Nursing Notes

October 13, 2010

How do so many journalists miss it?

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This article originally appeared in The Washington Post, but I found it on one of my favorite websites, The Truth About Nursing.  This article is stunning in that a nurse was able to use common sense and experience to help a patient after numerous specialists were stumped.  I wondered, after reading the article, if any of these physicians ever really looked at the patient or asked him any questions about his life and locale.

I simply saw the picture and knew he had Lyme’s Disease, but I live in an area where ticks and deer are plentiful.  Maybe, in the defense of the doctors, they had never been in an area where either of these two organisms are found and therefore knew nothing about them.

Please read the entire article and leave them a comment if you feel like it.  There are many wonderful articles and stories to be read on that site.  I hope you enjoy.


bulls-eye rashSeptember 27, 2010 —  Today The Washington Post published a lengthy entry in its “Medical Mysteries” series headlined “Nurse solves mysterious ailment that puzzled orthopedists, oncologist.” Sandra G. Boodman’s piece describes a local man who spent more than a year consulting various specialist physicians, enduring “two unnecessary knee surgeries and dozens of physical therapy sessions, as well as acupuncture and other useless and sometimes painful treatments that cost thousands of dollars,” before “a nurse” at an infectious disease specialist’s office suggested that he might have Lyme disease. He did. You might think, then, that the article would be a tribute to nursing expertise, but instead the central fact of the story is overwhelmed by disrespect for nursing. It’s not just that the piece repeatedly dismisses what the nurse did by calling it “simple” and “obvious,” “a basic query by a nurse, not the acumen of five specialists.” No, the most striking thing is that in this 1,300 word story describing all the erroneous thinking of the “specialists,” the nurse who actually solved the problem is never named, quoted, or further described. It’s true that none of the specialists are named or quoted directly either, which certainly protects them from embarrassment. And it seems that the approach of these pieces is to rely mainly on the patient’s account; perhaps this patient never actually met the nurse, though he says he “remains grateful” to the nurse. But the piece does name and quote an infectious-disease expert the patient consulted after the diagnosis, so it might have done more with the nurse, even if could not give the nurse’s real name. The net effect of what we do have here is to suggest that the nurse solved the problem by being so simple and limited, with a mind uncluttered by real expertise. Needless to say, there is no suggestion that maybe the nurse solved the problem because of her own expertise, or the nature of nursing, including the profession’s holistic and flexible approach, which is no less “expert” for being broad. The piece pokes fun at the specialist physicians, but it still reinforces the idea that they are the main source of health knowledge–the same idea that seems to have gotten this patient in so much trouble.

This is the story of John Gordon, the 54-year-old president of a commercial real estate firm. Gordon thinks he might have been better off “had his office not been located in a Montgomery County high-rise that also houses many medical offices,” which made it convenient for him to see all the specialists there. Gordon, “whose father and father-in-law were doctors,” says he did not ask enough questions, and was “too good a patient,” which must mean accepting whatever physicians say–hardly surprising for a person with that background. The result, apparently, was “two unnecessary knee surgeries and dozens of physical therapy sessions, as well as acupuncture and other useless and sometimes painful treatments that cost thousands of dollars.” This part of the article hints that we should not be so trusting of specialist physicians. But then we get this:

In the end, it was a basic query by a nurse, not the acumen of five specialists, that led to the correct diagnosis of a common malady. “If you don’t ask simple questions, you screw up,” Gordon said. “I see that in my business all the time.”

The piece traces the history of Gordon’s problem, which appeared in 2007, when he first noticed that his knee was swollen. He consulted an orthopedist, who recommended physical therapy. That did not help. The orthopedist drained the knee and gave Gordon cortisone shots. That did not help for long. An MRI showed no torn ligaments or cartilage, so the orthopedist recommended exploratory surgery. A surgeon operated, “told Gordon he had a partially torn meniscus, a common injury involving cartilage,” and then “repaired the cartilage.” That did not help.  Gordon consulted a physiatrist, who specializes in rehabilitation and pain management. This physician considered whether it might be an infection, but assumed that had been ruled out, and suggested acupuncture. That did not help. Gordon got a second MRI, and his orthopedist suggested surgery for “pigmented villonodular synovitis, which causes an overgrowth of tissue for no apparent reason.” Gordon switched orthopedists but had the surgery. It did not help. The surgeon suggested that the abnormal tissue in the knee pointed to cancer, and referred Gordon to an orthopedic oncologist and an infectious-disease specialist. But the tissue biopsy was negative.

