Nursing Shortage in the US

"An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said."


The excerpt above was taken from a "new" article from Yahoo!News. But the topic is certainly old news and conservative at the very least. Nursing shortage in the US is a harsh reality that the Obama administration should address the soonest possible time.

The truth is, the nurse-to-patient ratio is just horrible especially in the Nursing Homes where in most night shift cases, the ratio is up to 1 nurse for every 30 patients or more. The hospitals are not doing good either with a 1:12 nurse-to-patient ratio.

The Day shift ratio in most hospitals is a bit better at 8:1/ 7:1 but not the ideal numbers either. This is not only dangerous to the health and well-being of the patients but also to the health practitioners as well.

Since the US cannot provide the necessary manpower to address the said issue at the moment, the government should continue to look for measures that will help ease the burden on the overworked and heavily burdened US Nurses in order for them to continue to provide optimal health care to their patients.

One of the measures that they should do is to remove the quota for competent nurses coming to the United States especially from English-speaking countries (e.g. Philippines) wherein the nursing curriculum is very akin to that of the US system. This is necessary to answer the shortage for the time being.

And it has been proven time and again that Filipino nurses are not only competent and at par with their American counterparts with regards to their knowledge and skills but compassionate towards their patients as well. They treat every patient with dignity and respect.

Also these nurses are Bachelor's Degree holders and therefore are better equipped with the proper knowledge and expertise to handle the cases that they will encounter in the field.



Here's the article from Yahoo!News---

WASHINGTON (Reuters) – The U.S. healthcare system is pinched by a persistent nursing shortage that threatens the quality of patient care even as tens of thousands of people are turned away from nursing schools, according to experts.

The shortage has drawn the attention of President Barack Obama. During a White House meeting on Thursday to promote his promised healthcare system overhaul, Obama expressed alarm over the notion that the United States might have to import trained foreign nurses because so many U.S. nursing jobs are unfilled.

Democratic U.S. Representative Lois Capps, a former school nurse, said meaningful healthcare overhaul cannot occur without fixing the nursing shortage. "Nurses deliver healthcare," Capps said in a telephone interview.

An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said.

The shortage is expected to worsen in coming years as the 78 million people in the post-World War Two baby boom generation begin to hit retirement age. An aging population requires more care for chronic illnesses and at nursing homes.

"The nursing shortage is not driven by a lack of interest in nursing careers. The bottleneck is at the schools of nursing because there's not a large enough pool of faculty," Robert Rosseter of the American Association of Colleges of Nursing said in a telephone interview.

Nursing colleges have been unable to expand enrollment levels to meet the rising demand, and some U.S. lawmakers blame years of weak federal financial help for the schools.

Almost 50,000 qualified applicants to professional nursing programs were turned away in 2008, including nearly 6,000 people seeking to earn master's and doctoral degrees, the American Association of Colleges of Nursing said.

PAY DIFFERENCES

One reason for the faculty squeeze is that a nurse with a graduate degree needed to teach can earn more as a practicing nurse, about $82,000, than teaching, about $68,000.

Obama called nurses "the front lines of the healthcare system," adding: "They don't get paid very well. Their working conditions aren't as good as they should be."

The economic stimulus bill Obama signed last month included $500 million to address shortages of health workers. About $100 million of this could go to tackling the nursing shortage. There are about 2.5 million working U.S. registered nurses.

Separately, Senator Dick Durbin and Representative Nita Lowey, both Democrats, have introduced a measure to increase federal grants to help nursing colleges.

Peter Buerhaus, a nursing work force expert at Vanderbilt University in Tennessee, said the nursing shortage is a "quality and safety" issue. Hospital staffs may be stretched thin due to unfilled nursing jobs, raising the risk of medical errors, safety lapses and delays in care, he said.

A study by Buerhaus showed that 6,700 patient deaths and 4 million days of hospital care could be averted annually by increasing the number of nurses. "Nurses are the glue holding the system together," Buerhaus said.

Addressing the nursing shortage is important in the context of healthcare reform, Buerhaus added. Future shortages could drive up nurse wages, adding costs to the system, he said.

