December 05 – International Volunteer Day

December 05 marks International Volunteer Day – The Young Active Citizens would like to pay tribute to all young people across the country, who have made it their extramural activity to roll their sleeves and dedicate their precious time to partake in community-uplifting projects. Let’s keep this spirit of volunteerism flaring and continue to do our best in becoming advocates for change in our respective communities.

Below is an excerpt  from the lyrics of ‘If You’re Out There’ By Grammy Award winning artist, John Legend:

“If  you hear this message
Wherever you stand
I’m calling every woman
Calling ever man

“We’re the generation
We can’t afford to wait
The future started yesterday
And we’re already late.”

December 10 – International Human Rights Day

 International Human Rights Day This year marks the 16th anniversary of the Universal Declaration for Human Rights, also known as International Human Rights Day. This year, the theme for this day will focus on non-discrimination. As Young Active Citizens, let’s all stand together in the fight against any form of discrimination, be it in our schools, workplace, congregations and communities.

Remember: “All human beings are born free and equal in dignity and rights”

December  16 & 18 – Day of Reconciliation & International Migrants Day

We are planning to host two soccer tournaments in Cape Town and Johannesburg to commemorate the Day of Reconciliation and the International Migrant Day.

**We will post more details in due course.

IOM urges more rest for residents in push to improve patient safety.

Recommendations call for cutting back consecutive hours without sleep and providing more off days.

By Brian Hedger, amednews staff.

Posted Dec. 22, 2008.

Five years ago, the Accreditation Council for Graduate Medical Education implemented an 80-hour-workweek limit for residents — an effort to ease resident fatigue and boost patient safety. But a new Institute of Medicine report says residents are still too tired. The 324-page report, released in December, calls for keeping the 80-hour standard but recommends changes such as limiting shifts with no sleep period to 16 hours, increasing time off per month and restricting moonlighting hours. The IOM recommendations also include increasing supervision by experienced physicians, limiting patient loads, scheduling overlaps to make handoffs more seamless and providing transportation home for fatigued residents.

“Our overarching conclusion is that the science clearly shows that fatigue increases the chances for errors, and residents often work long hours without rest and regular time off,” said Michael M.E. Johns, MD, the report’s chair and chancellor of Emory University in Atlanta. The report estimates it will cost $1.7 billion a year to pay for the recommendations, which will require added work for attending physicians, plus hiring more residents and other health care staffers. It also says stakeholders in residency funding should share the cost. The American Medical Association supports keeping the 80-hour limit and spreading the costs of changes among payers. “The AMA is deeply concerned about working conditions for resident physicians and the role that resident fatigue may play in both patient safety and the welfare of physicians in training,” AMA Board of Trustees member Samantha L. Rosman, MD, said in a statement. The Assn. of American Medical Colleges said duty hours ought to be examined, but it stopped short of agreeing that shifts need to be cut. The American Assn. of Neurological Surgeons was more critical, saying further restrictions in duty hours “will jeopardize quality resident training and patient safety.”

The ACGME will host a March 2009 conference with international leaders in graduate medical education to review the IOM report and discuss potential changes to duty-hour standards. Requiring sleep breaks Under the IOM recommendations, residents would still be able to log 30-hour shifts, but after working 16 hours they would be required to get five hours of uninterrupted sleep between 10 p.m. and 8 a.m. They then could return to work for educational or transitional activities but not admit new patients. The report noted that duty-hour limits frequently are violated and underreported. In 2006-2007, the ACGME found that 8.8% of residency programs were “substantially noncompliant with some aspect of duty-hour limits,” according to the committee of medical and scientific experts who wrote the report. Committee members also said that was likely an “underestimation of noncompliance” due to the risk of disaccreditation for training programs that report all violations. They called for increased policing by the ACGME, Joint Commission and Centers for Medicare & Medicaid Services.

“What they’re asking for is tighter oversight,” said ACGME CEO Thomas J. Nasca, MD. “We have evolved from a situation five years ago where there was absolutely no oversight.” As the report stirs debate in the medical community, one major concern voiced by residents and program directors is how to balance rest with hands-on experience. “You hear the horror stories from people who’ve come before you,” said Amy Schindler, MD, a third-year internal medicine resident at Vanderbilt Medical Center in Tennessee. “I’m glad to not be practicing under those conditions. But those people are now the great doctors that we’re learning from.”

One doctor who logged staggering hours as a resident prior to the 2003 work-hour standards is H. Hunt Batjer, MD, professor and chair of neurological surgery at Northwestern University Feinberg School of Medicine in Chicago. He said unrestricted hours in the past weren’t good for residents or patients, but he also has doubts about the IOM report’s claim that tired residents increase errors. “I would say that you’ve got some subtle, not very scientific evidence that after being awake for a long period of time you’re not as precise with some of your hand-eye coordination and some of your attention skills as when you are fresh,” said Dr. Batjer, who testified before the IOM committee and oversees neurological surgery residents. “Now, does that translate into medical errors? The evidence of that is very, very flimsy, if present at all.” Another area of concern is the patient handoff portion of shifts.

