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Those who are at high risk for myocardial infarction or stroke, or who have already had such an event, can live longer, experience a better quality of life and lower the chance of a repeat attack or the need for artery-opening procedures through healthy habits and medication.
That statement was the crux of joint guidelines released Thursday from the American College of Cardiology Foundation and the American Heart Association. The Preventive Cardiovascular Nurses Association endorsed the guidelines.
“Unless improvements are made in your behavior and medical therapy, the same blood vessel problem that caused your first heart attack or stroke can occur again — and may result in death — so long-term changes need to be initiated to get the vascular disease under control,” said Sidney C. Smith Jr., MD, chairman of the guideline writing group and professor of medicine at the University of North Carolina-Chapel Hill.
Smith said the guidelines are important because increasing numbers of older adults are living with cardiovascular disease, and in clinical practice many patients are not getting indicated therapies.
The guidelines are the first to recommend that all patients be referred to a comprehensive cardiac rehabilitation program after myocardial infarction, stroke, bypass surgery or the diagnosis of heart-related chest pain or blockages in leg arteries. In addition, the guidelines note the usefulness of screening heart disease patients for depression, a common occurrence after myocardial infarction or bypass surgery that can interfere with quality of life and the ability to initiate positive changes in health behaviors.
The guidelines recommend that patients with coronary heart disease and other vascular disease such as stroke and peripheral artery disease stop smoking and avoid exposure to tobacco smoke; get at least 30 minutes of exercise five to seven days a week; reduce fat if they are overweight, obese or have a large waist; get an annual flu shot; and take low-dose aspirin unless their doctor prescribes a higher dose or recommends against it because of medical contraindications.
In response to evidence from recent clinical trials, the guidelines make several changes for health professionals in the recommended use of antiplatelet agents and anticoagulants. New drugs such as prasugrel or ticagrelor, which may be used instead of clopidogrel in combination with aspirin for patients receiving coronary stents, are now included.
The guidelines emphasize the importance of adequate dosages for statin therapy for all patients with known atherosclerotic vascular disease. Low-dose aspirin therapy (75-162 mg) continues to be recommended for patients with known heart disease.
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Physicians preparing to deliver a baby look at fetal heart rate patterns to guide them in deciding whether or not to perform a C- section. But a new study by maternal-fetal medicine specialists at Intermountain Medical Center shows that those heart rate patterns may not be a good indicator of a baby’s health, and in fact may lead to unnecessary interventions and higher costs.
“We’re trying to create a better a road map for labor,” says Marc Jackson, MD, a maternal-fetal medicine specialist at Intermountain Medical Center, the flagship facility for the Intermountain Healthcare system, and principal investigator on the study. “For years we’ve used the fetal heart rate to try to identify problems, but it’s not a very good map because we have so many babies in an ‘indeterminate’ category.”
In an attempt to clear up that uncertainty, Dr. Jackson and his colleagues at Intermountain Medical Center studied fetal heart rate patterns from more than 48,000 labor and delivery cases at 10 Intermountain Healthcare hospitals over a 28-month period. The fetal heart rates were then classified using a system developed in 2008 by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the American College of Obstetricians and Gynecologists.
The results of the study are published in the October issue of the journal Obstetrics and Gynecology.
The system is comprised of three categories: Category I heart rate patterns are considered normal, and, as a rule, do not indicate fetal stress. Category III patterns are abnormal and rare, and usually indicate a problem. Category II patterns are considered indeterminate, and their significance uncertain.
Researchers examined the time babies spent in each of these categories and neonatal outcomes. The fetal heart rate patterns were classified as category I nearly 78% of the time, as category II patterns 22% of the time, and as category III rates only very rarely, 0.004% of the time when data from all stages of labor were analyzed.
But, when looking at the data for just the final two hours of delivery, the numbers changed. The data show that category I rates decreased to 61%, while category II rates increased to 39%, and category III rates increased to 0.006%.