And if the health changes championed by Obama raise the number of Americans with access to medical care, more nurses will be needed to help accommodate them, Buerhaus said.

(Editing by Maggie Fox and Mohammad Zargham)

Time Bomb

Here's an article from TIME Magazine written by Laura Blue that according to a new study, researchers have found a link between Anxiety and Heart Attack.

This is study is not really new but just a re- affirmation of that age- old belief with regards to the relationship between a person's frame of mind and disease.

So, to all of you out there, Relax and Enjoy Life. . :)

Read on...

It's no secret that men with angry, explosive personalities are at a higher risk of a heart attack. But they're not alone: Nervous, withdrawn and chronically worried people are courting coronary problems, too, according to a new long-term study in the Journal of the American College of Cardiology. Of 735 American middle-aged or elderly men who had good cardiovascular health in 1986, those who scored highest on four different scales of anxiety were far more likely to suffer heart attacks later in life. Men in the top 15% on any of the four scales, or on a combined scale of all four, had a 30% to 40% greater chance of heart attack than their less anxious peers.

Researchers have long known that problems of the mind can affect health. Other studies have looked at the relationships between heart-attack risk and factors like "Type A" personality, anger or depression. But "very few studies look at many psychological factors at one time," says Biing-Jiun Shen, lead author on the anxiety paper and an assistant professor of psychology at the University of Southern California. "I think that's a unique part of this study."

Using data from the U.S. Normative Aging Study, Shen reviewed the men's responses to a series of questions on the Minnesota Multiphasic Personality Inventory (a commonly administered personality test), and pulled out their scores on four separate anxiety scales that measured obsessive or compulsive thoughts; introversion and social exclusion; phobias; and a predisposition to become tense or have a physical reaction, like nausea or hyperventilation, to stressful situations. Even after accounting for other mood problems, like depression or anger, and for a whole host of physiological and demographic indicators — including age, body mass index, education, blood pressure, cholesterol levels and smoking and drinking habits — the effect of chronic anxiety was clear. It was also a stronger risk factor for heart attack than any of the other psychological problems in the study.

What's not so clear is why that might be. The relationship between stress, psychological problems and coronary disease or other physical woes is still not well understood. But it is the subject of intense scientific scrutiny. Many other researchers are trying to understand the interaction between mood disturbances like anxiety or depression and other health problems.

Shen notes the results of his study may not be universally applicable across populations. "We only looked at men who are older, around 60," he says. While men may suffer more heart attacks than women, women are far more likely to suffer from anxiety, just as they're more likely to suffer from depression. Gender aside, there's no reason to believe that the link between anxiety and heart attacks is straightforward. "We're not saying depression's not important. We're not saying anger's not important," Shen says. "Different factors can be essentially different for different groups." Still, psychological problems are often related, which means that different problems can affect the body in the same ways. The bottom line is that more study will be needed before we know how much sway our brains have over our heart function — and how much we can control what happens in the mind to prevent a heart attack.

Study: Timing of BP Pills Might Matter

Taking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don't know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn't dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they're at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It's the latest research in the field of chronotherapy: How our bodies' internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore's Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

"I think it's huge," says Hopkins' Dr. Lawrence Appel. "This is our best lead" into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph's Hospital in Atlanta.

"It does make good sense to take some in the morning and some in the evening," says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older "statin" pills fight cholesterol best if taken at bedtime; they target a liver enzyme that's most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients' dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That's also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

"We know now that you can change medication timing and lower blood pressure at night," he explains.

That doesn't mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. "That's the million-dollar question," Rahman cautions.

Still, Lundberg says it's worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn't hurt.

--LAURAN NEERGAARD, AP Medical Writer

The Role of Antibiotics and Nasal Steroids on Acute Sinusitis

This article I came across only shows that not all sinus infections are created uhm infected equal. he-he

Seriously, this British study is a known fact since a long, long time ago to most people in the medical profession.

In fact, this was harped on us over and over again by our professors in the Best Medical School along Aurora Boulevard in the Philippines years back when I was a young med student.

