NursingLink

Experts say radical measures won't stop swine flu

Thu, 19 Nov 2009 09:25:50 -0800

Vaccines in Sight for AIDS, Alzheimer's, TB, Herpes

Wed, 18 Nov 2009 10:04:38 -0800

New Advice: Skip Mammograms in 40s, Start at 50

Associated Press/AP Online — Tue, 17 Nov 2009 14:44:00 -0800

NEW YORK - Most women don't need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday. It's a major reversal that conflicts with the American Cancer Society's long-standing position.

Also, the task force said breast self-exams do no good and women shouldn't be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women's odds of survival.

"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group, said insurance coverage isn't likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Experts expect the task force revisions to be hotly debated, and to cause confusion for women and their doctors.

"Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem," said Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer.

The guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.

The new advice says:

-Most women in their 40s should not routinely get mammograms.

-Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)

-The value of breast exams by doctors is unknown. And breast self-exams are of no value.

[page]

Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. Decades ago, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.

The guidelines and research supporting them were released Monday and are being published in Tuesday's issue of the Annals of Internal Medicine.

The new advice was sharply challenged by the cancer society.

"This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he said. The cancer society feels the benefits outweigh the harms for women in both groups.

International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years.

Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.

Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated.

In most women, tumors are slow-growing, and that likelihood increases with age. So there is little risk by extending the time between mammograms, some researchers say. Even for the minority of women with aggressive, fast-growing tumors, annual screening will make little difference in survival odds.

The new guidelines balance these risks and benefits, scientists say.

The probability of dying of breast cancer after age 40 is 3 percent, they calculate. Getting a mammogram every other year from ages 50 to 69 lowers that risk by about 16 percent.

"It's an average of five lives saved per thousand women screened," said Georgetown University researcher Dr. Jeanne Mandelblatt.

[page]

Starting at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.

"You save more lives because breast cancer is more common, but you diagnose tumors in women who were destined to die of something else. The overdiagnosis increases in older women," Mandelblatt said.

She led six teams around the world who used federal data on cancer and mammography to develop mathematical models of what would happen if women were screened at different ages and time intervals. Their conclusions helped shape the new guidelines.

Several medical groups say they are sticking to their guidelines that call for routine screening starting at 40.

"Screening isn't perfect. But it's the best thing we have. And it works," said Dr. Carol Lee, a spokeswoman for the American College of Radiology. She suggested that cutting health care costs may have played a role in the decision, but Petitti said the task force does not consider cost or insurance in its review.

The American College of Obstetricians and Gynecologists also has qualms. The organization's Dr. Hal Lawrence said there is still significant benefit to women in their 40s, adding: "We think that women deserve that benefit."

But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.

"Overall, I think it really took courage for them to do this," she said. "It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."

Abernethy, who is 41, said she got her first mammogram the day after her 40th birthday, even though she wasn't convinced it was needed. Now she doesn't plan to have another mammogram until she is 50.

Barbara Brenner, executive director of the San Francisco-based Breast Cancer Action, said the group was "thrilled" with the revisions. The advocacy group doesn't support screening before menopause, and will be changing its suggested interval from yearly to every two years, she said.

Mammograms, like all medical interventions, have risks and benefits, she said.

"Women are entitled to know what they are and to make their best decisions," she said. "These guidelines will help that conversation."

Baby Survives 11 Blood Transfusions Inside the Womb

Daily Mail UK — Tue, 17 Nov 2009 14:41:00 -0800

Miracle baby Jasmine Tanner needed 11 life-saving blood transfusions - while she was still in her mother's womb.

Doctors repeatedly performed the intricate procedure after they discovered Jasmine's blood type was incompatible with that of her mother Melanie.

The rare condition, called rhesus disease, was causing antibodies produced by Melanie, 34, to destroy her child's blood cells.

Without intervention little Jasmine would have died from heart failure.

The baby girl was eventually delivered at 34 weeks by caesarean and immediately taken into intensive care where she had a further three blood transfusions.

Now more than a year on, Jasmine is a picture of health and the only evidence of her battle for survival are small needle scars on her abdomen.

The condition, which affects just one in 10,000 women, was diagnosed only nine weeks into Melanie's pregnancy with treatment starting seven weeks later.

Each time the intricate procedure was carried out there was a one in 10 chance of Melanie losing her precious baby.

Nurse Mrs Tanner, from Warsash, Hants, said: 'It was awful but we just had to get on with it because we had no choice.

'But I knew each time that I might actually come out without a baby. Every time I drove to the hospital I had a feeling of doom mixed with anxiety.

'But we had to do everything possible to give our baby the best chance of survival.'

At first, when the foetus was small, blood was injected directly through Melanie's stomach into the baby's tummy and then absorbed into her circulation.

From 20 weeks, the baby was big enough for a needle to be guided directly into her 4mm wide umbilical vein using ultrasound images.

Melanie added: 'I was petrified but I tried to keep it to myself as much as I could.

'I never looked at the needle and I tried to concentrate on staying perfectly still for the baby.

'It was a very tense and stressful time.'

