The Emotional State and The MRI: What's Love Got To Do With It?

A news item in todays New York Times reports that researchers studying brain patterns of people who are newly in love, have seen "the neural activity associated with romantic love alters slightly, and in some cases primes areas deep in the primitive brain that are involved in long-term attachment".

"In the study, a computer-generated map of particularly active areas showed hot spots deep in the brain, below conscious awareness, in areas called the caudate nucleus and the ventral tegmental area, which communicate with each other as part of a circuit." It is in the caudate nucleus that was particularly active in people who measured highly in a questionnaire measuring passionate love. What is interesting is that this part of the brain is on the opposite side that registers physical attractiveness. It does appear to be involved "in longing, desire and the unexplainable tug that people feel toward one person, among many attractive alternative partners."

Read the article:
Arthur Aron, Helen E Fisher, Debra J Mashek, Greg Strong, Hai-fang Li, and Lucy L Brown Reward, Motivation and Emotion Systems Associated with Early-Stage Intense Romantic Love J Neurophysiol, May 2005; 10.1152

Informatics Competencies

I came across the following article in my readings the other day that made me sit up and think.

Curren, C. Informatics competencies for nurse practitioners. AACN Clin Issues. 2003 Aug;14(3):320-30.

It discusses the informatics competencies that are essential for advanced level nurse education and practice. It is a landmark document, authored by a faculty member at Columbia University School of Nursing. She, along with two nurse informaticists and six nurse practitioners developed the proposed competencies. Prior to its publication, competencies in this area had not been defined and validated. They had been defined for general levels of nursing practice, but not for the level of students that we see here at YSN.

This is the earlier article defining competencies for general levels of nursing practice:
Staggers N. etal. A Delphi study to determine informatics competencies for nurses at four levels of practice. Nurs Res. 2002 Nov-Dec;51(6):383-90.

One of the most interesting aspects of the Curren article is that the panel had omited some of the earlier competenices because they are assumed as clinicians progress in their career. Those competencies added relate to Evidence Based Practice. Going forward these competencies need to be addressed at the level of education of the clinicians who are taking on advanced level nursing roles. This is because currently nurse managers in hospitals are playing catch-up, eager to understand the principals that were not part of their education, anxious because of the implications if they don't.

It is great food for thought.
It is easy to read.
The tables enable a quick glance at the competencies.

YSN Library May 23 - May 27

These are the hours that I will be in the Library this week. Questions, comments, concerns, please email me: janene.batten@yale.edu

Monday 5/23
Call Medical Library for assistance - 737-4065

Tuesday 5/24
Call Medical Library for assistance - 737-4065

Wednesday 5/25
8:30 - 5:00

Thursday 5/26
Call Medical Library for assistance - 737-4065

Friday 5/27
8:30 - 5:00

Statistics - H-CUPnet

Need to get some statistics? Browse around the AHRQ's statistics tool where you can design your own criteria for the statistic set that you need.

What is HCUP?
The Healthcare Cost and Utilization Project (HCUP, pronounced "H-cup") is a family of health care databases and related tools that can assist you to synthesize the data. It is based on statewide data collected by individual data organizations across the United States and provided to AHRQ.

It includes the largest collection of longitudinal hospital care data in the United States, encompassing all-payer, discharge-level information.

Databases that can be found include:

• Nationwide Inpatient Sample (NIS)
• State Inpatient Databases (SID)
• State Ambulatory Surgery Databases (SASD)
• State Emergency Department Databases (SEDD)
• Kids' Inpatient Database (KID)

The website includes reports, news and events, and even has a link for technical assistance (my kind of page!).

Here is the link to the page if you haven't already linked to it: http://hcup.ahrq.gov/HCUPnet.asp

Guidelines and Standards Update

Updates and new Guidelines: National Guideline Clearinghouse
For a full list, go to the National Guidelines Clearinghouse "What's New This Week"

Special treatment situations: pediatric migraine. Standards of care for headache diagnosis and treatment.  (National Headache Foundation)

Treatment of primary headache: patient education. Standards of care for headache diagnosis and treatment.  (National Headache Foundation)

Nasotracheal suctioning - 2004 revision & update.(This updates a previously published guideline summary.)(American Association for Respiratory Care)

Metabolic measurement using indirect calorimetry during mechanical
ventilation - 2004 revision & update. (This updates a previously published guideline summary.)

