2007-10-30 00:00:00

Danger-Proofing Your Home By Britt Michaelian, MA


One day a few weeks ago, our 2 year old escaped within a matter of a minute from my sister???s front door. Three adults and five kids frantically searched for the toddler, only to find that she had opened the front door, climbed down the porch steps and scaled a very steep driveway, ending up in the middle of the street.

Was I being irresponsible? No. Was I paying close attention? Yes. Could I have done anything differently? Not really. As you hear with any tragic situation, it only takes a moment. With toddlers, this is especially true and this is why we not only need to beconstantly supervising our children, but we also need to be prepared in case there is a medical emergency. The fact is that there are moments where the child can slip away or where an injury can occur no matter how closely you supervise a child.

This story is an example of when childproofing is not enough. What can we do about it? Starting before your child can crawl, go through your entire home as an octopus bulldozer. Get on your knees, open the front door and crawl in. Grab onto and pull down on anything in your reach. Everything that has the potential to be opened, pinched, tumbled or broken needs to be addressed.

Start with getting electrical socket covers and place them high and low, in every electrical socket in your home! If you do this first, you will not be sorry! Our two year old has learned how to pull these out, but we still use them! Even though she can remove these covers, they are one added step that gives us time to react when we see her at the electrical outlet. While you are at it, get power strip covers and any cord ties to eliminate a tangle of cords that can be very intriguing to children.

If a piece of furniture or large object, such as a TV, moves or shifts at all in your crazy octopus experiment, it has the potentialto fall and needs to be anchored to the wall. If a vase or other heavy object can become loose or fall, it needs to be strapped down or moved to another location where it is not a danger. If drawers or cabinets can be opened, put safety latches on them. Different safety latches work best in different types of cabinets. Some cannot be used if your cabinet has a wide frame or irregular shape, so it is important to try different brands to figure out which latch works best on your furniture. We tried as many as four types of latches in some locations before finding one that worked!

Our smart, adorable little toddler girl has broken a lot of our child safety latches (and the ones at the doctor’s office) so, I highly recommend making sure any choking hazards, such as dry pasta noodles, hard candy or other hard foods be stored up high both in the refrigerator and in other areas of the kitchen. Obviously, liquid detergent and other cleaning chemicals are extremely dangerous and should be stored in the highest possible location as well. Over the refrigerator or oven are usually safe.

Until recently, our toddler could not open doors, so I found that keeping all of the doors in the house closed is a good way to monitor her location. Most importantly, the bathroom door needs to remain shut and the toilet closed with a toilet guard.

Other hazards in the bathroom include but are not limited to the bathtub, medicine cabinet, any drawers, hairdryers, make up, nail polish, lotions and potions as well as anything that can fall on top of the child. Don’t forget, these drawers and cabinets need safety latches as well!

Another thing to keep in mind is that medications may be difficult for children to open, but not impossible. Keep ALL medications stored up high and out of reach, even when your child is very sick. And DO NOT keep any medications on your own nightstand! Many children suffer from accidental poisonings as a result of medications being left out in places where the child can easily reach them.

If you have stairs in your house, you will need a gate at the top of the stairs and another gate at the bottom to keep baby from climbing up without your assistance (and possibly falling down). If your stairway has rails that are more than 2 3/4 inches wide, you will need to get a banister guard made to keep baby from going between the rails. You will also need to make sure your windows are safe. If you have safety mechanisms on your windows, use them! If you don’t have safety windows, you can buy window guards or stints that can be removed quickly by an adult in case of fire.

When your toddler is big enough to reach the counter or stove, get a counter or stove guard. This handy plastic shield will block little hands from getting burned or pulling knives down when you are cutting food for dinner. A woman we know has a large scar on her cheek because when she was 9 months old, she pulled a dishtowel down from the counter. There was a knife on top of the dishtowel that went through her cheek and the scar remains today.

