Hi everyone;

        I just wanted to share this article that I recently read in "Contemporary OB/GYN."  The article actually relates to Assignment Three that is due this week.  It is amazing the different tools we will be using in the future to relate to our patients.  Kim (2012) suggests that "social media, defined as various forms of online and mobile electronic communication with user generated content, is having a transformative impact on society and the way we communicate on a daily basis" (p. 40).  It appears that social media will definitely be the tool to link our communication with not only our friends but also our provider.  According to the literature providers are only using social media sites like Facebook, Twitter, Linkediln, and YouTube for their own personal use until some barriers like liability and patient privacy can be resolved.
        Kim (2012) explains that "direct messaging through social media sites, rather than public posts, is one strategy to ensure privacy of communications" (p. 42).  It appears that in spite of the barriers patients are showing interest in social media for patient-provider communication.  Furthermore patients are  reporting their experiences regarding their own medical conditions.  For example a "recent study used Twitter, mobile apps, and podcasts to help empower patients in a behavioral weight-loss intervention" (Kim, 2012, p. 44).  There are also many other ways that social media is being used in health care.  For example "providers have become early adopters of social media as a form of marketing and communication with the public" (Kim, 2012, p. 44). 
        Overall "social media allows free or low-cost marketing, help build brand name recognition and personalize interactions by developing relationships online, and providers can enhance their brand attractiveness by building social capital through audience engagement" (Kim, 2012, p. 44).  It is obvious that  this particular area of technology is the wave of the future.  Furthermore "by embracing these new tools, providers can communicate better with patients and expand their message to reach larger populations" (Kim, 2012, p. 46). 

Reference:

Kim, D. S. (2012).  Harness social media, enhance your practice.  Contemporary OB/GYN, 57(7), 40-46.  Retrieved:  CONTEMPORARYOBGYN.NET

  

High-carbohydrate diet linked to Alzheimer's:

 

        I am not sure if any of you had the opportunity to read today's article in the Arizona Republic, but I would like to share my thoughts on this topic. A recent study conducted by a team of researchers from the Mayo Clinic indicated that a high carbohydrate diet might be linked to mild cognitive impairment (MCI).  Also that "sugars play a role in the development of MCI, which is often a precursor to Alzheimer's disease" (Lloyd, 2012, p. A1).  The research team did their study on 1,230 people between the ages of 70 to 89.  The individuals were asked to present a dietary log from the previous year.  After evaluating the dietary logs; the number of individuals that showed no sign of MCI were 940 and were asked to continue the study for 15 months more.  At the end of the four year study 200 out of the 940 were starting to present with MCI.  According to the author the study found that "compared with people who rank in the bottom 20 percent for carbohydrate consumption, those in the highest 20 percent had a 3.68 times greater risk of MCI" (Lloyd, 2012, p. A9). 

        As health care providers we are aware that a high carbohydrate diet can be unhealthy due to  carbohydrates affecting both glucose and insulin metabolism.  Some sugar is good because it fuels the brain but "high glucose levels  affect the brain's blood vessels and play a role in the development of beta amyloid plaques, proteins toxic to brain health that are found in the brains of people with Alzheimer's" (Lloyd, 2012, p. A9). 

        In doing my own literature search regarding carbohydrates linked to Alzheimer's, I found that a high carbohydrate diet can very likely be related to this devastating disease.  Seneff, Wainwright, and Mascitelli (2011) suggests that "an excess of dietary carbohydrates, particularly fructose, alongside a relative deficiency in dietary fats and cholesterol, may lead to the development of Alzheimer's disease" (p. 134).  Furthermore Seneff, Wainwright, and Mascitelli (2011) suggest that "a first step in the pathophysiology of the disease is represented by advanced glycation end-products in crucial plasma proteins concerned with fat, cholesterol, and oxygen transport.  This leads to cholesterol deficiency in neurons, which significantly impairs their ability to function" (p. 134).  Apparently over a length of time the "response leads to impaired glutamate signaling, increased oxidative damage, mitochondrial and lysosomal dysfunction, increase risk to microbial infection, and, ultimately, apoptosis.  Other neurodegenerative diseases share many properties with Alzheimer's disease, and may also be due in large part to this same underlying cause" (Seneff, Wainwright, & Mascitelli, 2011, p. 134). 