The infectious-disease specialist confidently suggested that Gordon had contracted “valley fever,” a serious fungal infection, from a recent trip to the Southwest. Gordon took “the maximum dose of a potent antifungal drug” for two weeks. It did not help, but it did make Gordon “feel weak and very nauseated.” The infectious disease specialist was stumped, though that did not stop him from prescribing an antibiotic.

But a week later, in June 2008, the doctor called back. Gordon said he reported that during a staff meeting at which his case was being discussed, a nurse asked whether Gordon had ever been tested for Lyme disease.

nurse-physician discussionGordon said he had not, and that “no one had mentioned it.” We’re actually impressed that the physician admitted that this was the nurse’s idea. Physicians often receive credit for life-saving nursing ideas and observations, whether because physicians present the ideas to patients as their own, patients assume they must have been the physician’s idea, or nurses hide their own role. Of course, it’s also impressive that this specialist’s office had meetings in which a nurse’s professional opinion was considered. Physicians routinely leave nurses out of discussions of diagnosis and treatment, even though nurses’ input can mean the difference between life and death. Nurses must often use complicated social dances to have their views considered. Naturally, the Post article explores none of this, though it certainly would be worth discussion in a major newspaper.

In any case, the infectious-disease physician faxed an “order” for the test, which was positive. The disease was responsible for Gordon’s knee problems. The piece gives some basic information about Lyme disease, which is “a bacterial infection caused by a deer tick bite.” Lyme arthritis is “sometimes permanent.” Gordon was “stunned,” and wondered how this could have been “missed by so many specialists.”

For some answers, the piece turns to “Adriana Marques, an infectious-disease expert at the National Institute of Allergy and Infectious Diseases who is studying the natural course of Lyme…[read the rest of this article]


August 11, 2010

Hospital-Acquired MRSA Infections On the Decline, CDC Says

A ruptured MRSA cyst.
Image via Wikipedia

I found this article on Business Week and thought it would be a good piece of information to showcase here.  At my hospital, we are still seeing quite a large number of MRSA patients, but apparently the rest of the country is  not.  I found this article to be informative and helpful and I hope you will also.  If this is indeed true, then it will make nursing easier overall.  MRSA is insidious and has long term effects for both patients and staff.  I will be happy to see its demise.


Better infection control may have antibiotic-resistant Staph on the run, experts say

By Madonna Behen
HealthDay Reporter

TUESDAY, Aug. 10 (HealthDay News) — Could American patients and health care workers be winning the war against potentially deadly methicillin-resistant Staphylococcus aureus (MRSA) bacteria?

Infections with MRSA that began in hospitals and other health care settings have declined 28 percent in recent years, a new government study of roughly 15 million people finds.

Researchers at the U.S. Centers for Disease Control and Prevention (CDC) report that rates of “invasive” MRSA infections that had their onset in hospitals or other health care facilities declined an average 9 percent annually from 2005 through 2008. Invasive MRSA infections are those that are found in a normally sterile body site, such as the bloodstream.

According to the study, which is published in the Aug. 11 issue of the Journal of the American Medical Association, invasive MRSA infections that were associated with health care settings but began outside, in the community, also declined by about 6 percent annually, for a total of a 17 percent decrease over the four-year period.

“While we don’t know for sure what caused these rates to go down, we’re hopeful and encouraged that the aggressive infection control programs that many hospitals have instituted are having an impact,” said lead author Dr. Alexander J. Kallen, medical officer in the division of Healthcare Quality Promotion at the CDC.

For the study, Kallen and his colleagues evaluated a CDC population-based surveillance system of MRSA infections that covers nine metropolitan areas across the United States. After evaluating all reports of laboratory-identified episodes of invasive MRSA infections, they limited their analysis to infections that began in hospitals or those that began in the community but were associated with a health care setting. MRSA infections associated with health care settings made up 82 percent of the total infections. The researchers did not evaluate community-acquired MRSA infections.

A subset analysis of just bloodstream infections showed even greater decreases: a 34 percent drop in hospital-onset infections, and about a 20 percent decrease in community-onset infections over the four-year period.