As for outcomes, babies that spent the entire time in category I scored well. Five minutes after birth, only 0.6 percent had Apgar scores of less than seven. Apgar is a system for determining a newborn’s health using a scale of zero to 10, with 10 being the healthiest. Only 0.2 percent required admission to the neonatal intensive care unit. Category III fetal heart rates were very uncommon, occurring in only 0.1 percent of the patients studied, and resulted in admission to the NICU about half the time.
Category II fetal heart rate patterns showed up most often, occurring in 84 percent of all labors. They also found that the amount of time spent in category II increased in the two hours before delivery. This also coincided with lower Apgar scores and increased admissions to the NICU.
Regardless of those statistics, the vast majority of category II babies had no short-term problems after delivery. This means that using category II heart rate patterns as an indicator of fetal health is an unreliable method, researchers say.
Without a good map to guide them during those critical hours, doctors and nurses must play a guessing game – one that will almost always spur them to act with caution – possibly ordering a C-section delivery when it might not be necessary.
“Our next step, obviously, is to sort out those patterns in Category II to determine which ones are more predictive of a baby that’s sick and one that’s healthy,” says Dr. Jackson. “When we know that, we will be able to make better decisions for both the mother and her baby.”
Dr. Jackson and his team are currently examining the data on preterm babies during the same period in hopes of uncovering more clues that will help them better decipher category II patterns.
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 The headline said it all: Diabetes rates “doubles”. But where, and among whom? According to new research published online in the journal The Lancet global diabetes rates doubled to between 314—382 million in 2008 from 1980 rates. Although researchers at Imperial College and Harvard University analyzed data for both Types 1 and 2 diabetes, the researchers contend that the majority of people in the study (there were 2.7 million participants) were diagnosed with type 2 diabetes. The increase in prevalence since 1980 has been attributed to population growth and aging as well as by increasing age-specific prevalence. The Oceania region saw the largest rise, with prevalence still high in the Caribbean region. One of things the data shows is that rates are high in developing and middle income countries. Could it be that the rise in individual income directly impacts the kinds of food we eat? The type of activities we engage in? How we get around town?
That being said, rates did not rise in all regions, and there were differences among income groups in certain regions. There was almost no change in East and Southeast Asia and Central and Eastern Europe. So what? Well, when it comes to prevention, we need to look as much as what works as well as what doesn’t. I recently read somewhere that too much money is being thrown at understanding risk behaviors and not enough at understanding protective behaviors. I second that. Although I’m uncertain what the outcome would be, I’m interested in knowing why one region has lower rates than others. One factor may be genetic.
But beyond that, what cultural social, environmental factors affect diet, nutrition and physical activity and ultimately obesity and diabetes rates? How does the policy environment impact rates? Does the country include sidewalks when they build highways? Are there an abundance of safe parks or other spaces for play? From young, are kids encouraged to engage in activities that keep them moving? What are their food sources? Beyond behavioral changes, what structural interventions can be implemented?
An overview of The Lancet article can be viewed here:http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960679-X/fulltext#article_upsell
The BBC story on the study is available here: http://www.bbc.co.uk/news/uk-13917263
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Have you ever left after a shift and realized you forgot to relay some important piece of information to the next nurse? It can be tough to organize and prioritize your communication in a timely manner. A structured format or even the use of a template can be helpful; however experience definitely plays a role here too. Like anything else, giving report to an oncoming shift or during any patient hand-off takes practice. A common acronym used to ensure an organized and thorough report is SBAR: Situation, Background, Assessment, and Recommendation.
When I first heard of this method, it seemed too short for me. How could 4 letters/headings be used to convey all the information about my patients after a 12-hour shift? As I learned a little more about SBAR, I realized it was not much different from the method of report I had been using for years.
S= Situation. Include admitting diagnosis, history of present illness, events of hospitalization (Tip: for patients with long hospitalizations, a timeline of events is helpful.) Also, what is the patient’s current situation? Include review of vital signs and events from the past 24 hours.
B= Background. Past medical history, past surgical history, family history, psychosocial history.
A= Assessment. Review of systems. My preferred method of organization has always been neurologic, respiratory, cardiovascular, gastrointestinal, genitourinary, hematologic/immunologic, and endocrine systems; skin; laboratory values and diagnostic findings; medications; psychosocial issues.
