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Age-Specific Mortality During the 1918 Influenza Pandemic

Age-Specific Mortality During the 1918 Influenza Pandemic | nursing | Scoop.it

The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889–90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics.

 


Via burkesquires, Ed Rybicki
Patti Hamilton's insight:

Wow, this is an interesting story.  Check it out.

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Ed Rybicki's comment, August 16, 2013 6:23 AM
Nice one!
Ed Rybicki's curator insight, August 16, 2013 6:26 AM

This is the second purported explanation I have seen for this phenomenon: the first was that people older than 28 were PROTECTED more, due to prior exposure, and that if this were not the case, the mortality curve would have just kept rising.

Just as happened - at a far lower mortality incidence - for the recent H1N1 pandemic, incidentally.

Mel Melendrez-Vallard's comment, August 16, 2013 10:34 AM
Right, makes sense. 2 sides of the coin here for sure. This article seems to imply timing of exposure in terms of 'age' as well given the evolution of the virus and how it antigenically changed from the 1889 virus that the 28 yr olds were purportedly exposed to as babies. This same virus from 1889 on an adult, given adult development and immune response could've elicited protection from 1918 flu to an extent while negatively impacting their children/babies which would've been exposed at the same time. Both would've 'survived' to experience the 1918 flu but the babies which are now ~28 would be at a disadvantage because when they got the 1889 virus their bodies were perhaps not developed enough to sustain protective immunity or the virus perhaps? food for thought, it was a nice article.

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Californians Report Fewer Health Care Access, Financial Issues - California Healthline

Californians Report Fewer Health Care Access, Financial Issues - California Healthline | nursing | Scoop.it
A Commonwealth Fund study finds states that have expanded Medicaid, such as California, have a lower percentage of residents who report problems accessing needed care, compared with non-expansion states.
Patti Hamilton's insight:

You won't find many surprises here. 

Now, if we could just get the Commonwealth Fund to fund our research on nurse staffing legislation.

Patti

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Nurses Confess: 4 Insider Secrets That Could Affect You - ABC News

Nurses Confess: 4 Insider Secrets That Could Affect You - ABC News | nursing | Scoop.it
Nurses let ABC News in on the secrets of their profession.
Patti Hamilton's insight:

This is a fascinating look at hazards to patients and nurses in hospitals. At the end, the advice these nurses give may surprise you.

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Nurse-To-Patient Mandate Reintroduced In Congress - KPBS

Nurse-To-Patient Mandate Reintroduced In Congress - KPBS | nursing | Scoop.it
A measure that would mandate minimum nurse-to-patient ratios in all hospital units has been reintroduced in Congress.
Patti Hamilton's insight:

I find this sound clip interesting because Australia has several types of nurse:patient policies (different in every one of the states there).

In the US at the national level  there has been strong resistance to ratio measures but also to policies such as Texas' which mandate nurse staffing committees responsible for overseeing staffing patterns and examining their effect on patient outcomes.

Are you a ratio fan?  Why or Why Not?

Patti

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Effects of increasing nurse staffing on missed nursing care - Cho - 2015 - International Nursing Review - Wiley Online Library

Effects of increasing nurse staffing on missed nursing care - Cho - 2015 - International Nursing Review - Wiley Online Library | nursing | Scoop.it
Effects of increasing nurse staffing on missed nursing care
(1:7 vs 1:17)

http://t.co/nD7ehVp4ap
Patti Hamilton's insight:

This is a brand new paper on the connection between missed care and staffing.  A word of caution in interpreting the findings.  The usual manner of measuring missed care is to ask nurses to identify specific tasks that are missed.  Often these tasks are items of care that most often are carried out during 7a to 7p shifts when the staffing is richest.  After hours, the time with lean staffing, may be times when items of care are "missed" because they are not usually performed after hours (walking, feeding, bathing).  An association between lean staffing and missed care needs to be examined very carefully for other confounding variables and for the effect of instruments not well suited for all contexts.

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Michael West: developing cultures of high-quality care

Michael West: developing cultures of high-quality care | nursing | Scoop.it
In the first of our series of lectures on leadership in the NHS, Michael West, Professor of Organisational Psychology at Lancaster University Management School, looked at how leaders can develop a culture of high-quality care and patient safety in...
Patti Hamilton's insight:

I found this lecture to fit closely with our own observations and findings- especially the notion that there is "slippage" from our vision to our language and our focus.

