Tuesday, December 7, 2010
Caffeine+Alcohol= DANGEROUS COMBINATION!!
There has been talk recently talk in the news about these drinks that contain high levels of alcohol with high levels of caffeine. These drinks are attracting college students nationwide. There has been many incidents where students have been hospitalized for alcohol poisoning. One of the very popular drinks is the drink named, Four Lokos. Four Lokos means Four crazies in Spanish. Many colleges in the area are now banning these drinks on campus. What is your take on it? Below I posted an article from MedPage Today.
FDA Cans Alcoholic Beverages that Contain Caffeine
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The FDA has acted to effectively ban the sale of beverages that combine caffeine and alcohol, including Four Loko and Joose, by declaring that caffeine is an unsafe food additive for alcoholic beverages. The agency issued warning letters Wednesday to four makers of caffeinated alcoholic beverages, saying that addition of caffeine to their malt beverages is not "generally recognized as safe (GRAS)," the industry standard.  "Several studies have shown that stimulants mask the intoxicating effects of alcohol," Joshua Sharfstein, MD, deputy FDA commissioner, told reporters. This can lead to overconsumption of the beverages and, subsequently, alcohol poisoning, he said.Most of the drinks contain 12% alcohol by volume and are sold in 24- to 32-oz cans. So, one can contains as much alcohol as four or five regular-sized beers. "Young, inexperienced drinkers may not realize just how impaired they are and drink to the point of alcohol poisoning," David Vladeck, director of the bureau of consumer protection at the Federal Trade Commission, said on the call. The four manufacturers include Four Loko maker Phusion Projects, Joose maker United Brands Company, Charge Beverages Corp., and New Century Brewing Co. Earlier today, Chicago-based Phusion Products, issued a statement saying it intended "to reformulate its products to remove caffeine, guarana, and taurine nationwide." "Going forward, Phusion will produce only non-caffeinated versions of Four Loko," the company said. Robert McKenna, attorney general of the state of Washington -- one of four states that has already taken action against the beverages -- said on the call that the company's move is a "cynical ploy." "It's like an employee who is about to get fired saying, I quit!" McKenna said. Several state attorneys launched their own investigations into the products in 2007 and subsequently brought the issue to the FDA's attention, he added. The Federal Trade Commission will also notify manufacturers that they're potentially marketing the products illegally, the FDA said, and that further action including seizure of the products, is possible under federal law. The FDA action follows a scientific review begun in November 2009 into the safety of the drinks. At that time, the agency sent letters to 30 manufacturers -- far more than the four that received warning letters today. Sharfstein said the agency's review is ongoing, and may lead to action against other products.  There's been a spate of recent action on caffeinated alcoholic beverages. A handful of states -- including Oklahoma, Utah, Michigan, and Washington -- have banned Four Loko in the wake of a rash of hospitalizations, heart attacks, and death associated with its consumption.Just this week, the New York liquor authority and the state's largest beer distributors agreed to stop selling the drinks, according to a release from Sen. Charles Schumer (D-N.Y.), who announced the FDA's pending decision on Tuesday. And on Monday, Connecticut Attorney General and the state's senator-elect Richard Blumenthal sent a letter to FDA Commissioner Margaret Hamburg, MD, calling for the ban of the energy drinks. Two deaths may be associated with use of the drinks. An 18-year-old Long Island resident, Nicole Lynn Celestino, allegedly died in August of cardiac arrest after drinking four cans of Four Loko on top of a diet pill she had taken earlier in the day. And the family of 20-year-old Jason Keiran of Florida is suing the drink maker over claims that it caused him to behave so erratically that he shot himself. The FDA's warning letters request that the companies inform the agency in writing within 15 days of the specific steps that will be taken to remedy the violation and prevent its recurrence. If a company does not believe its products are in violation, it may present its reasoning and any supporting information as well. | ||
Tuesday, November 30, 2010
Nurses’ Role in the Future of Health Care
This is an article that I found on the New York Times website in regards to the future of nurses role. Let me know what you think.