R= Recommendation. Include anything that needs ongoing or further attention.
What method of report works best for you?
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 Please follow these rights Chances are that some of you may not have known that in addition to the well-known 5 right of medication administration, some experts have added 3 more to the list.When it comes to patient safety, it’s never a bad time to review some of the basics and increase your awareness of newer recommendations. Please add any of your own tips and medication safety advice by leaving a comment. Thanks!
Rights of Medication Administration
1. Right patient
- Check the name on the order and the patient.
- Use 2 identifiers.
- Ask patient to identify himself/herself.
- When available, use technology (for example, bar-code system).
2. Right medication
- Check the medication label.
- Check the order.
3. Right dose
- Check the order.
- Confirm appropriateness of the dose using a current drug reference.
- If necessary, calculate the dose and have another nurse calculate the dose as well.
4. Right route
- Again, check the order and appropriateness of the route ordered.
- Confirm that the patient can take or receive the medication by the ordered route.
5. Right time
- Check the frequency of the ordered medication.
- Double-check that you are giving the ordered dose at the correct time.
- Confirm when the last dose was given.
6. Right documentation
- Document administration AFTER giving the ordered medication.
- Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug.
7. Right reason
- Confirm the rationale for the ordered medication. What is the patient’s history? Why is he/she taking this medication?
- Revisit the reasons for long-term medication use.
8. Right response
- Make sure that the drug led to the desired effect. If an antihypertensive was given, has his/her blood pressure improved? Does the patient verbalize improvement in depression while on an antidepressant?
- Be sure to document your monitoring of the patient and any other nursing interventions that are applicable.
Lisa Bonsall, MSN, RN, CRNP
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This is a time of year when many new nurses enter the workforce. Learn from the mistakes of those I’ve watched…and from the mistakes of the new graduate I used to be!
1. Channel your inner boy scout. Always be prepared with the following essential items: A black pen, a pair of bandage or trauma shears, a stethoscope, a calculator and a watch.
2. Take care of yourself. If you are a spazz in your off time, you will be the same at work. Drink lots of water, get plenty of rest and do something FUN and RELAXING on your days off.
3. Don’t ever call a patient by their first name unless they give you permission. Also, don’t call people Honey, Dear, Sweetie, etc. You never know who you might offend.
4. Listen three times as much as you talk. It will keep you from experiencing foot in mouth syndrome.
5. Watch how other nurses do things and pick what works for you. Ask lots of questions and find out whose style you admire and whose style you don’t.
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As Caribbean leaders begin to sign the Agreement to establish the Caribbean Public Health Agency(CARPHA), the new Agency stepped into the international spotlight. On Monday 13th June CARPHA partnered with CARICOM and PAHO to hold its 2nd annual International partners meeting in Washington D.C. to gain backing from the global community for this single, people-focused public health agency for the region.
Delegations from the governments of Canada, USA, UK, Aruba, Netherlands and international development organisations including the World Bank and the Inter-American Development Bank were represented at the partners meeting to signal strong and continued support for the new agency, and the Caribbean’s place in global Health.
At the meeting the CARPHA team announced that the legal agreement for the agency would be formally signed on 4th July 2011 at the Heads fo Government Meeting in St Kitts and Nevis.
Commenting on the new agency, Dr Edward Greene (CARPHA Special Advisor and former Assistant Secretary General to CARICOM) said:
“This new agency is a major step towards improving health for people in the Caribbean, and is a significant step in the Region’s development. For the first time the Caribbean will have a single voice to represent our Region in health at the global level. It will help us realise the vision of the Nassau Declaration of 2001 – The health of the Region, is the wealth of the Region”.
CARPHA will provide a collective response to public health challenges for the residents and visitors to the Caribbean, including disease surveillance, the health aspects of disasters and longer-term problems associated with lifestyle diseases, such as diabetes and hypertension. The creation of this agency as a centre of excellence is projected to contribute greatly to the Region’s development and to enhance its very important tourist industry.
