Archive for the ‘Children's Health’ Category

Simulation Labs: Helping Teach Nurses in Baltimore

Tuesday, September 27th, 2011

From nursing.jhu.edu

Any one who has ever had a hospital stay or knows a loved one or friend who has been in the hospital knows that the nurses play a vital role in caring for patients. Nurses do many of the day-to-day activities of caring for patients in hospitals and clinics. They are also often the first ones at the bedside if a problem arises – so -isn’t it essential that nurses be well trained in all forms of emergency procedures? Even when doctors are present, nurses often play vital roles in assisting the doctors in providing life-saving care to patients.

Law and Medicine Intersect Once Again

I have recently been working on a case in which both doctors and nurses were present during an in-hospital delivery that ended with a significant injury to the child. During the delivery, a problem was encountered that has a low incidence rate during deliveries.  In considering this problem, I wondered just how frequently doctors and nurses are able to practice the skills they would need to successfully and calmly deliver a baby in a situation like this.  Faced with this “emergency” situation, how many of the doctors and nurses in the room had not experienced this problem before? For those who had –  just how much “experience” did they bring to the problem they were facing?

Simulations Rooms and Simulation Patients Provide Training Opportunities

Thankfully, technology is making it more feasible for training healthcare providers to practice handling a myriad of clinical situations during their education process that they might otherwise not experience frequently enough for their skills to develop in real world settings. In Baltimore, the Johns Hopkins University School of Nursing (JHUSON) has simulation rooms in which nursing students are able to practice a variety of procedures and techniques using simulation patients in rooms that are designed to replicate the real patient areas of the hospital. There is also a whole family of simulators to help. This “sim fam” is not like the lifeless plastic dummies you might be imagining. They are a variety of different types of “…life-like practice manikins, including Sim Man, Vital Sim Man, Noelle with newborn, and Sim Baby [that] give nursing students the hands-on experience without the anxiety of working with actual human beings.”

Harvey the Cardiac Sim, SimNewB and Sim Man 3G  - All New Additions to the “Sim Fam”

From nursing.jhu.edu

Just this year, in March, JHUSON added Harvey to its collection of simulators.  While Harvey is new to JHUSON, he is not exactly new technology:

For almost 40 years Harvey, developed in cooperation between Laerdal Medical Corporation and Miami University Miller School of Medicine, has been a proven simulation system teaching bedside cardiac assessment skills that transfer to real patients, and remains the longest continuous university-based simulation project in medical education.

Harvey’s job is to be able to simulate “nearly any cardiac disease at the touch of a button: varying blood pressure, pulses, heart sounds, and murmurs. The software installed in the simulator allows users to track history, bedside findings, lab data, medical and surgical treatment.”  He joins a collection of other sim patients that enable healthcare providers to learn and practice critical life-saving measures such as CPR, defibrillation, intubation and yes – even the proper checking of vital signs. JHSON has adult, child and baby versions of these simulators. Some of them can even “talk” to the practicing nurses. (I wonder if they are programmed to be cooperative and informative or hostile and combative – hmmm.)

New Family Members Arrived this Past August

Even newer, in August, JHUSON added SimNewB and Sim Man 3G to the family. The SimNewB is:

…a 7 pound, 21 inch female baby, with realistic newborn traits. Students will be able to simulate a wide variety of patient conditions with her, including life-threatening ones. The department’s current Sim baby is the size of a 6 month old and is not as conducive to delivery room procedures.

She is also interactive, though she is not wireless like the Sim Man 3G. Some of the new Sim Man’s traits include “…breath sounds both anteriorly and posteriorly, … pupil reactions, [and] skin temperature changes.”

What about Obstetrics Cases?

So, what about the case I was mentioning that involved obstetrical care? Well, JHUSON also has a pregnant simulator, which is can be used to practice a whole host of obstetrically related procedures. These include “Leopold maneuvers, normal vaginal and instrumented delivery, breech delivery, C-section, and postpartum hemorrhaging, among other functions.” The JHUSON sim family also has the new Sim newborn – SimNewB.

The “Jury” Is Still “Out”

Can there be any doubt that additional hands-on practice opportunities with simulators is a good idea for situations that may not come up very often in everyday practice? Won’t it help healthcare practitioners gain skills and keep those skills up-to-date? Any opinion I might have on these issues is not based on evidence….yet. Luckily, JHSON is “…among 10 nursing schools nationwide collaborating on a landmark study to find out just how well patient simulators—high-tech manikins that respond to a nurse’s care—help prepare the nurses of tomorrow.”  I – for one – will certainly be interested in the outcome of that study.

What about you? Do you think that it makes sense for nurses in training to make use of simulation rooms and simulated patients? Would it be better for them to spend more time in real world situations doing real patient care under the supervision of experienced practitioners? What about techniques that might not come up very often?

If any of the readers of this post have used these sim patients in your training and can give us firsthand information as to how, if at all, it carried-over to make you more “experienced and skilled” when facing similar clinical situations with real patients, your comments would be most welcomed as well.