        I am not sure if  changing to a low carbohydrate diet is the answer to fixing MCI, which is a precursor to Alzheimer's disease but it is a topic that is vital to address.  "Epidemiological indicators suggest that the incidence of Alzheimer's disease in the U.S. and likely the Western world is currently increasing at an alarming rate and disproportionately with the increase in the aged population" (Seneff, Wainwright,  & Mascitelli, 2011, p.138).  It is obvious that this disease is  devastating, "in terms of both mental anguish and health care costs" (Seneff, Wainwright, & Mancitelli, 2011, p. 138).  As health care providers it is our responsibility to continue the study regarding the cause of this horrible disease and especially continue to educate our patients regarding a healthier diet.  

 

Reference:

 

Lloyd, J. (2012, October 19).  Study ties diets heavy in carbs to Alzheimer's.  The Arizona Republic.

Retrieved from http://www.azcentral.com

 

Seneff, S., Wainwright, G.,  & Mascitelli, L.  (2011).  Nutrition and Alzheimer's disease: The detrimental role of a high carbohydrate diet.  European Journal of Internal Medicine, 22, 134-140.

 

  

 

 

 





IOM Report 2012: Calling All Lifelong Learners

The Institute of Medicine (IOM) released its latest report last month on the healthcare system. While this may not be the most exciting thing you’ve heard all week, allow me to recast this bureaucratic, lengthy report in a much brighter light.

The report (which can be found here) is titled Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. I found the 5-page report brief to be incredibly informative, succinct, and relevant to what we are learning here in our DNP program, and to the challenges we face while participating in patient care. In essence, the report highlights the inefficiencies and lack of quality with which healthcare is currently delivered in this country, and sets out specific recommendations to produce a more adaptive and efficient system. Let me briefly discuss what I found to be the three essential components recommended for our current healthcare system.

A comprehensive use of technology. Using technology tools in healthcare, such as EHRs and patient portals, are no longer considered optional. In order to continuously and effectively adapt to the complex and changing system of healthcare—which is made up of complex and changing patients—we must utilize the affordable and convenient tools that are available to us. This means creating patient portals where patients and clinicians can share knowledge, resources, and other information. It means connecting with clinical databases that offer real-time clinical decision-making support. It also means capturing all data—including patient and financial outcomes—electronically, in order to continuously assess the healthcare processes and make changes more quickly.

Patients as an integral part of the healthcare team. Patient inclusion and empowerment is, thankfully, a growing trend in healthcare discussions. In this report, the IOM repeatedly references patients as being an essential part of the clinical decision making process. Treatment plans should be tailored to the individual needs and preferences of each individual patient. Patients should be encouraged to use patient portals for education, communication with providers, and sharing of data that can be used to evaluate patient reported outcomes. In response to the call for greater use of technology, it is even proposed that technology developers create digital tools that can further empower patients in managing their own care.

An open culture of learning. The cultural wisdom is clear and we all know it is true: The best experts in any field are the ones who are lifelong learners. The unending thirst for knowledge can be instilled in practitioners through their education programs, which should offer students the most current knowledge and skills in accessing, managing, and applying evidence for practice. However, the workplace culture is what must continue to support this quest for knowledge by offering a safe place for questioning, adapting, and collaborating. Healthcare leaders (which includes us) need to embody the qualities of respectfulness, transparency, and inquisitiveness in order to foster a culture of lifelong learning.

For there is only one constant in the complexity and chaos of healthcare: Change. 

[photo credit]

An Uphill Battle...

            Are we as soon-to-be advanced practice nursing graduates prepared on the doctoral level going to welcomed into the healthcare community because of the increasing shortage in primary healthcare providers throughout the United States or will we be continually fighting against the stigma that we are not adequately trained to provide quality care to our patients?

 

Anyone who keeps up with an advanced practice nursing organization has heard about the continual struggle for NPs to be allowed to practice to the full extent of their training. An article recently published by the New York Times (found here) discussed the worsening shortage of physicians and the looming influx of patients that will gain insurance coverage under Obama’s healthcare law. AANP’s President Angie Golden provided this reply,

 

“Nurse practitioners can play a critical role in addressing the country’s growing physician shortage.

 

With advanced degrees, they are skilled diagnosticians and clinicians who treat acute and chronic illness and prescribe medications.

 

Four decades of research show that nurse practitioners provide high-quality, cost-effective, comprehensive, patient-centered primary health care with excellent outcomes.

 

In a growing number of states, a nurse practitioner can own and operate an autonomous, independent practice, not requiring any physician involvement. But in too many states, antiquated laws prevent us from practicing to the full extent of our advanced education and clinical training.

 

Elected officials in affected states should work to remove these unnecessary barriers. Doing so will instantly increase access to quality health care, improve outcomes and make health care more affordable for all Americans.”