In fact, make sure all knives are pushed all the way to the back of the counter, if not stored in one of the latched cabinets! Our adorable two year old has pushed a chair over to the counter, climbed up and grabbed knives from the knife block in about 2 seconds. In addition, remember to cook on the back burners of the stove. If you are making a lot of food and need to use the front burners, have someone entertain baby outside of the kitchen or put the baby in a safe place while you cook! Every home should also have fire alarms and carbon monoxide detectors that are tested every year (keep a journal of all appliances that need parts tested or changed in your kitchen).

Security alarms are another thing that parents underestimate the value of! Security alarms areimportant to protect from burglars and home invasions, but they also have wonderful functions such as a warning beep when a door or window is opened or closed and fire alarms that signal the fire department.

I highly recommend hiring a childproofing expert to come to your house to install every safety device that your house can accommodate! I also highly recommend and believe it should be mandatory for all parents and caregivers to take CPR and first aid courses every year.

In addition to this, it is important for you to prepare a family log that is readily available in case of emergency. You can use a binder and make spread sheets with your family???s important information. Make a list of any and all medical history items and medications that anyone in your family takes regularly. Have an extra dose on hand in case of a natural disaster or other emergency and list where that is (better yet, store a few in a pouch with the log!) Any information that you or another caregiver would need to know should be in this log.

Families need to have an outside the immediate area person to contact if there is a catastrophic emergency. All family members should have this person’s phone number on hand at all times. This person should also have a copyof your household???s important documents. Each household should have an emergency survival kit with enough food, water, medication and supplies for a week. Each vehicle should have an emergency survival pack (including water and food) and a well-stocked first aid kit.

Filed under: — @ 2007-10-30 00:00:00
2007-10-29 00:00:00

Week in Review: Adolescents on an “Average Day”

Today may be an average day, but see if your definition of “average” changes after reading this new data from the Substance Abuse and Mental Health Services Administration (SAMHSA), which found that on an average day in 2006:

  • Nearly 50,000 adolescents used inhalants;
  • Nearly 27,000 adolescents used hallucinogens;
  • Nearly 13,000 used cocaine;
  • Nearly 3,800 used heroin;
  • Nearly 8,000 adolescents ages 12 to 17 drank alcohol for the first time;
  • Approximately 4,300 adolescents used an illicit drug for the first time;
  • Around 4,000 adolescents smoked cigarettes for the first time;
  • Nearly 3,600 adolescents used marijuana for the first time; and
  • Approximately 2,500 adolescents abused pain relievers for the first time.

Overall, SAMHSA finds fewer adolescents are using illicit drugs than in 2002, but misuse of prescription drugs among adolescents increased from 5.4 percent in 2002 to 6.4 percent in 2006, largely attributable to the increase in nonmedical use of pain relievers. In this week’s Healthcare Business Weekly Update, read about a SAMHSA pilot to deliver point-of-sale substance abuse prevention information sheets to purchasers of highly abused prescription drugs, a first step in combating prescription drug misuse among teens and young adults.

Filed under: — @ 2007-10-29 00:00:00
2007-10-29 00:00:00

Desperate Patients: When Treatment is Too Expensive

With all the emphasis on transparency in the healthcare industry, will we ever see a day when the pharma industry is held to the same reporting standard for pharmaceutical costs?

In this October 29, 2007 Newsweek article, Geraldine Ferraro describes how her ongoing battle with multiple myeloma has opened her eyes to the frailties of the U.S. healthcare system. The real eye-opener of the article, however, is the extreme lengths to which one sufferer must go in order to obtain treatment when the conventional path is too expensive:

Ferraro writes:

I routinely get calls from multiple-myeloma patients around the country. One conversation in particular sticks out: it was from a retired teacher in Montana who explained that he was feeling terribly fatigued. When I asked him about his hemoglobin levels (you get to know about this stuff when you have a blood cancer), they were startlingly low. “Oh, my God, they’re not giving you Procrit or Aranesp or one of the other anemia medicines?” I asked. “No. I can’t afford it. It costs $800 a shot,” he said. He explained that he’d had to devise a cheaper alternative to manage the anemia. “I wait until my hemoglobin gets down to seven [that’s really low] and then I go to the hospital and get a transfusion, which only costs $50,” he said.