Guidelines for the management of chronic kidney disease in HIV-infected patients (Infectious Diseases Society of America (IDSA))

Pediatric Medication Errors

Medication errors in children can be far more harmful that errors in adults. According to a recent article children that are most at risk for medication errors include those:

• who are younger than two years.
• who are in ICUs, especially neonatal ICUs
• who are in EDs, especially if seriously ill, between the hours of 4 AM and 8 AM or on weekends
• who are receiving chemotherapy
• who are receiving IV medication
• whose weight hasn’t been documented
  

This article includes information about calculating the right dosage for children using weight based method, body surface area, status of prematurity, and dilution. It also give indepth commentary on how to avoid medication errors including knowing the medication that is to be administered, confirming that the right patient is receiving the medication, double checking orders, minimizing distractions when administering medications, and communicating with parents/caregivers throughout the child's care.

Even if this topic is very familiar to you, this article is well worth reviewing.

Hughes RG, Edgerton EA. Reducing Pediatric Medication Errors: Children are especially at risk for medication errors. Am J Nurs. 2005 May;105(5):79-84

Unique Value of Highly Educated Nurses

American Organization of Nurse Executives (AONE) is promoting the issue of having a more highly educated workforce. They believe that "that education has a direct impact on the skills and competencies of a nurse clinician." Evidence is also becoming available "which underscores the importance of baccalaureate nursing education to safe patient care and quality outcomes." This is a position that is has been long advocated by the AACN.

Read the American Association of Colleges of Nursing (AACN) Postion Statement: The Baccalaureate Degree in Nursing as Minimal Preparation for Professional Practice

American Association of Colleges of Nursing (AACN) Fact Sheet: The Impact of Education on Nursing Practice

American Association of Colleges of Nursing (AACN) Press Release: AACN Applauds New Study that Confirms Link Between Nursing Education and Patient Mortality Rates

YSN Library May 16 - May 20

I will be away at a conference this week. Please contact the reference desk with any questions 737-4065, or email the reference desk by going to this web page.
http://www.med.yale.edu/library/ref/ask.html

Monday 5/16
Call Medical Library for assistance - 737-4065

Tuesday 5/17
Call Medical Library for assistance - 737-4065

Wednesday 5/18
Call Medical Library for assistance - 737-4065

Thursday 5/19
Call Medical Library for assistance - 737-4065

Friday 5/20
Call Medical Library for assistance - 737-4065

Support for first time mothers

The results of a study about the support that first-time mothers received and how it related to their confidence in care fo their infant.

"This paper reports a study whose primary aim was to explore the relationship between social support for first-time mothers and their confidence in infant care practices. A secondary aim was to identify their sources of support in the postnatal period."

Results of the study showed that new mothers that received "appraisal support" had a statistically significant moderate relationship with confidence in infant care practices. Those mothers that received "nformational support" had a weaker but statistically significant relationship.

Primarily, "appraisal support" came from partners and their own mothers, while "informational support" came from public health nurses and mothers.

The study concluded that "first time mothers' husbands/partners need to become active participants in antenatal and postnatal care. Interdisciplinary educational programmes need to be developed so that public health nurses and midwives work collaboratively in facilitating social support for first-time mothers in caring for their infants. Curricula for public health nurses and midwives need to be evidenced-based with respect to social support."

Leahy, Warren P. First-time mothers: social support and confidence in infant care. J Adv Nurs. 2005 Jun;50(5):479-88.

QuickStats: Primary Contraceptive Methods Among Women

Here are some statistics from the National Center for Health Statistics.

Primary Contraceptive Methods Among Women Aged 15-44 Years - United States, 2002

QuickStats: Primary Contraceptive Methods Among Women Aged 15-44 Years--United States, 2002: JAMA 2005;293 2208.

Merits of Personalized Discharge Teaching

A study published in Circulation adds to the increasing body of literature showing that focused predischarge education given to individuals improves patient outcomes. Patients who received this attention, in the form of one-hour predischarge education required fewer hospital readmissions, conducted better self-care and incurred lower health care costs than patients who received routine discharge instructions.