The authors of an editorial accompanying the study said that while the findings are encouraging, government surveillance systems should be expanded to more geographical areas and should include all Staphylococcus aureus infections, as well as other important health care-associated pathogens.

“Even if MRSA causes half of all Staph infections, that means that all the other strains of S. aureus are causing the other half, and we need to focus on these infections as well,” said co-author Dr. Daniel J. Diekema, director of the division of infectious diseases  [read the rest of article]

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August 4, 2010

The Do-It-Yourself House Call

Here’s an article from the Wall Street Journal about the future of medicine as it applies to chronic and debilitating disease–in this case, congestive heart failure.  Although I am sure the issue here was supposed to be the cost savings for the insurance companies, what stood out to me was the importance of the role of the nurse in this scenario.  Without a nurse to review and monitor the data collected remotely, there would be no cost savings.  Hmmm…..

Read this article and then tell me what your thoughts are on this topic.  I do believe that remote monitoring is going to become normal practice in the future, I just hope that nursing gets credit for being the linchpin on which the success lies.



Insurer-Endorsed Remote-Monitoring Technology Leads Heart Patients to Take Their Readings at Home


Technology that aims to keep congestive heart failure patients out of the hospital is gaining traction.

The idea is for heart patients to take readings like their weight, blood pressure and other key metrics using wireless and other technologies; the data are then transmitted to a case manager or medical care giver. That way health care givers can catch, and address, warning signs before the patient lands in the ER with shortness of breath or a heart attack. In the past, patients have found such technology difficult to use. But a number of managed-care companies are experimenting with electronic devices meant to make the process easier.

A big benefit is that it allows patients to stay in their homes, but the systems can’t catch everything, and patients shouldn’t be lulled into a false sense of security by the technology.


Alfred Giancarli for The Wall Street Journal

WellPoint Inc.’s Anthem unit in California is piloting a wireless scale and blood-pressure cuff that communicates in real time with nurses on alert for fluctuations that can signal heart failure, or when the heart can no longer pump enough blood to the body’s organs. Humana Inc. in January will launch a program to track heart patients’ vital signs wirelessly and link them up via video to chat with nurses if appropriate.

And Aetna Inc. is running a clinical trial with Intel Corp. to assess how remote monitoring of vital signs can cut down on unnecessary hospitalization for heart patients.

It is more important than ever for health plans and patients to combat medical costs, growing at a clip of between 6% and 9% a year, according to various estimates. Heart failure—which can be triggered by simple mistakes such as consuming too much salt—is a leading cause of hospital readmissions, with about 25% of patients returning to the hospital within 30 days. It’s also one of the biggest single claims expenses at insurance companies. Aetna estimates that 40% of readmissions are avoidable.

For patients, the extra surveillance could cut down on trips to the hospital and provide peace of mind. That’s what Carolyn Brown, a 63-year-old retired teacher’s aide from Bronx, N.Y., found when she started using a new monitoring system covered by her insurer, MetroPlus Health Plan Inc., after she suffered two heart attacks.

“I was constantly going to the doctor. Now they can tell right away if I am in trouble,” she said.

The program puts a scale, blood-pressure cuff and glucose monitor into patients’ homes and then collects the data daily via wireless or landline. Nurse case managers follow up with the patients if any of the vital signs seem worrisome.

The plan, which specializes in Medicaid and Medicare and is owned by the New York City Health and Hospitals Corp., says it pays about $6,300 for a Medicaid heart patient’s typical hospital stay. The plan foots the bill for the remote monitoring system, which is rented and worth approximately $626.

Such remote monitoring programs have limitations. Doctors can get over-alerted when patients put the cuffs on wrong, or step onto the scale with their shoes on. The technology requires ill patients to remember to use it, and can be troublesome if it acts up. For instance, Ms. Brown’s data at first weren’t uploading through the modem correctly, a problem that was solved within 24 hours when the machinery was converted to a wireless hookup.


Ms. Brown’s blood-pressure reading and transmission devices.

Both Humana and WellPoint are incorporating video-chat into their approaches to connect members more closely with nurses. UnitedHealth’s wireless scale asks a series of questions in the morning and evening that are followed up by nurses and doctors if appropriate. “The relationship between the consumer and doctor is primary,” said Sam Meckey, chief operating officer for disease solutions at UnitedHealth’s OptumHealth unit.