At the start of my surgical training, I helped to care for a middle-aged patient who was struggling to recuperate from a major operation on his aorta, the body’s central artery, and the blood vessels to his legs. As the days wore on, the surgeon in charge began consulting various experts until the once spare patient file became weighted down with the notes and suggestions of a whole roster of specialists.
The patient eventually recovered, thanks to the efforts of many. Nonetheless, one afternoon while walking around the wards with the senior surgeon, I couldn’t help but make a crack about the sheer heft of the patient’s chart; it was, after all, my job to carry it around while she visited with patients.
“Remember this for when you get out into the real world,” she said, taking the chart from me and letting it dip in a way that exaggerated its bulk. “When the ship seems to be going down, you’ve got to get all hands on deck.”
We might do well to remember that surgeon’s advice right now.
As we inch toward 2014, the year that the Patient Protection and Affordable Care Act, the centerpiece of the health care overhaul, takes effect, it has become increasingly clear that the ship known as our health care system is in the process of sinking. And it is not spiraling costs or an overreliance on technology that is weighing most heavily on the health care system, but the sheer volume of patients it must serve.
Currently overloaded with a rapidly aging patient population and their attendant complex medical problems, the system has yet to absorb the 32 million newly insured patients on the horizon. Moreover, over the next 10 years, a third of current physicians will retire, and the physician deficit will increase from just over 7,000 to almost 100,000, with shortages in all specialties, and not just primary care.
But like crew members frantically moving deck chairs, policy makers, medical center administrators, third-party payers and even doctors and patients have remained focused on one thing: the physicians. In all the discussions about adjusting the number of medical schools and training slots, rearranging physician payment schedules and reorganizing practice models, one group of providers has been conspicuously missing.
The nurses.
Nurses currently form the largest sector of health care providers, with more than three million currently registered; but few have led or even been involved in the formal policy discussions regarding the future care of patients. To address this discrepancy, the Institute of Medicine and the Robert Wood Johnson Foundation assembled a national panel of health care experts that has been meeting for the last two years to discuss the role of nurses in transforming the current health care system. Their final report was published last month with no less ambitious a title than “The Future of Nursing: Leading Change, Advancing Health.”
The report, it turns out, lives up to its name. Free of the kind of diatribes that usually creep into discussions about the roles of different health care providers, this report instead relies heavily on the evidence amassed over the last 50 years in clinical trials on the efficacy of nursing care. Weighing in at almost 600 pages, it offers several recommendations, including what amounts to a rebuke of the current piecemeal education of nurses and a debunking of the notion that physicians are the only ones who should lead (and be reimbursed for) any changes in the current health care system.
Leaders in nursing have welcomed the report. “I think it’s a good blueprint for the future,” said Catherine L. Gilliss, president of the American Academy of Nursing, who was not a member of the panel.
Part of that blueprint includes innovative nursing-led services like the Transitional Care Model program at the University of Pennsylvania in Philadelphia, where nurses are assigned to elderly hospitalized patients deemed to be at high risk for relapse. For up to three months after discharge, the nurse makes home visits, accompanies the patient to doctors’ offices and collaborates with the primary care physician and family caregivers. In early trials, the program has significantly decreased hospital readmissions and costs by as much as $5,000 per patient. But because not all third-party payers and institutions are willing to enroll patients in a nurse-directed program or pay for new nursing services, not all patients who are eligible for the special care can enroll because they won’t be reimbursed.
“What is fundamentally operating here is the culture of care,” said Mary D. Naylor, a principal investigator in the Transitional Care Model program and a professor of nursing at the University of Pennsylvania. “We don’t recognize how critically important it is to maximize the contributions of everyone.”
But the report was just as forceful in urging nurses to revamp the way they are educated, citing the decades-long struggle within the profession to define what exactly a nurse is. The term “registered nurse” can refer equally to graduates of two-year associate’s programs, four-year baccalaureate programs, and advanced master’s or doctorate programs. In addition to proposing the addition of postgraduate clinical training, or residency, programs, similar to what physicians currently go through, the panel recommended increasing the number of nurses with baccalaureate degrees to 80 percent from 50 percent and doubling the number of nurses with doctorate degrees over the next 10 years.