In this study, discharge education included the nurse educator delivering a 60-minute, one-on-one teaching session. The nurse educator gave a Power Point presentation developed by the study’s authors that addresses 50 heart failure topics, ranging from causes to symptom management. Amongst other things, patients had their individual questions answered, and also received a copy of CHF treatment guidelines “written in layman’s terms”.

Ultimately, the authors note, the costs of medical care are significantly reduced for the patient when the time is taken to do this additional discharge care.

Todd M. Koelling, Monica L. Johnson, Robert J. Cody, and Keith D. Aaronson. Discharge Education Improves Clinical Outcomes in Patients With Chronic Heart Failure. Circulation, Jan 2005; 111: 179 - 185.

APN Nursing Roles

Despite the growing demand for advanced practice nurses, there is limited published information to guide the successful implementation and optimal utilization of these staff.

This paper provides a participatory, evidence-based, patient-focused process, for guiding the development, implementation, and evaluation of advanced practice nursing (APN) roles. It is well worth the read.

Bryant-Lukosius, Denise & DiCenso, Alba (2004). A framework for the introduction and evaluation of advanced practice nursing roles. Journal of Advanced Nursing 48 (5), 530-540.

YSN Library - May 9 - May 13

Here is the schedule for when I will be at YSN for this week. Questions, comments, concerns? .... please email me janene.batten@yale.edu

Monday 5/2
8:30-12:30
Class: 1:00-2:00 RefWorks (TCC - Med Library)

Tuesday 5/3
Call Medical Library for assistance - 737-4065

Wednesday 5/4
8:30-5:00

Thursday 5/5
Call Medical Library for assistance - 737-4065

Friday 5/6
8:30-5:00

Preparing for an Influenza Pandemic

This commentary in today's New England Journal of Medicine is using the science of the Internet to it's fullest!

Listen to an audiocast of an interview from Dr. Michael Osterman about preparing for an influenza pandemic. This is courtesy of NEJM and is a supplement to the article Osterholm MT. Preparing for the Next Pandemic. N Engl J Med 2005;352(18):1839-42. When you are finished listening, NEJM give also gives you the opportunity to view an interactive figure showing the proposed mechanism of the cytokine storm evoked by the influenza virus.

Isn't this the best use of internet technology? You have to be just slightly impressed! If I had copyright clearance I could download it to my palmOne (or iPod) and listen to it there. The technology is there, we just have to use it!

Dr. Osterholm is the director of the Center for Infectious Disease Research and Policy, the associate director of the National Center for Food Protection and Defense, and a professor of public health at the University of Minnesota, Minneapolis. Rachel Gotbaum, the interviewer, is an independent producer based in Boston.

Barriers to Patient Centered Care

Hospitals have developed tools that allow patients to give feedback about the standards of care during their hospital stay. When patients give negative evaluations it is sometimes difficult for hospital administrators to know how to respond.

The authors of the study Overcoming the barriers to patient centered care believe that nursing staff are acutely aware of the deficits in standards of care that are reported by patients. The authors believe that nursing staff can provide the hospital with information about the organization, management, and resourcing of care that can be used to improve patients' experiences.

The study is well worth the read.

West, E., Barron, D. N., & Reeves, R. (2005). Overcoming the barriers to patient-centred care: Time, tools and training. Journal of Clinical Nursing, 14(4), 435-443.

RefWorks - New Direct Export From Ovid

Ovid has streamlined the process for getting your citations from any of its databases into Refworks.

After selecting the records you would like in in your RefWorks database, use the Direct Export option in the Results Manager. Then press save. If your RefWorks account is already open the citations will be directly imported in. If RefWorks is not open, the window will open, just sign in and then the citations will automatically be imported in.

Need more help? Just let me know.

JAMA and NEJM this week

There are a number of articles that might be of interest to you in this weeks issue of JAMA (April 28, 2005).

• Bone Mineral Desity and the Risk of Incidental Nonspinal Fractures in Black and White Women
• Outcomes of Routine Episiotomy
• The Research on Adverse Drug Events and Reports (RADAR) Project

And an image in NEJM that might be of interest

• Image of the Week: Painless Loss of Vision after Vomiting in a 24 year-old who was 30 weeks pregnant

For full table of contents for click journal names of each.

Substitution of Doctors by Nurses in Primary Care

A Cochrane Review was recently published that states "appropriately trained nurses can produce as high quality care as primary care doctors and acheived as good health outcomes for patients."

