|3 Comments
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Treating Kids With Asthma in the ED Means More Than Just Putting Out Fires

EDs play an important role in the care of children with asthma. ED clinicians often treat families who don’t have a consistent relationship with a primary care provider. Given this opportunity, it’s essential that all members of the pediatric ED health care team be informed, educated, and updated on the latest asthma treatment guidelines to ensure best practice and high quality outcomes.

In this month’s Emergency column, “Managing Pediatric Asthma Exacerbations in the ED” (which will be free for the next six months), three nurses at Children’s Hospital Boston present a composite case, review the evidence regarding treatment options, describe practices at their own hospital and asthma treatment guidelines, and emphasize the crucial importance ED nurses can play in making sure these children don’t end up back in the ED because of lack of follow-up care or poor care in the home.

Have a look and let us know what you’re doing to make sure you’re not just putting out fires when you treat a child with asthma in the ED.—JM, senior editor

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2016-11-21T13:14:02-05:00February 15th, 2011|Nursing|1 Comment
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Web Roundup: Comparing Online Health Info, Questioning a Breast Cancer Treatment, Guilt in Any Gender

Many women with early breast cancer do not appear to need removal of their lymph nodes, as is often recommended, according to a federally funded study released Tuesday.

Read the full Washington Post story about a new study published in JAMA (abstract is here). This story is being covered in most major news sources today, and it may signal a significant treatment shift for some patients. (One of the possible adverse long-term effects of lymph node removal is lymphedema. Here’s a page with links to the two-part article we ran about the condition a while back, as well as a related blog post by senior editor Sylvia Foley that looked at what people had been writing about their experiences with this condition.)

Speaking of advice about your health and about treatments, the health care journalism blog Covering Health alerts us today to an article at the NY Times comparing health information found at the WebMD and Mayo Clinic sites. Do you prefer the glitzy, highly produced one with lots of corporate sponsors, or the nonprofit? You know which one gets more visitors . . .

And speaking of patients, as we should, what about those who are transgendered? Does it confuse or challenge you to care for such a patient? There’s a very sensitive and painful post at the blog Nursetopia about caring for a transgendered patient […]

2016-11-21T13:14:03-05:00February 9th, 2011|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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