Ray Freeland, a 54-year-old heart patient who is part of Anthem’s pilot program, said the system he uses to monitor his weight and blood pressure has “eliminated those trips to the doctor to find out everything is still the same.” But in March, the system picked up through Mr. Freeland’s pulse measurements that he might be experiencing abnormal heart rhythm. Mr. Freeland, who lives in Glendale, Calif., was sent to his doctor to shock his heart back into a normal rhythm. His medical center, Cedars-Sinai, estimates that about $30,000 was saved on Mr. Freeland’s care between March and July.

New approaches aim to find problems earlier. A study of 1,450 patients out Tuesday in Circulation, a journal of the American Heart Association, showed that implantable defibrillators that wirelessly transmit data on the patient’s heart function reduced in-hospital evaluations by 45%. Suspected cardiac events were evaluated in less than two days compared with 36 days.

Another approach being tested by devicemaker CardioMEMS Inc. uses an implantable sensor device to measure pulmonary artery pressure and wirelessly transmit readings to a secure Web site for doctors and nurses. The idea is to detect changes and intervene before the patient has to be hospitalized. The wireless transmitter resulted in a 30% reduction in hospitalization for heart-failure patients, the study of 550 patients released last month showed.

Write to Avery Johnson at

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June 11, 2010

New Way Bacterium Spreads in Hospital

Clostridium difficile
Image by AJC1 via Flickr

I am always interested when I find new research that helps me stay safe and helps me keep my patients safe from being exposed to organisms that can be potentially harmful or even fatal.  C-diff is a very nasty bug and one I would like to stay far away from.

This article exposes the newest research in how this bacteria is spread.  This makes me shudder.  It seems you cannot be safe anywhere, especially inside of a hospital.

This article is from the New York Times “Health” column.  I highly recommend this site for up-to-date information about current issues.


Health care workers and patients have yet another source of hospital-acquired infection to worry about, British researchers are reporting.

Clostridium difficile, a germ that causes deadly intestinal infections in hospital patients, has long been thought to be spread only by contact with contaminated surfaces. But a new study finds that it can also travel through the air.

The researchers emphasized that there is no evidence that C. difficile can be contracted by inhaling the germs. Rather, they float on the air, landing in places where more people can touch them.

The bug is commonly spread by contact with infected feces, and the British scientists said the new study made it even more urgent to isolate hospital patients with diarrhea as soon as possible — even before tests confirm a C. difficile infection.

“We don’t want people to wait for the confirmation,” said the study’s senior author, Dr. Mark H. Wilcox, a professor of medical microbiology at the University of Leeds. “By then, the cat’s out of the bag.”

Outbreaks of C. difficile, a bacterium resistant to many antibiotics, have been increasing in the United States since 2001, along with the evolution of more virulent strains.

People in good health are rarely infected. But broad-spectrum antibiotics can wipe out the bacteria that normally live in the intestines, allowing C. difficile to flourish. Hospitalized people on antibiotics and the elderly, even when not taking medicine, are at high risk.

Health care workers who touch contaminated feces can spread the disease by direct contact with other people or just by touching objects. The spores are resistant to disinfectants and can survive in open areas for months.

The bacterium produces toxins that can cause fever, nausea, abdominal pain, severe diarrhea — and sometimes colitis, a serious inflammation of the large intestine.

Treatment involves replacing the broad-spectrum antibiotics with other antibiotics, usually vancomycin or metronidazole.

The British researchers began with a six-month investigation of 50 patients, symptomatic and not, with confirmed infection. The air near 12 percent of them was found to be contaminated with C. difficile. The more active their diarrheal symptoms, the more likely they were to have spores in the air around them.

Then the scientists repeatedly tested 10 patients with symptomatic illness over a 10-hour period, and the air near 7 was positive for c. difficile, usually during visiting hours or when there was activity in patient rooms like food delivery, ward rounds or bedding changes […more…]

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May 5, 2010

Screening for Sleep Apnea

Day 46 - Breathe
Image by Robbie Kennedy (Expresbro) via Flickr

This article really opened my eyes and gave me food for thought.  I am sure that most if not all of my patients would probably meet the criteria as set forth in this article.  This is an area that gets little or no attention, yet this condition sets the stage for so many chronic and life-threatening disorders.  Makes you wonder why it has taken so long for anyone to get interested in patient’s sleep, doesn’t it?