The expert panel is scheduled to convene again at the end of this month, this time to discuss implementing their recommendations. They will have their work cut out for them. Critics like the American Medical Association have charged that the report overlooks the extensive education and training of physicians and ignores the importance of physician-led teams in ensuring patient safety. In its official statement, the AMA warns that “with a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage.”
Whatever the final outcome, leaders in the nursing community believe that the report is an important first step toward organizing nurses to better serve patients through the challenges of the next few decades.
“I don’t think any group has a lock on advocacy,” Dr. Gilliss said, “and I don’t believe that any one group is restricted from reaching out and being in the patient’s world, making home visits, doing a little something out of the ordinary.”
“There’s a need for many hands,” she added, “and this may be nursing’s shining moment.”
At the start of my surgical training, I helped to care for a middle-aged patient who was struggling to recuperate from a major operation on his aorta, the body’s central artery, and the blood vessels to his legs. As the days wore on, the surgeon in charge began consulting various experts until the once spare patient file became weighted down with the notes and suggestions of a whole roster of specialists.
The patient eventually recovered, thanks to the efforts of many. Nonetheless, one afternoon while walking around the wards with the senior surgeon, I couldn’t help but make a crack about the sheer heft of the patient’s chart; it was, after all, my job to carry it around while she visited with patients. “Remember this for when you get out into the real world,” she said, taking the chart from me and letting it dip in a way that exaggerated its bulk. “When the ship seems to be going down, you’ve got to get all hands on deck.”
We might do well to remember that surgeon’s advice right now.
As we inch toward 2014, the year that the Patient Protection and Affordable Care Act, the centerpiece of the health care overhaul, takes effect, it has become increasingly clear that the ship known as our health care system is in the process of sinking. And it is not spiraling costs or an overreliance on technology that is weighing most heavily on the health care system, but the sheer volume of patients it must serve.
Currently overloaded with a rapidly aging patient population and their attendant complex medical problems, the system has yet to absorb the 32 million newly insured patients on the horizon. Moreover, over the next 10 years, a third of current physicians will retire, and the physician deficit will increase from just over 7,000 to almost 100,000, with shortages in all specialties, and not just primary care.
But like crew members frantically moving deck chairs, policy makers, medical center administrators, third-party payers and even doctors and patients have remained focused on one thing: the physicians. In all the discussions about adjusting the number of medical schools and training slots, rearranging physician payment schedules and reorganizing practice models, one group of providers has been conspicuously missing.
The nurses.
Nurses currently form the largest sector of health care providers, with more than three million currently registered; but few have led or even been involved in the formal policy discussions regarding the future care of patients. To address this discrepancy, the Institute of Medicine and the Robert Wood Johnson Foundation assembled a national panel of health care experts that has been meeting for the last two years to discuss the role of nurses in transforming the current health care system. Their final report was published last month with no less ambitious a title than “The Future of Nursing: Leading Change, Advancing Health.”
The report, it turns out, lives up to its name. Free of the kind of diatribes that usually creep into discussions about the roles of different health care providers, this report instead relies heavily on the evidence amassed over the last 50 years in clinical trials on the efficacy of nursing care. Weighing in at almost 600 pages, it offers several recommendations, including what amounts to a rebuke of the current piecemeal education of nurses and a debunking of the notion that physicians are the only ones who should lead (and be reimbursed for) any changes in the current health care system.
Leaders in nursing have welcomed the report. “I think it’s a good blueprint for the future,” said Catherine L. Gilliss, president of the American Academy of Nursing, who was not a member of the panel.