FES Equipment Coming to Baltimore’s Mount Washington Pediatric Hospital

Thursday, September 8th, 2011

Author - Sarah Keogh

Back in February, Jon Stefanuca wrote about a study in the Journal of Neurorehabilitation and Neural Repair about Functional Electrical Stimulation (FES) and the benefits it can provide to those individuals who have suffered spinal cord injuries. He explained how FES is able to provide electrical impulses to stimulate paralyzed muscles. The study’s authors found improvements based on using FES that led them to recommend using stimulation therapy in conjunction with occupational therapy for patients with incomplete spinal cord injuries. This technology is now also being used to help people with a wide range of injuries and illnesses including, stroke, multiple sclerosis, traumatic brain injury, and cerebral palsy, in addition to spinal cord injuries. According to the Christopher and Dana Reeves Foundation website, FES works by applying “small electrical pulses to paralyzed muscles to restore or improve their function”. The benefits can be extensive:

FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores. From: Christopher and Dana Reeves Foundation website

Improved Technology To Be Locally Available

Since FES was originally developed, the technology improved from being something that was typically integrated into large expensive equipment, such as exercise bikes and wheelchair based equipment, into smaller more portable devices. The good news for individuals with neuro-motor injuries in Baltimore City and the surrounding areas is that this type of FES treatment is about to become more available locally. At the end of August, Mount Washington Pediatric Hospital announced that they have received a “Quality of Life” grant from the Christopher and Dana Reeve Foundation. The article explains:

The money will help Mt. Washington Pediatric Hospital purchase Bioness® equipment for its Adaptive Equipment Rehabilitation Clinic (the clinic). The clinic works with patients with neuro-motor disorders to maximize their movement as much as possible given their physical limitations.

From Bioness.com

The Bioness website explains that they produce a variety of “medical devices designed to benefit people with Stroke, Multiple Sclerosis, Traumatic Brain Injury, Cerebral Palsy, and Spinal Cord Injury. These products use electrical stimulation to help people regain mobility and independence, to improve quality of life and productivity.” While I do not know what particular equipment will be available at the Mount Washington Pediatric Hospital, Bioness makes equipment to assist patients with hand paralysis, foot drop and thigh weakness among other conditions.

MWPH Uses Interdisciplinary Approach Combining FES and Therapy

The article about the grant explains some of the many wonderful things available for patients at the Mount Washington Pediatric Hospital (MWPH):

  • …[an] interdisciplinary approach to the assessment and management of adolescents and children with neuromuscular impairments, paralysis and/or movement disorders
  • … [a] team of 21 experienced specialists in physiatry, occupational therapy, and physical therapy.

The new equipment at MWPH will be used along with the other occupational and physical therapy options available to patients. A study described in US Neurology looked at stroke victims and found the combination of FES and traditional therapies that include repeated motion provide the best results:

Stroke patients with limited voluntary movement could now benefit from technologies such as functional electrical stimulation (fes) combined with necessary repetition of functional tasks (use-dependent plasticity) to enhance the neural repair process and improve outcomes, thus enabling them to begin to overcome their previous limitations and to improve their physical capabilities.

From Bioness.com

The goal at MWPH for children and adolescents is based on a similar idea:

Patients whose muscles can be retrained will require several months of therapy to gain normal range of motion and strength. For those patients with more severe conditions where muscles cannot be retrained, the Bioness® equipment will be used to augment their range of motion. Using these two therapy modalities, patients will acquire greater functionality, range of motion, muscle strength, and the ability to move independently.

This multi-disciplinary approach should allow these children and teens to have the best chances of improved motor use and the most independence in their future lives.

Related Articles:

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

Spinal Cord Injury Updates: More Reasons for Optimism?

New Treatment Holds Promise for Patients With Spinal Cord Injuries

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Asthma News: Parents Underestimate Children’s Symptoms, Placebos Effective in Improving Patient’s Subjective Improvement but Not Objective Health

Monday, July 25th, 2011

image from consumerreports.org

A couple of months ago, one of my colleagues, Jon Stefanuca, wrote a post for Eye Opener entitled Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem. In that article, he explained the importance of patients proactively knowing and explaining their asthma symptoms to healthcare providers. He focused on some of the key features of asthma and the unique symptoms that each individual may experience. If you have not already read that article, I highly recommend it as a great way to become a better advocate for yourself or someone in your life that suffers from asthma.

Over the last few months, I have been thinking about Jon’s advice in relation to some work I have been doing. It makes good sense and hopefully will help people receive better care when they are having exacerbations of their asthma. However, I was disheartened to read a recent article from Reuters about how frequently parents underestimate their children’s asthma symptoms.

Parents Underestimate Their Children’s Asthma Symptoms

I am always a little leery of studies that are drugmaker-funded, particularly when the study suggests that perhaps more medications are needed to combat a problem. However, taken at face value, this is a pretty frightening idea given how many children now suffer from asthma and how serious a condition it can be for those children and families. The article points to a disconnect between the parents’ description of their child’s asthma and whether the asthma was actually being adequately treated:

While more than seven out of every 10 parents interviewed described their child’s asthma as “mild” or “intermittent,” the disease was adequately treated in only six in 10 kids.