In the same article, Ferraro laments the lack of transparency when it comes to pharmaceutical price:

It amazes me that in Italy, you can buy drugs for a fraction of what they cost here. Why? Because Italy and many other countries regulate the price of drugs. Yet here in the United States, consumers and insurers are subsidizing those cheap drugs by paying high prices to the pharmaceutical companies. That’s not fair.

Filed under: — @ 2007-10-29 00:00:00
2007-10-26 00:00:00

It’s a bird, it’s a plane…no, it’s Super Bug!

With the recent wave of MRSA staph infections on the nation’s front burner, super bugs are on the brain here in the US as well as overseas.

Curing Death blogs about some new ways the UK is fighting other super bugs in hospitals. The Bradford Infection Group (BIG), based within the University of Bradford’s Schools of Engineering, Design & Technology and Life Sciences, was awarded a grant that will be used to fund an investigation into alternative strategies for controlling hospital acquired infections.

“Approximately one in ten patients pick up an infection during a hospital stay. While hand washing and other hygiene measures arevital, evidence suggests that these measures alone are not always enough to prevent certain infections and therefore a fresh approach is needed,” said Clive Beggs, head of the Bradford Infection Group and professor of medical engineering at the University of Bradford.

Filed under: — @ 2007-10-26 00:00:00
2007-10-26 00:00:00

Smoke Break: Employers Try to Wean Workforce from Smoking

The New York Times highlights employers’ efforts to get workers to quit smoking. Employers are motivated by financial gain from reduced healthcare costs and an expected boost in productivity from healthier employee lifestyles.

Filed under: — @ 2007-10-26 00:00:00
2007-10-25 00:00:00

FDA Approves New Breast Cancer Treatment

The U.S. Food and Drug Administration (FDA) recently approved Ixempra to be used in patients with metastatic breast cancer who have not responded to certain other cancer drugs.

The drug was approved to be used in combination with capecitabine, another cancer drug. It is to be used for patients who do not benefit from two other chemotherapy treatments???an anthracycline (such as doxorubicin or epirubicin) and a taxane (such as paclitaxel or docetaxel)???any longer. Ixempra was also approved for use in patients who no longer benefit from an anthracycline, a taxane and capecitabine, without being combined with capecitabine.

“This approval is important because it provides certain patients with a new chemotherapy option in instances where other drugs have failed,” said Douglas C. Throckmorton, M.D., deputy director of the FDA’s Center for Drug Evaluation and Research. “FDA is working every day to support the development of safe and effective new therapies that benefit patients in need.”

Filed under: — @ 2007-10-25 00:00:00
2007-10-25 00:00:00

Heart Health

This week’s Disease Management Update focuses on healthy hearts and presents two possible techniques for maintaining heart health in your patients. Visit this blog entry to read (and hear) about two nurses from Hackensack University Medical Center who are pursuing perfect care with their award-winning heart failure team.

Filed under: — @ 2007-10-25 00:00:00
2007-10-25 00:00:00

Why Do Some Physicians Cling to Unhealthy Behaviors?

Nick Jacobs at the World Health Care blog describes the unhealthy behavior of attendees at a world cardiology conference. Happily, the patient outcomes reported at the conference were positive.

My last four days were spent at a world conference on cardiology where the work done by our research institute???s cardiac team on the impact of behavioral modification on this disease was our presented topic. Our research revolves around diet, exercise, stress management and group support, and the results observed from our patients have been nothing less than remarkable.

It is fair to say, however, that, upon observing the actions and choices of those present my heart sank. The secret of life appeared to be firmly seated in the minds of at least 40 percent of those in attendance that tobacco, alcohol, heavy fats and little exercise are the keys to happiness.

…What then is the problem? Denial? The high pressure life styles of these life saving physicians, cultural considerations, a laissez faire attitude toward the Boogie Man or just another version of man???s on going stupidity and ignorance toward what appears to be very clear evidence?

I just don’t get it. I suppose that physicians are human, after all. The behavior described in this post may contribute to the low ratings many healthcare providers get for coaching patients to rid themselves of unhealthy behaviors. Nick’s experience is dismaying, especially after two experiences this week—one personal and one professional—that emphasized providers’ commitment to reducing the effects of heart disease.