Part of that blueprint includes innovative nursing-led services like the Transitional Care Model program at the University of Pennsylvania in Philadelphia, where nurses are assigned to elderly hospitalized patients deemed to be at high risk for relapse. For up to three months after discharge, the nurse makes home visits, accompanies the patient to doctors’ offices and collaborates with the primary care physician and family caregivers. In early trials, the program has significantly decreased hospital readmissions and costs by as much as $5,000 per patient. But because not all third-party payers and institutions are willing to enroll patients in a nurse-directed program or pay for new nursing services, not all patients who are eligible for the special care can enroll because they won’t be reimbursed.
“What is fundamentally operating here is the culture of care,” said Mary D. Naylor, a principal investigator in the Transitional Care Model program and a professor of nursing at the University of Pennsylvania. “We don’t recognize how critically important it is to maximize the contributions of everyone.”
But the report was just as forceful in urging nurses to revamp the way they are educated, citing the decades-long struggle within the profession to define what exactly a nurse is. The term “registered nurse” can refer equally to graduates of two-year associate’s programs, four-year baccalaureate programs, and advanced master’s or doctorate programs. In addition to proposing the addition of postgraduate clinical training, or residency, programs, similar to what physicians currently go through, the panel recommended increasing the number of nurses with baccalaureate degrees to 80 percent from 50 percent and doubling the number of nurses with doctorate degrees over the next 10 years.
The expert panel is scheduled to convene again at the end of this month, this time to discuss implementing their recommendations. They will have their work cut out for them. Critics like the American Medical Association have charged that the report overlooks the extensive education and training of physicians and ignores the importance of physician-led teams in ensuring patient safety. In its official statement, the AMA warns that “with a shortage of both nurses and physicians, increasing the responsibility of nurses is not the answer to the physician shortage.”
Whatever the final outcome, leaders in the nursing community believe that the report is an important first step toward organizing nurses to better serve patients through the challenges of the next few decades.
“I don’t think any group has a lock on advocacy,” Dr. Gilliss said, “and I don’t believe that any one group is restricted from reaching out and being in the patient’s world, making home visits, doing a little something out of the ordinary.”
“There’s a need for many hands,” she added, “and this may be nursing’s shining moment.”
Tuesday, November 16, 2010
Alcohol-related emergency room visits skyrocket in New York: 74,000 in 2009
Nearly 74,000 people wound up in hospitals in 2009 for alcohol-related reasons, compared with just 22,000 in 2003 - a jump of nearly 250%, said the city Health Department study, which was released yesterday.
"Excessive alcohol use in general is a serious problem," said Health Commissioner Thomas Farley. "The data suggest that the problem is getting worse."
Hard drinkers wind up in the ER for reasons ranging from alcohol poisoning to barroom fights and drunken spills.
While the majority of alcohol-related deaths in New York - 1,537 adults in 2008 - resulted from health problems, the study said, a solid proportion were caused by accidents, suicides and homicides.
The top boozing neighborhoods, with more than 4% of their overall emergency room visits linked to alcohol, are Greenwich Village, Murray Hill and Chelsea in Manhattan; Bay Ridge and Greenpoint in Brooklyn, and the northeastern stretches of Queens.
"A lot of bars have a lot of fights," noted John Connors, a 55-year-old transit worker slugging back Buds in Bay Ridge. "At one time there were 363 bars in this neighborhood - I know, I counted them."
Staten Island, central Brooklyn, the northeast Bronx and the Rockaways in Queens had the lowest number of alcohol-related hospital trips.
Among adult drinkers surveyed by the Health Department, 42% acknowledge binge drinking - defined as slugging back five or more drinks in a sitting. Eleven percent describe themselves as heavy drinkers.
"On a Monday afternoon you can end up with a full bar - look at this one," Connors said pointing to the more than 15 patrons bending elbows at Kelly's Tavern yesterday afternoon.
"I got here at about 2 p.m. and I'll be here until about 4 a.m."
Health officials said the data did not explain why the emergency room figures had shot up so much. Farley noted that the general thinking was that heavy drinkers were less likely to end up in the emergency room.
"This is not normally alcoholics, but moderate drinkers who had too much to drink," he said.