A doctor who was not involved in the study explained it this way:

“Parents are only aware of asthma when the child is more severely ill,” Dr. Gordon Bloomberg…

“Physicians cannot just ask the parent ‘how is your child doing?’ The physician will get a global answer that doesn’t reflect the child’s quality of life,” said Bloomberg, of Washington University in St. Louis.

Poor treatment may influence asthmatic children’s quality of life, as well as that of their families.

In the survey, more than four in 10 parents reported missing work because of their child’s asthma, and similar numbers of parents regularly lost sleep for the same reason.

Children are Better Reporters Than Their Parents of Symptoms

Interestingly, “[t]he study also found children tended to be better than their parents at determining how well their asthma was being treated.” So, clearly, doctors must take the time to discuss the asthma symptoms and treatments not only with parents but also in a sensitive and appropriate way with the children patients themselves in order to receive a better indication of the disease status. The doctors interviewed for the Reuter’s article had different opinions on what this means for asthma treatment:

According to a new report, this suggests parents need more education about asthma medications.

But one expert said more medication is not the be-all and end-all for children.

“The idea of total control…is not where we should be putting our energy,” Dr. Barbara Yawn from Olmstead Medical Center in Rochester, Minnesota, told Reuters Health in an email.

Instead of just giving children with stubborn breathing problems more medication, she said better communication is needed to determine how children’s lives are affected, and what it will take to prevent their symptoms.

New Study Shows Receiving Treatment, Even with Placebo, Important for Asthma Patients – But Does not Improve Objective Health

image from 123rf.com

In another recent study, reported in the New England Journal of Medicine, researchers looked at how asthma patients responded to a medication (bronchodilator), two different types of placebos (fake inhaler or fake acupuncture), or no intervention at all. An objective measure was taken of the patient’s ability to exhale after each intervention (or lack of intervention) and the patient’s own rating of improvement was noted. What was so interesting about this study were the different outcomes between the objective (spirometry) and subjective (patient’s self-reporting) measurements of improvement.

The bronchodilator provided markedly better objective treatment over the placebos or no treatment – a 20% improvement rather than 7% for the placebos or no treatment. However, the subjective measure of improvement found that patients were almost the same, 45-50% improvement, whether the patients received the actual bronchodilator (50%), the placebo inhaler (45%) or the sham acupuncture (46%).  All of which were higher than the 21% improvement reported by those who did not receive intervention.

An article about the study in medicalnewstoday.com explains the outcome this way:

Now a study of asthma patients examining the impact of two different placebo treatments versus standard medical treatment with an albuterol bronchodilator has reached two important conclusions: while placebos had no effect on lung function (one of the key objective measures that physicians depend on in treating asthma patients) when it came to patient-reported outcomes, placebos were equally as effective as albuterol in helping to relieve patients’ discomfort and their self-described asthma symptoms.

The study’s senior author, Ted Kaptchuk, Director of the Program in Placebo Studies at Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School explained it this way in the article:

“It’s clear that for the patient, the ritual of treatment can be very powerful…This study suggests that in addition to active therapies for fixing diseases, the idea of receiving care is a critical component of what patients value in health care. In a climate of patient dissatisfaction, this may be an important lesson.”

However, I wonder if it cannot also be understood another way – which is that patients are likely to feel like their symptoms have been improved after a visit to a doctor, even if objectively their airway is still compromised.

How Should this Impact Asthma Treatment?

So what can be done with this new information? I think that Jon’s advice about patient’s knowing their own symptoms and expressing them clearly to their doctors is critical. I also agree completely with his advice that patients should ask for an objective measure of their respiratory improvement before leaving a health care facility. These two steps seem key to making sure that patients objective health is being improved – not just their subjective opinion of improvement. Finally, I think that it is critical that parents act as the best advocates possible for their children – which may include making sure that the children are heard on their own symptoms since parents are not the most reliable reporters.

What do you think? Are there other tips for asthma patients and their parents out there? How do respond to these new studies?

Related Videos:

Videos about Asthma

Related Articles:

Four Tips For Getting the Medical Care You Need When You Are Having An Asthma Problem

Asthma – How to Protect Your Child When the Steroid Inhaler Fails

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

Service dogs in school — a fresh look

Friday, July 22nd, 2011
Service Dog and Boy

service dogs

A while back I wrote a piece on the topic of service dogs for kids and mentioned the use of service dogs in schools. A regular reader of our blog then wrote in with a number of comments and questions about the propriety of dogs in schools. To help answer her questions, I recently spoke with Nancy Fierer, who is the Director at Susquehanna Service Dogs in Harrisburg, Pennsylvania, which is an organization that trains and places service dogs. Susquehanna is the organization that placed two of the dogs mentioned in this NPR story.

