Category: Recommendations

Hurricanes & Our Health

As Hurricane Florence approaches, there are many worries on the minds of those who live in its path. Residents in the South Eastern United States are anxious about the wellbeing of their property, belongings, surrounding environment and loved ones. Along with these concerns, it’s important to be weary of how a destructive hurricane can also have serious implications on medicine and public health. Considering these risks before the onset of the storm could eliminate smaller preventable problems and render larger issues easier to address.

Before the hurricane arrives, it’s advised that any medical prescriptions be refilled and retrieved promptly. Resultant power outages and infrastructural damages may limit a pharmacy’s ability to operate and supply their patients’ needs. If you know you are at risk of power outages, it’s important to stock up on non-perishable foods, water, and anything else necessary for your individual health. Along with this, following proper safety precautions to protect your home from water and wind damage can also prevent a number of storm-related injuries.

In North Carolina, the magnitude of rain expected to come with Hurricane Florence is especially worrisome. Excessive rainfall could cause flooding in farmland which contain animal manure lagoons. Such lagoons could overflow, spreading waste and increasing risk of disease transmission. Additionally, North Carolina is home to a number of dangerous coal-ash ponds. If these sites flood, it could unleash this waste into the surrounding environment. Coal-ash is toxic, and if released from ponds could contaminate people’s public drinking water.

 

https://www.wltx.com/article/news/local/make-preparations-for-your-health-ahead-of-hurricane-florence/101-592900265

 

http://time.com/5392478/hurricane-florence-risks-sludge-manure/

 

https://www.nationalgeographic.com/environment/natural-disasters/hurricane-safety-tips/

 

 

 

Book Review: The Medical Library Association Guide to Data Management for Librarians

Federer, L. (Ed.). (2016). The Medical Library Association Guide to Data Management for Librarians. Rowman & Littlefield.

The Medical Library Association Guide to Data Management for Librarians (published by Rowman & Littlefield; September 2016; $65 paperback or $125 hardback) attempts to prepare librarians to meet the growing demands for data management assistance and instruction with chapters from librarians across the spectrum of libraries, including medical libraries, academic libraries, government libraries, and special libraries. The growing desire for data management services makes this edited volume particularly timely.

Lisa Federer, who edited the volume, is a well-known research data informationist at the National Institutes of Health (NIH) Library, holding an MLIS from UCLA, an MA in English, and graduate certificates in data visualization and data science. The other contributors are similarly well-credentialed, representing individuals with PhDs or library science degrees, researchers from different areas, and data scientists and librarians.

The volume is separated into three parts: Data Management: Theory and Foundations; Data Management across the Research Data Life Cycle; and Data Management in Practice. The final product provides a useful and expansive discussion of data management, making this an important book for librarians who are just getting their feet wet in the field, which is likely the case for many librarians who don’t have experience in data management but who are being asked to provide these services. However, this broad brush also means that some depth is lost. The chapters are generally short with about ten or fewer pages of text, which provides a useful and brief introduction for librarians to start thinking about data services—further facilitated by the “pearls” providing at the end of each chapter, reflecting key points. They also generally provide recommended readings and the bibliographies are extensive sources for possible future reading.

Nonetheless, as seems to be the case in many edited volumes, the usefulness and rigor of chapters is fairly variable. Several chapters fall too far down the theory rabbit hole. The chapters are already fairly short, which becomes more of an issue when half of the chapter is taken up in regurgitating theory. For example, the chapter “Data 101” spends considerable ink discussing adult learning theory but then only provides short paragraphs on interesting topics such as data information literacy. The chapter “Library Infrastructures for Scholarship at Scale” buries itself in theory to make the simplistic claim that different disciplines have different data needs.

On the other hand, many of the chapters provide incredibly useful insights, such as the chapter on Data Information Literacy (DIL), which expands on the lacking definition in “Data 101” to develop the topic, and the chapter on data visualization which provides practical advice for providing data visualization services in the library. Further, the final section on Data Management in Practice, provides important context in the academic library, the undergraduate population, the medical center, the lab, and the hospital, providing useful examples of the variance in implementation throughout different communities and environments.

