A review of existing research confirms that health-care workers should
undergo a month of preventive drug treatment if they are exposed to HIV
on the job.
Still, the reviewers say that there's been little research into
so-called occupational postexposure prophylaxis, and it's still not
clear what should be done when health-care workers are exposed to
patients who are resistant to some drugs.
The review appears in the current issue of The Cochrane Library,
a publication of The Cochrane Collaboration, an international
organization that evaluates medical research. Systematic reviews draw
evidence-based conclusions about medical practice after considering
both the content and quality of existing medical trials on a topic.
Doctors, nurses and other health-care providers have worried about HIV
exposure since the AIDS epidemic first began in the early 1980s. Since
the virus that causes AIDS is transmitted through blood, a simple
needle stick could infect anyone treating a patient.
The risk, however, is quite low. The Centers for Disease Control and
Prevention estimated in 2005 that the risk of HIV transmission through
a contaminated needle stick is 0.3 percent, or about 1 chance in 333.
The low transmission risk may be related to two factors the small
amount of virus that gets into the body through health-care workers'
wounds and the barrier to the virus posed by the lower levels of the
skin, said review co-author George Rutherford, M.D., of the University
of California, San Francisco's Institute for Global Health.
Still, a 1-in-333 risk is hardly insignificant. Many countries
recommend postexposure prophylaxis, or PEP in which doctors try to kill
the virus in the body before it takes hold if a health-care worker has
been potentially exposed to HIV. The same approach is used to treat
people who have been potentially exposed to HIV through sex.
The low number of actual cases of infection makes it difficult for
researchers to find enough people to study the effectiveness of
postexposure treatment, Rutherford said. He added that, not
surprisingly, exposed health-care workers haven't been willing to take
part in any study that might result in their taking a placebo instead
of drug treatment.
The researchers were only able to find a single study that compared those who took drugs after exposure to those who didn't.
That study, of 712 exposed health-care workers, found that the odds of
becoming infected with HIV were reduced by about 81 percent among those
who took zidovudine an anti-HIV drug also known as AZT or Retrovir
after exposure. The study also reported that the odds of HIV infection
were higher if a health-care worker had a deep injury, if there was
visible blood on the device (such as a needle), if the needle had been
placed in the infected patient's blood vessel or if the patient was
terminally ill. A deep injury appeared to be by far the most dangerous
of the factors.
HIV patients typically take more than one drug, and doctors prescribe
multiple drugs as prophylaxis for exposed health-care workers, too.
While there's no research suggesting whether that's a good idea in the
latter case, the reviewers still recommend a multiple-drug regimen
because it works in HIV-infected patients.
Questions still remain, however, about what to do if an HIV patient is
resistant to existing medications. "That is," Rutherford asked, "what
do you do if you know a patient is not susceptible to the first-line
drugs?"
There's also the matter of side effects, which can keep people from
wanting to continue on HIV drugs for the recommended full month.
For now, Rutherford recommends that health-care workers follow federal
guidelines regarding the risk of HIV infection from needle sticks.
Still, the risk of an infection seems likely to never go away. An
estimated 26 percent of nurses surveyed reported having been injured
once in their careers by a "sharp" contaminated with a patient's blood,
while 14 percent reported having been injured at least twice, according
to Frank Myers, director of clinical epidemiology and safety systems at
Scripps Mercy Hospital in San Diego.
Fifty-six percent of nurses, surveyed, however, reported no such
injuries, said Myers, whose study will be published in the journal Nursing 2007.
On the positive side, hospitals are worrying more about potential risks
on the job and companies are developing safer medical devices, such as
syringes that retract needles when they're removed from patients.
"The more years of experience, the more likely you are to have had such
an injury," Myers said, "driven in part by both the years at risk and
the earlier years of having fewer safety devices and a poorer safety
environment."
Young TN, et al. Antiretroviral post-exposure prophylaxis (PEP) for
occupational HIV exposure. (Review). Cochrane Database of Systematic
Reviews 2007, Issue 1.
The Cochrane Collaboration is an international nonprofit, independent
organization that produces and disseminates systematic reviews of
health care interventions and promotes the search for evidence in the
form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.
Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
http://www.hbns.org
[General
]
14 August, 2008 17:45
Health-Care Workers Exposed To HIV On Job Need Preventive Treatment
[General
]
14 August, 2008 17:42
Coping effectively with a predicted influenza pandemic that threatens
to affect the health of millions worldwide, hobble economies and
overwhelm health care systems will require more than new drugs and good
infection control.
An international medical ethics think-tank says that all-important public cooperation and the coordination of public officials at all levels requires open and ethical decision making.
The Influenza Pandemic Working Group at the University of Toronto Joint Centre for Bioethics today recommended a 15-point ethical guide for pandemic planning, based in part on experiences and study of the Severe Acute Respiratory Syndrome (SARS) crisis of 2003.
The report says plans to deal with a flu pandemic need to be founded on commonly held ethical values. People need to subscribe in advance to the rationale behind such choices as: the priority recipients of resources, including hospital services and medicines; how much risk front line health care workers should take; and support given to people under restrictions such as quarantine. Decision makers and the public need to be engaged so plans reflect what most people will accept as fair and good for public health.
"A shared set of ethical values is the glue that can hold us together during an intense crisis," says Peter Singer, M.D., Director of the University of Toronto Joint Centre for Bioethics (JCB), which undertook the advisory report. "A key lesson from the SARS outbreak is that fairness becomes more important during a time of crisis and confusion. And the time to consider these questions and processes in relation to a threatened major pandemic is now."
The report concludes that flu pandemic plans universally need an ethical component that address four key issues:
1. Health workers' duty to provide care during a communicable disease outbreak.
2. Restricting liberty in the interest of public health by measures such as quarantine;
3. Priority setting, including the allocation of scarce resources such as medicines;
4. Global governance implications, such as travel advisories.
Health care workers duty to care
The SARS crisis exposed health care systems to hard ethical choices that rapidly arose. Dozens of health care workers, for example, were infected through their work and some died. Other failed to report for duty to treat SARS patients out of fear for their own health or that of their family. A flu pandemic, where there may be no absolute protection or cure, would put far greater pressures on health care systems around the world.
"Workers will face competing obligations, such as their duty to care for patients and to protect their own health and that of families and friends," says JCB member Ross Upshur, M.D., Director, Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre. "Medical codes of ethics in various countries provide little specific guidance on how to cope with this very real dilemma. Professional colleges and associations need to provide this kind of particular guidance in advance of an infectious disease outbreak crisis."
Governments and hospitals also need to provide for the health and safety of workers, and for the care of those who fall ill on duty. This might include an insurance fund for life and disability to cover health care workers who become sick or die as they place themselves in harm's way.
