July 27th, 2009 by Nicholas Genes, M.D., Ph.D. in Better Health Network, News, Opinion
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Friends visiting New York City this summer keep asking if it’s safe. As in, will they be catching and suffering from novel H1N1 (swine) flu.
I like to think my friends are pretty sharp, discerning folks (after all, they’re choosing my company) so I have to attribute these inappropriate questions to a wider problem.
For reference, here’s the latest and thought probably not last NYC DOH guideline on H1N1, which notes about 900 hospitalization and 45 deaths in H1N1+ patients over three months. About three quarters of these patients had at least one risk factor such as existing lung disease.
This deaths and hospitalizations are concerning, naturally, but some perspective is in order: as many as half a million New Yorkers have been infected with H1N1, and this spring in US cities, we actually saw a smaller fraction of deaths due to infectious respiratory illness, compared with 2008. Also, for reference, based on data from a few years ago, I’m guessing that any given three month period, there are between 10,000 to 15,000 deaths in New York City.
So why were ED’s swamped in May? Why are my friends still afraid to come to NYC? Dr. David Newman has some thoughts in EPMonthly:
…with constant messages of swine flu lethality on the nightly news, it is little surprise that ED’s in New York City, departments in a chronic state of over-crowding and crisis, were soon bursting at the seams with record volumes. In some institutions daily ED volumes doubled, as EP’s worked through third-world conditions of extreme crowding, questionable hygiene, extended wait times, and swarms of infectious, coughing congregates all within arm’s reach of each other.
The impact is clear: lives were lost. High quality studies have shown repeatedly that when ED’s experience crowding patients in need of rapid, high intensity care are identified later, treated more slowly, and devoted fewer resources. Mortality goes up during crowding in virtually every condition that has been studied, including MI, sepsis, and others. The irony is stark: Once a critical mass is reached, the more that come to be saved, the fewer we can save.
…The overall management of information during the swine flu of 2009, despite some progress in our access to information, was misguided and dangerous. Frantic media outlets drove a nation to fabricated fears, while state-level institutions not only failed to contain or counteract these messages, but also used expensive, fruitless, prescription-only pills, available to most only in their local ED’s, as a means of false comfort. Instead of using honest information to provide safety, comfort and education, the approach created panic, cost money and resources, and took lives.
All of this was preventable and is reversible for the future. There is no reason why the media cannot be recruited into the information dissemination process…
Unfortunately, there is a good reason why: Responsibly framing public health risks is no longer a role that suits traditional media. They’ve decided it’s just not in their interest.
I remarked on this years ago with West Nile virus, which never will never kill as many as, say, food poisoning or swimming pool accidents.
There are many factors driving the public appetite for health risk information — and that’s understandable. I think it’s even ok for news organizations to shuffle around reporting to some extent, to satiate those desires.
But what happened in NYC this spring was media malpractice — night after night, opportunities to put the risks of swine flu in perspective were passed up for breathless reporting. I recall one occasion in which a phalanx of reporters were camped outside a hospital I worked at, providing next to no detail about an infant who died it respiratory distress. It turns out this child did not have H1N1, but communicating that was not a priority — by the next day the lead story was ED’s are overcrowded and schools are closing.
EPMonthly ran a nice sidebar from Dr. Jim Augustine, enumerating the ways in which ED docs can engage the media to get the right message out.
But I’m more encouraged by approaches to bypass traditional media and reach patients directly. Yesterday I heard some encouraging news from the CDC: their emergency twitter feed has over 500,000 followers. Millions saw their videos. This is amazing reach, for public health communication.
It wasn’t enough to help ED’s this spring. But individual hospitals and the CDC is ramping up their use of social media, even as traditional news sources decline in influence. It’s really the first good viral news I’ve heard in a while.
*This blog post was originally published at Blogborygmi*
May 21st, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, Health Tips
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Patients I’ve seen who succeeded in quitting, sometimes tell me what it was that enabled them to quit this time when they had been unsuccessful many times before. Sometimes it was a change in personal circumstances, sometimes an aspect of the treatment we gave them, but sometimes they tell me there was a single thought, tip or piece of information that stuck in their mind and really helped.
So I thought I’d share a few of those thoughts or tips that helped others, and ask readers to share the things that helped them most. Here are a few:
1. “Move a muscle, change a thought”
This phrase stuck on one patient’s head as a reminder that when he was sitting and bored and starting to crave a smoke, he should get up, and get busy to help shake the thought of a cigarette from his mind.