I will be more aware and observant of my patients now that I have read this article.  I hope you, too, will be able to translate this information into your own practice.

By Haydn Bush

A hospital observes patients for signs of the condition and creates a care plan for those who have it.

Haydn Bush

Several years ago, Napoleon Knight, M.D., the vice president of medical affairs for Carle Foundation Hospital in Urbana, Ill., noticed that a growing number of patients admitted to the hospital were overweight. Knight began researching the connection between obesity and other medical complications, and learned that the hospital’s clinicians were encountering more patients with sleep apnea, a potentially deadly ailment in which breathing is interrupted during sleep due to blockages of the airway.

When Knight was in medical school, sleep apnea was a relatively rare condition, but its prevalence has increased in recent decades along with obesity rates. The American Association for Respiratory Care now estimates that 18 million Americans suffer from sleep apnea, which can lead to high blood pressure, cardiovascular disease, headaches and memory loss. Sleep apnea has also been linked to workplace impairment, and a 2008 study by the Vancouver Coastal Health Research Institute and the University of British Columbia found that patients with sleep apnea have double the risk of being in a car accident.

“It’s a problem that gradually crept into the environment,” Knight says.

Looking at All Patients

Undetected sleep apnea can pose a major problem for hospitals, Knight says, especially with patients who are admitted for related chronic conditions. Knight helped form a sleep apnea prevention work group at Carle Foundation Hospital, and in the summer of 2009, the group adapted a sleep apnea screening tool that had been used for bariatric surgery patients to screen the entire patient population for the condition.

At admission, staffers now ask all patients if they have already been diagnosed with sleep apnea, and those who answer yes are given continuous positive airway pressure masks to aid their breathing during their stay at the hospital.

In addition, patients who have not been diagnosed with the condition are asked a series of questions to determine if they are at risk for developing it. When patients answer yes to more than three of the questions, the hospital’s electronic medical record automatically opens a sleep apnea prevention patient care plan, which is sent directly to the patient’s nursing unit. So far, roughly 40 percent of adult patients are screening positive for sleep apnea susceptibility, according to Daniel Picchietti, M.D., a board-certified sleep medicine physician at Carle Foundation Hospital.

“That’s a huge number of patients at risk,” Picchietti says.

The patients are monitored remotely with pulse oximeters that alert unit nurses to sleep interruptions, and they are visited regularly. According to Kristina Vasnaik, R.N., a night shift nurse at the hospital and a member of the sleep apnea prevention work group, nurses are trained to quietly enter patients’ rooms while they are sleeping and watch their breathing for several minutes at a time. The work group carefully trained nurses to complete the observations without waking patients and disturbing their sleep patterns, Vasnaik says.

“There was a big education push on the protocol and what it entailed,” Vasnaik said. “We have a lot of new people on nights, and constant education is needed for them.”

Educating Patients and Doctors

The effort has proven successful; since Carle Foundation Hospital began screening for sleep apnea susceptibility, there have been no sleep apnea-related deaths at the hospital, and internal compliance with the screening process has reached 92 percent.

But the initiative doesn’t end at discharge. Patients deemed at risk of developing sleep apnea are given educational materials on the condition during their stay, and their primary care physicians are alerted to the risk. Knight says the work group plans to begin evaluating screening tools aimed at pediatric patients, who are increasingly susceptible to sleep apnea due to rising child obesity rates.

Knight also hopes to expand the initiative beyond the hospital to Carle’s outpatient affiliates, which he believes are uniquely positioned to diagnose potential sleep apnea sufferers before they land in the hospital.

“In the ideal world, this issue would be picked up in the outpatient environment before they get to the hospital,” Knight says. “All we would have to do is know they have sleep apnea.”

Knight urges all providers to research the potential impacts of obesity on their patient populations, noting that sleep apnea is one of many complications. “Once you identify it as an issue, it allows you to focus on the interventions you can put in place,” Knight says. “I look at it as a patient safety issue.”

Haydn Bush is a quality resources specialist at the AHA Quality Center.

For further information on this topic, visit

This article 1st appeared on May 3, 2010 in HHN Magazine online site.