The Human Costs of Restrictive Measures
Officials need to provide support for those in quarantine, cut off from family, friends, work, shopping and possibly medical care for other aliments, the report says. The public should also be made aware of the need for quarantine and the consequences of non-compliance.
"The decision to use restrictive measures need to be made in an open, fair and legitimate manner. The public has a right to know the compelling public health reasons for curtailing rights and restricting normal activities. If quarantines are used, those affected need adequate care and job protection. Preventing financial hardship is important to obtaining full compliance from the public," says Dr. Upshur.
Measures to protect against stigmatization and to safeguard the privacy of individuals and/or communities affected by quarantine also should be part of pandemic preparedness plans the report recommends.
Allocating Scarce Resources, Medicines
All countries will face scarcities of medicines, equipment and health care workers during a pandemic, according to the group. Governments, hospitals and health regions should publicize a clear rationale for giving priority access to anti-viral medicines and vaccines to particular groups (e.g., front line health workers, children, decision-makers).
Advance planning ought to include criteria for resource allocation decisions, created in consultation with the general public.
Travel Bans
The World Health Organization (WHO) has warned that if the H5N1 strain of bird flu mutates and infects people it could reach all continents in less than three months. The WHO would likely impose regional travel restrictions in hopes of slowing the spread of the disease.
However such decisions can have major economic impacts. Canada, and Toronto in particular, suffered millions in economic losses when the WHO advised international travelers against all nonessential travel because of SARS.
Decisions about travel restrictions need to be clearly justified and the process must be transparent the report says.
At the same time, the WHO relies on individual countries for reporting disease outbreaks. Such surveillance may be beyond the capacity of many developing countries. The developed world should continue to invest in the surveillance capacity and the overall public health infrastructures of developing countries.
The WHO recommends that ethical issues be a consideration in the planning process for an influenza pandemic. Canada's province of Ontario has incorporated this framework into its plan.
"Other jurisdictions and nations should assess their pandemic plan against this ethical framework and these recommendations," says Dr. Singer.
"Looking ahead, we can say that if the pandemic strikes it will cause great hardship, but societies will struggle through. They will be better able to do so if they have general agreement on an ethical approach. Afterwards, history will judge today's leaders on how well they took decision on the ethical challenges they faced in the midst of the crisis."
Ten substantive values to guide ethical decision-making for a pandemic influenza outbreak
Individual liberty
In a public health crisis, restrictions to individual liberty may be necessary to protect the public from serious harm. Restrictions to individual liberty should:
- - Be proportional, necessary and relevant.
- - Employ the least restrictive means.
- - Be applied equitably.
Protection of the public from harm
To protect the public from harm, health care organizations and public health authorities may be required to take actions that impinge on individual liberty. Decision makers should:
- - Weigh the imperative for compliance.
- - Provide reasons for public health measures to encourage compliance.
- - Establish mechanisms to review decisions.
Proportionality
Proportionality requires that restrictions to individual liberty and measures taken to protect the public from harm should not exceed what is necessary to address the actual level of risk to or critical needs of the community.
Privacy
Individuals have a right to privacy in health care. In a public health crisis, it may be necessary to override this right to protect the public from serious harm.
Duty to provide care
Inherent to all codes of ethics for health care professionals is the duty to provide care and to respond to suffering. Health care providers will have to weigh demands of their professional roles against other competing obligations to their own health, and to family and friends. Moreover, health care workers will face significant challenges related to resource allocation, scope of practice, professional liability and workplace conditions.
Reciprocity
Reciprocity requires that society support those who face a disproportionate burden in protecting the public good, and take steps to minimize burdens as much as possible. Measures to protect the public good are likely to impose a disproportionate burden on health care workers, patients and their families.
Equity
All patients have an equal claim to receive the health care they need under normal conditions. During a pandemic, difficult decisions will need to be made about which health services to maintain and which to defer. Depending on the severity of the health crisis, this could curtail not only elective surgeries, but could also limit the provision of emergency or necessary services.
Trust
Trust is an essential component of the relationships among clinicians and patients, staff and their organizations, the public and health care providers or organizations, and among organizations within a health system. Decision makers will be confronted with the challenge of maintaining stakeholder trust while simultaneously implementing various control measures during an evolving health crisis. Trust is enhanced by upholding such process values as transparency.
Solidarity
As the world learned from SARS, a pandemic influenza outbreak, will require a new vision of global solidarity and a vision of solidarity among nations. A pandemic can challenge conventional ideas of national sovereignty, security or territoriality. It also requires solidarity within and among health care institutions. It calls for collaborative approaches that set aside traditional values of self-interest or territoriality among health care professionals, services or institutions.
Stewardship
Those entrusted with governance roles should be guided by the notion of stewardship. Inherent in stewardship are the notions of trust, ethical behaviour and good decision-making. This implies that decisions regarding resources are intended to achieve the best patient health and public health outcomes given the unique circumstances of the influenza crisis.
Five procedural values to guide ethical decision-making for a pandemic influenza outbreak
Reasonable
Decisions should be based on reasons (i.e., evidence, principles and values) that stakeholders can agree are relevant to meeting health needs in a pandemic influenza crisis. The decisions should be made by people who are credible and accountable.
Open and transparent
The process by which decisions are made must be open to scrutiny, and the basis upon which decisions are made should be publicly accessible.
Inclusive
Decisions should be made explicitly with stakeholder views in mind, and there should be opportunities to engage stakeholders in the decision-making process.
Responsive
There should be opportunities to revisit and revise decisions as new information emerges throughout the crisis. There should be mechanisms to address disputes and complaints.
Accountable
There should be mechanisms in place to ensure that decision makers are answerable for their actions and inactions. Defence of actions and inactions should be grounded in the 14 other ethical values proposed above.
Summary of Recommendations
An ethical guide for pandemic planning
1. National, provincial/state/territorial, and municipal governments, as well as the health care sector, should ensure that their pandemic plans include an ethical component.
2. National, provincial/state/territorial, and municipal governments, as well as the health care sector, should consider incorporating both substantive and procedural values in the ethical component of their pandemic plans.
Four key ethical issues
Issue 1: Health workers' duty to provide care during a communicable disease outbreak
1. Professional colleges and associations should provide, by way of their codes of ethics, clear guidance to members in advance of a major communicable disease outbreak, such as pandemic flu. Existing mechanisms should be identified, or means should be developed, to inform college members as to expectations and obligations regarding the duty to provide care during a communicable disease outbreak.
2. Governments and the health care sector should ensure that: a. care providers' safety is protected at all times, and providers are able to discharge duties and receive sufficient support throughout a period of extraordinary demands; and b. disability insurance and death benefits are available to staff and their families adversely affected while performing their duties.