[page]

Rhesus disease occurs after a mother with rhesus negative blood gives birth to a rhesus positive baby.

The mother is sensitised to the rhesus positive blood when a tiny amount of it enters her blood stream during pregnancy and labour.

Her body will then start producing antibodies which attack the rhesus positive blood and can affect future pregnancies.

Rhesus disease is easily prevented if injections are given to the mother preventing her from developing the antibodies that cause the problems.

In Melanie's case, she did have the injections after the birth of her first child, seven year old Ryan who is rhesus negative.

But during her second pregnancy with Owen, four, one injection was forgotten.

This caused his late onset of rhesus disease. He was born severely anaemic and had a transfusion of donated blood as soon as he was born.

Every rhesus positive baby after is likely to develop an even worse version of the condition and Melanie and husband Duncan had counselling before conceiving Jasmine.

They hoped for a rhesus negative baby but a blood test at nine weeks in her third pregnancy confirmed she was expecting a rhesus positive baby.

Melanie and Duncan, 33, a systems analyst, said they think of Jasmine as their miracle baby.

The couple also called on the public to donate blood to help save lives.

Melanie added: 'Without people who generously donate blood, our beautiful little girl would not be here with us today.

'We really would urge anyone who can donate blood to do so. It can help save a life before it's even begun.

'Jasmine has brought us so much happiness. She's a little miracle.'

Melanie and Duncan have decided against any further pregnancies.

Melanie said: 'We would love to have another child, but we wouldn't want to put our other three children or ourselves through such a potentially difficult if not worse time.

'Obviously it is difficult making this choice when there is always a 50 per cent chance that our next pregnancy could be rhesus negative like Ryan was.

'In this case the baby would be perfectly safe.

'We are just glad to have Jasmine after everything she went through.'

Baby Survives 11 Blood Transfusions in Womb

Tue, 17 Nov 2009 08:53:45 -0800

Migraine Increases Likelihood of Stroke

Mon, 16 Nov 2009 13:59:36 -0800

Uninsured People Should Call Now to Register for Free Health Clinic in New Orleans

PRNewswire — Mon, 16 Nov 2009 11:25:00 -0800

Uninsured residents of Louisiana who want to attend a free health clinic in New Orleans on Saturday, Nov. 14, should call 877-233-5159 toll-free as soon as possible to schedule appointments.

About 400 doctors and other medical providers and 700 other volunteers are expected to participate in the C.A.R.E. (Communities Are Responding Everyday) Clinic at the Ernest N. Morial Convention Center sponsored by the National Association of Free Clinics (NAFC). They will provide care for all types of medical issues at no cost to participants or taxpayers from 8 a.m. until 5 p.m.

"People without insurance are up to four times less likely to have a regular source of health care and are more likely to die from health-related problems," Jeanette Alcon, executive director of the Louisiana Association of Free Clinics, said. "The C.A.R.E. Clinic could give many of them their first opportunity in a long time to receive professional help for their medical problems."

Almost 22 percent of Louisiana residents do not have health insurance, according to the Kaiser Family Foundation. That's one of the highest rates of uninsured residents in the nation.

"Almost 2,000 people turned out for a similar one-day, free clinic in Houston in September, so we urge people to register in advance to be seen by health care professionals at the New Orleans C.A.R.E. Clinic," NAFC Executive Director Nicole Lamoureux said. "We also will try to accommodate as many walk-ins as possible, but that will be on a first-come-first-served basis."

In addition to the toll-free number for patients to register for the C.A.R.E. Clinic, patients and volunteers also can find information about the clinic online at: http://freeclinics.us/. All types of medical volunteers are needed to help with the C.A.R.E. Clinic in New Orleans. Non-medical volunteers also are needed to help with documentation, logistical support and patient intake, as well as assisting patients with scheduling follow-up appointments at their local charitable clinics.

More than 1,200 free clinics across the United States, including a dozen in Louisiana, provide health care for uninsured people at no charge to the recipients. The majority of free clinics use no federal or state funding. During 2008, four million people received health care from free clinics with the help of more than six million volunteers, including doctors, nurses, nurse practitioners and support staffs.

"Free clinics have been serving America's working poor since the 1960s, but over the last year, our patient base has grown to include white-collar and blue-collar workers who have lost their jobs and health insurance," Lamoureux said.

In addition to the C.A.R.E. Clinic in New Orleans on Nov. 14, similar clinics will be held at the State House Convention Center in Little Rock on Nov. 21 and the Kansas City Convention Center's Bartle Hall in Kansas City on Dec. 9-10.

About the National Association of Free Clinics:

The National Association of Free Clinics is the only nonprofit 501(c)(3) organization whose mission is solely focused on the issues and needs of more than 1,200 free clinics and the people they serve in the United States.

Founded in 2001 and headquartered in Washington, D.C., the NAFC is an effective advocate for the issues and concerns of free clinics, their volunteer workforce of doctors, dentists, nurses, therapists, pharmacists, nurse practitioners, technicians and other health care professionals, as well as the patients served by free clinics in communities throughout the nation.