The ADA and dogs in school

I also did a little more research on the Americans with Disabilities Act (“ADA”) and its impact on the issue. The ADA requires that all public facilities allow a disabled person and his or her service dog (not pets) to enter the premises just the same as a non-disabled person. So is a school considered a public facility? It’s an interesting question. On the one hand it is accessible to the public in the sense that parents and students can freely enter a school. However, if you’re not the parent of a child at the school, can you just walk into a school and roam the halls like you might roam around a mall? I think if you tried that, you would get stopped pretty quickly and asked to leave if you had no valid business there. However, the law appears to be settled that schools are considered public facilities at least for those areas that are open to the public such as administrative offices, gymnasiums during sporting events, and auditoriums during public events. Therefore, schools must be accessible to service dogs in these public areas. For class rooms, however, it’s not so clear. While the law appears to favor allowing service dogs in class rooms, it is being decided on a case-by-case basis because there are other considerations as well – the age of the child, the disability at issue, the ability to control the dog, etc.

How much school assistance is necessary?

I have to admit that when I first wrote on this topic, I had envisioned that the dog and child were a self-contained unit that required little in the way of adult assistance. Ms. Fierer indicated that that is usually not the case. Depending on the age of the child and the level of disability, the child may be able to care for the dog independently. However, in most instances an adult (teacher’s aide or nurse perhaps) is required to pitch in with help giving the dog water and taking it out for bathroom breaks. Ms. Fierer indicated that the dog does need water breaks during the day (feeding can be done at home before and after school). This is usually accomplished by keeping a water bowl in a nearby room – perhaps a nurse’s office or a counselor’s office. Several times a day, either the child (if he/she is old enough) or an adult can take the dog for a drink. The same is true for bathroom breaks (pee only; No. 2 is usually taken care of at home). Again, service dogs do require assistance from the school but from what Ms. Fierer told me, the disruption is fairly minimal and can be worked out with proper planning.

Controlling a service dog

A larger issue is the child’s ability to control the dog. Even though service dogs are highly trained, the owner (in this case a child) must still be able to control the dog before being permitted to take a dog into school. These include such basic commands as making the dog sit, stay, come, leave it, and walk on loose leash. These are some of the common commands that all service dogs must know. In addition, a service dog also receives additional training in a particular disability and learns specific commands unique to that disability, e.g., retrieving specific items, pulling a wheelchair, responding to seizures, search and rescue. These commands must be mastered as well. For example, if an autistic child is in need of the dog to put its head in the child’s lap to help calm him/her down, the child (or a trained adult) has to be able to give the dog that command. If the child cannot give that command to the dog, then it undermines the usefulness of the dog in school.

Because of the demands that service dogs place on the child, very young children usually do not take dogs to school unescorted. Ms. Fierer said she would be surprised to see a six-year-old, for example, taking a dog to school alone. Older children can, with proper training, be permitted to take a dog to school alone. To ensure that the child is capable of caring for the dog, Susquehanna utilizes the Assistance Dogs International Public Access Test. This test requires the owner and the dog to perform multiple tests in a variety of settings to ensure that the dog is well-trained and that the owner can properly control the dog. For children, Ms. Fierer indicated that the testing is usually administered with the parent and child because she uses the team approach – the parent, child and dog are a team. For a child taking the dog to school, however, the parent is usually not there so the child must be able to control the dog independently. Only when a child is adept at controlling the dog should the child be permitted to take the dog to school. Even then, parents have to work closely with the child’s teacher and other school staff to coordinate the details of how the dog will be cared for.

Other concerns

Our reader also asked questions about whether service dogs are a distraction in school and whether they can pose a danger to other children. After talking to Ms. Fierer, it’s my opinion that these are not major concerns. As for being a distraction, Ms. Fierer said that is usually not the case. Service dogs are generally introduced into the school gradually, starting with maybe a half-hour per day and building from there. The children get accustomed to the dog and the novelty soon wears off. Also, the other children need to be educated that this is a service dog and not a pet to be played with. Children can easily learn this lesson. As for being a danger to other children, Ms. Fierer said she has never heard of a dangerous incident happening at school such as a dog biting a child. These dogs are amazingly well-trained and the trainers allow zero tolerance for aggressive behavior. If a dog shows any aggression, that dog does not make the cut for being a service dog. Therefore, I don’t believe this concern is a valid reason for denying a child a service dog.

Training a service dog

In terms of the actual training given to the dogs, Ms. Fierer said that when a puppy is eight weeks old, it starts living with a dedicated puppy handler who is responsible for teaching the dog basic manners.  This time includes classes at Susquehanna twice per month.  This arrangement goes on till the dog is 18 months old, at which time the dog receives about six months of intense training.  About 50-60 percent of training is the same for all service dogs. The rest is devoted to the unique needs of each disability. Before a dog is placed, Susquehanna spends about 2 and ½ weeks training the family that is receiving the dog. Even after placement, Susquehanna continues to do follow-up training – at first on a weekly basis and then gradually declining over the next six months. It even does annual re-testing.