2. “My cigarettes are radioactive”
The information that cigarette smoke contains radioactive chemicals like polonium-210 really stuck in the mind of one ex-smoker and helped her stay off them.It is estimated that smokers of 1.5 packs of cigarettes a day are exposed to as much radiation as they would receive from 300 chest X-rays a year.
In case you don’t mind polonium, here are some other substances found in cigarette smoke:
Ammonia: Household cleaner
Arsenic: Used as a poison
Benzene: Used in making dyes
Butane: Gas; used in lighter fluid
Cadmium: Used in car batteries
Cyanide: Deadly poison
Lead: Poisonous in high doses
Formaldehyde: Used to preserve dead specimens
3. “Get rid of ALL tobacco and lighters from the house and car”
Many smokers have told me that this was the single most important piece of advice they followed. They said that many times the cravings were so strong that if they had cigarettes in the house they would have smoked them. But having very thoroughly cleared them out of the house gave them some peace of mind and bought them enough time to deal with the cravings when they occurred.
I’d be interested to hear from readers what their most helpful tip or piece of information was when quitting smoking. Feel free to use the comment section to post your favorites.
This post, Tips To Help You Quit Smoking, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
May 18th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network
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I’ve previously written about what face-to-face smoking cessation services typically do, largely based on my own experience. However, while at the SRNT annual conference I met two Smoking Cessation Advisors working in Lancashire, England who appeared to have a successful service, so thought it worth sharing some of their information.
Jan Holding and Eileen Ward manage a UK National Health Service (NHS) Stop Smoking Service in Lancashire in the north of England. Both are nurses by training and many of the 14 staff providing the treatment have primarily a nursing background. Their service sees around 450 new clients per month (i.e. over 5000 new clients per year). Services are provided at “community sessions” at various locations all over their catchment area, and clients are given their own hand-held record which they keep, and take with them to sessions, enabling them to attend whichever community location suits them at the time. While clients can make scheduled appointments, the service is also flexible, allowing clients to “drop-in” to community sessions without an appointment. Although some initial assessment sessions take place in a group format, most of the sessions are delivered in a one-to-one format via a relatively brief discussion with a smoking cessation advisor. These community sessions often take place in a large community room from 4pm to 8 pm in the evening, with multiple types of services being provided in the same room at the same time at different corners (e.g. initial assessments in one corner, prescribing of varenicline in another, and nicotine replacement therapy in another). It is not uncommon for around 200 clients to attend a single community session.
Clients are frequently encouraged to use NRT prior to quitting smoking (about half do this) and usually use more than one smoking cessation medicine (more than half do). Nicotine replacement therapy is provided via a voucher system requiring either no cost to the client, or just a co-pay (around $10 USD).
The service runs 6 days per week and includes evening sessions, and aims to reduce most of the usual barriers to entering treatment. Their “3 As” approach emphasizes “Accessibility, Availability and Adaptability”. They also specifically try to develop smoking cessation advisors who are passionate about their role, have a positive attitude to the importance of quitting smoking, and are therefore very committed to that work, as well as being knowledgeable about it.
My understanding is that the quit rates at this service are pretty good. But perhaps the best testimony to its success is the fantastic volume of clients who attend…..largely influenced by positive word-of-mouth via other clients. The success of this service reminds us that there isn’t just one way to do it, that all smoking cessation counselors and systems may need to be flexible and adaptable in order to help as many smokers to quit as possible.
For further information on what a smokers’ clinic does, see: What does a tobacco treatment clinic do?
This post, Smoking Cessation Programs: Lessons From The UK, was originally published on
Healthine.com by Jonathan Foulds, Ph.D..
April 18th, 2009 by CodeBlog in Better Health Network
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This story was related to me from a coworker:
I was taking care of a man who was on bipap. (Bipap is a form fitting mask that goes over the mouth and nose to help augment breathing. It has successfully been used numerous times in place of intubating patients and putting them on ventilators.) He was becoming restless and tired of the mask. I had to wait for the doctor to come and see him, though, before I could remove it.
Due to his medical condition, it was very important that he get an aspirin that day. Since I couldn’t give it to him by mouth (because of the mask), I had to explain to him that I’d need to give it rectally as a suppository.
He nodded his consent and I proceeded to give the aspirin.
A short while later, the doctor came to see the patient and agreed that we could take the bipap mask off for awhile. I happily entered the patients room to take the mask off… and before it was even off his face, he stuck his finger in the air and said,
“FOR THE RECORD, that is a hell of a way to take an aspirin!!”
It’s a hell of a way to give one, too.
*This blog post was originally published at Gina Rybolt, RN’s Code Blog.*