Deaths from Synthetic Opioids outnumbered those from Prescription Opioids for the First Time in 2016

In a research letter published by the Journal of the American Medical Association, researchers noted that overdose deaths from synthetic opioids, such as fentanyl, surpassed prescription opioids and heroin as the leading cause of overdose deaths in the United States. There has been an increasing trend of fentanyl and other synthetic opioids being found in illicit supplies of heroin, cocaine, methamphetamine, and other drugs. Utilizing data from the National Vital Statistics based on death certificates including information on all deaths in the US, Jones et al were able to examine overdose related deaths. While there has been an increasing trend in the number of opioid overdose deaths, previously these have been primarily related to prescription opioids. Of the 42,249 opioid related overdose deaths that occurred in 2016, Jones et al found that 19,413 involved synthetic opioids, while 17,087 involved prescription opioids, and another 15,469 involved heroin. Of the 19,413 deaths related to synthetic opioids, the majority (79.7%) involved another drug or alcohol, with the most common being another opioid. There are some limitations regarding the completeness of data, and the authors suggested that the increase may be due to an increase in testing for synthetic opioids. Still, this data paints a startling picture of the state of the opioid epidemic, showcasing a need to move beyond prescribing habits in order to reduce overdose deaths.

 

Sources –

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA 2018;319(17):1819-1821. doi:10.1001/jama.2018.2844.

Health Orientations for New Patients

Orientations for new patients are one technique for setting the stage for positive patient experiences with a new clinic, especially for those who are unfamiliar with the healthcare system. These orientations have been shown to be successful in reducing stress for cancer patients, preparing patients for beginning psychotherapy, and reducing no-show appointments in a primary care setting, which improves clinic efficiency.

As the Patient Navigator at a Federally-Qualified Health Center (FQHC) from 2016 to 2017, I was tasked with creating this type of program for immigrant and refugee patients, whose cultural differences and unfamiliarity with the American healthcare system often serve as a barrier to successful clinic interactions. From speaking to clinic providers on various levels, as well as patients from refugee communities, I established the following priorities for the orientation curriculum:

  1. Prescription refill process
  2. Calls to our clinic – what to expect, how to request an interpreter, how to speak to a nurse
  3. Difference between preventative and acute care, and emergencies, and benefits of seeing your provider at least once a year
  4. How to make and cancel appointments, and why no-shows reduce our efficiency
  5. Different occupations that clinic staff hold, and how staff can connect patients to other resources they may need
  6. General information about the American healthcare system that may be confusing, such as insurance coverage and social services application processes
  7. Patient rights and responsibilities
  8. Interactions with providers – letting patients know that they can and should ask questions when confused, or when misunderstood by an interpreter or provider

I quickly found that creating a curriculum like this presents several challenges. For example, “refugees and immigrants” is a broad group of people, representing those from wildly different education levels and familiarity with Western healthcare systems. Many times, it was impossible to know patients’ backgrounds before meeting with them to discuss our clinic. I had to be careful to be informational without seeming patronizing, while basing communication strategy on the perceived level of understanding of the patient, which can also be influenced by cultural norms.

Patient orientations have a great potential to reduce patient stress, improve understanding of clinic operations, and give the power back to the patient when it comes to their own health. However, cultural differences must be given weight when developing this type of program. Using community leaders or liaisons for curriculum development and delivery may be a way to bridge that gap.

Sources:

https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1099-1611(199805/06)7:3%3C207::AID-PON304%3E3.0.CO;2-T

https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-4679(198311)39:6%3C872::AID-JCLP2270390610%3E3.0.CO;2-X

https://onlinelibrary.wiley.com/doi/full/10.1046/j.1525-1497.2000.00201.x

https://www.sciencedirect.com/science/article/pii/S0277953610003199

RICE your knees…How to care for a sports injury

As the weather is starting to warm up, many of us are thinking about getting outside and getting active.  With this increased movement, it’s no wonder that a search of google trends from 2004-2016 showed that April of each year is the most common month for searches related to knee injuries (1).

The R.I.C.E. method is one of the most commonly recommended ways to treat sports injuries to joints and muscles.  It has even received a stamp of approval from the American Orthopaedic Foot and Ankle Society (2).  This method has 4 steps:

 

R is for Rest  Try to avoid using the injured area and putting weight on it for 24-48 hours if possible (3)

I is for Ice Every 4 hours, put rice on the injury for 20 minutes at a time (3).  For comfort, you can place a thin cloth between the ice bag and your skin (2).

C is for Compression Wrap the area with a bandage, like an ACE wrap, in order to gently compress the injured area.  This will help control swelling.  Just be careful not to wrap it too tight and cut of your blood flow (3).

E is for Elevation This is your opportunity to sit and prop your feet (or other injured spot) up.  Use pillows or other comfortable items to try to keep the area above the level of your heart.  This can reduce swelling (3).

 

Once you start feeling better, you can SLOWLY and GENTLY start using the injured area again.  Also, if you’re not sure how bad you’ve hurt yourself, be sure to get it checked out by a medical provider.