The IOM recommendations could create more handoffs due to the mandated five-hour sleep period on 30-hour shifts. The report says most errors occur during handoffs and additional training to improve transitions is essential to patient safety. A 2007 study in the Archives of Internal Medicine found that 87% of surveyed faculty said continuity of care declined after duty-hour limits were imposed. The study also said that while residents’ well-being improved, faculty workloads increased and their job satisfaction decreased.

At Vanderbilt University School of Medicine, residents have been reluctant to accept some handoff practices, said John Sergent, MD, vice chair for education and the residency program director in the Dept. of Medicine. He said Vanderbilt put in “night float” shifts for internal medicine residents to cover the work-hour limits implemented in 2003. Night floats are residents who relieve regular teams for eight to 12 hours then hand patients back to daytime teams. But Vanderbilt’s internal medicine residents disliked using night floats because of the increased handoffs and lobbied successfully to remove them in 2004.

The practice may return if the IOM recommendations are embraced. “If we go to this new policy, we will have to have some sort of float system,” Dr. Sergent said. “It would definitely change the way we do things. What we have now is working well. Our residents love it. They didn’t want to be at a place with a lot of night floats and handoffs.”

ADDITIONAL INFORMATION: Resident work hours In 2003, the Accreditation Council for Graduate Medical Education set duty hour standards to address resident fatigue. A December Institute of Medicine report concluded that residents still are tired. Here is a look at the ACGME standards and IOM recommendations: 2003 ACGME duty hour limits IOM recommendation Maximum work hours per week 80 hours, averaged over 4 weeks No change Maximum shift length 30 hours (admitting patients up to 24 hours, then 6 more hours for transitional and educational activities) 30 hours (admitting patients up to 16 hours, plus 5-hour sleep period between 10 p.m. and 8 a.m. with remaining hours for transition and educational activities; 16 hours with no protected sleep period Minimum time off between scheduled shifts 10 hours after shift length 10 hours after day shift; 12 hours after night shift; 14 hours after any extended duty period of 30 hours and no return until 6 a.m. of next day Mandatory time off duty 4 days off per month; 1 day (24 hours) off per week, averaged over 4 weeks 5 days off per month; 1 day off per week, no averaging; one 48-hour period off per month.

Source: “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” Institute of Medicine, Dec. 2 Back to top Weblink “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety,” Institute of Medicine, Dec. 2 (www.iom.edu/CMS/3809/48553/60449.aspx)

Below is a press release we received for an important and timely December 3rd event on the future of nursing, including links to attend the forum by live Webcast or to follow it on Twitter.

Initiative Exploring the Future of Nursing Convenes National Forum in Philadelphia

The Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (www.iom.edu/nursing) will hold the second of three national forums on December 3 in Philadelphia. Participants including committee chair Donna Shalala discuss how to improve the delivery of medical treatment for Americans in Community Health, Public Health, Primary Care, and Long-Term Care settings across the country. This forum will look at opportunities in which nurses – who are key front-line providers of care – can play a role in ensuring patients in all settings receive the best possible care.

**A live webcast of the meeting will be available via www.thefutureofnursing.org**

**Follow the forum live on Twitter at http://twitter.com/FutureofNursing**

WHAT: A national forum held by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine focusing on nursing across community and primary care settings.

WHO:             Donna E. Shalala, Chair of the Initiative and President of the University of Miami

Governor Edward G. Rendell

Stephen M. Curtis, Community College of Philadelphia

Mary Selecky, Washington State Department of Health

Tine Hansen-Turton, National Nursing Centers Consortium

Claudia Beverly, University of Arkansas Medical Sciences School of

Nursing

Dawn Bazarko, UnitedHealth Group, Center for the Advancement of Nurses

Sandra Dodge, U.S. Public Health Service

Carol Raphael, Visiting Nurse Service of New York 

WHEN: Thursday, December 3, 2009

12:30 – 5:30 p.m. Eastern Time

WHERE: Community College of Philadelphia

Great Hall, Winnet Student Life Building

1700 Spring Garden Street – M2-5

Philadelphia, PA

RSVP: Amy Levey, (202) 745-5116, alevey@gymr.com

Patient Safety At Ten: Unmistakable Progress, Troubling Gaps / Robert M. Wachter
Health Affairs  v.29,  no. 1 (2010)
doi: 10.1377/hlthaff.2009.0785
http://dx.doi.org/10.1377/hlthaff.2009.0785

ABSTRACT

“December 1, 2009, marks the tenth anniversary of the Institute of Medicine report on medical errors, To Err Is Human, which arguably launched the modern patient-safety movement. Over the past decade, a variety of pressures (such as more robust accreditation standards and increasing error-reporting requirements) have created a stronger business case for hospitals to focus on patient safety. Relatively few health care systems have fully implemented information technology, and we are finally grappling with balancing “no blame” and accountability. The research pipeline is maturing, but funding remains inadequate. Our limited ability to measure progress in safety is a substantial impediment. Overall, I give our safety efforts a grade of B−, a modest improvement since 2004.”