 

Shortly after the publication of the New York Times article, a report was released by the AAFP (found here) stating, “Granting independent practice to nurse practitioners would be creating two classes of care: one run by a physician-led team and one run by less-qualified health professionals. Americans should not be forced into this two-tier scenario. Everyone deserves to be under the care of a doctor.”  While this seems harsh, the report later goes on to state, “The training and certification nurse practitioners receive is appropriate for dealing with patients who need basic preventive care or treatment of straightforward acute illnesses and previously diagnosed, uncomplicated chronic conditions. But patients with complex problems, multiple diagnoses, or difficult management challenges require the expertise of primary care physicians working with a team of health care professionals.”  The report also states that, “Utilizing all health professionals in a team approach will work for the patient and the practice. It is important to recognize that ‘involving nurse practitioners in a practice team and exerting their full capabilities is a promising way to expand primary care workforce.’ ”

 

Following the aforementioned AAFP report, an interesting blog post was written by one of the AAFP board members (found here) discouraging independent practice for NPs. What I found most interesting was the comments posted by other providers. Some of these comments were very anti-NP stating that NPs are trying to kick primary care providers out of practice, drive down their reimbursements, and even calling for a media campaign to “instill fear in the public” about the “reduced training” NPs have. One poster even accused NPs of making more mistakes than physicians which the writer stated caused an “increase in healthcare costs”. However, others were more reasonable noting the research that has been done supporting positive NP outcomes and proposing that NPs and physicians work together for the advancement of healthcare in our country.

 

I hold a fairly moderate view on this issue. It is my feeling that this discussion speaks to NPs knowing their scope of practice, limitations, and when to refer patients to other providers. As a new NP I certainly do not plan to go around telling anyone that I am a physician, that my education compares apples to apples with a physician, that I can provide better care than a physician, that physicians do not play an important role on a patient’s healthcare team, or that I should replace a physician. However, there are things that I feel I am adequately trained and fully capable of doing without the supervision of a physician including wellness exams and screenings, diagnosis and treatment of acute illnesses, and diagnosis and management of non-complex chronic conditions. Although I don’t know what the future will bring, I currently have no intention of practicing 100% independently, without ever getting input from or collaborating with a physician.

 

I know there are a multitude of different opinions out there, even among our fellow DNP students. What are your thoughts? Should NPs practice independently? Does independent NP practice push us beyond our scope of practice?

Prebiotics & Probiotics in Women's Health

Prebiotics & Probiotics in Women’s Health

Over the last 20 years it was discovered that Lactobacillus iners is a bacteria that helps to maintain vaginal health in women (Reid, 2012). These discoveries lead to an influx of studies which directed the concept of restoration of vaginal health using probiotics with lactobacilli. Atopobium vaginae is a bacteria which is the major cause of bacterial vaginosis in patients. Often women with recurrent cases of bacterial vaginosis have depletions of lactobacilli (Reid, 2012). It has been proposed that prebiotics and probiotics can be used to restore vaginal health and prevent future disruptions of the healthy vaginal flora.

Prebiotics play a role in maintaining a healthy environment because lactobacilli are already present helping to prevent the overgrowth of pathogenic organisms. Probiotics attempt to replace the missing lactobacilli in order to restore a healthy environment. The delivery route of prebiotics and probiotics to the vagina has been a major challenge. When prebiotics and probiotics are used for gastrointestinal health, swallowing a capsule directs the organisms to where they need to go. However, the first route of delivery to maintain or restore vaginal health would be through intravaginal administration. Intravaginal administration requires regulatory approval as a drug and because food companies have been the major manufacturers of probiotics, they are not interested in developing drug therapies (Reid, 2012). Therefore, the next choice of delivery is through capsules of dried product ingested orally. The reason this form of delivery works is because of the concept of passive ascension from the rectum to the vagina. The idea was discovered since pathogens enter and infect the vagina and bladder by this route, therefore good bacteria such as lactobacilli ingested on a regular basis could do the same (Reid, 2012).

Reid (2012) discusses a study that used capsules of Lactobacillus rhamnosus and Lactobacillus reuteri to cure bacterial vaginosis successfully. Another study found that daily intake of lactobacilli GR1 and RC14 replenishes vaginal health, protects the stomach and small intestine,  reduces the risk of urogenital infections, reduces side effects of antifungal drugs, and improves the cure rate of bacterial vaginosis if taken daily for 1 year (Reid, 2012). The uses of lactobacillus prebiotics and probiotics have shown promise for women’s health. However, continued studies are need on the mode of delivery to advance to use of prebiotics and probiotics.

Reference

Reid, G. (2012). Probiotic and probiotic applications for vaginal health. Journal of AOAC International, 95(1), 31-34.