3. Governments, hospitals and health regions should develop human resource strategies for communicable disease outbreaks that cover the diverse occupational roles, that are transparent in how individuals are assigned to roles in the management of an outbreak, and that are equitable with respect to the distribution of risk among individuals and occupational categories.
Issue 2: Restricting liberty in the interest of public health by measures such as quarantine
1. Governments and the health care sector should ensure that pandemic influenza response plans include a comprehensive and transparent protocol for the implementation of restrictive measures. The protocol should be founded upon the principles of proportionality and least restrictive means, should balance individual liberties with protection of public from harm and should build in safeguards such as the right of appeal.
2. Governments and the health care sector should ensure that the public is aware of:
a. the rationale for restrictive measures;
b. the benefits of compliance; and
c. the consequences of non-compliance.
3. Governments and the health care sector should include measures in their pandemic influenza preparedness plans to protect against stigmatization and to safeguard the privacy of individuals and/or communities affected by quarantine or other restrictive measures.
4. Governments and the health care sector should institute measures and processes to guarantee provisions and support services to individuals and/or communities affected by restrictive measures, such as quarantine orders, implemented during a pandemic influenza emergency. Plans should state in advance what backup support will be available to help those who are quarantined (e.g., who will do their shopping, pay the bills and provide financial support in lieu of lost income). Governments should have public discussions of appropriate levels of compensation in advance, including who is responsible for compensation.
Issue 3: Priority setting, including the allocation of scarce resources, such as vaccines and antiviral medicines
1. Governments and the health care sector should publicize a clear rationale for giving priority access to health care services, including antivirals and vaccines, to particular groups, such as front line health workers and those in emergency services. The decision makers should initiate and facilitate constructive public discussion about these choices.
2. Governments and the health care sector should engage stakeholders (including staff, the public and partners) in determining what criteria should be used to make resource allocation decisions (e.g., access to ventilators during the crisis, and access to health services for other illnesses), should ensure that clear rationales for allocation decisions are publicly accessible and should provide a justification for any deviation from the pre-determined criteria.
3. Governments and the health care sector should ensure that there are formal mechanisms in place for stakeholders to bring forward new information, to appeal or raise concerns about particular allocation decisions and to resolve disputes.
Issue 4: Global governance implications, such as travel advisories
1. The World Health Organization should remain aware of the impact of travel recommendations on affected countries, and should make every effort to be as transparent and equitable as possible when issuing such recommendations.
2. Federal countries should utilize whatever mechanisms are available within their system of government to ensure that relationships within the country are adequate to ensure compliance with the new International Health Regulations.
3. The developed world should continue to invest in the surveillance capacity of developing countries, and should also make investments to further improve the overall public health infrastructure of developing countries.
University of Toronto Joint Centre for Bioethics
Innovative. Interdisciplinary. International. Improving health care through bioethics.
The JCB is a partnership among the University of Toronto and 15 health care organizations. It provides leadership in bioethics research, education, and clinical activities. Its vision is to be a model of interdisciplinary collaboration in order to create new knowledge and improve practices with respect to bioethics. The JCB does not advocate positions on specific issues, although its individual members may do so.
JCB Members: Ross E.G. Upshur, Karen Faith, Jennifer L. Gibson, Alison K. Thompson, C. Shawn Tracy, Kumanan Wilson, Peter A. Singer
For more information:
www.utoronto.ca/jcb
An international medical ethics think-tank says that all-important public cooperation and the coordination of public officials at all levels requires open and ethical decision making.
The Influenza Pandemic Working Group at the University of Toronto Joint Centre for Bioethics today recommended a 15-point ethical guide for pandemic planning, based in part on experiences and study of the Severe Acute Respiratory Syndrome (SARS) crisis of 2003.
The report says plans to deal with a flu pandemic need to be founded on commonly held ethical values. People need to subscribe in advance to the rationale behind such choices as: the priority recipients of resources, including hospital services and medicines; how much risk front line health care workers should take; and support given to people under restrictions such as quarantine. Decision makers and the public need to be engaged so plans reflect what most people will accept as fair and good for public health.
"A shared set of ethical values is the glue that can hold us together during an intense crisis," says Peter Singer, M.D., Director of the University of Toronto Joint Centre for Bioethics (JCB), which undertook the advisory report. "A key lesson from the SARS outbreak is that fairness becomes more important during a time of crisis and confusion. And the time to consider these questions and processes in relation to a threatened major pandemic is now."
The report concludes that flu pandemic plans universally need an ethical component that address four key issues:
1. Health workers' duty to provide care during a communicable disease outbreak.
2. Restricting liberty in the interest of public health by measures such as quarantine;
3. Priority setting, including the allocation of scarce resources such as medicines;
4. Global governance implications, such as travel advisories.
Health care workers duty to care
The SARS crisis exposed health care systems to hard ethical choices that rapidly arose. Dozens of health care workers, for example, were infected through their work and some died. Other failed to report for duty to treat SARS patients out of fear for their own health or that of their family. A flu pandemic, where there may be no absolute protection or cure, would put far greater pressures on health care systems around the world.
"Workers will face competing obligations, such as their duty to care for patients and to protect their own health and that of families and friends," says JCB member Ross Upshur, M.D., Director, Primary Care Research Unit, Sunnybrook and Women's College Health Sciences Centre. "Medical codes of ethics in various countries provide little specific guidance on how to cope with this very real dilemma. Professional colleges and associations need to provide this kind of particular guidance in advance of an infectious disease outbreak crisis."
Governments and hospitals also need to provide for the health and safety of workers, and for the care of those who fall ill on duty. This might include an insurance fund for life and disability to cover health care workers who become sick or die as they place themselves in harm's way.
The Human Costs of Restrictive Measures
Officials need to provide support for those in quarantine, cut off from family, friends, work, shopping and possibly medical care for other aliments, the report says. The public should also be made aware of the need for quarantine and the consequences of non-compliance.
"The decision to use restrictive measures need to be made in an open, fair and legitimate manner. The public has a right to know the compelling public health reasons for curtailing rights and restricting normal activities. If quarantines are used, those affected need adequate care and job protection. Preventing financial hardship is important to obtaining full compliance from the public," says Dr. Upshur.
Measures to protect against stigmatization and to safeguard the privacy of individuals and/or communities affected by quarantine also should be part of pandemic preparedness plans the report recommends.
Allocating Scarce Resources, Medicines
All countries will face scarcities of medicines, equipment and health care workers during a pandemic, according to the group. Governments, hospitals and health regions should publicize a clear rationale for giving priority access to anti-viral medicines and vaccines to particular groups (e.g., front line health workers, children, decision-makers).