On Dec. 1, 2009, the journal Health Affairs published a paper written by Robert M. Wachter, professor and associate chair of the department of medicine at the University of California-San Francisco that graded the healthcare industry’s progress toward goals enumerated in the 1999 Institute of Medicine reporter “To Err Is Human.”

Wachter gave the industry a B- overall. He also assigned a B- to progress made toward improving doctor-patient and nurse-patient safety. Although the paper references SBAR (Situation, Background, Assessment, Recommendation) nurse-physician communication strategies, it does not address the lastest research underway to improve quality and safety education for nurses.

Dean-emeritus Linda Cronenwett and Associate Dean for Academic Affairs Gwen Sherwood are co-principal investigators on the Quality & Safety Education for Nurses (QSEN) grant funded by the Robert Wood Johnson Foundation. This program, which has received a total of $4.25 million in funding, is designed to prepare nurses who have the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work, based on the six quality and safety competencies. The six competencies are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

Currently, 15 pilot schools have partnered with QSEN to develop and disseminate strategies and best practices for improving nursing education and patient safety.

QSEN will hold a 2010 National Forum, entitled “Climbing from Good to Great,” in Denver on June 2-4. The conference is designed to attract innovators and nurture faculty leaders for the improvement of quality and safety education through exposure to innovations in curricular design and teaching strategies, research related to quality and safety education, and quality improvement or safety studies.

QSEN is currently accepting abstracts. For more information, see the Conference Details page or contact QSEN at qsen@unc.edu.

President Susilo Bambang Yudhoyono plans to issue a decree to combat people smuggling, a top official at the Ministry of Justice and Human Rights has said.

Muchdor, director of investigations and enforcement at the ministry’s Directorate General of Immigration, said the contents of the decree were being drafted by senior officials from 14 related institutions. He said that once finished, the decree would serve as the legal basis for interdepartmental cooperation in combatting people smuggling, which has been on the rise in many parts of the country.

Muchdor was speaking during the launch of a legal reference manual by the International Organization of Migration. The manual is intended to provide practical and technical guidance as well as a legal reference for Indonesian law enforcement officials dealing with the increasing number of illegal migrants traversing Indonesian territory, often on their way to Australia.

According to Adrianus Meliaia, a University of Indonesia expert in transnational crime, “The police always refer to the Criminal Code and immigration officers refer to the Immigration Act when handling people-smuggling cases, yet there are many other laws that they could refer to.”

Meliaia, who headed the project to produce the manual, said a team of researchers comprising the police and immigration, legal and criminal experts had worked since June to create it. The team selected nine Indonesian laws, from which related articles were extracted, to be used to prosecute people smugglers.

The manual contains articles from the Criminal Code, the 1992 Immigration Law, the 2002 Child Protection Law, the 2008 Sea Voyage Law, the 2002 Money Laundering Law, the 2006 Witness and Victim Protection Law and the 2007 Human Trafficking Law.

These are supplemented by the two 2009 laws that ratify the Palermo Convention on transnational organized crime and the UN protocol against the smuggling of migrants.

One of the project’s team members, Anjarina Soko, said the 2008 Sea Voyage Law was included because most people-smuggling activities used sea transportation, often traditional boats, to move illegal migrants in and out of Indonesian waters.

“Traditional boats were not designed to sail into the open seas so officials must be cautious if they find a traditional boat equipped with navigation instruments, as it might be a part of people-smuggling activities,” Anjarina said.

Another team member, Ahmad Khumaidi, said that people smuggling could not yet be categorized as a criminal offense in Indonesia as it was not prosecutable in the absence of a governing law, even though the country has ratified the UN’s anti-people-smuggling protocol.

“It could be prosecutable by amending the Immigration Law or by possibly deliberating a separate bill on people smuggling,” Ahmad said.

The team said there had been 58 recorded cases of illegal migration from August 2008 to July 2009, with 40 of these cases involving the illegal entry of 1,500 people into Indonesia, mostly from Afghanistan.

Since 2004, only 10 cases of illegal migration been prosecuted, resulting in prison terms of less than one year for the guilty parties, despite the five-year sentences demanded by prosecutors.

The reference manual was jointly produced by the IOM mission in Indonesia, the University of Indonesia’s Department of Criminology and the immigration office. It was financed by the Australian Federal Police.

“It was a joint effort from the very start between the University of Indonesia, immigration and the IOM. So it’s been a fruitful collaboration,” said Denis Nihill, the IOM’s mission head in Indonesia.

Although Indonesia has Law No. 21/2007 on the abolition of human trafficking, which usually involves deception and coercion, Steve Cook, former IOM mission head here, noted that it did not have a law specifically dealing with people smuggling, usually undertaken with the consent of the person being smuggled, despite the fact that it was an organized transnational crime.

Cook said the reference manual could be used by officials to more effectively handle the numerous cases of illegal migration in the country.