Since most acute sinus infections are caused by viruses which are self- limiting ergo no amount of antibiotics and nasal steroids can help cure them of the infection but still a lot of medical practitioners give them for reasons that they only know--

--is it because of trying to please their patients; that they will be satisfied that their doctor have given them something for their troubles rather than the “normal” advice in this particular case of just drinking plenty of fluids, rest and steam inhalations?

Or are they just beholden to the drug companies that give them some percentage of their sales, finance their travels for medical seminars or what have you?

Anyway this study published by HealthDay News is nothing but a re-affirmation of that belief that in most cases of sinus infections, antibiotics and nasal steroids actually doesn’t work.

Here’s the rest of the news…

TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work no better than a placebo in combating sinus infections, a new British study shows

"Antibiotics are probably not as effective as have been previously believed, particularly for the majority of cases of acute sinusitis," said study author Dr. Ian Williamson, a senior lecturer in primary medical care at the University of Southampton. "Patients should turn more to symptomatic remedies like analgesics while the body heals itself, usually over a period of three days to three weeks. Topical steroids have little overall effect, but may be beneficial, particularly in milder cases of acute sinusitis."

"For sinusitis, however it is being diagnosed in the primary-care setting, many of these cases do not require treatment, and a more cautious and conservative approach would seem to be warranted," added Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center College of Medicine and director of the division of otolaryngology at Scott & White, in Temple, Texas.

But other experts say the study, published in the Dec. 5 issue of the Journal of the American Medical Association, is no reason to scrap antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn antibiotics in those people who need them," said Dr. Michael Stewart, chairman of the department of otolaryngology at New York Presbyterian-Weill Cornell Medical Center, in New York City.

But, he added, only a minority of sinus infections are bacterial and will respond to antibiotics. The majority are viral infections, which won't respond to antibiotics.

According to an accompanying editorial, sinus problems account for 25 million doctor's office visits in the United States each year. Antibiotics are used to treat sinus infections 85 percent to 98 percent of the time in the United States.

Overuse of antibiotics not only won't help a patient with a viral infection get better, it will contribute to the growing problem of antibiotic resistance, experts have noted.

"Antibiotic resistance is rising dramatically, and there is no question about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one of four treatment groups: 500 milligrams of the antibiotic amoxicillin three times a day for seven days plus 200 micrograms of the nasal steroid budesonide once a day for 10 days; a placebo in place of the antibiotic plus budesonide; amoxicillin plus a placebo in place of budesonide; or two placebos.

In the amoxicillin group, 29 percent of patients had symptoms lasting at least 10 days, and 33.6 percent of those not receiving amoxicillin had the same symptom length of time.

In both the budesonide and no-budesonide groups, exactly 31.4 percent of patients had symptoms lasting at least 10 days.

The nasal steroids seemed to be more effective in individuals who had less severe symptoms.

As the editorial pointed out, most patients with acute sinusitis will get better on their own. Unfortunately, there's no good way to determine who has viral sinusitis and who has bacterial sinusitis.

"It's difficult to make a distinction in a primary-care setting," Baugh said.

If the symptoms are worse, treatment might be warranted, he added. "But for the bulk, I would assume it would be more of a wait-and-see approach. The bugs are winning," he said.

While researchers investigate possible new treatments, sinus infections sufferers might look to analgesics or brief use of steam inhalations, Williamson said.

Dr. William Morris, chairman and director of the department of osteopathic manipulative medicine at Touro College of Osteopathic Medicine in New York City, recommends an alternative approach: manual pressure to the bottom of the head and beginning of the neck, to allow better drainage from the head.

"One of the problems with sinusitis is that the sinuses tend to get closed up," he said. "If you don't drain properly, bacteria is just happy as a clam. If you can increase drainage and improve flow through the sinuses, you're going to be facilitating the process."

Worm study shows antidepressant may lengthen life

This article from Reuters looks promising for the millions who are suffering from cases of Depression worldwide.

But it is still a big but like the other experimental drugs. This is certainly worth the wait if ever it will be successful in the future.

Anyway, read on...