Advance planning ought to include criteria for resource allocation decisions, created in consultation with the general public.
Travel Bans
The World Health Organization (WHO) has warned that if the H5N1 strain of bird flu mutates and infects people it could reach all continents in less than three months. The WHO would likely impose regional travel restrictions in hopes of slowing the spread of the disease.
However such decisions can have major economic impacts. Canada, and Toronto in particular, suffered millions in economic losses when the WHO advised international travelers against all nonessential travel because of SARS.
Decisions about travel restrictions need to be clearly justified and the process must be transparent the report says.
At the same time, the WHO relies on individual countries for reporting disease outbreaks. Such surveillance may be beyond the capacity of many developing countries. The developed world should continue to invest in the surveillance capacity and the overall public health infrastructures of developing countries.
The WHO recommends that ethical issues be a consideration in the planning process for an influenza pandemic. Canada's province of Ontario has incorporated this framework into its plan.
"Other jurisdictions and nations should assess their pandemic plan against this ethical framework and these recommendations," says Dr. Singer.
"Looking ahead, we can say that if the pandemic strikes it will cause great hardship, but societies will struggle through. They will be better able to do so if they have general agreement on an ethical approach. Afterwards, history will judge today's leaders on how well they took decision on the ethical challenges they faced in the midst of the crisis."
Ten substantive values to guide ethical decision-making for a pandemic influenza outbreak
Individual liberty
In a public health crisis, restrictions to individual liberty may be necessary to protect the public from serious harm. Restrictions to individual liberty should:
- - Be proportional, necessary and relevant.
- - Employ the least restrictive means.
- - Be applied equitably.
Protection of the public from harm
To protect the public from harm, health care organizations and public health authorities may be required to take actions that impinge on individual liberty. Decision makers should:
- - Weigh the imperative for compliance.
- - Provide reasons for public health measures to encourage compliance.
- - Establish mechanisms to review decisions.
Proportionality
Proportionality requires that restrictions to individual liberty and measures taken to protect the public from harm should not exceed what is necessary to address the actual level of risk to or critical needs of the community.
Privacy
Individuals have a right to privacy in health care. In a public health crisis, it may be necessary to override this right to protect the public from serious harm.
Duty to provide care
Inherent to all codes of ethics for health care professionals is the duty to provide care and to respond to suffering. Health care providers will have to weigh demands of their professional roles against other competing obligations to their own health, and to family and friends. Moreover, health care workers will face significant challenges related to resource allocation, scope of practice, professional liability and workplace conditions.
Reciprocity
Reciprocity requires that society support those who face a disproportionate burden in protecting the public good, and take steps to minimize burdens as much as possible. Measures to protect the public good are likely to impose a disproportionate burden on health care workers, patients and their families.
Equity
All patients have an equal claim to receive the health care they need under normal conditions. During a pandemic, difficult decisions will need to be made about which health services to maintain and which to defer. Depending on the severity of the health crisis, this could curtail not only elective surgeries, but could also limit the provision of emergency or necessary services.
Trust
Trust is an essential component of the relationships among clinicians and patients, staff and their organizations, the public and health care providers or organizations, and among organizations within a health system. Decision makers will be confronted with the challenge of maintaining stakeholder trust while simultaneously implementing various control measures during an evolving health crisis. Trust is enhanced by upholding such process values as transparency.
Solidarity
As the world learned from SARS, a pandemic influenza outbreak, will require a new vision of global solidarity and a vision of solidarity among nations. A pandemic can challenge conventional ideas of national sovereignty, security or territoriality. It also requires solidarity within and among health care institutions. It calls for collaborative approaches that set aside traditional values of self-interest or territoriality among health care professionals, services or institutions.
Stewardship
Those entrusted with governance roles should be guided by the notion of stewardship. Inherent in stewardship are the notions of trust, ethical behaviour and good decision-making. This implies that decisions regarding resources are intended to achieve the best patient health and public health outcomes given the unique circumstances of the influenza crisis.
Five procedural values to guide ethical decision-making for a pandemic influenza outbreak
Reasonable
Decisions should be based on reasons (i.e., evidence, principles and values) that stakeholders can agree are relevant to meeting health needs in a pandemic influenza crisis. The decisions should be made by people who are credible and accountable.
Open and transparent
The process by which decisions are made must be open to scrutiny, and the basis upon which decisions are made should be publicly accessible.
Inclusive
Decisions should be made explicitly with stakeholder views in mind, and there should be opportunities to engage stakeholders in the decision-making process.
Responsive
There should be opportunities to revisit and revise decisions as new information emerges throughout the crisis. There should be mechanisms to address disputes and complaints.
Accountable
There should be mechanisms in place to ensure that decision makers are answerable for their actions and inactions. Defence of actions and inactions should be grounded in the 14 other ethical values proposed above.
Summary of Recommendations
An ethical guide for pandemic planning
1. National, provincial/state/territorial, and municipal governments, as well as the health care sector, should ensure that their pandemic plans include an ethical component.
2. National, provincial/state/territorial, and municipal governments, as well as the health care sector, should consider incorporating both substantive and procedural values in the ethical component of their pandemic plans.
Four key ethical issues
Issue 1: Health workers' duty to provide care during a communicable disease outbreak
1. Professional colleges and associations should provide, by way of their codes of ethics, clear guidance to members in advance of a major communicable disease outbreak, such as pandemic flu. Existing mechanisms should be identified, or means should be developed, to inform college members as to expectations and obligations regarding the duty to provide care during a communicable disease outbreak.
2. Governments and the health care sector should ensure that: a. care providers' safety is protected at all times, and providers are able to discharge duties and receive sufficient support throughout a period of extraordinary demands; and b. disability insurance and death benefits are available to staff and their families adversely affected while performing their duties.
3. Governments, hospitals and health regions should develop human resource strategies for communicable disease outbreaks that cover the diverse occupational roles, that are transparent in how individuals are assigned to roles in the management of an outbreak, and that are equitable with respect to the distribution of risk among individuals and occupational categories.
Issue 2: Restricting liberty in the interest of public health by measures such as quarantine
1. Governments and the health care sector should ensure that pandemic influenza response plans include a comprehensive and transparent protocol for the implementation of restrictive measures. The protocol should be founded upon the principles of proportionality and least restrictive means, should balance individual liberties with protection of public from harm and should build in safeguards such as the right of appeal.
2. Governments and the health care sector should ensure that the public is aware of:
a. the rationale for restrictive measures;
b. the benefits of compliance; and
c. the consequences of non-compliance.