Source: Jakarta Globe

On 19 and 20 November 2009, the “Regional Conference on Refugee Protection and International Migration in the Americas – Protection Considerations in the Context of Mixed Migration” will take place in San José, Costa Rica. The conference, which has been made possible through funding provided by the European Commission and the US State Department’ Bureau on Population, Refugees and Migration, is convened jointly by the United Nations High Commissioner for Refugees (UNHCR), the International Organisation for Migration (IOM) and the Organisation of American States (OAS) in cooperation with the Office of the United Nations High Commissioner for Human Rights.

The Conference will primarily focus on mixed migratory movements in the Americas. Participants will exchange information, experiences and views on mixed migration issues in the continent and shall particularly discuss protection considerations arising with respect to asylum-seekers and refugees, victims of human trafficking, unaccompanied children and victims of physical or sexual violence or trauma as well as with view to general human rights of people on the move.

The Conference, which will be conducted only in Spanish and English, will bring together representatives of 20 States from all over the Americas, interested donor countries, international and regional organizations, national institutions for the promotion of human rights, the academia, representatives of civil society organizations as well as other stakeholders directly involved in addressing mixed migratory movements in the region.

Source: ACNUR

In a new report from the Institute of Medicine (IOM), there is evidence that secondhand smoke can trigger heart attacks. The report also suggests that those with heart conditions should avoid exposure to tobacco smoke.

Requested by the U.S. Centers for Disease Control and Prevention (CDC), the report stated there is no safe level of exposure to secondhand smoke, and that people with cardiovascular disease could risk heart attack with less than an hour’s exposure to environmental tobacco smoke.

“If you have heart disease, you really need to stay away from secondhand smoke. It’s an immediate threat to your life,” said researcher Neal Benowitz of the University of California at San Francisco. Benowitz added that everyone, in fact, should avoid secondhand smoke, since many people who have heart disease are not aware of the problem if they have never had a heart attack.

Click here to view the report.

Resident Fatigue, Distress Can Lead to Medical Errors, Says Study

Program Directors Can Manage These Issues Locally, Says AAFP Leader

By Barbara Bein
10/20/2009

It is the responsibility of program directors to help trainees manage their sleep needs and general well-being, said Epperly. “We do that constantly here. We work with residents to help them manage their sleep, fatigue and their distress.”

The study, which was published in the Sept. 23/30 issue of JAMA, used data from 380 internal medicine residents who began their training between 2003 and 2008 and completed quarterly surveys through February 2009.

Residents were surveyed about their demographic characteristics, current rotations, coping strategies for dealing with stress and report of self-perceived medical errors. Validated survey tools were used to measure fatigue, quality-of-life, burnout and symptoms of depression.

Previous studies, including a 2006 JAMA article by many of the same authors as the current study, indicate that burnout — which the authors characterized as one form of distress — during the physician training process can lead to medical errors. Other studies have suggested that resident fatigue also increases the risk of medical errors.

The current study concluded that high levels of fatigue and distress are separately associated with medical errors, although how much each factor contributes individually to such errors remains unclear.

“While changes have been made to reduce fatigue and sleepiness during residency training, other changes may be necessary to more specifically address distress and burnout,” said Tait Shanafelt, M.D., a physician at the Mayo Clinic in Rochester, Minn., and lead author of the study report, in a Sept. 22 press release.

Epperly said he agrees that distress is an important issue among residents, and he added two more: substance abuse and mental or physical illness. But he stressed that these issues are most appropriately addressed locally by program directors.

“With the H1N1 flu epidemic, how do you ensure that residents aren’t coming to work sick or with depression? These are all issues of importance,” he told AAFP News Now.

The newly released study comes after the Institute of Medicine, or IOM, issued a report in December 2008 that recommended more restrictions on residents’ duty hours in an effort to minimize fatigue and maximize patient safety. For example, the IOM recommendations included a stipulation that on-site duty periods not exceed 16 hours unless a five-hour uninterrupted sleep period is provided between 10 p.m. and 8 a.m.

The Academy and other family medicine groups disagreed with the IOM recommendations in a Feb. 3 letter to the Accreditation Council for Graduate Medical Education, or ACGME. The Academy said that the recommendations, if implemented, would hurt patient care while increasing medical training costs.

In June, Epperly hammered that message home again, recommending in testimony during the ACGME National Congress on Duty Hours and the Learning Environment that the ACGME commission research studies to examine whether additional restrictions on resident duty hours would lead to improved clinical outcomes.

The AMA Council on Medical Education also is expected to report on the issue of resident duty hours (pp. 22-41 of 117-page PDF; About PDFs) at the 2009 interim meeting of the AMA House of Delegates in November.

Epperly reiterated that more research needs to be done on resident fatigue and distress and their relationship to patient care and medical errors, but he emphasized that it’s important that program directors, who are best suited to deal with residents who may experience these problems, remain in charge of handling these issues at the local level.

“Guidelines can be set nationally, but they should be implemented locally. It’s critical that program directors take ownership of these issues,” Epperly said.