First, my 73-year-old mother, who had a quadruple bypass five years ago, was hospitalized with chest pains. A catheritization determined that some additional blockage was the cause of her pain, and they are treating this with medicationfor now. Upon leaving her hospital room, I noticed a bulletin board devoted to discharge instructions. Every flyer on the board emphasized the danger of smoking for heart patients.

Secondly, in my professional life here, I am editing a book on Successful Management of Heart Failure Patients: Multidisciplinary Approach to Reducing CHF Readmissions, which chronicles the effort behind the dedicated heart failure unit at Hackensack University Medical Center in New Jersey, an exercise in pursuing perfect care. I am impressed by the dedication of the two cardiac nurses who head this effort. They have done similar work at other hospitals and are doing a phenomenal job at reducing hospital readmissions among this population.

When surrounded by evidence of the risk associated with these behaviors, wouldn’t providers make the obvious behavior choices? Or do they, like many adolescents, believe they are invincible?

Filed under: — @ 2007-10-25 00:00:00
2007-10-24 00:00:00

Electronic Medical Records: The Promise of Voice Recognition Software

A post on the The MedFriendly Blog emphasizes the importance of proofreading transcribed medical records:

The medical record is a crucial piece of information that when it is not proofread and is left with either incomplete or incorrect information, it diminishes the ability of other providers to fully understand the case. This is poor practice.


Dr. Joel DiamondThese observations by Dr. Dominic Carone reminded me of comments from Dr. Joel Diamond, who discussed the promise of voice recognition software during our recent Healthcare Trends and Forecasts in 2008 webinar. Dr. Diamond is chief medical officer, North America for dbMotion, Inc., a provider of medical informatics and an active partner at Diamond, Fera and Associates, a family medicine practice:

Anybody that is looking at EMRs will ask about voice recognition. A year ago or earlier, if you had asked me about voice recognition, I would have said that I was totally against it because voice recognition to date is really the same as transcription or writing. It amounts to free text in the medical record, and the problem with free text is that it???s worthless. There???s no way of getting that data out of the record when it???s free text; if it???s structured data, then we can do something with it ??? we could learn, do research, perform process improvement. One of the reasons I???ve come full circle on this is that free text allows physicians to work faster. Because of that, there is a higher adoption rate of EMRs. We???re in a race, and that is why we have to get as many doctors using EMRs as possible. If voice recognition allows us to do that, then that would be great.

Keep in mind, however, that as we look at voice recognition, we don???t want to sacrifice the future by trying to save some time today. If we can get physicians to use this technology in a meaningful way and get them to focus on the present illness or the assessment plan, then we could do well. Doctors ask me what to extract from these EMRs. There are several examples that I use. I know doctors that have an EMR, but tend to use free text or voice recognition to record their medicine lists or their problem lists.

A few years ago when the medication Vioxx ?? was recalled, it was the first time in my professional life that I just went to the computer and typed in the word ???Vioxx??? and got a printout with the name of every single patient for whom I had prescribed the drug. In fact, I saw several patients for whom I had never written a single prescription for Vioxx but had just handed out samples to those patients. This was an incredibly useful tool for notifying those patients and informing them of what had happened. Without an EMR, I probably would have waited until they came to see me because there would be no way of auditing those charts. Similarly, had I free-texted those charts, I probably wouldn???t have been able to get at it as well.

Filed under: — @ 2007-10-24 00:00:00
2007-10-24 00:00:00

Weight Gain Increases Risk of Breast Cancer

According to a recent study featured in U.S. News & World Report, women who gain weight after the age of 18 increase their risk of breast cancer, compared to those who maintain a stable weight.

Women who were at or below a normal weight at age 18 but were overweight or obese at ages 35 and 50 had 1.4 times the risk of developing breast cancer, compared with women who had maintained a normal weight. Women who subsequently lost weight had the same cancer risk as those who maintained a stable weight.

Filed under: — @ 2007-10-24 00:00:00
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