3. Governments and the health care sector should include measures in their pandemic influenza preparedness plans to protect against stigmatization and to safeguard the privacy of individuals and/or communities affected by quarantine or other restrictive measures.
4. Governments and the health care sector should institute measures and processes to guarantee provisions and support services to individuals and/or communities affected by restrictive measures, such as quarantine orders, implemented during a pandemic influenza emergency. Plans should state in advance what backup support will be available to help those who are quarantined (e.g., who will do their shopping, pay the bills and provide financial support in lieu of lost income). Governments should have public discussions of appropriate levels of compensation in advance, including who is responsible for compensation.
Issue 3: Priority setting, including the allocation of scarce resources, such as vaccines and antiviral medicines
1. Governments and the health care sector should publicize a clear rationale for giving priority access to health care services, including antivirals and vaccines, to particular groups, such as front line health workers and those in emergency services. The decision makers should initiate and facilitate constructive public discussion about these choices.
2. Governments and the health care sector should engage stakeholders (including staff, the public and partners) in determining what criteria should be used to make resource allocation decisions (e.g., access to ventilators during the crisis, and access to health services for other illnesses), should ensure that clear rationales for allocation decisions are publicly accessible and should provide a justification for any deviation from the pre-determined criteria.
3. Governments and the health care sector should ensure that there are formal mechanisms in place for stakeholders to bring forward new information, to appeal or raise concerns about particular allocation decisions and to resolve disputes.
Issue 4: Global governance implications, such as travel advisories
1. The World Health Organization should remain aware of the impact of travel recommendations on affected countries, and should make every effort to be as transparent and equitable as possible when issuing such recommendations.
2. Federal countries should utilize whatever mechanisms are available within their system of government to ensure that relationships within the country are adequate to ensure compliance with the new International Health Regulations.
3. The developed world should continue to invest in the surveillance capacity of developing countries, and should also make investments to further improve the overall public health infrastructure of developing countries.
University of Toronto Joint Centre for Bioethics
Innovative. Interdisciplinary. International. Improving health care through bioethics.
The JCB is a partnership among the University of Toronto and 15 health care organizations. It provides leadership in bioethics research, education, and clinical activities. Its vision is to be a model of interdisciplinary collaboration in order to create new knowledge and improve practices with respect to bioethics. The JCB does not advocate positions on specific issues, although its individual members may do so.
JCB Members: Ross E.G. Upshur, Karen Faith, Jennifer L. Gibson, Alison K. Thompson, C. Shawn Tracy, Kumanan Wilson, Peter A. Singer
For more information:
www.utoronto.ca/jcb
[General
]
14 August, 2008 17:35
Home oxygen providers in the Midwest prepared for
the deadly ice storm that struck earlier this week and responded with extra visits and contacts with
patients receiving home oxygen therapy.
An oxygen patient who uses an oxygen system that runs on electricity must have a back-up supply of
oxygen that will last until power is restored. Oxygen therapy is critical to more than one million
Americans who suffer from respiratory illnesses such as chronic obstructive pulmonary disease
(COPD).
Responses in Missouri
Tim Moore, a regional manager at Wilkinson Home Care Equipment in Nevada, Missouri, noted that in two of the communities the company serves, more than half the population is without power. Today, he commented about his company's activities: "We have filled and delivered well over 100 tanks in the last three days to keep our current patients, nursing homes, and some of our competitors (who had no power, but had customers in need) in a constant supply of oxygen. We have made daily runs 65 miles south to Joplin [Missouri] to ensure that our store there had enough tanks to handle the needs that might arise. We have made these runs regardless of weather and what might happen, because these are our customers. Just because the roads are bad, or the power is out, we still have an obligation as providers. I drove to Joplin on Sunday and delivered about 30 tanks to a nursing home without power, and to our own store. We have employees without power in their own homes, who are working to meet the [patient's] needs. We had one store without power for about 48 hours, but we had the manager stationed there in case customers came by to get tanks or supplies. These are the things that make this industry different from so many other healthcare entities."
Responses in Oklahoma
Maria Lucas is chief executive officer of Asthma & Respiratory Services of Oklahoma (Tulsa) which covers most of northeast Oklahoma and the Oklahoma City and Enid areas. The company cares ventilator patients as well as oxygen patients. "I have to say our team has done a remarkable job of planning for this storm. We were hit last year with several major ice storms and we learned from that experience. We started midweek last week contacting our patients and making sure they were stocked up before the storm hit…. We have a break now in between storms, and we are again rushing to get our people covered for the next storm that is moving in on Friday. We do ground our fleet when the weather is at its worst as we do not want to have our employees in danger, but we are out again just as soon as possible."
Family Medical Equipment in Altus, Okla. has oxygen customers in the southwest part of the state, some of whom were affected by the recent ice storm. Josh Drake, of Family Medical, noted, "We used the time available prior to the storm to contact each customer who may be affected. We spent many extra hours in service calls and mileage, above our budget, to deliver extra oxygen to each patient in our service area." While Family Medical will not receive any extra reimbursements for its efforts, they note with satisfaction that, "not a single customer had a shortage of oxygen while electricity was off."
Responses in Iowa
In Iowa, Long Term Medical Supply has seven locations serving home patients and nursing facilities, three of which were severely affected by the storms that hit Southern Iowa earlier this week. Mari Banse, who works in the corporate office in Hampton, Iowa, described one phone conversation from the week: "When I received a call from one of our store managers down in Osceola, IA today sharing his feelings and stories with me about the amazing effort he was putting into his job, it almost brought me to tears. In the earlier hours of the morning this man started out in the pitch black, eerie town that got around three inches of rain turning into ice that took out all of the power and was taking down trees. Concerned about the safety of his patients, he began to travel from home to home to insure that they were safe and not afraid of their lack of power and inability to get to a safe place. He shuttled people to shelters that were set up at the local hospital and Casino, even going above and beyond his job description he took hot meals and blankets to elderly patients. This was an area that some streets were not even passable due to downed trees. When he couldn't get down roads he made sure that he got in contact with them some how to make sure that they were ok just to get a cheerful response that everything was ok."
About Oxygen Therapy
The typical Medicare home oxygen beneficiary is a 73 year-old who suffers from late- stage COPD with associated severe low levels of oxygen in the blood (hypoxemia). COPD is the only leading cause of death for which both prevalence and mortality are rising. COPD is a chronic, debilitating disease characterized by severe airflow limitation resulting from chronic inflammation of the airways. Approximately 12 million Americans have been diagnosed with COPD, and an estimated 12 to 15 million more remain undiagnosed. Use of medical oxygen equipment is imperative to the overall well-being of patients on oxygen therapy.