Press Release - TAMIL ASYLUM SEEKERS IN MERAK SAY IOM IS PRESSURING THEM TO LEAVE THEIR BOAT

Refugee advocates in Australia are concerned that the Australian government may be co-ordinating action to try and force the Tamil asylum seekers in Indonesia to leave their boats.

While media statements this morning refer to the threat to forcibly remove the 78 asylum seekers on the Oceanic Viking, a statement from the 250 Tamil asylum seekers stranded in Merak, Indonesia says that the International
Organisation of Migration (IOM) is pressuring them to leave the ship by cutting their supplies. More 

Weight gain during pregnancy in inevitable and actually necessary. The challenge is that most women actually put on too much weight during pregnancy. A lot of women totally let themselves go which is why there is unnecessary weight gain.

Pregnancy weight gain in the US and other countries have been steadily increasing. It was earlier thought that higher maternal weight gain resulted in improved health of the infant at birth. Recent  studies  have found that there are more negative than positive effects of too much weigh gain.  Some of these negative effects include;

• Undesirable outcomes at birth such the baby is too big to pass through the birth passage
• Child has higher risks of being overweight ( Am J Obstet Gynecol)
• Mother has lower chances of losing excess weight (Nutritional Reviews,

Approximately 40–50% of pregnant women gain more than what is the recommended pregnancy weight gain by current Institute of Medicine (IOM) guidelines as reported in the Epidemiology Review.

How much of pregnancy weight gain is too much? The Institute of Medicine (IOM) has the following guidelines on what’s healthy weight loss. These are  based on a woman’s BMI (Body mass Index) before she conceived the baby;

• Underweight woman         (BMI less than 18.5)       :          Gain 28-40 pounds
• Normal weight woman     (BMI 18.5 to 24.9)           :          Gain 25-35 pounds
• Overweight woman            (BMI 25 to 29.9)              :          Gain 15-25 pounds
• Obese woman                       (BMI more than 30)       :           Gain 11-20 pounds

The IOM guidelines do not advise any woman to lose weight while pregnant. Although the IOM guidelines allow a 11 to 20 pound weight gain for obese women, some experts believe that an obese woman may be able to give birth to a health baby with much less weight gain as compared to what is proposed.

In 2003, the average pregnancy weight gain was approximately 30.5 pounds according to the National Center for Health Statistics. Some women could retain up to 11 pounds of additional weight after 6 – 18 months of delivery.

According to experts, a pregnant mother needs a meager 300 calories in addition to her normal caloric intake. For a woman with a daily caloric intake of up to 1800 calories, it’s an additional 15%.

The challenge with pregnancy weight gain is that most women are already out of shape when conceiving. A lot of women are able to get away with starvation diets up to the point of pregnancy. Prior to pregnancy, lot of young women are able to maintain their skinny figures by missing meals or reducing food intake. But this too, comes at a cost. The metabolic system is usually severely compromised when these women conceive. The starvation diets result in considerable muscle loss which result in the sluggish metabolic rate. Pregnancy sends their weight into a downward spiral. It seems impossible to maintain a healthy weight gain during pregnancy and losing it after delivery.

Women who are in great shape when conceiving have the best chance to get in shape after delivery. Some experts now suggest women who are very overweight to get in shape before thinking of getting pregnant. The best advise for young women is to practice a healthy lifestyle that must include exercise. The exercise must consist of weight resistance  and cardiovascular training. Preparation for pregnancy occurs long before conceiving. A fit and healthy mum will have a safer pregnancy and impose lesser risk on the unborn child.

Caveat : the above are only guidelines and women should refer to their doctors when determining healthy weight gain during their pregnancy.

Tags: pregnancy weight gain, Institute of Medicine, IOM, post pregnancy weight loss, maternal weight gain, BMI, body mass index, metabolic rate, sluggish metabolic rate, weight loss, starvation diet, exercise

A report from the Institute of Medicine (IOM), shows evidence that secondhand smoke can trigger heart attacks and urges those with heart conditions to avoid exposure to tobacco smoke.

The report, which was requested by the U.S. Centers for Disease Control and Prevention, noted that there is no safe level of exposure to secondhand smoke. Reasearcher Neal Benowitz stated, “If you have heart disease, you really need to stay away from secondhand smoke. It’s an immediate threat to your life.”

Researchers found “clear and consistent” evidence that smoking bans cut the rate of heart attacks, according to statistician Stephen Feinberg of Carnegie Mellon University, a member of the IOM committee that compiled the report.

Click here to view the full report.

Here is another take on the upcoming Institutes of Medicine’s study to reform healthcare.  All of the working RN’s I know already know the answers to the questions put forth in this study.  We are over worked, under appreciated, and tired.  We daily struggle with people’s lives and the lives of their families.  We try to meet the demands of so many people in the course of a routine 8 hour shift, that we don’t have time to go to the bathroom or take a lunch break.

Nurses want to be able to nurse.  We are tired of doing paperwork, of defending ourselves from litigation for doing what we were trained to do.  We want to interact and support our patients in getting well.  We want to have the pleasure of actually getting to know our patients as people.  We want our patients to have confidence in our abilities and trust that we will advocate for them in this confusing system.  You cannot do this when you are caring for 8-9 patients that, by current studies, have been shown to be sicker and in need of more care.