Here’s the link to the original article

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April 26, 2010

MRSA More Likely to Lurk in Certain Patients

MRSA exploded
Image by jbtiv via Flickr

MRSA has become a major issue nurses face daily.  It was once very rare, but now has become almost commonplace.

The question I have about this disease is what becomes of a nurse who contracts this organism while on the job.  Can he or she continue to nurse?  Will everyone they treat become infected?  I just don’t know the answers to this problem, but I do know that 4% of healthcare workers will contract this organism this year.

Nurses are constantly bombarded with all types of contagious agents.  Along with exposure you can add excessive stress and long work hours which both work to lower the resistance of a person.  So, with this in mind, it seems like a good question to find answers for, don’t you agree?

One in five long-term elder care patients carried the dangerous germ in their nose, study finds

FRIDAY, April 23 (HealthDay News) — Certain patients are far more likely than others to carry methicillin-resistant Staphylococcus aureus (MRSA), in their noses, a new study shows.

Although they are not infected with the potentially lethal germ, its mere presence heightens their risk of developing MRSA-related pneumonia, bloodstream infection and surgical site infection, the research concludes.

In the United States, about 1 percent of people carry MRSA in their nose. But this study of 2,055 patients found that MRSA was present in the noses of 20 percent of long-term elder care patients, 16 percent of HIV-infected patients, and 14 percent and 15 percent of inpatient and outpatient kidney dialysis patients.

“Hospitals performing active surveillance for MRSA should consider such patient populations for screening cultures,” study author Leonard Mermel, medical director of the department of epidemiology and infection control at Rhode Island Hospital, said in a news release.

USA100 — a health care-associated MRSA strain — was the most common MRSA strain detected in patients, but a more virulent community-associated strain known as USA300 was much more commonly found in HIV-infected patients, the researchers noted. They also detected some MRSA strains not previously identified in the United States, including an MRSA clone common in Brazil.

There were huge differences in the number of MRSA colonies in the noses of the patients in the study. Some had as few as three colonies of MRSA while others had as many as 15 million colonies.

“This finding is important because heavy MRSA colonization of the nose is an independent risk factor for the development of a surgical site infection,” Mermel said.

Further research is needed to learn why people have different strains and quantities of MRSA in their noses, Mermel said.

The study appears online and in the June print issue of the journal Infection Control and Hospital Epidemiology.

More information

The U.S. Centers for Disease Control and Prevention has more about MRSA.

— Robert Preidt

SOURCE: Rhode Island Hospital, news release, April 20, 2010

Last Updated: April 23, 2010

Read the original article here

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April 20, 2010

Better Training Needed to Curb ‘Fatism’ Within the Health Professions, Study Finds

What An Honor - I Am In Print
Image by Tobyotter via Flickr

Here is an interesting article that shows us an area we need to improve upon.  When I first read this, I thought it silly that Science Daily would be posting such an article.  Upon review and thought of past experiences, I find I am glad to see such an article.

As a nurse, I know the damage obesity can do to the human body.  I also know that overeating can cause obesity.  However, the belief that obesity is caused simply by overeating is wrong.  The logic is faulty.  As a psych nurse, I know that many of the medications I routinely give my patients will cause weight gain.  I know this because my patients tell me that weight gain is the main reason for going “off my meds”.  I also know that genetics, age, activity levels, mood, physical health, and medications all together play a part.

It is sad that the “helping profession” is seen as being biased toward the obese.  Instead, why are we not helping our obese patients to discover the underlying cause of the disorder and then making them a care plan to help resolve the problem?  Let me know you thoughts on this matter, won’t you?


ScienceDaily (Apr. 16, 2010) — Prejudice towards obese people is rife among trainee health professionals, but can be modified, new research has found.

The study, published in the journal Obesity, says weight-based discrimination by the public has increased by 66% over the past decade with anti-fat prejudice among health professionals found to be high in western nations, and often exceeding that found within the general population.

The research, by scientists at the Universities of Manchester and Hawaii and Yale University, suggests that medical and allied health professions need to present a balanced view of the causes of, and treatment for, obesity when training young professionals in order to reduce the strong prejudice towards obese people.

The team found that the prejudice could be either increased or decreased depending on the type of obesity training pre-service, health-professional students received.