The American Association for Homecare (AAHomecare) represents providers of durable medical equipment and related services and supplies as well as equipment manufacturers. AAHomecare members serve the medical needs of millions of Americans who require home oxygen equipment, wheelchairs and other mobility products, hospital beds, medical supplies, inhalation drug therapy, home infusion, and other medical equipment, therapies, services, and supplies delivered in the patient's home. AAHomecare's provider members operate more than 3,000 homecare locations in all 50 states.
American Association for Homecare
Responses in Missouri
Tim Moore, a regional manager at Wilkinson Home Care Equipment in Nevada, Missouri, noted that in two of the communities the company serves, more than half the population is without power. Today, he commented about his company's activities: "We have filled and delivered well over 100 tanks in the last three days to keep our current patients, nursing homes, and some of our competitors (who had no power, but had customers in need) in a constant supply of oxygen. We have made daily runs 65 miles south to Joplin [Missouri] to ensure that our store there had enough tanks to handle the needs that might arise. We have made these runs regardless of weather and what might happen, because these are our customers. Just because the roads are bad, or the power is out, we still have an obligation as providers. I drove to Joplin on Sunday and delivered about 30 tanks to a nursing home without power, and to our own store. We have employees without power in their own homes, who are working to meet the [patient's] needs. We had one store without power for about 48 hours, but we had the manager stationed there in case customers came by to get tanks or supplies. These are the things that make this industry different from so many other healthcare entities."
Responses in Oklahoma
Maria Lucas is chief executive officer of Asthma & Respiratory Services of Oklahoma (Tulsa) which covers most of northeast Oklahoma and the Oklahoma City and Enid areas. The company cares ventilator patients as well as oxygen patients. "I have to say our team has done a remarkable job of planning for this storm. We were hit last year with several major ice storms and we learned from that experience. We started midweek last week contacting our patients and making sure they were stocked up before the storm hit…. We have a break now in between storms, and we are again rushing to get our people covered for the next storm that is moving in on Friday. We do ground our fleet when the weather is at its worst as we do not want to have our employees in danger, but we are out again just as soon as possible."
Family Medical Equipment in Altus, Okla. has oxygen customers in the southwest part of the state, some of whom were affected by the recent ice storm. Josh Drake, of Family Medical, noted, "We used the time available prior to the storm to contact each customer who may be affected. We spent many extra hours in service calls and mileage, above our budget, to deliver extra oxygen to each patient in our service area." While Family Medical will not receive any extra reimbursements for its efforts, they note with satisfaction that, "not a single customer had a shortage of oxygen while electricity was off."
Responses in Iowa
In Iowa, Long Term Medical Supply has seven locations serving home patients and nursing facilities, three of which were severely affected by the storms that hit Southern Iowa earlier this week. Mari Banse, who works in the corporate office in Hampton, Iowa, described one phone conversation from the week: "When I received a call from one of our store managers down in Osceola, IA today sharing his feelings and stories with me about the amazing effort he was putting into his job, it almost brought me to tears. In the earlier hours of the morning this man started out in the pitch black, eerie town that got around three inches of rain turning into ice that took out all of the power and was taking down trees. Concerned about the safety of his patients, he began to travel from home to home to insure that they were safe and not afraid of their lack of power and inability to get to a safe place. He shuttled people to shelters that were set up at the local hospital and Casino, even going above and beyond his job description he took hot meals and blankets to elderly patients. This was an area that some streets were not even passable due to downed trees. When he couldn't get down roads he made sure that he got in contact with them some how to make sure that they were ok just to get a cheerful response that everything was ok."
About Oxygen Therapy
The typical Medicare home oxygen beneficiary is a 73 year-old who suffers from late- stage COPD with associated severe low levels of oxygen in the blood (hypoxemia). COPD is the only leading cause of death for which both prevalence and mortality are rising. COPD is a chronic, debilitating disease characterized by severe airflow limitation resulting from chronic inflammation of the airways. Approximately 12 million Americans have been diagnosed with COPD, and an estimated 12 to 15 million more remain undiagnosed. Use of medical oxygen equipment is imperative to the overall well-being of patients on oxygen therapy.
The American Association for Homecare (AAHomecare) represents providers of durable medical equipment and related services and supplies as well as equipment manufacturers. AAHomecare members serve the medical needs of millions of Americans who require home oxygen equipment, wheelchairs and other mobility products, hospital beds, medical supplies, inhalation drug therapy, home infusion, and other medical equipment, therapies, services, and supplies delivered in the patient's home. AAHomecare's provider members operate more than 3,000 homecare locations in all 50 states.
American Association for Homecare
[General
]
14 August, 2008 17:32
As the new year begins, many
resolutions will be made and many will be broken. Fortunately, for all
those people who have resolved to find a new and better job, or to land a
dreamed- about promotion, the International Hyperhidrosis Society (IHHS)
has tips to make the process sweat-free and, therefore, more successful.
We all know that jobs and careers can cause stress and anxiety that leads to increased perspiration. In fact, according to a survey recently conducted by IHHS and Harris Interactive(R) nearly two-thirds of respondents said that job-related issues make them sweat more than anything else(1).
Whether one is interviewing for a new job, wining-and-dining clients, or attempting to give a compelling presentation to colleagues, it's mandatory to exude confidence and give off a positive first impression -- there is no room in these important workplace situations for excessive sweating! For instance, according to the above-mentioned the Harris poll, two-thirds of adults perceive someone who is sweating to be "nervous" and four out of ten adults who sweat on the job say that their sweating makes them feel very upset. And, in a separate study, results showed that 42% of those with hyperhidrosis (a medical condition characterized by near-constant excessive sweating) actually changed career paths because of their sweating problems.(2) In a similar poll conducted by the IHHS, 86% of responding hyperhidrosis patients said that they have experienced negative comments about their sweating, compounding the emotional impact that excessive sweating has on its sufferers(3).
As the second in a series of Tip Sheets offered from the leader in helping people eliminate and cope with excessive sweat, the IHHS is offering suggestions for minimizing and dealing with anxiety-induced sweating throughout one's career (for the first Tip Sheet visit http://www.SweatHelp.org). For all those people who have resolved to make positive changes in their careers in 2007, here are some great ways to get off on the right -- and dry -- foot!
