The Friday Funny: How Infections Are Transferred
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Nurses And The Military: A Historical Perspective From Walter Reed
In honor of National Nurses Week, the National Museum of Health and Medicine hosted a discussion about the history of nursing at Walter Reed. Debbie Cox, former Army Nurse Corps Historian, initiated the conversation by describing what nursing was like at the turn of the 20th century. Steam-driven ambulances transported patients out of “mosquito-infested” Washington, DC to fresh-aired Fort McNair. A leading controversy of the time involved the intention of the hospital administrators to place the nurse baracks near the horse stables rather than the main hospital. In a dramatic twist, Jane Delano (cousin of Franklin D. Roosevelt) saved the nurses from relegation to the stables. However, it wasn’t until 1920 that nurses were given rank by the army.
Entry into nursing was through the Red Cross exclusively until the first nursing school was opened at Walter Reed in 1918. From there, nurses grew in numbers and prestige, until they became a cornerstone of medical research in the 1950s, leading the way in understanding how to reduce the spread of infections in the OR, decubitus ulcers in the hospital wards, and radiation damage related to nuclear war.
Jennifer Easley, a nurse who works in the pediatric intensive care unit at Walter Reed, described her experiences as a nurse leader for a team of soldiers in Iraq. She derived great satisfaction as an officer in her unit, and said that the team spirit and camaraderie was unlike anything she experienced in civilian nursing. She had this to say:
“I only made it 18 months as a civilian nurse. When I was called back to serve in the army, I had my paperwork in so fast you could hardly blink. I found out that in the private sector, no one ‘has your back.’ There’s no protection for those who raise safety concerns and nurses don’t have the authority to request back up in cases where units are dangerously understaffed.
I remember one day when several nurses called in sick and there weren’t enough of us to cover the children and babies in the ICU safely. I reported this to my nurse supervisor and she told me that maybe I wasn’t cut out for a challenging work environment. I was shocked, and really feared for the patients.
Another problem with private sector nursing is that there are glass ceilings. If you apply for a job as a staff nurse, you can’t work your way up to nurse manager. You’d have to leave that hospital and apply for a nurse manager position elsewhere. In the army, I had many more opportunities to contribute, grow, and lead.”
The final speaker was a nurse who returned from Iraq with head and neck cancer. He (LTC Patrick Ahearne) was an inpatient at Walter Reed for many months, losing 35 pounds and experiencing severe nausea, vomiting, and depression. At his lowest point, when he had lost hope of recovery and wanted to die, he was met with kindness by an experienced nurse who knew how to ask the right questions and reframe his perspective:
“This wonderful nurse stayed with me for 2 hours, watching me vomit and talking me through it. I remember her asking me what I’d learned about myself through my illness. I thought it was a strange, and medically irrelevant question – but it was just what I needed at the time. I realized how strong the human body can be, and the inner strength I had to endure my cancer. In those two hours nurse McLaughlin took me from wanting to die to wanting to live. She taught me that it was ok to be angry. It was ok to be sick.”
Many thanks to the unsung heroes out there who touch lives like nurse McLaughlin. We couldn’t do it without you.
ADHD Drugs Abused By College Students
This week’s episode of CBS DOC DOT COM took me to a college campus where I got schooled by two students about the widespread use of ADHD (Attention Deficit Hyperactivity Disorder) meds – by kids without a diagnosis of the condition – to study, stay attentive, and sometimes just to feel good. A 2005 Web survey found that 5% of US undergraduates reported having used stimulants over the previous year for non-medical reasons. But the real number may be much higher, especially if you listen to the students I interviewed with Dr. William Fisher, a psychiatrist at Columbia University Medical Center.
Features of ADHD include inattention, hyperactivity, and impulsiveness. A national survey in 2003 reported that about 4.4 million children in the US have been diagnosed with ADHD and 56 percent take medication to treat it. It’s estimated that about one to two thirds of the children with ADHD continue to have symptoms in adult life.
ADHD medication was in the news last week with a report that medication use in elementary school children improved math and reading scores. The gains – equal to about a fifth of a school year in math and a third of a school year in reading – still left the treated children lagging behind kids without the disorder. The study fans an ongoing debate on who should receive medications such as Adderall and Ritalin. These medications – along with behavioral/psychological therapy and educational interventions – help patients with ADHD; but they’re also being used by students and adults who have not been diagnosed with the disorder.