Check it out.

 

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Young nurse guides teen mothers - DesMoinesRegister.com

Young nurse guides teen mothers - DesMoinesRegister.com | nursing | Scoop.it
Carrie Torbert works with new moms through Visiting Nurse Services of Iowa.
Patti Hamilton's insight:

A very nice story.  Amazing that this is news, however.  What happened to the days when home visiting and health promotion were everyday activities for nurses?

 

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Rescooped by Patti Hamilton from Breast Cancer News
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NYU College of Nursing Researchers Find a New Solution in Detecting Breast-Cancer Related Lymphedema

NYU College of Nursing Researchers Find a New Solution in Detecting Breast-Cancer Related Lymphedema | nursing | Scoop.it

"Viewed as one of the most feared outcomes of breast cancer treatment, doctors struggle detecting and diagnosing breast-cancer related Lymphedema--a condition affecting the lymphatic system and causing psychosocial distress and physical challenges for patients.

...more about:
> ALPHA Business Solutions > breast cancer > breast cancer survivors > breast-cancer > cell membrane > L-Dex > lymphedema > Medicine

Now, a team of researchers led by Mei R. Fu, PhD, RN, ACNS-BC, associate professor of Chronic Disease Management at the New York University College of Nursing (NYUCN), offers supporting evidence for using Bioelectrical Impedance Analysis (BIA) ratios to assess Lymphedema.

The study, “L-DEX Ratio in Detecting Breast Cancer-Related Lymphedema: Reliability, Sensitivity, and Specificity,” published in Lymphology, argues because the low frequency electronic current cannot travel through cell membranes, it provides a direct measure of lymph fluid outside the cells. This allows for a more accurate assessment of lymphedema using a Lymphedema Index named L-Dex ratio.

“To lessen breast cancer survivors’ worry about lymphedema development, the BIA may have a role in clinical practice by adding confidence in the detection of arm lymphedema among breast cancer survivors,” says Dr. Fu, “even when pre-surgical BIA baseline measures are not available.”


Via Susan Zager
Patti Hamilton's insight:

Some folks will be surprised to learn that nurses do this type of research.

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Susan Zager's curator insight, November 14, 2013 3:13 PM

According to the article:
"Measuring lymphedema is challenging because most methods cannot distinguish bone and soft tissues from extracellular fluid. BIA is time-efficient, easy to operate and easy to interpret, making it ideal for clinical practice. Dr. Fu’s research collected data from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema, demonstrating that survivors with lymphedema had significantly higher L-Dex ratios, which shows the possibility of using BIA to discriminate between those cohorts of women.
“Our study also demonstrated that using a more sensitive L-Dex cutoff point, this allowed for BIA to catch 34% of the usually missed lymphedema cases,” said Dr. Fu. “This allows for earlier treatment, which naturally leads to better outcomes for at-risk patients.”

Rescooped by Patti Hamilton from Social Media and Healthcare
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Social media nightmare for health IT

Social media nightmare for health IT | nursing | Scoop.it

 

Few healthcare IT policies these days are as delicate, sensitive and potentially emotionally explosive as efforts to restrict or regulate employee social media activity. And yet hospital hierarchies are routinely stepping on these political minefields as providers try to protect their reputations.

Consider a recent incident at the 2,478-bed New York Presbyterian Hospital.

An ER nurse posted a photograph of a trauma room – no staff or patients were in the picture – after caring for a man who had been hit by a subway train. The caption: "Man vs. 6 train." The image simply showed a room that had seen a lot of action moments before. The veteran nurse was fired after the incident, according to an ABC News report, not because she had breached hospital policy or violated HIPAA, but, as she put it: "I was told I was being fired for being insensitive."

This legitimately raises key issues around what a hospital's social media policy should be. This specific incident, though, appears to be an impressively poor choice for the hospital to have selected to make its stand. First, there really was no privacy issue at play. The photo shows nothing more than a slightly messy trauma room. The caption is vague and is hardly worse than a police officer posting a car accident image, with a note warning people against drinking/texting while driving. (To be precise, the injured car would be recognizable to the patient along with friends and family, especially if a license plate were visible, whereas a generic trauma room photo isn't.)