I hope this follow-up addresses our readers’ concerns. Ms. Fierer emphasized that service dogs are not the solution for every child. Susquehanna actually does therapy sessions with families before even agreeing to place a dog to ensure that the dog and the family are a good fit. She indicated that it is a big responsibility to own a service dog and it is not a decision that is made lightly by the dog trainers. However, for the right child and the right family, a service dog can be an amazing asset.

Related Nash and Associates Links:

Service Dogs for Kids

 

photo from servicedogtraining.wordpress.com

 

 

 

 

 

 

 

 

 

 

 

Week in Review: (July 2 – July 9, 2011) Eye Opener Health, Law and Medicine Blog

Saturday, July 9th, 2011

Eye Opener’s Week in Review

From the guest editor:         Good morning! I was hoping that you would take a break from making your “to do” list to stop by and check in with us. As usual, we have been busy blogging. And practicing law. And getting ready for trial. And in trial! Needless to say, we have been pushing it to the limits. In truth, we wouldn’t have it any other way. Before we get back to trial preparation, lets take a step back and look at the past week.

–Jason Penn, guest editor

Litigating for the Sake of Litigating: A Temptation to Be Resisted

By Jon Stefanuca

What do you do when your opposing counsel forgets that the practice of law is a profession and not a blood sport? What do you do when the phase “zealous representation” gets confused with “obnoxious obstructionist behavior?” When faced with similar frustrations, Jon Stefanuca broke out his keyboard and explained what we litigators deal with on a day to day basis. Being a lawyer is a very rewarding profession, but like any other, it has its share of frustrations. Don’t take my word for it, read more

Can Copper Surfaces and Duct Tape Reduce Hospital Infections and Deaths?

By Sara Keogh

Germs are in your kitchen.  They are in your bathroom and your bedroom.  They are on your fingertips and even on your tongue.  And everyone knows that there are going to be germs in hospitals. Even the best hospitals have to work to keep the patients, rooms and visitors clean and safe.  Sara Keogh reported on news that may make keeping hospitals and other health care environments less germy in the future. Two simple solutions, copper and duct tape, might have a major impact on infection control.  Read more

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.
  • And more!

Images courtesy of:

www.lifehack.org

www.mountainpulse.blogspot.org

 

Week in Review: (June 27 – July 1, 2011) Eye Opener Health, Law and Medicine Blog

Monday, July 4th, 2011

Eye Opener’s Week in Review

From the (guest) editor:  Good morning!  With the morning workout complete, I thought now would be a good time to take a look back.  We had a sneaking suspicion that with the excellent weather forecast you might spend some time outdoors.  Before you do, make sure you read our Summer Series.  This week we gave you what you need to know before you (and your little ones) head to that family BBQ.  Enjoy your Independence Day, drink a tall glass of fresh squeezed lemonade and enjoy!

–Jason Penn, guest editor

Cancer: HIV/AIDS Patients At Increased Risk

By Jon Stefanuca

As if life with HIV/AIDS is not difficult enough, researchers have also found that HIV/AIDS patients are also more prone to developing various malignancies when compared with the non-infected population. In fact, cancer is one of the leading causes ofmortality in the HIV/AIDS  population. It is estimated that 30%-40% of HIV patients will develop some type of cancer during their life time.  Read more

Skin Cancer: Types, Causes and How to Protect Yourself

By Sara Keogh

We can all agree that “skin cancer” is bad.  When we refer to skin cancer, what do we mean?  Most often we are referring to squamous cell, basilar cell or malignant melanoma.  On Tuesday, Sara described the different types of skin cancer and the  associated rates and survival statistics.  Read more

Skin Cancer Prevention: Will new FDA Rules Help?

By Sara Keogh

So Sara’s piece on Tuesday convinced you that sunscreen is necessary?  But how do you pick one?  Last week, the FDA announced new regulations of sunscreen. If sunscreens meet the new legal standards, they can use certain marketing phrases so that consumers know what level of protection will be provided by the product.  Read more

Diseases of Summer: Ticks and Lyme Disease

By Theresa Neumann

Summer is heating up, and there are lots of outdoor activities in which to participate. Along with the thermostat, however, there is also a rise in the deer tick population! This equates to an increase in Lyme disease, the most commonly reported vector-borne illness in America! Maryland, Virginia, Pennsylvania, Delaware and New Jersey all all“hotbeds” for this disease, comprising 5 of the top  12 states comprising 95% of all Lyme disease cases nationwide. Before you leave for the family picnic, you should read more

Skin Cancer Prevention: The Dangers of Tanning Beds

By Sara Keogh

It is popular to “pre-bake” before hitting the beach.  A tanning bed is often the The use of tanning beds or “indoor tanning” greatly increases a person’s risk of developing skin cancer. It is a completely voluntary exposure to UV radiation, and yet many people choose to expose themselves despite all of the risks.  Before you opt to “fake and bake,” you should read more

Sneak Peak of the Week Ahead:

The Eye Opener and its writers are excited about the week ahead too!  Here’s a sneak peak of what’s in store for you:

  • Service dogs for children:  more than just a pet
  • Legal Boot Camp is back in session and Part IV of our Cerebral Palsy tutorial.
  • And more!