-- Do your homework on a potential employer; visit the organization's Web site and review its background, products and offerings so that you are informed, can minimize surprises and stay cool
-- Visit online job search engines that offer tips on what to expect during interviews so you are prepared, practiced and ready to make the best first impression
-- Prior to an interview, write down key points and characteristics about yourself and examples of how you've succeeded; highlighting your successes will make you more confident which can lead to less sweating
-- Apply antiperspirant to your underarms once in the morning and again prior to bedtime; application twice daily -- and especially before bedtime -- has been shown to be more effective at keeping you dry. Antiperspirants may be used on hands and feet as well as on underarms; gently massaging them into the skin may be useful
-- Steer clear of sweat-inducing spicy foods, caffeinated beverages and alcohol in the days leading up to an interview or client presentation so you are clear-headed, aroma-free and sweat is minimized; it is probably a good idea to forgo the coffee offered by the interviewer too (choose a cool glass of water instead)
-- Be sure to shower and wash with antibacterial soap, such as Safeguard(R), at least once a day; when perspiration and bacteria mix, body odor results
-- Dress for success - wear polished and professional outfits made of natural materials (e.g., cotton) rather than synthetic materials (e.g., nylon). At the very least, ensure that your under layers are made of natural fabrics that offer more air circulation around the body and wick away moisture; avoid wearing suit jackets except during professional meetings and interviews
-- "Dress shields," small pads that go in your armpits to absorb sweat, may be an option for you; you may also want to keep an extra shirt with you for emergencies
-- Black or white solid colors or patterned fabrics with a black and white background will best camouflage underarm sweat marks
-- Keep a handkerchief in your pocket to absorb extra sweat on your palm prior to shaking hands with a colleague or interviewer; or swipe your hand on your pants leg as you raise it to meet the offering hand (clothing made from absorbent materials like cotton or wool or in a darker shade are less likely to show sweat marks)
-- Keep a travel-sized extra antiperspirant at your desk or in your car or purse for quick application prior to interviews, presentations and meetings
-- Schedule client appointments and interviews earlier in the day -- you will be fresher physically and mentally and your commute is likely to be cooler in the mornings
-- Participate in regular stress-relieving activities, such as meditation, yoga or other exercises; for immediate anxiety (and sweat) reduction, a breathing exercise will help. Note: A great practice right before "show time" is to breathe slowly through the nose for five seconds and blow out through your mouth for another five seconds; repeat for five minutes or as necessary
-- Consider using a stronger over-the-counter soft solid antiperspirant, such as Secret Platinum(R). You can also apply an absorbent powder to body areas that you know will perspire in stressful situations (be sure to wipe excess powder off your clothing)
-- And to really eliminate any chance of excessive sweat, talk to your dermatologist about longer-lasting sweat reducers, like prescription antiperspirants, Botox(R) injections or iontophoresis. For more info on these treatments and to find a physician familiar with hyperhidrosis, use the Physician Finder on the IHHS Web site at http://www.SweatHelp.org.
Human Resources Q&A
Over the years, human resources managers have contacted the IHHS in search of ways to help company employees with their excessive sweating. We commend these personnel representatives for taking an active role in helping their employees. One example is below:
Question:
"I have an employee who has indicated that he has hyperhidrosis (excessive sweating) leading to excessive body odor. Can you provide any suggestions on how to accommodate this? Even though it may or may not be defined as a disability under the Americans with Disabilities Act, we obviously would like to assist the employee."
Answer:
Excessive body odor is typically not a characteristic of hyperhidrosis since the glands (there are two types of sweat glands) that are affected by hyperhidrosis produce large volumes of watery, odorless sweat which usually wash away excess bacteria, the main culprit in generating body odor. Still, if sweat is allowed to dry on the skin and mix with bacteria anywhere on the body, unappealing odor may result. The first step in minimizing odor is to keep sweaty body parts dry through the use of antiperspirants, powders, and frequent clothing changes. Next, regular washing with antibacterial soap will ensure that bacteria do not proliferate on the body. An antiperspirant, like Secret Platinum(R) soft solid should also be used consistently and a deodorant may be helpful. Sometimes changes in diet can also help, like avoiding caffeine and alcohol (which can stimulate sweating) and foods with pungent aromas that may permeate through the skin. The employee should also speak with a dermatologist who can prescribe stronger sweat minimizers, such as prescription antiperspirants or periodic Botox(R) injections. Since not all health plans may cover existing treatments, employees should speak with their benefits managers about which insurance plans cover recommended treatments and prescriptions. A wealth of information (from understanding the basics of sweat to insurance tools, including an overview of hyperhidrosis treatment coverage for many health plans) can be found on SweatHelp.org.
About Hyperhidrosis
While on the job stress can cause most people to sweat more than usual, more than eight million Americans sweat excessively all the time-despite the weather or the situation. Hyperhidrosis, defined as excessive sweating, is a chronic and debilitating condition estimated to affect at least three percent of the world's population. Those battling hyperhidrosis suffer loss of friendships and distancing from colleagues due to the embarrassment of profuse sweating. Additionally, they often withdraw socially because of the reactions of others.
Fortunately, symptoms are frequently treatable by a qualified dermatologist. Existing therapies include strong over-the-counter antiperspirants like Secret Platinum(R) soft solid, prescription antiperspirants, iontophoresis (a water bath conducting a mild electric current through the skin's surface), and longer-lasting physician-administered sweat reducers like Botox(R) injections. Surgery may be an option if other therapies are not effective, but should only be considered after speaking with a dermatologist as there is a high risk of serious and permanent side effects.
The International Hyperhidrosis Society Web site, SweatHelp.org, includes a Physician Finder to help anyone with excessive sweating to find medical help, information on additional treatment options and a comprehensive collection of insurance and reimbursement tools, including downloadable forms, which can help sufferers work with their physician, health insurance plan and employer to get the correct coverage for necessary treatments. There are practical tips to make the most out of appointments with physicians and information on clinical trials and a free newsletter that will keep everyone current on hyperhidrosis news and medical breakthroughs. A self assessment tool is also available to help people determine how much sweat is too much. And because hyperhidrosis usually starts in the teenage years, the IHHS has created an online teen forum to help teenagers learn how to cope with the condition and find effective solutions.
The International Hyperhidrosis Society is a non-profit organization that strives to improve the quality of life for those affected by excessive sweating. The Society promotes research and conducts education on the physiological effects of hyperhidrosis, raises awareness about its emotional and economic impact and advocates for patient access to effective treatments. The International Hyperhidrosis Society is composed of members from all over the world, making it a true international network for people who treat or suffer from hyperhidrosis. Look for more Sweat Tips at http://www.SweatHelp.org.
(1) Results from a 2005 Harris Interactive Study are available upon request from the International Hyperhidrosis Society
(2) H Hamm, MK Naumann, JW Kowalski, S Kutt, C Kozma, C Teale. Primary Focal Hyperhidrosis: Disease Characteristics and Functional Impairment. Dermatology 2006; 212: 343, 353
(3) Results from a 2005 International Hyperhidrosis Society Online Survey are available upon request from the International Hyperhidrosis Society
International Hyperhidrosis Society (IHHS)
http://www.SweatHelp.org
We all know that jobs and careers can cause stress and anxiety that leads to increased perspiration. In fact, according to a survey recently conducted by IHHS and Harris Interactive(R) nearly two-thirds of respondents said that job-related issues make them sweat more than anything else(1).