WASHINGTON (Reuters) - An antidepressant may help worms live longer by tricking the brain into thinking the body is starving, U.S. researchers reported on Wednesday.

The drug, called mianserin, extended the life span of the nematode Caenorhabditis elegans by about 30 percent, the researchers reported in the journal Nature. They hope to find out if the same mechanism can help people live longer.

Three other compounds, including another antidepressant, have similar effects, said Michael Petrascheck of the Fred Hutchinson Cancer Research Center in Seattle. But the life-extending benefits come at a cost.

"Weight gain and increased appetite seems to be one of the side effects. It is one of the reasons these are not such popular antidepressants," Petrascheck said in a telephone interview.

Many studies have shown that slightly starving certain animals -- reducing how much they eat by about 30 percent -- can cause them to live longer.

It is not entirely clear if this occurs in humans, but researchers are keen to duplicate the beneficial effects of calorie restriction without the misery of going hungry.

Howard Hughes Medical Institute researcher Linda Buck and colleagues were looking for drugs that might do this.

C. elegans is a roundworm, or nematode, much studied because despite its tiny size, its biology is similar to that of humans and other animals.

Buck's team did a random search through 88,000 different drug compounds to see if any of them happened to make C. elegans live longer.

They found four drugs that extended life span by 20 percent to 30 percent. The drug with the strongest effect was mianserin, in a class of drugs known as tetracyclic antidepressants.

It blocks brain cell signaling by the neurotransmitter or message-carrying chemical serotonin, which is linked with mood and appetite.

The drug is used in Europe under several brand names, including Bolvidon, Norval and Tolvon but not usually in the United States. It can cause aplastic anemia and other effects on immune system cells.

Buck's team found that in addition to interfering with serotonin in the worm, it also blocked receptors for another neurotransmitter, octopamine.

They said some other research suggests that serotonin and octopamine may complement one another -- with serotonin signaling the presence of food and octopamine signaling starvation.

Buck said it is possible that mianserin drug tips the balance in the direction of octopamine, tricking the brain into thinking it has been starved.

Petrascheck said another antidepressant, mirtazapine, had similar effects. An antihistamine and migraine drug called cyproheptadine, as well as a compound not used in people called methiothepin also affected serotonin and extended worm life span.
They tested other popular antidepressants that affect serotonin and found they did not make the worms live longer.

He is worried that people will rush to take the drugs in the hope of living longer.
"It is a stretch from a worm to a human being," Petrascheck said.

(Reporting by Maggie Fox, editing by Will Dunham and David Wiessler)

New Guideline to Treat Unprovoked Seizure

A guideline developed by the American Academy of Neurology recommends a routine electroencephalogram (EEG) and brain scans be considered when diagnosing and treating adults who experience their first unprovoked seizure. Evidence shows such tools often detect brain abnormalities that caused the seizure and predict seizure recurrence. The guideline is published in the November 20, 2007, issue of Neurology, the medical journal of the American Academy of Neurology.

The guideline recommends a routine EEG be considered as part of the diagnosis of a person with a first unprovoked seizure. “Evidence shows an EEG revealed abnormalities indicating epilepsy in about one in four patients and was predictive of seizure recurrence,” said Krumholz, who is also a professor of neurology at the University of Maryland School of Medicine.

The guideline also recommends CT or MRI brain scans be routinely considered since the scans are significantly abnormal in one of 10 patients, helping to indicate the cause of their seizure. “A CT scan or MRI may lead to the diagnosis of disorders such as a brain tumor, stroke, an infection, or other structural lesions and may help determine a person’s risk for a second seizure,” said Krumholz.

For adults who experience their first unprovoked seizure, Krumholz says the results of an EEG, CT or MRI will influence aspects of patient care and management, including drug treatment, patient and family counseling, and the need for immediate hospitalization and subsequent follow-up.

Seizures are among the most common serious neurological disorders cared for by neurologists. Annually approximately 150,000 adults will have a first seizure in the United States. It is estimated that in 40 to 50 percent of these people, seizures recur and are classified as epilepsy.

Source: American Academy of Neurology