Prime Minister Denzil Douglas (Prime Minister of St Nevis and St -Kitts, and Caricom Lead Head of Government for Health and Human resources) gave the keynote speech at the second annual CARPHA international partners meeting. Dr Mirta Roses, Director of the Pan American Health Organization (PAHO) and Her Excellency Ambassador Lolita Applewhaite, Secretary General (acting), Caribbean Community (CARICOM) and Her Excellency Hon Senator Therese Baptiste-Cornelis (Minister of Health for Trinidad and Tobago) also addressed the international leaders in health and development, to secure continued support for this new Agency, which marks a step-change in Caribbean health.
-ENDS-
Notes to the Editor
- The Caribbean Public Health Agency (CARPHA) is a new single Public Health Agency which is currently being established. In March 2010, Caribbean Community Heads of Government confirmed that the new Agency would be created. It is expected to begin operating on a phased basis from 2012. CARPHA will combine and build on the functions of the Caribbean’s five Regional Health Institutes; Caribbean Epidemiological Research Center (CAREC); Caribbean Health Research Council (CHRC); Caribbean Food and Nutrition Institute (CFNI); Caribbean Environmental Health Institute (CEHI); Caribbean Regional Drug Testing Laboratory (CRDTL). The new agency will be located in Port of Spain, Trinidad & Tobago from 2014. Further information: www.carpha.org
- The second annual CARPHA partners meeting will be streamed live on the internet at:http://www.livestream.com/paho. The link will also be posted on www.carpha.org from 8.30am on Monday 13th June 2011. The meeting will be held in Washington DC, USA, at the Pan-American Health Organization (PAHO) Headquarters.
- Dr Edward Greene, is currently acting as Special Advisor to the Caribbean Public Health Agency, with special remit for Resource mobilisation. He was previously Assistant-Secretary General at Caribbean Community (CARICOM) Secretariat, where he was responsible for Human and Social Development, a division which covered health.
- On 1 June 2011 at the 28th meeting of the Community Council in Georgetown, Guyana. The following countries were the first to sign the Inter-Governmental Agreement (IGA) to legally establish CARPHA: Antigua and Barbuda; Belize; Grenada; St Kitts and Nevis; Saint Lucia.
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ST GEORGE’S, Grenada — St George’s University (SGU) in Grenada has partnered with the Pan American Health Organisation (PAHO), Grenada’s National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control (CDC) to provide a workshop geared at addressing the concerns of occupational hazards to health care workers (HCWs) specifically in relation to needlestick injuries and exposure to blood borne pathogens.
The workshop, which is in line with a growing global movement towards dealing with this very critical public health issue, aims to “prepare leaders in healthcare to provide training on occupational health and prevention of blood borne infections, implement and evaluate policy and intervention measures to protect health workers and establish a regional surveillance network for occupational health”.
The three-day workshop, which began on Tuesday, is being attended by 40 health care professionals with combined experience amounting to about 500 years.
The attendees come from nine countries — Grenada, Trinidad and Tobago, Barbados, Dominica, St Lucia, Belize, Nevis, Suriname and the British Virgin Islands — and various professions and foci within the health care sector, including physicians, Ministry of Health officials, professors, nurses and other HCWs working in the areas of infection control, trauma / accident care, midwifery and neonatology.
The attendees will be responsible for conveying the knowledge and skills gleaned from the workshop to their respective organisations and countries.
The workshop is the brainchild of Dr Omar Cinar Elci, Director of SGU’s Department of Public Health and Preventive Medicine (DPHPM).
In his opening address he commented: “We need to take care of our working people. We rely on our health care workers for our health but often do not consider their safety.”
He pointed out that HCWs were exposed to even more occupational hazards than agricultural, construction and factory workers.
Dr George Mitchell, a Ministry of Health official and graduate of SGU’s Department of Public Health and Preventive Medicine, represented Senator Ann Peters, Grenada’s Minister of Health, who was out of the island.
Mitchell commented: “We are ever conscious that a healthy, uninjured workforce is vital to our country’s well-being.”
He urged participants to find ways to implement what they learnt in the workshop.