 

Images courtesy of:

www.news.getaroom.com

www.topnews.net.nz

www.dsf.chesco.org

www.magazine.ayurvediccure.com

www.frenchtribune.com

 

 

Skin Cancer Prevention: The Dangers of Tanning Beds

Friday, July 1st, 2011

 

Image from hometanningbed.com

In my last two posts, I have examined the various types of skin cancer, their prevalence and survivability rates, and some prevention methods. Today, I will focus on another major risk factor for skin cancer. The use of tanning beds or “indoor tanning” greatly increases a person’s risk of developing skin cancer. It is a completely voluntary exposure to UV radiation, and yet many people choose to expose themselves despite all of the risks.

Known Dangers of Tanning Beds

Here are just a few statistics about indoor tanning from the Skin Cancer Foundation:

  • “Ultraviolet radiation (UVR) is a proven human carcinogen. Currently tanning beds are regulated by the FDA as Class I medical devices, the same designation given elastic bandages and tongue depressors.
  • The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet (UV) tanning devices in its Group 1, a list of the most dangerous cancer-causing substances. Group 1 also includes agents such as plutonium, cigarettes, and solar UV radiation.
  • Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.
  • Ten minutes in a sunbed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.
  • Nearly 30 million people tan indoors in the U.S. every year; 2.3 million of them are teens.
  • On an average day, more than one million Americans use tanning salons.
  • Seventy-one percent of tanning salon patrons are girls and women aged 16-29.
  • Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors.
  • People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.
  • The indoor tanning industry has an annual estimated revenue of $5 billion.”

Internal references omitted

 

Horrifically, it is mainly young people choosing to use these devices despite the greatly increased risk of melanoma and other skin cancers. Given the enormous financial incentive to service young people – the industry cannot be expected to regulate itself. If they can make $5 billion dollars a year in revenue with a largely young female population, why would they stop? (Aside from morality of course…)

How to Protect the Skin – Even if You Don’t Want To

From a social perspective, there need to be some changes to the value our society places on certain skin color and beauty. This is outside of the realm of this post – but what a shame that in this century, men and woman would still rather expose themselves to harmful radiation than live life with their natural coloring (or lack thereof).

From an education perspective, I think that public awareness and an increased focus on education must continue to be one prong to battle this problem. However, clearly warnings alone are not enough. This is exemplified by a recent news story about a now 23-year-old woman who visited tanning salons three to five times a week starting when she was 16 years old.  This young woman, who despite knowing the risks of tanning continued to use tanning beds until 2009, had to endure surgeries, drug therapies and over a year of painful treatment at the age of twenty-one for the advanced melanoma that had spread to her lymph nodes. Luckily, she is now cancer-free, but living with a greatly increased risk of developing another cancer. This is a cautionary tale, but it is also an example of the invincibility thinking of many young people that makes the risks seem lower than they really are to using tanning beds.

Legal Options – Regulation

So what remains? The tanning salon industry has a financial disincentive towards preventing skin cancers, the young patrons of these establishments may not understand the risks and consequences, yet the individuals and society are going to pay the price of devastating illness, high cost medical treatments and people’s lives if the current use of tanning beds continues. That is where the legal side of this post enters. There are a number of states that have started to regulate the use of these tanning beds – at least for minors. Most states do not regulate these very heavily. The National Conference of State Legislatures has compiled regulations from many states on their website. There are a combination of approaches which generally include either banning the use of tanning beds by very young children and teens (typically under 14 or 16 – but few states have an outright ban) and/or requiring parental consent for the use by children below a certain age (typically 18, occasionally 16). Some of these consent statutes require the parent to be present (in person) to provide consent. Others allow written consent or require the parent to be present only one time in the year. Do you think that these statutes are sufficient? Should the requirements involve vivid pictural warnings like the new requirements for cigarrettes?

In Maryland, Howard County is a leader in regulating this industry. In Howard County, minors under 18 years of age are not permitted to use tanning devices without a doctor’s note stating a medical reason and allowed frequency.  These rules are not subject to a parent’s consent. Many states legislators have proposed tougher legislation in the past few years to increase the regulations on this industry across the country, but few have been successful.

Your Thoughts?

What do you think should happen with the tanning industry? Do you think that there should be an outright ban for any minors using these devises? What about adults? There are still lots of tanning customers who are young adults who are over 18. What can be done to protect them from the increased risks of skin cancer? Is public education sufficient? Could it be done better?

Related Posts:

Skin Cancer: Types, Causes and How to Protect Yourself

Skin Cancer Prevention: Will New FDA Rules Help?

Skin Cancer Videos

 

Diseases of Summer: Ticks and Lyme Disease

Thursday, June 30th, 2011

family-time2

Summer is heating up, and there are lots of outdoor activities in which to participate. Along with the thermostat, however, there is also a rise in the deer tick population! This equates to an increase in Lyme disease, the most commonly reported vector-borne illness in America! Maryland, Virginia, Pennsylvania, Delaware and New Jersey all all “hotbeds” for this disease, comprising 5 of the top  12 states comprising 95% of all Lyme disease cases nationwide.