National Association of Free Clinics

CONTACT: Nicole Lamoureux, National Association of Free Clinics,+1-703-577-7204, nlamoureux@freeclinics.us

Web Site: http://freeclinics.us/

Nurse Practicioners Look to Spread the Word

Statesville Record & Landmark — Mon, 16 Nov 2009 11:23:00 -0800

Nov. 14--Physicians work with patients to treat what ails them, but nurse practitioners reach out beyond their patients' medical needs.

The leadership of the Iredell Regional Nurse Practitioner Group decided to use Nurse Practitioner Week to inform the general public what they as "NPs" do, compared to what a doctor does.

"A good physician has a good nurse practitioner," said Malinda Sherrill, a family nurse practitioner at Statesville Cardiology Clinic and president of the IRNP.

Sherrill said nurse practitioners have either a master's degree or doctorate, and can obtain a certificate to specialize in medical areas such as internal medicine, cardiology or pediatrics.

According to the American Academy of Nurse Practitioners, the first NPs were educated at the University of Colorado in 1965. As of 2009, there are around 125,000 practicing.

Even though nurse practitioners can examine and write prescriptions for patients, they should be perceived as an extension -- not a replacement -- for a physician's care, Sherrill said.

Statesville resident Wayne Mills said he has discovered nurse practitioners take more time with their patients and have more contact with them.

"It's more personal, to be honest with you," he said. "You get to know them a lot better as far as the one-on-one situation. They know you good enough to know if something is wrong or not."

Mills said he doesn't believe the average person knows how much training nurse practitioners have, and how they can assist someone.

The group formed two years ago and meets monthly to network and discuss topics such as smoking cessation, hypertension and diabetes. Sherrill said the group hosts continuing education workdays for medical issues, such as narcotic dependency and anticoagulation.

The next meeting is scheduled for 6 p.m. Tuesday at Black Angus Grille on North Center Street.

Sherrill said the organization provides nurse practitioners with the opportunity to network with one another.

The annual group dues go toward educational programs or are donated to community organizations such as HealthReach Community Clinic in Mooresville.

+++

Want to learn more?

For more information about the group, visit the Iredell Regional Nurse Practitioner Group's Web site at www.irnp.org.

Study Raises New Questions About Popular Cholesterol Drugs

Mon, 16 Nov 2009 11:20:14 -0800

Lawyers: Nurse Was Trying to Comfort Terminally Ill Patients, Not Kill Them

Mon, 16 Nov 2009 11:18:29 -0800

All UK Nurses to Have 4 Year Degrees by 2012

Belfast Telegraph — Mon, 16 Nov 2009 10:00:00 -0800

All nurses will need to be educated to degree level from 2013, the Government announced today.

At present, nurses receive a diploma after two or three years of training but they will now have to complete three or four years to obtain a degree.

The move is as a result of changes to the way nurses work, including handling more advanced levels of practice, prescribing and working in specialist disease areas, such as diabetes.

[widget:791]

Nursing courses will match up to a new set of standards set out by the Nursing and Midwifery Council and will include more practical experience outside of hospitals.

Current training involves a combination of theoretical and practical work but the new standards, which are open to consultation, will include a focus on students gaining experience in community health teams.

Trainees will also shadow school health nurses and district nurses who work with people in their own homes.

Health Minister Ann Keen said: "Nurses are the largest single profession within the health service, and are critical to the delivery of high quality health care. By bringing in degree-level registration we can ensure new nurses have the best possible start to meet the challenges of tomorrow."

Chief nursing officer Christine Beasley said: "More young people than ever are studying for a degree and this will make nursing more attractive to them.

"Degree-level nurse education will be supported by a national framework for preceptorship which will ensure that new nurses have the support they need to make the transition to confident practitioner."

Dr Peter Carter, chief executive of the Royal College of Nursing, said: "This is an important and historic development, which the RCN has been in support of for many years.

"All nurses need to put quality care at the centre of what they do, and they also need extensive knowledge, analytical skills and experience to work in a range of settings."

Ex-Air Force nurse on trial for killing 3 patients

Mon, 16 Nov 2009 04:31:32 -0800

Television Time Linked to Aggression in Toddlers

Sun, 15 Nov 2009 05:59:32 -0800

Sugary and Fatty Food Cravings Could Be as Addictive as Illegal Drugs

Sun, 15 Nov 2009 05:29:54 -0800

PTSD: Each Day 18 U.S. Vets Commit Suicide

Sun, 15 Nov 2009 05:28:29 -0800

Govt: Medicare paid $47 billion in suspect claims

Sat, 14 Nov 2009 16:59:35 -0800

FDA finds bits of steel, rubber in Genzyme drugs

Sat, 14 Nov 2009 16:09:57 -0800

Feds ignored Medicare scam warnings for years

Sat, 14 Nov 2009 16:08:34 -0800

Obesity responsible for 100,000 cancer cases annually

Sat, 14 Nov 2009 01:49:06 -0800

Flu shot mixup forces health department to explain error

Fri, 13 Nov 2009 12:45:31 -0800