Among topics to be covered at the workshop are the risk of occupational transmission of blood-borne pathogens, management of these risks, measures to be taken after exposure, how to conduct workplace assessment and how to carry out a rapid assessment for blood-borne pathogens. |
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BRIDGETOWN, Barbados, Wednesday April 20, 2011 – Health Minister Donville Inniss is fighting a battle both at home and in the regional arena over a government policy that prevents non-nationals who are not citizens or permanent residents from accessing diagnostic, clinical and pharmaceutical services at public medical facilities.
While he has had to address Guyana’s Health Minister’s criticism of the decision, Inniss is also facing some level of resistance from local doctors who say that while they will follow the directive, they will be treating all patients equally.
The Barbados Association of Medical Practitioners (BAMP) has said its members will not be checking to see whether non-nationals who seek health care have regularized their status.
But, speaking at a press briefing, Minister Inniss responded: “We never asked them [the doctors] to do that in the first place. I don’t think it’s their duty. We haven’t sought to add any additional responsibility onto doctors.”
He said the task of screening will continue to be handled by medical records clerks at the polyclinics and the Queen Elizabeth Hospital.
The minister said he had spoken to BAMP President Dr. Carlos Chase to clarify the situation.
Inniss insisted that his task was to find solutions that would redound to the benefit of citizens and health care access is no exception.
“There are several instances where some people have been residing here in Barbados for an inordinate length of time [and] have not had their status regularized,” he said.
“I am not a cruel and inhumane Minister. I hear these complaints every day. I have spoken with the Chief Immigration Officer, I have spoken with the Minister with responsibility for immigration as recently as (Monday), and I am satisfied that as a Government we will work together to ensure that all of those who are rightfully entitled to anything in Barbados will get what they are entitled to. We just need to ensure that the processes are followed.”
Inniss also addressed criticism of the policy by Guyana’s Health Minister Dr. Leslie Ramsammy at last week’s meeting of the Caribbean Community (CARICOM) Council for Human and Social Services (COHSOD).
The host minister, who is also COSHOD Chairman, had said that the decision was worrying and suggested that regional governments provide free health care to all CARICOM nationals.
Inniss said he did not expect any fallout in Barbados’ relationship with Guyana over the issue.
“Minister Ramsammy made his comments. I, in response, on the margins of the meeting would have spoken with him and enlightened him. I think there was a misinterpretation of what he would have read in the newspapers…but what is important to me is that the people of the Caribbean are able to love each other as brothers and sisters and that we are treated with a great level of hospitality when we visit each other’s nations,” Minister Inniss said.
“I am of the opinion that we as Ministers can have our differences of opinion, but I am also satisfied that whilst politicians talk and shout at each other, the ordinary citizens of the Caribbean are living the true CARICOM experience,” he added.
Read more: http://www.caribbean360.com/index.php/news/barbados_news/362334.html#ixzz1OW6z1D00
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SLNA was establish 1947 and was registered as a professional organization in 1949. In 1975, SLNA gained bargaining rights when it became a registered Trade Union with its objectives being to protect and defend the rights of nurses. In 1976 SLNA got international recognition when it became a member of the International Council of Nursing (ICN).
SLNA was establish 1947 and was registered as a professional organization in 1949. In 1975, SLNA gained bargaining rights when it became a registered Trade Union with its objectives being to protect and defend the rights of nurses. In 1976 SLNA got international recognition when it became a member of the International Council of Nursing (ICN).
SLNA was establish 1947 and was registered as a professional organization in 1949. In 1975, SLNA gained bargaining rights when it became a registered Trade Union with its objectives being to protect and defend the rights of nurses. In 1976 SLNA got international recognition when it became a member of the International Council of Nursing (ICN).
SLNA was establish 1947 and was registered as a professional organization in 1949. In 1975, SLNA gained bargaining rights when it became a registered Trade Union with its objectives being to protect and defend the rights of nurses. In 1976 SLNA got international recognition when it became a member of the International Council of Nursing (ICN).
SLNA was establish 1947 and was registered as a professional organization in 1949. In 1975, SLNA gained bargaining rights when it became a registered Trade Union with its objectives being to protect and defend the rights of nurses. In 1976 SLNA got international recognition when it became a member of the International Council of Nursing (ICN).
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