According to a recent post by Roberta Seldon in Boomer Health and Lifestyle, the deer tick population is a “bumper crop” this year, partly due to the wet winter in the Midatlantic and Northeast United States. Tick activity peaks in June and July, and this correlates to rates of illness as reported by the Centers for Disease Control (CDC). The CDC also reported 2009 as the second-highest incidence of disease cases, following 2007; with the estimated increase in the deer tick population, 2011 might go down in the record books as the highest year ever since the beginning of recording/reporting lyme disease (1995). The Maryland Department of Health and Mental Hygiene (DHMH) breaks down the jurisdictions even further into cases per County, with the top two counties being Baltimore and Anne Arundel, with Howard, Harford and Carroll counties being right in the mix.

What is a deer tick and what does it look like?

The deer tick, as it is commonly called, is really the black-legged tick or Ixodes scapularis. This is NOT the same as the dog tick; it is a much-smaller version with different coloration. The Canadian Lyme Disease site provides an excellent pictoral description and differentiation of the various types of ticks and relative sizes. The deer tick, especially in the nymph stage, is so very tiny and nearly impossible to see, and it is this very pinpoint little bug that causes most of the infections.

The CDC website (one of my favorites for all kinds of information related to infectious diseases and other public health topics) details the disease transmission process and prevention, diagnosis and treatment information. The site discusses many myths about the tick, its removal, the disease, its symptoms and long-term sequellae.

Did you know that the tick itself does not cause the disease? The tick carries a bacteria called Borrelia burgdorferi that has to be transmitted through the saliva during feeding. It takes at least 24 hours, if not 36 to 48  hours, of tick attachment and feeding in order to transmit the bacteria. Thus, besides various prevention techniques with appropriate clothing and wearing bug spray with DEET, it is critical to perform (or have someone else perform) a “tick-check” after being in wooded areas or areas known to have deer activity. The best way to remove this little critter is by using tweezers and grasping the head while applying gentle traction in the opposite direction of attachment. Even if you are not the environmental type but you have a dog, be sure to apply tick-prevention remedies to your pet since they can bring these critters into your home.

What are some common symptoms of Lyme disease?

The most common symptom, and the one classically associated with Lyme disease, is the bulls-eye type rash (called erythema migrans) that develops at the site of the infection/tick bite.

There is a central area of redness, and over several days, the red ring starts to migrate peripherally, followed by an area of clearing; it clearly resembles a bulls-eye target. According to the CDC, approximately 68% of those infected report this rash. The next most common symptom is joint pain that can involve one or more joints and typically migrates to various joints. Other more serious presentations include paralysis of the facial nerve (Bell’s palsy), meningitis or encephalitis, and even heart block or problems with the electrical conduction system of the heart leading to irregular heart rhythms.

The Maryland DHMH just released a video on Lyme Disease in Maryland. Dr. Katherine Feldman describes the disease.  It is a 7-minute and 23-second video with lots of good information. Please, click the link to watch and learn!

Other tick-borne illnesses:

Lyme disease is not the only disease transmitted by ticks. Ticks live on the blood of the hosts on which they feed. They can transmit a variety of pathogens via their bite and/or saliva that have been acquired from other hosts. Some of these infections include anaplasmosis, babesiosis, ehrlichiosis and Rocky Mountain Spotted Fever (RMSF). As an aside, don’t let the Rocky Mountain part fool you! North Carolina has one of the highest incidence rates of RMSF nationwide!

QUESTION: Do you know someone who has had Lyme Disease? Were there any unusual circumstances surrounding the diagnosis? Share your story so others can be more aware!

Images courtesy of:

(c) L. Gerlach on Blisstree.com

Skin Cancer Prevention: Will new FDA Rules Help?

Wednesday, June 29th, 2011

In yesterday’s post, I examined the various types of skin cancer and their prevalence in the US. Melanoma is the most deadly form of skin cancer and its incidence is on the rise. In that post, I examined some of the ways to protect yourself from the types of UV radiation that cause skin damage and cancer. One of these protection methods is the use of sunscreen. Sunscreen matters because the data is clear that sun exposure is what is causing deadly skin cancers:

  • About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.
  • The vast majority of mutations found in melanoma are caused by ultraviolet radiation.
  • About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.
  • One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.
  • A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.

Statistics from the Skin Cancer Foundation website

However, up until now, there has been very little regulation of the marketing of different sunscreens. It has been very difficult for the American public to know whether the sunscreen they were choosing was going to be effective in protecting them from both UVA and UVB rays.  There was also little way to know how much protection you were really receiving and whether the claims like “waterproof” and “sunblock” were just marketing or really claims with research behind them. Why does this matter? Check out this video from the FDA:

How the New FDA Rules Will Help

Well, some of this is going to change next summer. Last week, the FDA announced new regulations of sunscreen. If sunscreens meet the new legal standards, they can use certain marketing phrases so that consumers know what level of protection will be provided by the product. For example, “[u]nder the new labeling, sunscreens labeled as both Broad Spectrum and SPF 15 (or higher), if used regularly, as directed, and in combination with other sun protection measures will help prevent sunburn, reduce the risk of skin cancer, and reduce the risk of early skin aging.”