Health profession trainees from Australia were randomly assigned to one of three intensive, seven-week tutorial courses as part of their degree. One tutorial course educated students about the role of diet and physical activity as the primary cause of, and treatment for, obesity. A second tutorial course focused instead on educating students about the uncontrollable causes of obesity, such as the contribution of genes and environmental factors, like junk-food marketing and pricing. Finally, a third control group of students attended a tutorial course that addressed alcohol use in young people.

Measures of obesity prejudice were taken before the courses and then two weeks after completion. Significant reductions in obesity prejudice of 27% and 12% were found on two forms of prejudice for the course delivering material on genetic and environmental factors, while students on the course focusing on diet and physical activity showed a 27% increase in obesity prejudice.

Lead author Dr Kerry O’Brien, from The University of Manchester, UK, said: “One reason for the high levels of obesity prejudice is that people only hear that obesity is due to poor diet and lack of exercise, which implies that obese people are just lazy and gluttonous, and therefore deserve criticism. But, uncontrollable factors, such as genes, the environment and neurophysiology, play an important role.

“Weight status is, to a great extent, inherited. It’s crucial that health professionals, such as nurses, doctors, dieticians and physical educators, are aware of these other influences, as well as their own potential prejudices, and don’t just blame the individual for their weight status.

“Those tasked with providing health services to obese people may become frustrated with patients when they do not lose weight following counselling and treatment, but the research shows that weight loss is extremely difficult to maintain long term. Obese people are constantly fighting their physiology and the environment. If professionals keep this in mind it may help in not stigmatising their clients.”

Reviews of both adult and child obesity stigma research by study co-authors Dr Rebecca Puhl, from Yale University, and Dr Janet Latner, from the University of Hawaii, have shown that weight-related teasing and obesity stigma have serious psychological, physical and social consequences.

People with obesity also report receiving poorer treatment and stigma from health professionals and are less likely to seek treatment for certain conditions because of a fear of being stigmatised.

Dr Puhl said: “Unfortunately, weight stigma towards obese patients is very common in health care settings and efforts are clearly needed to reduce biased attitudes among health professionals and to improve quality of health care towards this patient population.”

Dr O’Brien added: “We were surprised by how few efforts to reduce obesity prejudice or weight stigma had been made, particularly within health professionals who are tasked with treating overweight and obese patients. Perhaps this represents a tacit acceptance that obesity prejudice is somehow okay.”

The authors suggest the results should not be interpreted as providing justification for reducing the emphasis on diet and exercise as cornerstones of obesity prevention. Instead, they say health educators should ensure that balanced information on the causes of obesity is delivered in a convincing manner.

The study adopted a model of persuasion often used in advertising, but also provided motivation for students to process course material in depth, with related assignments contributing 10% to course grades. This may be a valuable component for other stigma-reduction strategies. By assigning a tangible value to the information presented, the curriculum reinforces the importance and credibility of that information to students.

Story Source:

Adapted from materials provided by University of Manchester.

Journal Reference:

  1. Kerry S. O’Brien, Rebecca M. Puhl, Janet D. Latner, Azeem S. Mir and John A. Hunter. Reducing anti-fat prejudice in pre-service health students: A randomized trial. Obesity, 2010; DOI: 10.1038/oby.2010.79

Here’s the link to the original article

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November 26, 2009

Drug-resistant bacteria on increase in U.S.: study

MRSA is a very dangerous organism, killing a number of people each year.  With it firmly entrenched out in our communities now, hospitals and nurses have a daunting challenge.  This article simply explains the results of a study that says community-based MRSA needs to be addressed.
We’ve all known that for some time.  However, what I find so interesting about this article and the others I have posted about MRSA and C-Diff, is that now the national media is finally starting to pay attention.  I guess it took a flu pandemic to get their attention, but once under the microscope of the news media, everything is fair game.
As a nurse, you need to arm yourself with whatever information is available, so read this article and then see if you can find the actual study.  I believe that this problem will only get worse.  The sooner we deal with it, the better.
Tue Nov 24, 2009 12:41am EST

More News

Medical workers balk at mandatory flu vaccines
Friday, 13 Nov 2009 06:00pm EST

WASHINGTON (Reuters) – Cases of a drug-resistant bacterial infection known as MRSA have risen by 90 percent since 1999, and they are increasingly being acquired outside hospitals, researchers reported on Tuesday.

They found two new strains of methicillin-resistant Staphylococcus aureus — MRSA for short — were circulating in patients and they are different from the strains normally seen in hospitals.