An even bigger problem with using this incident is that the nurse, Katie Duke, didn't even take that photograph. It was taken by a staff doctor and the doctor had posted it on the doctor's Instagram page. Nurse Duke had merely reposted it. The consistency killer? The doctor "was not reprimanded," ABCNews reported. To be fair, it's not clear whether the doctor's post included the "Man vs. 6 train" comment. Given that it appears that the comment – as opposed to the image – is the trigger here, the hospital's disciplinary process may or may not have been inconsistent.

Let's get back to the social media policy issues. I would hate to have to issue a concrete definition – acceptable to our friends in Legal – of "sensitivity." What if there had been no image and the nurse had simply said something like "A grim reminder at the ER today about how dangerous and deadly subways can be. Don't take any chances – ever." Is that insensitive? And if not, how is it meaningfully different than what Duke reposted? She specified the subway line, which, by itself, isn't insensitive nor especially revealing. And she used an image of the trauma center, which showed nothing. Would it have made any difference had she posted a generic trauma center image from Google Images?

If no patient or hospital privacy has been violated, what is the issue? The issue is that she was accused of violating hospital policy. We've now gone full circle. What is reasonable to ban, as long as no one's privacy nor hospital confidentiality is violated? (Classic hospital confidentiality: "Wow, my hospital is getting away with amazing markups. We just charged a patient $XXX for something, and I saw the paperwork that we only paid $X for it." The employee would be using information that she/he could only know because she worked there. That's a fine violation.)

Can a hospital ban employees from saying anything hospital-related on their social media posts? What if it's entirely positive, as in "Our surgical team is brilliant. We saved patients today that most surgeons would have lost"?

Here's the IT nightmare. What if the hospital says, "We're going to decide this on a case-by-base basis"? Danger, Will Robinson! Danger! Then things fall to IT to become the social media police. Are you to then track every social media feed of every employee and to then – gulp – review every posting for appropriateness? And somehow management thinks that this action will avoid lawsuits?

The simple fact is that a social media policy that covers what an employee does in his or her personal time is highly problematic. On the other hand, there certainly is social conduct that has to be dealt with. What if a doctor set up a site that identified herself as working at this identified hospital and then said how her team tries to inflict as much pain as possible and that they then place bets on when different patients will scream or pass out?

The easiest route from an administrative perspective – but certainly not from a legal perspective – is to adopt something akin to the Pentagon's infamous Don't Ask Don't Tell. That would be a program where there was zero effort to uncover such naughty social posts (as IT breathes a major sigh of relief) but a strict policy for punishing employees and contractors who engaged in bad behavior that the hospital happened to learn of.

The problem is that it leads to inconsistent punishment – with most people never getting caught – and to even vindictive behavior, with employees reviewing the social posts of a rival, looking for anything that might get them into trouble.

That policy might simply prohibit posts that reflect poorly on the hospital, which is vague enough to allow senior management to make customized decisions. As long as healthcare doesn't decide that it needs to proactively check on all posts – a thankless task that would almost certainly fall to IT, which would try to automate much of that assignment from Hell – any concrete policy is better than none.

 


Via Plus91
Patti Hamilton's insight:

What is the real problem here?  Is it breach of confidentiality, heightened risk management by hospitals, limits to freedom of expression, or could it be the lack of sensitivity of doctors and nurses?

 

What is your opinion?

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Nurses say 'staffing crisis' affects care | Otago Daily Times Online ...

Nurses say 'staffing crisis' affects care | Otago Daily Times Online ... | nursing | Scoop.it
Dunedin nurses are being forced to ration care to patients because of a staffing crisis, the New Zealand Nurses Organisation (NZNO) says. About 300 nurses attended a stop-work meeting this week with Southern District ...
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Four hours of sleep loss = a six-pack of beer -

Four hours of sleep loss = a six-pack of beer - | nursing | Scoop.it

A few weeks ago, I wrote an essay for the Wall Street Journal that mentioned how four hours of sleep loss produces as much impairment as consuming a six-pack of beer. Take a moment to think about the implications from this research.

Patti Hamilton's insight:

Nurses we interviewed told us they average 4 hours of sleep before night shifts

Scary!