These drugs have potentially serious side-effects such as high blood pressure, irregular heart beat, and dependency. Doctors prescribing them for patients with ADHD should be carefully weighing the risks and benefits. People taking them on their own are rolling the dice with their health. No matter what you may feel philosophically about using these stimulants, the risk-benefit of their use in patients without ADHD has simply not been established.
I feel strongly that ADHD medications should only be used under the guidance of a physician. But that’s apparently often not the case. In today’s segment, we explore this issue further. Why do people without ADHD take stimulants? How do they start? How does it make them feel? Is society’s metronome pulsing so much faster today that people feel pressured to take drugs just to keep up? Click here for a fascinating related article which appeared recently in The New Yorker.
Click here to see a video on this topic.
Does The e-Cigarette Deliver Nicotine?
I’m currently attending the annual conference of the Society for Research on Nicotine and Tobacco. This is the main organization for nicotine researchers and this conference is often the first place that exciting new research findings are presented, prior to being published in more detail in scientific journals. So this week my posts will be based on some of the most interesting things I have come across at this conference, including new developments in helping smokers quit.
There is currently considerable interest (hype?) in the e-cigarette, and I have written about it before. Last weekend I was walking through our local shopping mall in New Jersey with my 8-year old daughter when she tugged at my arm and said “dad, dad, theres a man smoking over there.” I told her that couldn’t be true because people arnt allowed to smoke inside the mall, but she insisted. On looking over I was surprised to see that sure enough, someone was standing next to a booth and appeared to be puffing away on a cigarette. So we walked over to investigate, and found out that in fact it was an e-cigarette and he was selling the product at the booth. We chatted and he showed me the product which actually looks very impressive. I had already purchased an earlier version a couple of years ago, which was more stogie cigar-sized, but this one looked and puffed very much like a cigarette and was also considerably less expensive than the earlier model.
But whenever discussing this product, to me the first and most critical question (after …”whats in the vapor and might it harm my health?”) is, “does it deliver enough nicotine to satisfy nicotine cravings? “ Until I came to this conference, I hadn’t met anyone who had completed a study that included measurement of blood nicotine levels in people using the e-cigarette. This question is critical because cigarette smokers are used to receiving a boost in blood nicotine levels of at least 10 ng/ml from each cigarette, and for a product to have any chance of effectively reducing craving for or replacing cigarettes it needs to come close to that level of nicotine delivery.
But I was lucky enough to bump into Dr Murray Laugesen, a tobacco control expert from New Zealand who has been one of the foremost proponents of the product. He showed me a preliminary report on the e-cigarette which was being presented at the conference. Full details of the study will be presented in a formal publication sometime in the future, but for right now the main conclusion is that although the e-cigarette CONTAINS a reasonable amount of nicotine it actually DELIVERS very little nicotine to the user, and certainly much much less that can be obtained from smoking. To my mind this relegates the status of this product to that of a very nice and cleverly designed theatre prop, and unfortunately not a product that is likely to be highly effective in helping smokers to quit smoking.
As always, if you are interested in using a product to assist you in quitting smoking, your best bet is to use a product that has been approved by the medicines licensing agency in your country as safe and effective for that purpose (e.g. in the U.S. that would be the FDA).
For more information about Dr Laugesen’s work on the e-cigarette, visit:
http://www.healthnz.co.nz/ecigarette.htm
*This post, Does The e-Cigarette Deliver Nicotine?, was originally published on Healthline.com by Johnatan Foulds, MA, MAppSci, PhD.*
When Eating Becomes Disordered
I was thumbing through the newspaper today while my teen was eating breakfast before school. Watching her measure out a serving size of cereal “just for the fun of it” makes me a tad bit nervous, considering she doesn’t have an ounce of fat on her. I quickly searched for the health section – it gives me an idea of what my patients will ask about during the work day (such as the “swine” flu), and it can also be a good starting point for blog ideas.
The front page of the health section Tuesday had a picture and quote from a beautiful teen who had died of bulimia several years ago. She looked familiar. My eyes scanned down to the name below the quote, and upon recognizing the name, my eyes immediately welled with tears. She had been my patient years ago, and I didn’t know she died. She was a great, sweet, smart teen who was well aware of her bulimia and the possible consequences. And she died.