Ramanan Laxminarayan of Princeton University in New Jersey and colleagues studied data on lab tests from a national network of 300 microbiology laboratories in the United States for their study.

“We found during 1999-2006 that the percentage of S. aureus infections resistant to methicillin increased more than 90 percent, or 10 percent a year, in outpatients admitted to U.S. hospitals,” they wrote in a report published in the journal Emerging Infectious Diseases.

“This increase was caused almost entirely by community-acquired MRSA strains, which increased more than 33 percent annually.”

MRSA is now entrenched in U.S. hospitals. It was also known to be circulating in the community but it was not clear whether patients were carrying the infections out of hospitals, or the other way around.

Laxminarayan’s team found that many more people were being diagnosed with the community-acquired strains, and these strains were not replacing the known hospital strains. Instead, they are just adding to the overall number of MRSA cases.

“Our findings have implications for local and national policies aimed at containing and preventing MRSA,” they wrote.

For one thing, new, fast tests are needed so patients can be diagnosed and treated quickly. It is possible to treat MRSA but doctors need to know straight away so they start patients on the correct antibiotics.

“Lastly, infection control policies should take into account the role that outpatients likely play in the spread of MRSA and promote interventions that could prevent spread of MRSA from outpatient areas to inpatient areas,” they added.

MRSA is one of the most common causes of hospital-acquired infections. It can also now be picked up in schools, at fitness centers and elsewhere.

Symptoms range from abscesses to bloodborne infections that can kill quickly.

The researchers estimate that 20,000 people in the United States die each year from MRSA, and treating MRSA can range from $3,000 to more than $35,000 per case.

(Editing by Cynthia Osterman)

© Thomson Reuters 2009 All rights reserved

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November 3, 2009

Virulent Strain of MRSA Resists Treatment

MIAMI - OCTOBER 17:  Dr. Gio Baracco, director...
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As a nurse in a psychiatric hospital, I am very alarmed by this article.  It seems that MRSA has become commonplace with the population I serve and my patients are not known for being compliant with therapy.  As a nurse, working with these patients, I frequently wonder if I will become infected despite the use of universal precautions.

This article is important to all nurses and future nurses.  We need to be informed of the potential risks we face and we need to understand the possible outcomes if we are to do our jobs and not become infected.

Please read the following article and then visit the website at the end to obtain more information.


Type that causes bloodstream infections can be quickly fatal, study finds

SUNDAY, Nov. 1 (HealthDay News) — New research holds bad news for health officials worried about a potentially lethal infection called MRSA that haunts hospitals: A strain that infects the bloodstream is five times more deadly than other strains.

To make matters worse, the USA600 strain appears to be at least partially immune to an antibiotic that’s used to treat the condition, the researchers have found.

A full half of patients infected with the strain died within a month, according to a study scheduled to be presented at the annual meeting of the Infectious Diseases Society of America, held Oct. 29 to Nov. 1 in Philadelphia. That’s nearly five times the death rate of other people infected with MRSA, and 10 to 30 percent of those who acquire

MRSA infections in the bloodstream die within a month, the study found.MRSA, or methicillin-resistant Staphylococcus aureus, causes infections in the skin and bloodstream. It can also infect surgical wounds and cause pneumonia. In most cases, it sickens people in the hospital, but cases are becoming more common outside the health-care community, according to information in a news release from the Henry Ford Health System.

Researchers think it’s possible that the USA600 strain is unique. But they don’t know if other factors — such as the age of patients — could be at play.

Those who developed the USA600 strain tended to be older than those who acquired other MRSA strains, averaging 64 compared with 52 years old, the study noted.

“While many MRSA strains are associated with poor outcomes, the USA600 strain has shown to be more lethal and cause high mortality rates,” Dr. Carol Moore, the study’s lead author and a research investigator at the Henry Ford Hospital’s division of infectious diseases, said in the news release.

“In light of the potential for the spread of this virulent and resistant strain and its associated mortality,” she said, “it is essential that more effort be directed to better understanding this strain to develop measures for managing it.

“MRSA is challenging to treat because strains can be immune to many medications. The USA600 strain appears to be more immune than other strains to the drug vancomycin, which often still has the power to vanquish MRSA.

More information

The U.S. Centers for Disease Control and Prevention has more about MRSA.



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