The pattern was similar for adults and underage drinkers.
For those younger than 21, the number of hospital visits shot up to 4,000 in 2009 from 1,000 in 2003, with the peaks seen in many of the same neighborhoods where adult alcohol-related visits rose.
The stats were released as the State Liquor Authority successfully pressured local beverage distributors to stop selling the controversial Four Loko caffeinated alcohol brew here.
lalpert@nydailynews.com
Read more: http://www.nydailynews.com/ny_local/2010/11/15/2010-11-15_alcoholrelated_emergency_room_visits_skyrocket_in_new_york_74000_in_2009.html#ixzz15TQiFGdD
Tuesday, November 9, 2010
AAA.....and No I am Not Talking About the Car Club
For my clinical presentation for the semester I am doing a presentation on Abdominal Aortic Aneurysms. So I thought I would share some information with you. Let me know what you think. Are you at risk for a AAA?
AA Prevalence
- Approximately one in every 250 people over the age of 50 will die of a ruptured AAA
- AAA affects as many as eight percent of people over the age of 65
- Males are four times more likely to have AAA than females
- AAA is the 17th leading cause of death in the United States, accounting for more than 15,000 deaths each year.
- Those at highest risk are males over the age of 60 who have ever smoked and/or who have a history of atherosclerosis ("hardening of the arteries")
- 50 percent of patients with AAA who do not undergo treatment die of a rupture
Smoking is a Major Risk Factor for AAA and other Vascular Disease
- Those with a family history of AAA are at a higher risk (particularly if the relative with AAA was female)
- Smokers die four times more often from ruptured aneurysms than nonsmokers
AAA Symptoms
AAA is often called a "silent killer" because there are usually no obvious symptoms of the disease. Three out of four aneurysms show no symptoms at the time they are diagnosed. When symptoms are present, they may include:
- Abdominal pain (that may be constant or come and go)
- Pain in the lower back that may radiate to the buttocks, groin or legs
- The feeling of a "heartbeat" or pulse in the abdomen
Once the aneurysm bursts, symptoms include:
- Severe back or abdominal pain that begins suddenly
- Paleness
- Dry mouth/skin and excessive thirst
- Nausea and vomiting
- Signs of shock, such as shaking, dizziness, fainting, sweating, rapid heartbeat and sudden weakness
AAA Diagnosis
In some, but not all cases, AAA can be diagnosed by a physical examination in which the doctor feels the aneurysm as a soft mass in the abdomen (about the level of a belly button) that pulses with each heartbeat.
The most common test to diagnose AAA is ultrasound, a painless examination in which a device (a transducer) about the size of a computer mouse is passed over the abdomen. Sound waves are computerized to create "pictures" of the aorta and detect the presence of AAA. Other methods for determining the aneurysms' size are CT scan (computerized tomography), MRI (magnetic resonance imaging), and arteriogram (real time x-rays).
AAA Treatments
Currently, there are three treatment options for AAA:
Watchful waiting - Small AAA's (less than 5 centimeters or about 2 inches), which are not rapidly growing or causing symptoms, have a low incidence of rupture and often require no treatment other than "watchful waiting" under the guidance of a vascular disease specialist. This typically includes follow-up ultrasound exams at regular intervals to determine if the aneurysm has grown.
Surgical Repair - The most common treatment for a large, unruptured aneurysm is open surgical repair by a vascular surgeon. This procedure involves an incision from just below the breastbone to the top of the pubic bone. The surgeon then clamps off the aorta, cuts open the aneurysm and sews in a graft to act as a bridge for the blood flow. The blood flow then goes through the plastic graft and no longer allows the direct pulsation pressure of the blood to further expand the weak aorta wall.
Interventional Repair - This minimally invasive technique is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient's artery. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm, then opened, creating new walls in the blood vessel through which blood flows.