Nurse-doctor substitution in primary care is intended to reduce costs, increase service capacity and reduce doctors’ workload, while maintaining quality of care. It could also help to meet the increasing demand due to ageing populations and support the shift in care from hospitals to primary care.

The researchers analysed 16 studies from around the world that looked at the effects of substituting nurses for doctors in primary care to see the impact on health outcomes (e.g. morbidity, mortality, patient satisfaction, and quality of life), standards of care, and use of healthcare resources.

The authors found that health outcomes were similar for nurses and doctors, but patient satisfaction was higher with nurse-led care. Nurses spent longer over consultations and higher rates of patient recall than doctors.

Read the full report by clicking the Cochrane Library link on the Medical Library Website, and searching for the following title.

Laurant, M. Sergison, M. Sibbald, B. Substitution of doctors by nurses in Primary Care. [Protocol] Cochrane Effective Practice and Organisation of Care Group Cochrane Database of Systematic Reviews. 1, 2005.

MeSH - Medical Subject Headings

I wanted to point you to Jan's Searching Tips this morning (see the permanent link in the right hand column).

MeSH: Heirarchical List

She neatly describes why we get the results we do when we do a search in the MedLine or Cinahl database.

Medical subject headings are instrumental in pulling the results we want into the retreived set. When you are doing your search, be sure to keep each concept in a separate search. Search them individually and then combine after you have sets for each. The medical databases are quite sophisticated and cannot easily handle a phrase searching and then give you back meaningful (and complete) results sets.

I urge you to read Jan's blog today, and other days.

If you think that you need to refine your searching, come to one of Jan's (or my classes), or just ask me for some extra help.

New Food Pyramids

The government has disbanded the old food pyramid. Remember, food groups stacked high, with the ones we like most at the top. It showed what was previously thought the be a guide to healthy eating - lots of grains at the bottom, minimal fats and sweets on the top, and moderate helpings of vegetables, fruits, dairy products in the middle.

The new look food pyramid is a more personalized food group allocation. We are now encouraged to figure out our own calorie and exercise needs using a new government Web site (www.mypyramid.com). It's kind of fun. The individual puts in their age, sex, and how much exercise they do in a week. The end result is the perfect mix of food groups just for you. It is somewhat simplistic, and does not take into account any other personal side issues such as current medical conditions, current weight, or any other personal details.



The idea of the new look is to base daily caloric needs on 12 different models depending who you are — from the 1,000 calories for sedentary toddlers to 3,200 for teenage boys. For clinicians, the USDA has put together a pyramid anatomy to assist in reading the new pyramid and helping people to work out what their focus should be.

The pyramid follows in the wake of the new Dietary Guidelines for Americans, released in January 2005. In a nutshell, these guidelines encourage appropriate calorie intake and exercise. The new look pyramid is an attempt to personalize it for everyone. All in all, I find it a little confusing, and way to many clicks (and I like to click). I wonder how the average person feels?

Whatever you think ... sign on ... do the math ... and Bon Appetite!
Oh, I almost forgot to tell you - it's National Physical Education Week.

Healthy or Not

A study in last week's Archives of Internal Medicine found that a "paltry number of Americans maintain the four basic healthy lifestyle characteristics (HLCs).

• eating well
• refraining from smoking
• exercising regularly
• maintaining a healthy weight

Out of 153,000 only 3% maintained all four HLCs. Within the individual HLCs, 76% of participants were nonsmokers, 40.1% maintained a healthy weight, 23.3% ate five servings of fruit and vegetables per day, and only 22.2% said they exercised for at least 30 minutes five or more times a week.

The researchers conclude that the biggest reason many Americans do not lead healthy lifestyles is the “‘current cultural norm’ to live unhealthy lives,” adding that many people “lack information about the dangers of unhealthy habits.” The study also notes that many Americans do not get enough exercise because they live in areas “more conducive to driving everywhere than walking or biking.”

The researchers say the findings are troublesome because previous research has found that following the four HLCs can “add years to your life, slash medical expenses, cut your risk of heart disease, and generally improve your quality of life.”


Healthy lifestyle characteristics among adults in the United States, 2000. Arch Intern Med. 2005 Apr 25;165(8):854-7.