Please visit this site and read the article in full; then make up your own mind about what you think nurses and nursing needs.  Then tell your elected officials what you think.

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The IOM has convened a nursing initiative to draft a blueprint for nursing, but some say ‘corporate elites’ will only provide toothless recommendations

By Joe CarlsonPosted: July 20, 2009

A wave of reform legislation threatens to upend many certainties in healthcare, the industry’s largest single workforce—nursing—already finds itself at the cusp of significant change.

Today’s nurses sit in an uneasy state of tension on critical issues, such as: when to expand their scope of practice to meet primary-care needs, whether technology is actually freeing up more time for patient care, and how to train enough new nurses at appropriate educational levels.

Experts say those are some of the key issues that are likely to emerge when an Institute of Medicine commission begins an inquiry that organizers are billing as a ground-breaking study of the profession.

The Initiative on the Future of Nursing, funded by a $4 million grant from the Robert Wood Johnson Foundation, is intended as a critical examination that could shatter existing conceptions of the field and lay out a blueprint for 21st century nursing. “They consider this a transformational opportunity, and they’d like a report that is transformational,” said study commission Chairwoman Donna Shalala, who was an HHS secretary in the Clinton administration and today is president of the University of Miami. “It could be like a torpedo, and cut right through the trees, and the forest, and give us a clear pathway if it’s successful.

”The commission held its inaugural meeting in Washington on July 14, two days before nursing took the national stage as President Barack Obama announced in a pro-reform news conference in the White House Rose Garden, “I should disclose right off the bat, I have a long-standing bias towards nurses.

“Due in fall 2010

Although the IOM commission’s official announcement was swathed in language referencing the ongoing reform efforts in Congress, organizers say that their report is not due out until fall 2010—well after the self-imposed deadlines for reform legislation. Organizers say they want the report to have its impact when providers and payers start scrambling toward the goals enshrined in whatever reform legislation becomes law. “We hope we will get legislation this year for health reform, but I think it’s inconceivable that that will be the last word for health reform,” IOM President Harvey Fineberg said.

Committee members include: Linda Burnes Bolton, chief nursing officer with 914-bed Cedars-Sinai Medical Center, Los Angeles; Jennie Chin Hansen, president of the AARP; C. Martin Harris, chief information officer of the 1,080-bed Cleveland Clinic; Robert Reischauer, president of the Urban Institute; and John Rowe, professor of health policy at Columbia University and former chairman and CEO of Aetna.

The effort already is not without critics. Vanderbilt University School of Nursing Dean Colleen Conway-Welch said nurses already know the answers to most of the questions posed by the group, but those solutions will never become reality until the other fractured healthcare constituencies, like physicians and specialty practitioners, also agree to changes. Labor leaders noted that the 16-member committee lacks a union representative or, for that matter, any member who is an active staff nurse besides a nurse-midwife who graduated with her degree in 2008 (See related editorial, p. 20).

Suzanne Gordon, author of more than half a dozen nursing books, including co-authorship of Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care, said she expected no greater impact from this latest IOM commission than what happened after the institute’s 1996 report from its committee called the Adequacy of Nurse Staffing in Hospitals and Nursing Homes. “Like the other IOM report, the 1996 report on staffing, this one suffers from the same problem, which is that you have corporate elites doing the study, and you end up with a series of recommendations that are all voluntary,” Gordon said.>>>read more by clicking below

Click here to read the entire article: Rethinking Nursing – Modern Healthcare

There is a Mini gathering up at the TT Grandstand on Sunday so if you have any Manx registered Minis in your garage, shed or on the drive (the pre-BMW sort) why not head up there?

Its been orgainsed as part of the marque’s 50th birthday and it all gets going at about 10.30 in the morning.

For more information email John at jonetee@manx.net

Sounds like a bit of a do!

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It was reported today on www.iomonline.co.im that the boss of the Venda claimed that the Manx online shopping portal www.shopiom.com is ‘visionary’.

As I don’t really agree with what Dan Wagner (The Venda Boss) has said or the decision taken by the DTI to use a UK based company and pay such considerable fees using the Manx tax payers cash (Freedom to Flourish in action), I thought I would share with you a some song lyrics of that 1998 classic by the Vengaboys – The Venga Bus, that I have adapted only slightly to indicate my true feelings on the matter, so here goes.

If you cant remember the tune and how it goes, check out this link on youtube so you can get the jist of the tune!

Vendaboys – Venda Boss Lyrics

I like to party (Dan Wagner)

I like, I like to party

I like to party

I like, I like to party

I like to party

I like, I like to party

I like to party (I’m not flippin surprised!)

