Shortly before our
world was turned upside down by COVID-19, I visited Space Center Houston with
my family. We marveled at the collective ambition and investment it took to
move from space travel being an aspirational dream to setting foot on the moon.
I thought about my favorite scene from the movie Apollo 13, when Gene Kranz
overhears the NASA Director saying “This could be the worst disaster NASA has
ever experienced,” and candidly replies, “With all due respect, sir, I believe
this is going to be our finest hour.”
Just months later, our entire planet is on a mission to turn tragedy into triumph. Only this time, Americans have not led the way in proactively translating science into action for the benefit of humankind. Instead, we ignored scientists who warned about the inevitability of a pandemic and now lead the world in most confirmed cases (which, due to our testing debacles, underestimates actual cases). As a public health nurse, this is not a race I want to see us leading. Future outbreaks are all but certain while we wait for a vaccine. Every single one of us must start preparing now, for we will all have a role to play.
To be sure, it
is imperative that we all stay the course with current physical distancing efforts
to prevent spread, minimize death, and avoid the collapse of our healthcare
system and its ability to care for patients with COVID-19 and other life-threatening
conditions that do not pause just because of a pandemic. But social distancing
cannot be the only public health tool used to bring the pandemic under
Public health experts agree we need a coordinated national public health surveillance strategy that includes widespread testing in order to identify and isolate infected people early (this is crucial given how many contagious people are asymptomatic), contact tracing to figure out who has been exposed to infected individuals, and quarantining everyone who tests positive or has come in contact with an infected person. We must leverage technology to ensure testing provides fast and accurate results, and that we are able to safely and comprehensively track exposures. Without accurate, detailed, and timely data about the epidemiology of COVID-19, we cannot make scientifically sound decisions about how to ease social distancing or ethical decisions about how to equitably allocate scarce healthcare resources to communities of greatest need.
The World Health Organization has named 2020 the Year of the Nurse and Midwife. However, most Americans have never experienced a midwife’s care. In my over 30 years working in maternal-child health, I’ve heard plenty of reasons why. Families are understandably nervous about that with which they are unfamiliar, and nervous about pregnancy and birth in general, with good reason. The cesarean birth rate in the US has more than quadrupled since the early 1970’s, yet we aren’t seeing healthier mothers and babies as a result. In fact, compared to the prior generation, women in this country are 50% more likely to die in childbirth, and for women of color (particularly black women) that risk is three to four times higher than white women, regardless of the woman’s education level or socioeconomic status. For those expecting a baby in the new year, let me set the record straight about midwifery care.
Today’s certified nurse-midwives (CNM) and certified midwives (CM) have earned a minimum of a Master’s degree, as well as have passed a rigorous certification exam. A third category, certified professional midwives, are not required to have an academic degree, but they must also must pass a certification exam “based on demonstrated competency in specified areas of knowledge and skills.” Midwives are intensely educated both in normal, as well as in complications of, pregnancy and childbirth, and are well-prepared to address emergencies as they arise.
Midwives generally care for women with low-risk pregnancies; however, most pregnancies arelow-risk. And in those instances when a patient’s pregnancy or birth becomes high-risk, the midwife collaborates with physician colleagues to provide comprehensive team care to result in the best outcome for mother and baby.
Forced absence from gun violence has created a literal and metaphorical void in schools across our country that may impact students and staff for decades to come. The students are referred to as “Parkland kids,” “Sandy Hook students,” or “Columbine survivors.” These labels are sadly reflective of a new reality for American schools, as students, teachers, and staff no longer feel safe. America’s students feel vulnerable as the facade of schools as a safe place is no longer true. The Center for American Progress recent report revealed that 57% of teenagers now fear a school shooting.
Often, perpetrators of gun violence leave a trail of “red flags” for years, as they are troubled youths. This was the case in the Parkland shooting. Tragically, multiple agencies failed to respond to the signs the troubled young man was leaving, including specifically writing online that he aspired and planned to be a school shooter.