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Rescooped by Patti Hamilton from Family-Centred Care Practice
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Is Flu Vaccine Causing Increase in H1N1 Outbreaks? 5 Year Old Boy Dies from H1N1 Virus, Even Though He Was Vaccinated Month Before | Health Impact News

Is Flu Vaccine Causing Increase in H1N1 Outbreaks? 5 Year Old Boy Dies from H1N1 Virus, Even Though He Was Vaccinated Month Before | Health Impact News | nursing | Scoop.it
A 5-year-old boy in Oregon died just shortly after Christmas due to complications from the H1N1 virus. He and his siblings had received the flu vaccine the month before.

Via Velvet Martin
Patti Hamilton's insight:

What should we make of this?

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In Community Practice: Balancing Between 'Rational' and 'Rationed' Care - Clinical Oncology News

In Community Practice: Balancing Between 'Rational' and 'Rationed' Care - Clinical Oncology News | nursing | Scoop.it
Clinical Oncology News
In Community Practice: Balancing Between 'Rational' and 'Rationed' Care
Clinical Oncology News
In a discussion of “rational versus rationed care,” Jennie Crews, MD, the medical director of PeaceHealth St.
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Why Being Hospitalized On A Weekend Costs More Lives, Health Care Dollars - Forbes

Why Being Hospitalized On A Weekend Costs More Lives, Health Care Dollars - Forbes | nursing | Scoop.it
Why Being Hospitalized On A Weekend Costs More Lives, Health Care Dollars
Forbes
Patients hospitalized Friday night or over the weekend stay longer than patients admitted for the same problems Monday through Thursday.
Patti Hamilton's insight:

In one way this is old news.  However, it is focusing on staffing issues other than nursing and that is a good thing.  Nurses are primarily the ones who remain in hospitals after others have gone home. They are dependent on off-site providers responding to their requests for services their patients need.  By putting off-peak care in a business context and showing why/how it costs more, we may finally get support for change so that excellent care is available 24/7, regardless of day of the week!

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The difference between Night/Day shift nurses

The difference between Night/Day shift nurses | nursing | Scoop.it
Click here to view more Nurse Videos
Patti Hamilton's insight:

Anyone interested in why there is more missed care during day shifts MUST see this video.  He highlights the difference in activity and the need to make decisions based on ABC priorities.

This is wonderful!!!!!!!!!!!

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TV nurse to address social media concerns - Shreveport Times

TV nurse to address social media concerns - Shreveport Times | nursing | Scoop.it
Nurse Katie Duke works social media, from Instagram and Twitter to Facebook and YouTube.
Patti Hamilton's insight:

I remember when this incident happened.  The nurse lost her job for re-posting a photo of a bloody trauma room after the patient was moved, the physician who sent her the photo did not lose his job.

 

 Now this nurse is using a bad experience to create a new role for herself in social media.

 

What are your thoughts about the rights of health care providers to be "insensitive" online if they do not divulge personal information about patients or employers?

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Rescooped by Patti Hamilton from EHR and Health IT Consulting
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Why Data Handoffs Matter | The Health Care Blog

Why Data Handoffs Matter | The Health Care Blog | nursing | Scoop.it

Chief information officers (CIOs) and chief medical information officers (CMIOs) have spent the better part of two decades on a quest for interoperability; yet, their Achilles heel lies in the “information” part of their titles. If information is the sole beacon of efficiency and value, the invaluable contours of human suffering, personal preferences and humanity itself are lost.

Information is the first step to developing knowledge and understanding, but what physicians and patients rely on in the real clinical setting, rife with changes, are knowledge, understanding and empathy. The cold, hard calculus of a=b does not always apply when dealing with people because they are much more complex and complicated than binary machines with screens. If it were so easy, there would be no problem reaching 100% compliance with medication or a plan of action.

Sadly, all data lives in a database; which might as well be called a wait-a-base; after all, the data just sits there and waits for someone to look at it.

The fundamental problem with today’s information architecture is that all data are not created equal. Data, information and knowledge degrade with each new doctor that becomes involved. In addition, systems design lacks an understanding of how the human computer works in the context of illness, anxiety or uncertainty. Healthcare is a people business in need of data, not a data business in need of people. Data are the means; people are the beginning and the end.

 

Today’s environment is laden with an emphasis on revenue, cost and quality, while big data, mobile devices and the Affordable Care Act also bring promise. The follies of contrived informatics harm the system it serves and the patients (and doctors) that rely upon it.

