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Researchers at the University of Missouri Sinclair School of Nursing noted that nurse practitioners (NPs) with more authority reduced hospitalization of skilled nursing facility (SNF) residents. The report notes that, "States that allow NPs to practice to the fullest extent of their training without a supervising physician have lower hospitalization rates across a range of groups in addition to SNF residents. These groups include inpatient rehabilitation patients and dual-eligible Medicare and Medicaid beneficiaries."

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The American Association of Nurse Practitioners (AANP) tracks state laws for NPs, and whether NPs have full, reduced, or restricted scope of practice. As of January 2013, NPs were allowed full practice in 17 states. Sinclair researchers linked the AANP information with hospitalization data from various sources, including a 2013 government report that ranked states according to their nursing home hospitalization rates.


Though a linkage exists, the findings alone do not prove that allowing full scope of practice causes SNF hospitalization rates to improve. It can be noted, however, that previous research confirms that full scope of practice is associated with fewer hospitalizations, lower healthcare costs, and better outcomes. Researchers conclude that the results of this study should encourage nursing groups and other stakeholders to press for full scope of practice laws.- Accessed 10/17/2014.



A new device has been approved by the U.S. Food and Drug Administration. The HealthPatch(TM) MD is a wearable biosensor that can help healthcare providers make more accurate diagnoses and monitor a patient during treatment for signs of complications or new symptoms. "The technology is a Bandaid(R)-like patch patients wear on their chest 24-hours a day called HealthPatch(R) MD. Data collected from the sensors are sent to a relay or smartphone/tablet via Bluetooth and are stored in a Health Insurance Portability and Accountability Act (HIPPA)-compliant cloud. The provider can analyze the stream of data to develop a more accurate diagnosis and treatment plan." HealthPatch(TM) MD helps healthcare providers know if a patient needs to be seen; and, if emergency assistance is needed, the device sends an alert.


HealthPatch(TM) MD weighs just 10 g and is only 6 mm (0.24 in.) thick. Its small size makes it comfortable and less cumbersome than conventional monitoring equipment. The data can be customized for individual patients. "Encapsulated within the HealthPatch(TM) MD are cutting-edge sensor and electronics technologies. Combined with Vital Connect's proprietary algorithms, these technologies enable the device to provide clinical-grade measurements of the following core health metrics: single lead electrocardiogram (ECG); heart rate; heart rate variability; respiratory rate; skin temperature; posture, including fall detection and severity; and steps taken."


In 2010, there were 129.8 million emergency department visits. Of those, 17.2 million resulted in an admission. In discharge or nonadmittance situations, healthcare professionals can use the device for follow-up treatment. In chronic care situations, it enables home healthcare professionals to monitor patients 24/7.


Vital Connect CEO, Nersi Nazari, said, "Healthcare professionals will soon be able to provide unparalleled service to their home care patients because the HealthPatch(TM) MD will allow them to know if a patient's heart rate or respiratory rate, for example, crosses a predetermined threshold and react accordingly. And, bulky machines that interfere with daily activities will no longer inhibit a patient's normal routine. Monitoring will occur seamlessly and will not interfere with a patient's routine at home, work, or leisure. Patients outside of the healthcare setting will have confidence that their condition is being monitored by a healthcare professional."


For more information, visit Connect News Release, August 11, 2014.



Changing menstrual periods, periods lasting longer than 10 days, and irregular periods are all part of the normal process as a women nears menopause, a process that can take 2 to 10 years. During this time, extended and heavy menstrual bleeding is common. The process generally begins after age 45.


"For most women in their 30s, menstrual periods are highly predictable. With the onset of the menopausal transition in their 40s, women's menstrual periods can change dramatically. These dramatic changes can be disconcerting and often provoke questions about whether something is wrong," study author Sioban Harlow, a University of Michigan professor of epidemiology, noted.


For study purposes, 1,300 American women, ages 42 to 52 were questioned. It was noted that 91% had experienced bleeding for 10 or more days; spotting for 6 days or more was reported for 88%; and more than 75% had heavy bleeding for 3 or more days during menopause. Women of White, African American, Chinese, and Japanese descent from Michigan, Los Angeles, and northern California were studied. Earlier studies had been mostly limited to White women. Although more information is needed before study results could be used to change patient care, Dr. John Randolph, Jr. said, "We think this paper will be helpful to professionals, both clinical and investigational, as it describes in much more quantitative terms the range of bleeding patterns women may normally experience through the menopausal transition."


Randolph suggests that primary care providers take "watchful waiting" as an acceptable option when women patients report changes in bleeding patterns.-University of Michigan, News Release, April 15, 2014.