 

References

  1. Using Google Trends To Assess For Seasonal Variation In Knee Injuries. Dewan, Varun and Sur, Hartej. February 21, 2018, Journal of Arthroscopy and Joint Surgery.
  2. American Academy of Orthopaedic Surgeons. How to Care for a Sprained Ankle. American Orhopaedic Foot and Ankle Society. [Online] http://www.aofas.org/footcaremd/how-to/foot-injury/Pages/How%20to%20Care%20for%20a%20Sprained%20Ankle.aspx.
  3. Sports Medicine at the University of Pennsylvania Medical Center. How to Use the R.I.C.E Method for Treating Injuries. UPMC Health Beat. [Online] August 27, 2014. https://share.upmc.com/2014/08/rice-method-for-treating-injury/.

 

 

Welcome to Allergy Season

Right now, there is a yellow haze covering the state of North Carolina.  Noses are running, eyes are watering, and there are sneezes galore.  Welcome to allergy season.  Five North Carolina cities made the Asthma and Allergy Foundation’s list of the worst 100 U.S. cities for allergy sufferers (1).

 

If you’re feeling the effects of seasonal allergies, there are some things you can do in order to keep breathing clearly.

  1. Try to avoid tracking pollen into your home. This includes taking off your shoes when you come inside and wiping down pets when they come in.
  2. Dust and vacuum your home. Though the cleaning may stir up dust and make allergies worse in the short term, getting rid of allergens in your home can make a big difference overall.
  3. Netti pots are something else you can try if you’re not wanting to take medication. These allow you to flush your nasal passages with saline in order to wash the allergens out.
  4. Try an antihistamine. There are many over the counter antihistamines that can help decrease allergy symptoms.  Common non-drowsy options include loratadine and fexofenadine.  Diphenhydramine is another option, but it does make most people sleepy.  Cetirizine is one other over the counter antihistamine that make some people sleepy.
  5. Some people also benefit from an over the counter nasal steroid like fluticasone. It often takes 2-3 days of use before you see benefits, so it may not help much in the short term.  However, it can decrease overall nasal allergy symptoms.

As always, be sure to read the directions on over the counter medications, and check with your doctor if you have any other medical conditions before you try any new medicine.

 

Work Cited

  1. Asthma and Allergy Foundation. Spring Allergy Capitals 2016. Asthma and Allergy Foundation. [Online] 2016. http://www.aafa.org/media/Spring-Allergy-Capitals-2016-Rankings.pdf.

Crystal Bentley is a registered nurse with 2 years of dedicated allergy experience.

 

 

 

 

 

 

Headache Me This

What causes headaches? I find myself Googling this at least once every few months when a particularly nasty or persistent headache of my own decides to show up. And I think it’s because I never really get a satisfying explanation from my searches, likely due to the fact that there are hundreds of headache types and only 10% have a known cause. Let’s focus on primary headaches, ones not caused by an underlying condition.

There are a lot of culprits for primary headaches. Nerves/blood vessels/tissue around the skull, muscles of the head/neck, and chemical changes within the brain can spur on that pain. So what triggers these physical pain signalers? It is probably no surprise that stress or alcohol are included. Skipping meals, poor posture (thanks, laptops), disrupted sleep patterns, and changing weather as well.

Some of these triggers are outside of our control like the weather, but there are measures we can take for prevention. Even though yes, easier said than done, try to avoid known stressors where possible. Eat low-processed meals at regular intervals and prioritize consistent sleep habits. Deficiencies in magnesium may play a role so eat some avocado and nuts. And when all else fails, put the screens away, take a warm shower, apply a soothing compress to the neck, and go the heck to sleep. Admittedly just writing about all the things that I should be doing right now has not made my headache go away, so off to self-care I go.

Source: https://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800

Just Trust Me (Part IV)

In the past few weeks, I have illustrated how trust (or lack thereof) shapes the relationship between individuals and healthcare, and how mistrust is historically justified. In this last segment, I want to talk about potential solutions from a social justice standpoint.

Trust is often cited in public health from the angle of paternalism, something that public health is often associated with. When we think of optimal paternalism – using scientific knowledge to influence the health decisions of the general public – we ask ourselves: are we abusing trust, or using it for good?

Public health, while sometimes paternalistic, already stresses to its students the importance of working with oppressed communities as equals to identify and solve problems. Medicine needs to catch up. Many medical students already participate in racial and cultural training, but they need to be trained from a structural angle – to gain an understanding of oppression and policy – too.