A brief look at history reveals that the origin of “data” in healthcare is borne out of the medical claim, whose original purpose was to unlock the cash register, not create a knowledge system for understanding what matters most to doctors and patients. Instead, it was a system that wanted information to adjudicate cash. When the claim became the center of gravity, the ability to navigate knowledge and understanding devolved into a world where structured data and interoperability became the prizes.

Recalling the childhood game of “telephone” will illuminate part of the problem with informatics.

Today’s environment is laden with an emphasis on revenue, cost and quality, while big data, mobile devices and the Affordable Care Act also bring promise. The follies of contrived informatics harm the system it serves and the patients (and doctors) that rely upon it.

A brief look at history reveals that the origin of “data” in healthcare is borne out of the medical claim, whose original purpose was to unlock the cash register, not create a knowledge system for understanding what matters most to doctors and patients. Instead, it was a system that wanted information to adjudicate cash. When the claim became the center of gravity, the ability to navigate knowledge and understanding devolved into a world where structured data and interoperability became the prizes.

Recalling the childhood game of “telephone” will illuminate part of the problem with informatics.

“…the origin of “data” in healthcare is borne out of the medical claim, whose original purpose was to unlock the cash register, not create a knowledge system for understanding what matters most to doctors and patients.”

Getting a patient to agree to a care plan requires a belief in that plan and as with belief systems, there is an expectation of trust (or blind faith). Trust and communication are the bedrock of relationships; EHRs value transactions of data, not relationships.

Medical decision making requires the use of knowledge, experience and data; however, the current paradigm relies almost solely on the latter. It may be useful to look at the works of Heinz Von Forester, an Austrian American scientist and the father of second-order cybernetics (they investigate the construction of models of cybernetics), to appreciate the critical role of knowledge-based systems and the influence of those that create them.

Each new doctor that gets a hand-off from another doctor is often given the homogenous data file of the continuity of care document. Similar to the telephone game, the data have already changed once they have been received, and there is no data set for what has historically worked (knowledge) and for what patients’ preferences are (U-data). Furthermore, the feedback loop does not exist to ensure fidelity of understanding.

The American College of Physicians recently published a position paper (1) that basically states that all electronic medical records were built for defensive medicine and billing while adding unnecessary complexities to the lives of doctors and patients. The article says:

“Electronic health records should be leveraged for what they can do to improve care and documentation, including effectively displaying prior information that shows historical information in rich context; supporting critical thinking; enabling efficient and effective documentation; and supporting appropriate and secure sharing of useful and usable information with others, including patients, families and caregivers…Physicians must learn to leverage the enormous and growing capabilities of EHR technology without diminishing or devaluing the importance of narrative entries. Failure to do so will inevitably influence the way we think and teach to the detriment of patient care.”

Health is a foundational attribute of  life; it is existential and important. Information about what happened to us, what is happening to us and what could happen to us is all wrapped into a non-linear, non-local model. Different data types are often simultaneously dependent and independent on other data types; they interact with each other in non- linear and often non-obvious ways.

It’s time to take a deep breath and think more holistically about what needs to be accomplished for people, both proactively and reactively. If zeal for efficiency and cost containment drive strategy, they might result, but an amazing opportunity will have been missed—the opportunity to design a system to enable actionable information, wrapped in the context of the data types elucidated above; to use mobile technology whenever possible; and to teach how to observe, listen and respect the powerful nature of U-data.

The art of medicine in the context of religion, beliefs, fears, suffering and socio-economic status cannot be homogenized by data architecture. There needs to be a move towards integrating what matters to individuals with what is the matter with them. A recent study in the Harvard Business Review elucidated why people trust human judgement over algorithms; To err is human, but when an algorithm makes a mistake we’re not likely to trust it again. Furthermore, algorithms are unable to factor in the concept of the ‘benefit of the doubt’.

Healthcare has many interfaces where systems, subjects and organizations meet and interact. These multitudes of connections lend themselves to hyper-complexity; yet when boiled down to a functional unit, there is a human being in need of care. Losing sight of this element fails the entire system.

According to Sir William Osler, M.D., a Canadian physician often called the “father” of modern medicine, “The practice of medicine is an art, not a trade, a calling, not a business, a calling in which your heart will be exercised equally with your head.”