I’ve got something to tell ya

I’ve got news for you

Gonna put some online retail wheels in motion

Get ready ’cause we’re coming through

Hey now, hey now, here’s what I say now

Online retail happiness is just around the corner

Hey now, hey now, here’s what I say now

I’ll be there for you (for only £265,000)

The VendaBoss is coming

And everybody’s jumping

From Ramsey to Santon

A manx government fiasco

The wheel of fortunes turning

And the taxpayers pounds are burning

So if you like to part with your money

Get on and shopiom

I like to party

I like, I like to party

I like to party

I like, I like to party

Gonna put some online retail wheels in motion

Get ready ’cause we’re coming through

Hey now, hey now, here’s what I say now

Online retail happiness is just around the corner

Hey now, hey now, here’s what I say now

I’ll be there for you (for only £265,000)

The VendaBoss is coming

And everybody’s jumping

Ramsey to Santon

A manx government fiasco

The wheel of fortunes turning

And the taxpayers pounds are burning

So if you like to party

Get on and move your body

The VendaBoss is coming, the VendaBoss is coming

The VendaBoss is coming, the VendaBoss is..

I must admit I really hated that song when it came out, but I am quite liking the new version!

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This was posted on the BHIC Blog this morning.      As always, thank you Siobhan for being “on top of resources, events, etc.!

Institute Of Medicine Workshop on Integrating Health Literacy in Prevention Programs
Presentations from the IOM Workshop on Integrating Health Literacy in Prevention Programs are now available online: http://www.iom.edu/CMS/3793/31487/72432.aspx The workshop was held on September 15, 2009 in the Washington Plaza Hotel located at 10 Thomas Circle, NW in Washington DC.

Race, Ethnicity, and Language Data to Improve Health Care Quality:
An overview of the new Institute of Medicine report and perspectives from the field
You can access the archive of the complete webinar recording, presentation slides, and a supplemental resource document online: http://www.diversityrxconference.org/yourvoice/webinars/data/

Health OutLoud Podcast: Writing Health Information That Caregivers Can Understand and Providers Will Accept
http://tinyurl.com/mkawsf
Carol Levine works at the United Hospital Fund in New York City. There, she directs the Families and Health Care Project which focuses on developing partnerships between health care professionals and family caregivers, especially during transitions in health care settings. You can see this project online at http://www.nextstepincare.org. Levine has won numerous awards for her work on health and social policy issues. In 1993, she was awarded a MacArthur Foundation Fellowship for her work in AIDS policy and ethics. In 2007, she was named a WebMD Health Hero. In this podcast she talks with Helen Osborne about “Writing health information that caregivers can understand and providers will accept.”

By Diana Mason, editor-in-chief emeritus

Ann Keen

First, the necessary throat-clearing about who and where: I recently attended a public session held by the Institute of Medicine Initiative on the Future of Nursing. Chaired by University of Miami president and former secretary of Health and Human Services Donna Shalala and chief nurse for Cedar Sinai Medical Center Linda Burnes Bolton, the session began with presentations by two nurses involved in the Prime Minister’s Commission on the Future of Nursing and Midwifery in England: Ann Keen, Member of Parliament and Parliamentary Undersecretary for Health Services, who chairs the British commission; and Jane Salvage, the lead secretariat for the commission and a former contributing editor for AJN.

Now the point: During the formal session, Keen noted that various countries in the UK each have a chief nurse officer (CNO) who is responsible for developing a national nursing strategy. Afterwards, I interviewed Keen and Salvage, who both said they didn’t understand why American nurses were not supporting the call for a CNO for the United States, one who would be charged with developing and overseeing a national nursing strategy for this nation. In their eyes, a CNO who is on par with the surgeon general could help the nation to develop approaches to ensure an adequate nursing workforce, identify barriers to their full utilization, identify new models of care to better promote the health of the public, and develop strategies for removing the barriers that impede forward movement.

Opposition from nursing groups. In the U.S., organized nursing has largely opposed the efforts of a group of grassroots nurses who are calling for the establishment of an Office of the National Nurse. They argue that the American CNO is the assistant surgeon general. But President Obama refers to Mary Wakefield, PhD, RN, FAAN, the head of HRSA, Health Resources and Services Administration, as “the nation’s top nurse.” Yet Wakefield is not responsible for a national nursing strategy. Her portfolio is a broader one. Another argument against a CNO office is that it could divert resources away from important federal nursing initiatives. Sounds like a fear-based reaction to me.

Our colleagues across the pond are convinced that it makes a difference to have a national CNO who is visible, proactive, collaborative, and savvy. Keen urged nurses to “have courage and take your agenda forward.” While our current priorities should probably be ensuring that Congress passes health care reform legislation this year and that any legislation includes enabling language to improve access to advanced practice nurses, we’ll soon need to focus on how to transform the care we provide to emphasize health promotion and care coordination. Let’s do it with courage and include the notion of a national chief nurse.

Do you think we need a national chief nursing officer in the U.S.?

Campaign to target migrants as well as host communities in Djibouti, Ethiopia, Kenya, Somalia and Yemen… From VOA. Full story

This site may contain information about: aluminum fishing boat. For a different topic see telemarketing solutions . The blog is also related to: boat price.