We need to support training for healthcare providers that doesn’t shy away from the tough stuff. Hands-on learning, such as tactful poverty simulations, can help. This will allow them to understand things like how the cycle of poverty makes some patients less talkative with authority figures (such as doctors) than others. We need to support minority students in medicine, so that patients can see representation of themselves and feel understood. We need to provide incentives for students to stay in their own communities for residencies. Of course, broad class mobility-enabling policy is the ultimate solution.

Many times, our work seeks to increase trust, but that puts the burden on the patient instead of addressing the reasons behind mistrust. Teaching trust in and of itself is a paternalistic objective: we should instead focus on deserving it.

Sources:

http://commonhealth.legacy.wbur.org/2012/02/minority-doctors-diversity

https://campus.fsu.edu/bbcswebdav/institution/academic/social_sciences/sociology/Reading%20Lists/Social%20Psych%20Prelim%20Readings/IV.%20Structures%20and%20Inequalities/2002%20Lareau%20-%20Invisible%20Inequality.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2156058/

Crash or DASH- choosing the right diet

February is heart month.  We’re often told that in order to keep our hearts healthy we should maintain a healthy weight.  Many people try to do this by dieting, but do diets really make us healthier?

New research has emerged that meal replacement crash diets (typically consuming only 600 to 800 calories each day) can temporarily worsen heart function [1].  This means that if you have heart problems, these diets could actually make your health worse instead of better.  If you’re looking for a healthy way to lose weight, you may want to check out the National Heart, Lung, and Blood institute’s DASH diet.  In January, U.S. News and World Report ranked the DASH diet as the best overall diet plan for the eighth year in a row [2].  The DASH diet also claimed first place in the healthy eating and heart disease prevention categories.

If you feel like dieting, stop and ask yourself why you’re doing it.  If you’re trying to get your heart in shape, you may want to rethink that overly restrictive diet.

 

References

[1]   European Society of Cardiology (ESC). “Crash diets can cause transient deterioration in heart function.” ScienceDaily. ScienceDaily, 2 February 2018. www.sciencedaily.com/releases/2018/02/180202123836.htm

[2]  National Heart, Lung, and Blood Institute. (2018, January 3). DASH ranked Best Diet Overall for eighth year in a row by U.S. News and World Report. Retrieved from National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/news/2018/dash-ranked-best-diet-overall-eighth-year-row-us-news-and-world-report

 

Bare cupboards and full bellies: Food Purchasing patterns change over time

Food purchasing patterns are a pretty good indicator of what people eat on a regular basis.  If you purchase healthy food, it’s presumed that you eat healthy food.  Recently, research from the United States Department of Agriculture revealed that food purchasing habits are changing over time. The grocery carts of younger food shoppers’ look vastly different than previous generations’. According to one report, they may even be empty.

Millennials, anyone born between 1981 and 1996, tend to purchase more premade meals and eat away from home more than older generations [1].  Restaurants have become more popular among youth and time spent preparing meals at home is decreasing.  Overall, older generations consume food in restaurants and bars about 70 percent less than millennials. Millennials spend a large portion of their income on pasta, sugar/sweets, and prepared foods, and as they acquire more disposable income they purchase more vegetables to prepare at home.  These findings could indicate that although millennials are more likely to eat out as they move farther into their careers and acquire more household income, they could gravitate toward purchasing more fruits and vegetables.

While millennials gravitate toward healthier foods, we should pay attention to nutritious food options and the food available to lower-income millennials.  Foods prepared by restaurants and bars and premade foods are often high in sodium and sugar.  Fast food restaurants are notorious for these types of foods (think cheeseburgers, deep-fried French fries, milkshakes, and slushies) and found more often in lower-income communities.  These foods put people at risk for hypertension, heart disease, and diabetes.

Nutritionists could encourage eating and cooking at home more often because hello it’s cheaper, made just the way you like, and you know what’s going into your meals that’s not always feasible with busy schedules.  We can, however, consider the following tips for healthier meals away from home:

  1. Choose less processed foods. Foods that are less processed often have less sodium and sugar added. If you can choose between apple slices and an apple turnover, the apple is always a better option. Less sugar. More fiber.
  2. The more fruits and vegetables the better. Fruits and vegetables add a variety of nutrients, vitamins, and minerals to a diet. They also provide fiber, fill you up without so many calories and help you hydrate.
  3. Ask for nutrition facts. Nutrition labels which include sodium, calories, sugar, vitamins, etc let you know exactly what’s in your food.  If you need to cut back on sugar intake, you’ll know exactly how much you are getting.

References:

[1] https://www.ers.usda.gov/webdocs/publications/86401/eib-186.pdf?v=43097