RedScrubs
The Resource for Medical Professionals

Food stamp participation does cause weight gain and contributes to overweight and obesity.
However, this statement needs clarification. Results from reviewed studies indicate that for most participants in the Food Stamp Program – children, non-elderly men and the elderly – use of food stamp benefits does not result in an increase in the Body Mass Index (BMI). Furthermore, there is no indication that participation will increase the predisposition to obesity in these categories of participants.

Will healthcare organizations raise the bar on transparency and start reporting adverse events in a public forum as they do costs, and other quality of care indicators?

Transparency, a word with several connotations: free from pretense or deceit, readily understood, characterized by visibility or accessibility of information especially concerning business practices. When healthcare organizations discuss the notion of transparency the later two descriptions exemplify the concept. Organizational transparency in healthcare has typically taken the form of selected quality of care indicators.

A recent article published in the British Medical Journal (BMJ) is disputing the NICE guidelines established by the National Institute for Health and Clinical Excellence for women who are hyperglycemic during preconception to the postnatal period. NICE essentially states that screening for gestational diabetes should be by risk factor alone. The article acknowledges that NICE is aware that this approach has poor sensitivity and specificity compared with universal administration of the oral glucose tolerance test. However, in the guidelines that NICE expresses, this method misses nearly half of the women with gestational diabetes, particularly those with mild gestational diabetes.

I feel somewhat compelled to pen a verse or two regarding the linked article in the New York Times today regarding the continued pandemic this country has with obesity. Most of what we see in the media these days regarding obesity are warnings about the hazards of over indulgence. Heart disease, stroke, high blood pressure, loads of orthopedic problems color the pages of several health sections of any local paper.

More and more you will find on the doctor’s admission papers a place to put your vitamins, botanicals and other supplements that you may be taking over the counter. Dietary supplements are not subjected to the safety trials and pre-marketing approval process that is required of prescription drugs. The resulting caveat is a black hole in the knowledge base between dietary supplements and drug interactions, especially among patients with chronic disease who may be on multiple supplements.

Nursing plays an integral role in the overall care of any patient whether it is in an acute care setting or sub-acute facility. There are several interventions that are coordinated and implemented by nurses based on the clinical needs of a patient. Oral hygiene for intubated patients, elevating the head of a patient’s bed, and repositioning a patient to help thwart off the development of pressure sores are basic routine interventions. These seemingly rudimentary interventions as most nurses know are vitally important in improving the health of a patient and more importantly reducing the likelihood of an iatrogenic complication from occurring.

In a recent article published in Aliment Pharmacol Ther, Feb, 2008, it was brought to the attention of the healthcare community that patients on proton pump inhibitors such as Omeprazole may suffer from B12 deficiency despite normal serum levels of B12. This underestimates the prevalence of the deficiency and leaves many patients untreated.

The American Heart Association (AHA) released a scientific position paper in the Journal Circulation, in March, 2008 on the role of high blood sugars and Acute Coronary Syndrome (ACS). Hyperglycemia, although frequently documented in ACS patients, remains largely unappreciated as a risk factor and is undertreated in both the acute care and outpatient care settings. The researchers believe this is due largely in part to a lack of evidence-based research.

Scott MacStravic over at World Healthcare Blog authored a great piece the other day regarding the physician shortage and the use of mid-level providers as a means of improving access to care. I wanted to take an opportunity to echo Scott’s comments with this subject.