Hi Y’all,
Thursday, and another day of my weeks holiday grinds into life, and with some hope of it being a sunny day too. Here I am, reporting in at the writing station, and I must say it’s getting to be the first thing I want to do of a morning………. to write. that bodes well for November’s Nanowrimo. )

Mostly it’s emails, mostly to prospective New Chicks. Spurred into productivity, I admit, by my having hit a rich and glinting seam over the last couple of months, it’s golden reflections illuminating the digging and hacking away in the candlelit gloom of Kevin’s Mine of Hope and Comfort Sometimes too, I’ve recently been hitting the blog with some thoughts, random and rambling though they may usually be. Occasionally I’ve written stuff no one will ever read. That’ll be the real Wild Stuff then. The stuff no one would most likely understand. The stuff Plod would love to read.

‘Plod’, being a quaint and old-fashioned term for out great police force, and I actually mean that. The last police force in the world you can tell to fuck off, and not get shot for the indiscretion.

Mind you, it’s been a long time since I expressed such an imaginative course of action for our enforcement officers, the last time being way back in ’98 for leaving a thirty-limit on the Isle of Man, at double the limit I must admit, but, in my feeble defence, just before being outside the limit. They had, quite accidentally I’m sure, set the speed trap up thirty feet inside the limit and with the Goforit, or Golf Lima Foxtrot de-restriction black-stripe-on-white plainly in sight. I was quite upset at what I saw as an unfair and dastardly reaping of a abundant crop, there being some 35,000 of we bikers over there for the TT races, and a fair percentage of us being Adrenaline Freaks on a rush of speed.

(Golf Lima Foxtrot??…… There was hell-up amongst the Politically Correct weenies (small ‘w’) a few years ago, when it was disclosed that it was a common police radio instruction amongst traffic cops when chasing speeders…….. and it stands for, if you haven’t worked it out, Go Like Fuck.)

Let me point out that the spot they picked, quite accidentally I now realise after the calming of the years, was at the bottom of a downhill left-handed sweep and in deep and high hedges in the countryside. The last of the village buildings had been passed, and it was “Whoopy-doo” time with the scent of the speed-unlimited roads opening up again.

On the Isle of Man, there are no speed limits outside of the villages and towns. Let me tell you, it is an Adrenalin Freak’s Paradise.

They pulled me over, and, being a man with a strong sense of what is Just and Fair, I was a bit upset at their apparent cunning. Actually, ……….I was fucking livid, and then some. I suggested, quite graphically, that they might explore the pleasures of inserting the hair dryer up their ass (hand-held speed gun), and that they’d missed their vocation by not seeking employment with the IOM Tourist Board. Throwing the skid-lid across the road (I kid you not. I was bleddy mad as hell), I doubted the authenticity of their parentage, and offered to wipe my bottom with the speeding ticket.

Why was I so upset about such a thing? Well, see, there were a few reasons. Being whacked out on antidepressants that weren’t working, being over there with no chick, and it having been the wettest TT in living memory all added up to my being mentally right down on the floor. It was also the third time I’d been so sneakily ‘had over’ by the cunning IOM Plod in the last three visits to the Island of Speed, and on every occasion it had cost in excess of £160 in fines. That’s each time, so we’re talking about £500 in total (each being in excess of £160), and I do freely admit I was in considerable excess of the limit, before you point it out. )

You see, not unsurprisingly I guess these days, they set these traps up all over the place, and one copper over there told me that on Mad Sunday they gather something like 200 of we poor unsuspecting, safety-conscious, Speed Freaks an hour over the whole island. When you go to pay the fine, you just pay the fine, no licence, insurance, or proof of identity is asked for………. Just pay here, (sir), and sign here, (sir), and thank you for your cooperation in the matter, (sir). )

And, whaddya mean you’ve never heard of Mad Sunday??? Where y’all been all your lives??? )

Briefly, Mad Sunday is a long-standing tradition of mayhem and an open day for we nutters. It’s one mental day, where the mountain Course of the Isle of Man TT circuit of public roads used for the racing are opened up to one way traffic, and so becoming a race-track as it is on race days. Then let loose to all who dare to ‘ride the mountain’ on Mad Sunday. Many don’t dare, and with good reason. Safety is not a word that goes with the day. It’s the single reason I go over there, and quite secondary to watching the fantastic racing, which makes mainstream track races look like a kindergarten tea party.

Have a look…….. have a taste…..
http://www.youtube.com/watch?v=IRmNZlEXjQ0

Anyway………. the bottom line is, that our police force really is the best in the world. Mad and wild as I was, those two coppers just politely pointed out that maybe I might consider the pleasures of being arrested if I didn’t calm myself (sir). They just completed the paperwork, explaining that should I use it for the purpose I’d suggested, that more paper would not be provided to complete such an undertaking.

No gun was involved at any point, no handcuffs deemed as necessary, and no sudden appearance of any overwhelming ‘backup’ either.

Then they watched, as I cleared the thirty-limit sign a few yards away, and nailed the bike to 140 down the road away from them.

God bless them all. )

K.x )