It is no secret that being obese is a health risk. However, the risk of being underweight is linked to a higher risk of death than being obese. A Canadian review of research on the relationship between weight and risk of premature death finds that having a body mass index (BMI) in the underweight range is linked to an even higher risk of death than having a BMI in the obese range. A study, led by Dr. Joel Ray, a physician-researcher at St. Michael's Hospital, University of Toronto, found that for both adults and fetuses, being underweight is linked to higher risk of death from any cause. Researchers reviewed data from 51 studies that examined the link between BMI and deaths from any cause, and also data on newborn weight and stillbirths in Ontario, Canada.


"BMI is a measure of body fat based on weight and height that applies to adult men and women. It is commonly used to classify underweight, overweight, and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). According to the World Health Organization BMI classification, a BMI under 18.50 is classified as underweight; 18.50 to 24.99 is classed as normal; 25.00 to 29.99 is classed as overweight; and a BMI over 30.00 is classed as obese." Those with a BMI in the underweight category had a 1.8 times higher risk of dying from any cause than adults with a BMI classed as normal. Those with a BMI in the obese range had a 1.2 times higher risk than that of people with normal BMI. Those with a BMI in the severely obese category had a 1.3 times higher risk than those in the normal range.


Healthcare workers will realize that a healthy balance is needed regarding BMI, as it measures body fat and muscle mass. A healthy person is one with a reasonable amount of body fat and also sufficient bone and muscle. Both are needed for good health.- Accessed 10/14/2014.



Many families use complementary and alternative medical (CAM) treatments for young children with autism and other developmental delays, according to researchers at the UC Davis MIND Institute. Parents with higher levels of education and income seek alternate approaches more frequently. Currently, there is no medical treatment approved by the Food and Drug Administration for autism or developmental delays.


UC Davis studied young children using data from the Childhood Autism Risk from Genetics and the Environment (CHARGE). Nearly 500 children ages 2 to 5 years participated. In this group, 453 were diagnosed with autism, and 125 were diagnosed with developmental delay.


Alternative approaches include:


* Mind-body medicine such as prayer or meditation


* Probiotics


* Homeopathic remedies


* Special diets


* Antifungal medications



More invasive and risky therapies include:


* B-12 injections


* Intravenous immunoglobulin or chelation therapy



The study found that:


* CAM use was more common for children with autism (40%) than other types of intellectual disabilities (30%)


* 7% of children with autism were on a casein-free/gluten-free diet, especially children with gastrointestinal complaints


* Most families were choosing low-risk CAM therapies


* 9% of the children were on alternate treatments that the study classified as potentially not safe, unproven, or invasive such as chelation therapies, antifungal medications, and vitamin B-12 injections



"Our study suggests pediatricians and other providers need to ask about CAM use in the context of providing care for children with autism and other developmental disorders, and take a more active role in helping families make decisions about treatment options based on available information related to potential benefits and risks," said Roger Scott Akins, lead author.


"These findings emphasize the enormous and urgent need for effective treatments and for rigorous research that can identify them and verify their effectiveness and safety," Irva Hertz-Picciotto, professor of public health sciences and principal investigator for the CHARGE study, said. "Of course it is reasonable for parents to keep searching for ways to help their children, when there are few effective treatments, and none that can help every child."- Accessed 10/22/2014.



"Nehemiah had something that went beyond the authority of his position. Nehemiah had what we refer to as moral authority. It goes beyond position. Moral authority, just to throw out a simple definition: it's simply the credibility, and that's the key word, it's the credibility you earn by walking your talk. It's the credibility you earn when people look at you and say,


"I may not believe what he believes, but there is no doubt in my mind that he believes what he says he believes. I may not agree with the way he sees the world, but there is no doubt in my mind that there is consistency between the way he acts and views the world. We may not believe everything alike; we may have differences; but I tell you what, she is sincere. She speaks the truth, and is absolutely committed to what she says. There is no hidden motive, no hidden agenda, no duplicity, and no separation between what they say and what they do. And when you are eyeball to eyeball, when you are face to face with somebody who has earned and has moral authority it is a powerful thing. Because their moral authority is more convincing than any position of authority that someone might grant them."


Another way of thinking about it is this: that your position, whatever your position is-as a father, as a business leader, as the president of an association-gives you a measure of authority. But your moral authority is what gives you credibility and influence. Now, the phrase 'moral authority' isn't in the Bible, but there is a biblical phrase that communicates the same thing. In the Bible, we find this phrase: beyond reproach. Beyond reproach. That is, a person, that as we look deep into his life, we find there is extraordinary consistency between what he says, what he claims to believe, what he claims to be here for, what he actually says, and what he is actually all about."-Excerpted from The Credibility Factor by Andy Stanley, Accessed 10/17/2014.


-PulseBeats compiled by Cathy Walker, JCN Associate Editor