This is a less invasive method of placing a graft within the aneurysm to redirect blood flow and stop direct pressure from being exerted on the weak aortic wall. This relatively new method eliminates the need for a large abdominal incision. It also eliminates the need to clamp the aorta during the procedure. Clamping the aorta creates significant stress on the heart, and people with severe heart disease may not be able to tolerate this major surgery. Stent grafts are most commonly considered for patients at increased surgical risk due to age or other medical conditions.
The stent graft procedure is not for everyone, though. It is still a new technology and we don't yet have data to show that this will be a durable repair for long years. Thus, people with a life expectancy of 20 or more years may be counseled against this therapy. It is also a technology that is limited by size. The stent grafts are made in certain sizes, and the patient's anatomy must fit the graft, since grafts are not custom-built for each patient's anatomy.
Watchful waiting - Small AAA's (less than 5 centimeters or about 2 inches), which are not rapidly growing or causing symptoms, have a low incidence of rupture and often require no treatment other than "watchful waiting" under the guidance of a vascular disease specialist. This typically includes follow-up ultrasound exams at regular intervals to determine if the aneurysm has grown.
Surgical Repair - The most common treatment for a large, unruptured aneurysm is open surgical repair by a vascular surgeon. This procedure involves an incision from just below the breastbone to the top of the pubic bone. The surgeon then clamps off the aorta, cuts open the aneurysm and sews in a graft to act as a bridge for the blood flow. The blood flow then goes through the plastic graft and no longer allows the direct pulsation pressure of the blood to further expand the weak aorta wall.
Interventional Repair - This minimally invasive technique is performed by an interventional radiologist using imaging to guide the catheter and graft inside the patient's artery. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aortic aneurysm. Through the catheter, the physician passes a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm, then opened, creating new walls in the blood vessel through which blood flows.
This is a less invasive method of placing a graft within the aneurysm to redirect blood flow and stop direct pressure from being exerted on the weak aortic wall. This relatively new method eliminates the need for a large abdominal incision. It also eliminates the need to clamp the aorta during the procedure. Clamping the aorta creates significant stress on the heart, and people with severe heart disease may not be able to tolerate this major surgery. Stent grafts are most commonly considered for patients at increased surgical risk due to age or other medical conditions.
The stent graft procedure is not for everyone, though. It is still a new technology and we don't yet have data to show that this will be a durable repair for long years. Thus, people with a life expectancy of 20 or more years may be counseled against this therapy. It is also a technology that is limited by size. The stent grafts are made in certain sizes, and the patient's anatomy must fit the graft, since grafts are not custom-built for each patient's anatomy.
Second Opinion
In order to determine if you are a candidate for the interventional radiology procedure, it's best to get a second opinion from an interventional radiologist. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.
A stent-graft is threaded into the blood vessel where the aneurysm is located. The stent graft is expanded like a spring to hold tightly against the wall of the blood vessel and cut off the blood supply to the aneurysm.
Efficacy and Patient Safety
Interventional repair is an effective treatment that can be performed safely, resulting in lower morbidity and lower mortality rates than those reported for open surgical repair.
Recovery Time
- Patients are often discharged the day after interventional repair, and typically do not require intensive care stay post-op
- Once discharged, most return to normal activity within 2 weeks compared to 6-8 weeks after surgical repair
Benefits of Interventional Repair
- No abdominal surgical incision
- No sutures, or sutures only at the groins
- Faster recovery, shorter time in the hospital
- No general anesthesia in some cases
- Less pain
- Reduced complications
Disadvantages of Interventional Repair
- Possible movement of the graft after treatment, with blood flow into the aneurysm and resumption of risk of growth/rupture of the aneurysm
- Probable life-time requirement for follow-up studies to be sure the stent graft is continuing to function
Interventional Radiologists are Vascular Disease Experts
Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional radiologists are board-certified physicians with extensive training in vascular disease diagnosis, management and treatment. Their board certification includes both Vascular and Interventional Radiology and Diagnostic Radiology which are administered by the American Board of Radiology. This training marries state-of-the-art imaging and diagnostic expertise, coupled with clinical experience across all specialties and in-depth knowledge of the least invasive treatments.
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