Image from FDA.gov

Image from FDA.gov

The FDA explains the impact of the new regulations with the following:

  • Broad Spectrum designation. Sunscreens that pass FDA’s broad spectrum test procedure, which measures a product’s UVA protection relative to its UVB protection, may be labeled as “Broad Spectrum SPF [value]” on the front label. For Broad Spectrum sunscreens, SPF values also indicate the amount or magnitude of overall protection. Broad Spectrum SPF products with SPF values higher than 15 provide greater protection and may claim additional uses, as described in the next bullet.
  • Use claims. Only Broad Spectrum sunscreens with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Non-Broad Spectrum sunscreens and Broad Spectrum sunscreens with an SPF value between 2 and 14 can only claim to help prevent sunburn.
  • “Waterproof, “sweatproof” or “sunblock” claims. Manufacturers cannot label sunscreens as “waterproof” or “sweatproof,” or identify their products as “sunblocks,” because these claims overstate their effectiveness. Sunscreens also cannot claim to provide sun protection for more than 2 hours without reapplication or to provide protection immediately after application (for example– “instant protection”) without submitting data to support these claims and obtaining FDA approval.
  • Water resistance claims. Water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating, based on standard testing. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating.
  • Drug Facts. All sunscreens must include standard “Drug Facts” information on the back and/or side of the container.

Information from the FDA

So what does this all mean? It means that if you want a sunscreen that will provide protection against both UVA and UVB, you need to choose one that says “broad spectrum” AND has a minimum SPF of 15. You also need to look for a time limit on the water resistance of the sunscreen. In the future, other regulations may take effect, including limiting the SPF claims to 50 since there is no evidence that a higher SPF offers greater protection. The impact of the current rules should be an easier way for consumers to know that they are getting the greatest possible protection from the sunscreen they buy.

The New Regulations Do Not Address the Safety of Ingredients

So, while the new sunscreens will make it clearer whether the sunscreen protects against both UVA and UVB rays and how long the sunscreen will remain water resistant, the regulations do not regulate the ingredients that comprise the sunscreens. The ingredients in the sunscreens have not been tested for safety. Dr. Len has written a blog on the American Cancer Society website that touches on this issue:

Many of the ingredients of sunscreens have been used for years, however the FDA acknowledged today that they have not been tested for safety using modern techniques. They did emphasize that the benefits of sunscreens containing these ingredients far outweigh the risks given their longstanding safety profile.

Nanoparticles present in sunscreen-especially those containing zinc and titanium oxides-have been another source of concern.  It is the use of “nanotechnology” that has made these effective sunscreens more acceptable since they don’t leave you with that white, pasty look that inhibited their use in the past.

Although it appeared during a news conference this morning that the FDA is satisfied at this time that products containing nanoparticles such as zinc and titanium oxides are safe when used as directed based on scientific evidence, another representative seemed a bit more cautious in his comments at second briefing held a couple of hours later by stating that nanoparticles are still being evaluated for safety.

The FDA did say they will continue to examine the science and the data regarding sunscreen ingredients, and will advise consumers promptly should they find evidence to the contrary regarding their safety profile.

One interesting outcome of the FDA’s announcement was their statement that they will be seeking further information from manufacturers and others on the safety and effectiveness of aerosol sunscreens.  The FDA apparently is concerned about inhalation risks as well as effectiveness in real-life use.  This is a sunscreen delivery method that many of us (including me) use often because of ease and convenience, and the questions regarding safety and effectiveness are certain to get some notice.

As more and more people are educated and aware of the risks of skin cancer, the use of sunscreens will presumably rise. Does it worry you that the new regulations deal more with marketing issues and confirming that the sunscreens do work effectively to minimize exposure to UVA and UVB rays than with the safety of the ingredients that provide that protection? Do you agree that since the risk of skin cancer outweighs the potential risks caused by the ingredients?

Personally, I use sunscreen and put it on my children daily. However, I also go out of the way to try to use ones that seem to have the “safest” record in terms of the chemicals involved. I also choose to use sun-shirts and other protective clothing as much as possible when at the pool or beach to minimize the amount skin I have to cover with sunscreen. Okay – honestly – it is also to minimize the amount of sunscreen smearing that I have to do every day. In order to work effectively, you are really supposed to use a lot of sunscreen all over exposed skin. As much as possible, we try to spend out time outside during the early morning and late afternoon/evening to minimize the direct exposure.

What steps do you take to protect yourself from sun exposure? What about the idea that a certain amount of sun exposure is good for Vitamin D production? What about the new FDA regulations, do they may sense? Will you shop for sunscreen differently?

Related Posts:

Skin Cancer: Types, Causes and How to Protect Yourself