1 – Kuhn T, Basch P, Barr M, et al. “Clinical Documentation in the 21st Century: Executive Summary of a Policy Position Paper From the American College of Physicians.” Annals of Internal Medicine. Published online Jan. 13, 2015.

 


Via Technical Dr. Inc.
Patti Hamilton's insight:

As I read this I immediately saw the connections to Institutional Ethnography.  For example, the author correctly points out that information is "Worked up" by everyone in the loop and rich historical context about the patient and her/his experiences is lost. Real understanding is lost due to the way in which information is collected and transmitted.

 

What are your thoughts?
Patti 

 

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Hospitals Fail To Protect Nursing Staff From Becoming Patients - NPR

Hospitals Fail To Protect Nursing Staff From Becoming Patients - NPR | nursing | Scoop.it
Nursing employees suffer 35,000 back and other injuries nearly every year.
Patti Hamilton's insight:

I am still trying to decide what I think about Nina Pham's lawsuit against THR Presbyterian Hospital in Dallas over exposing nurses to undue risk.  When I saw this NPR story I thought it might help me to sort out the complex issues involved.

What do you think?

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Factors influencing why nursing care is missed - Blackman - 2014 - Journal of Clinical Nursing - Wiley Online Library

Factors influencing why nursing care is missed - Blackman - 2014 - Journal of Clinical Nursing - Wiley Online Library | nursing | Scoop.it
RT @jclinnursing: Free to read-> Factors influencing why nursing care is missed http://t.co/PZ41nGGeod
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Check out our team's latest article.

 

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Health official: Nurse staffing law to include neonatal ICU - wwlp.com

Health official: Nurse staffing law to include neonatal ICU - wwlp.com | nursing | Scoop.it
The law calls for a patient-nurse assignment ratio of 1:1 or 1:2 "depending on the stability of the patient as assessed by the acuity tool a…
Patti Hamilton's insight:

For those of us following legislation related to nurse staffing this story was good news.

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Night Shifts Are Damaging Your Brain!

Working the graveyard shift might not be fun, and new research shows that it might be damaging your brain! Tara explains. Read More: Chronic effects of shift work on cognition: findings...
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The research showing health hazards of off-peak work is accumulating.

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Night light exposure could make breast cancer tumors tamoxifen resistant - Medical News Today

Night light exposure could make breast cancer tumors tamoxifen resistant - Medical News Today | nursing | Scoop.it

Medical News Today
Night light exposure could make breast cancer tumors tamoxifen resistant
Medical News Today
Tamoxifen is an estrogen-blocking medication typically used to treat breast cancer that has spread to other parts of the body.

Patti Hamilton's insight:

This research has implications not only for our patients but also for those with sleeping conditions altered due to disturbed circadian sleep and light patterns.

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4 Myths About Poverty - Chronicle of Higher Education (subscription)

4 Myths About Poverty - Chronicle of Higher Education (subscription) | nursing | Scoop.it
Chronicle of Higher Education (subscription) 4 Myths About Poverty Chronicle of Higher Education (subscription) The supply of college graduates is also kept artificially low because the best private universities ration their available slots and the...
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Check out the comments about rationing of higher education.

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Missed visits common in early HIV care linked to death in US | The Westside Gazette

Missed visits common in early HIV care linked to death in US | The Westside Gazette | nursing | Scoop.it

In a private healthcare system in the United States, two thirds of people diagnosed with HIV missed at least one visit during their first year of care, and missing visits raised the risk of death 71 percent (Post Edited: Missed visits common in early...

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Country Doctor opens new after-hours clinic as an affordable emergency room ... - Seattle Central District News

Country Doctor opens new after-hours clinic as an affordable emergency room ... - Seattle Central District News | nursing | Scoop.it
Country Doctor opens new after-hours clinic as an affordable emergency room ...
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Sounds like an intriguing idea. 

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Rescooped by Patti Hamilton from Archaeology News
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Archeoastronomy of the Longest Night | Smithsonian

Archeoastronomy of the Longest Night | Smithsonian | nursing | Scoop.it

As our northern hemisphere days begin to lengthen, I like to think about the many ways people have marked the Winter Solstice throughout human history. Like Summer Solstice...


Via musée du quai Branly, David Connolly
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