At the very least, eating disorders can ruin their own lives and those of their families. And they kill. Although statistics vary based on the study, about 0.5% to 1% of teens and women in the United States have anorexia nervosa, an illness that involves significant weight loss and food refusal. About 1% to 3% of young American women have bulimia, a condition that includes regular binging and purging. Over 1 million males have an eating disorder and the numbers are climbing. Eating disorders are difficult to treat, especially once a pattern has been established and it has become a “way of life.” The earlier they are recognized, the more likely treatment will be successful.
These days, children have unrealistic expectations of what they should look like and how much they should weigh. Think about it. Their role models have changed dramatically over the past several decades. Girls and teens are exposed to ultra-thin, beautiful women wherever they turn – on TV, in magazines, music videos, and movies. And if that weren’t enough, moms, aunts, sisters and other teens and adults they know talk about food all the time – about eating too much, counting their calories, watching their weight, feeling “fat.” It’s no wonder that almost one-half of first through third grade girls want to be thinner and that over 80% of 10 year olds are afraid of being fat!
Our country’s obsession with food and it’s trickling down effect is readily apparent when we look at the results of the Youth Risk Behavior Survey for middle schoolers, a survey conducted in 10 states in 2005 (see end of blog) . By 6th grade, almost half of the students surveyed were trying to lose weight (even though only 14 to 18% were actually overweight), 5 to 7% vomited or took laxatives due to weight concerns, and 10 to 20% didn’t eat for at least 24 hours because they wanted to lose or didn’t want to gain weight! And we can’t forget that boys develop eating disorders, too. They tend to be diagnosed later than girls, possibly because we aren’t expecting to see males develop these illnesses.
What can we do? Society must take some responsibility for the large number of teens and adults with eating disorders. Genetics appears to play a role also. While these factors are out of our control, others are not. First of all, we can build our children’s self-esteem and confidence with regards to their academic and moral aptitude, rather than their outer appearance. We can make sure that we don’t discuss weight and eating around our children and that we act as good role models by eating well and maintaining a normal weight. We can limit TV, movies, and fashion magazines in our home and spend time together as a family. We can try to make our expectations for our children realistic and feasible. We can watch our children and teens closely for signs of an eating disorder, particularly if they are involved in sports, such as ballet, gymnastics, and wrestling, which focus on specific body types. And, if we are concerned about them, we can immediately make an appointment for them to be seen by their pediatrician and therapist to be weighed and to discuss any concerns. I can assure you it won’t be a wasted visit, even if your child turns out to have a healthy weight and eating habits. Don’t ignore signs of an eating disorder, as one of my patients did in the past. Upon hearing that her daughter weighed a mere 70% of her ideal body weight, her mom said that she was fine and that she, too, had gone through a similar “phase” when she was a teen. Eating disorders are real, and they kill.
Specific Results of the YRBS for Middle School Students
Across states, the percentage of students who were overweight ranged as follows:
• 6th grade: 14.4% to 18.7% (median: 18.6%)
• 7th grade: 10.0% to 15.8% (median: 14.0%)
• 8th grade: 8.0% to 14.9% (median: 13.0%)
Across states, the percentage of students who described themselves as slightly or very overweight ranged as follows:
• 6th grade: 19.6% to 26.7%
• 7th grade: 24.7% to 29.7%
• 8th grade: 24.2% to 29.7%
Trying to Lose Weight
Across states, the percentage of students who were trying to lose weight ranged as follows:
• 6th grade: 40.7% to 48.4% (median: 46.8%)
• 7th grade: 42.7% to 51.9% (median: 44.2%)
• 8th grade: 41.6% to 49.6% (median: 45.9%)
Ate Less Food to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever ate less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 35.0% to 47.9% (median: 41.4%)
• 7th grade: 39.1% to 47.5% (median: 41.6%)
• 8th grade: 41.1% to 47.5% (median: 46.6%)
Went Without Eating for 24 Hours or More to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever went without eating for at least 24 hours to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 10.0% to 19.2% (median: 15.6%)
• 7th grade: 13.9% to 18.3% (median: 16.6%)
• 8th grade: 18.1% to 21.6% (median: 19.5%)
Vomited or Took Laxatives to Lose Weight or to Keep From Gaining Weight
Across states, the percentage of students who ever vomited or took laxatives to lose weight or to keep from gaining weight ranged as follows:
• 6th grade: 4.8% to 7.5% (median: 6.3%)
• 7th grade: 4.0% to 6.2% (median: 4.7%)
• 8th grade: 6.4% to 8.2% (median: 7.3%)