In the aftermath of the Parkland, Florida tragedy, parents and school districts turned to security experts demanding a plan of action. Sadly, the information provided was substandard and lacked evidence to support the strategies as efficacious. Lives weigh in the balance and there is no more tolerance for guessing.
Research is needed to guide the creation of evidence-based frameworks for school communities to address prevention as well as protection. Threat assessment teams are a strategy to assess for potential threats, but more importantly is that an intrinsic safety network is woven into the fabric of the educational system. Exposing the root cause of the contagion of violence impacting our youth is key.
Today on Episode 58 of Health in 2 Point 00, Jess and I have more to share from Exponential Medicine, but this time we’re at the Health Innovation Lab checking out all of the startups. In this episode, Jess and I talk to Meghan Conroy from CaptureProof about decoupling medical care from time and location, Care Angel‘s Wolf Shlagman about the world’s first AI and voice powered virtual nursing assistant, and highlight Humm’s brain band which improves working memory, concentration, and visual attention. We leave you with some parting words from Godfrey Nazareth: “Let’s set the world on fire. Let’s change the world, with love.” -Matthew Holt
American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time.
In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is growing at a faster rate than the number of physicians. Since December, 2012, the number of nurse anesthetists has grown by 12.1 percent compared to 5.8 percent for physician anesthesiologists.
The numbers—about 46,600 nurse anesthetists and 45,700 physician anesthesiologists—reported in the National Provider Identifier (NPI) dataset for January, 2015, probably understate the growing disparity. Today, more and more physicians are leaving the front lines of medicine, many obtaining additional qualifications such as MBA degrees and embarking on new careers in hospital administration or business.
Physician anesthesiologists can expect that fewer of us every year will continue to work in the model of personally providing anesthesia care to individual patients. Clinical practice is likely to skew even more toward the anesthesia care team model, already dominant in every part of the US except the west coast, with supervision of nurse anesthetists and anesthesiologist assistants.
No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind. But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.
The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies. As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.
Here’s an example. An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result. Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees. Some are paying attention to the new rule, and many others are ignoring it. One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.
A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could be a pulmonary embolus or heart failure.
Treating the Well:
In my early career in Sweden, well child visits were done in nurse-led clinics, some of them only open on certain days, with a local doctor in attendance. Parents carried the children’s records with them, containing growth charts, immunization records and so on.
These nurses had great expertise in differentiating normal from abnormal appearance of children, and would direct the attending physician’s attention to children with abnormal metrics, appearance or behavior.
With this arrangement, the physician time requirement was reduced, and limited to evaluating children attending the clinics who needed special attention. Physicians also performed specific examinations at certain ages, such as checking for hip clicks. These clinics freed up the local pediatricians to evaluate more sick children.
Well-baby visits are now the bread and butter of American pediatricians and family practitioners, and with the ever expanding mandates of politically determined items that must be covered in order for doctors to get paid for their services, we sometimes have trouble accommodating illness care demands.
A group of nurses at Texas Health Presbyterian has come forward with a very different picture of what happened when Liberian Ebola patient Thomas Duncan arrived at the hospital with Ebola-like symptoms on September 28th. If true, the allegations are certainly unsettling.
In an unusual move, the nurses spoke anonymously to the media, conducting a blind conference call in which none of the participants were identified.
After arriving at the emergency room with a high fever and other symptoms of the disease , the nurses said the patient was kept in a public area, despite the fact that he and a relative informed staff that he had been instructed to go to the hospital after contacting the Centers for Disease Control in Atlanta to report a possible case of Ebola.
It’s a provocative question, but it’s also the wrong one.
The question ought to be: When will healthcare fully embrace technology and all it has to offer?
It’s widely known that the $2.8 trillion US health system has significant waste and errors – between 25% and 30% of our health dollars go to services that do not improve health. Technology has the ability to put a big dent in that through standardization, real-time insights, convenient gadgets and complex data analysis the human brain simply cannot perform.
Consider some of the early innovators. There’s the heart monitor in the phone. The wristbands that count steps. And then there’s Oto, the cellphone attachment that snaps an image of the inner ear sparing frazzled parents one more trip to the doctor’s office for yet another infection.