Whether one is interviewing for a new job, wining-and-dining clients, or attempting to give a compelling presentation to colleagues, it's mandatory to exude confidence and give off a positive first impression -- there is no room in these important workplace situations for excessive sweating! For instance, according to the above-mentioned the Harris poll, two-thirds of adults perceive someone who is sweating to be "nervous" and four out of ten adults who sweat on the job say that their sweating makes them feel very upset. And, in a separate study, results showed that 42% of those with hyperhidrosis (a medical condition characterized by near-constant excessive sweating) actually changed career paths because of their sweating problems.(2) In a similar poll conducted by the IHHS, 86% of responding hyperhidrosis patients said that they have experienced negative comments about their sweating, compounding the emotional impact that excessive sweating has on its sufferers(3).
As the second in a series of Tip Sheets offered from the leader in helping people eliminate and cope with excessive sweat, the IHHS is offering suggestions for minimizing and dealing with anxiety-induced sweating throughout one's career (for the first Tip Sheet visit http://www.SweatHelp.org). For all those people who have resolved to make positive changes in their careers in 2007, here are some great ways to get off on the right -- and dry -- foot!
-- Do your homework on a potential employer; visit the organization's Web site and review its background, products and offerings so that you are informed, can minimize surprises and stay cool
-- Visit online job search engines that offer tips on what to expect during interviews so you are prepared, practiced and ready to make the best first impression
-- Prior to an interview, write down key points and characteristics about yourself and examples of how you've succeeded; highlighting your successes will make you more confident which can lead to less sweating
-- Apply antiperspirant to your underarms once in the morning and again prior to bedtime; application twice daily -- and especially before bedtime -- has been shown to be more effective at keeping you dry. Antiperspirants may be used on hands and feet as well as on underarms; gently massaging them into the skin may be useful
-- Steer clear of sweat-inducing spicy foods, caffeinated beverages and alcohol in the days leading up to an interview or client presentation so you are clear-headed, aroma-free and sweat is minimized; it is probably a good idea to forgo the coffee offered by the interviewer too (choose a cool glass of water instead)
-- Be sure to shower and wash with antibacterial soap, such as Safeguard(R), at least once a day; when perspiration and bacteria mix, body odor results
-- Dress for success - wear polished and professional outfits made of natural materials (e.g., cotton) rather than synthetic materials (e.g., nylon). At the very least, ensure that your under layers are made of natural fabrics that offer more air circulation around the body and wick away moisture; avoid wearing suit jackets except during professional meetings and interviews
-- "Dress shields," small pads that go in your armpits to absorb sweat, may be an option for you; you may also want to keep an extra shirt with you for emergencies
-- Black or white solid colors or patterned fabrics with a black and white background will best camouflage underarm sweat marks
-- Keep a handkerchief in your pocket to absorb extra sweat on your palm prior to shaking hands with a colleague or interviewer; or swipe your hand on your pants leg as you raise it to meet the offering hand (clothing made from absorbent materials like cotton or wool or in a darker shade are less likely to show sweat marks)
-- Keep a travel-sized extra antiperspirant at your desk or in your car or purse for quick application prior to interviews, presentations and meetings
-- Schedule client appointments and interviews earlier in the day -- you will be fresher physically and mentally and your commute is likely to be cooler in the mornings
-- Participate in regular stress-relieving activities, such as meditation, yoga or other exercises; for immediate anxiety (and sweat) reduction, a breathing exercise will help. Note: A great practice right before "show time" is to breathe slowly through the nose for five seconds and blow out through your mouth for another five seconds; repeat for five minutes or as necessary
-- Consider using a stronger over-the-counter soft solid antiperspirant, such as Secret Platinum(R). You can also apply an absorbent powder to body areas that you know will perspire in stressful situations (be sure to wipe excess powder off your clothing)
-- And to really eliminate any chance of excessive sweat, talk to your dermatologist about longer-lasting sweat reducers, like prescription antiperspirants, Botox(R) injections or iontophoresis. For more info on these treatments and to find a physician familiar with hyperhidrosis, use the Physician Finder on the IHHS Web site at http://www.SweatHelp.org.
Human Resources Q&A
Over the years, human resources managers have contacted the IHHS in search of ways to help company employees with their excessive sweating. We commend these personnel representatives for taking an active role in helping their employees. One example is below:
Question:
"I have an employee who has indicated that he has hyperhidrosis (excessive sweating) leading to excessive body odor. Can you provide any suggestions on how to accommodate this? Even though it may or may not be defined as a disability under the Americans with Disabilities Act, we obviously would like to assist the employee."
Answer:
Excessive body odor is typically not a characteristic of hyperhidrosis since the glands (there are two types of sweat glands) that are affected by hyperhidrosis produce large volumes of watery, odorless sweat which usually wash away excess bacteria, the main culprit in generating body odor. Still, if sweat is allowed to dry on the skin and mix with bacteria anywhere on the body, unappealing odor may result. The first step in minimizing odor is to keep sweaty body parts dry through the use of antiperspirants, powders, and frequent clothing changes. Next, regular washing with antibacterial soap will ensure that bacteria do not proliferate on the body. An antiperspirant, like Secret Platinum(R) soft solid should also be used consistently and a deodorant may be helpful. Sometimes changes in diet can also help, like avoiding caffeine and alcohol (which can stimulate sweating) and foods with pungent aromas that may permeate through the skin. The employee should also speak with a dermatologist who can prescribe stronger sweat minimizers, such as prescription antiperspirants or periodic Botox(R) injections. Since not all health plans may cover existing treatments, employees should speak with their benefits managers about which insurance plans cover recommended treatments and prescriptions. A wealth of information (from understanding the basics of sweat to insurance tools, including an overview of hyperhidrosis treatment coverage for many health plans) can be found on SweatHelp.org.
About Hyperhidrosis
While on the job stress can cause most people to sweat more than usual, more than eight million Americans sweat excessively all the time-despite the weather or the situation. Hyperhidrosis, defined as excessive sweating, is a chronic and debilitating condition estimated to affect at least three percent of the world's population. Those battling hyperhidrosis suffer loss of friendships and distancing from colleagues due to the embarrassment of profuse sweating. Additionally, they often withdraw socially because of the reactions of others.
Fortunately, symptoms are frequently treatable by a qualified dermatologist. Existing therapies include strong over-the-counter antiperspirants like Secret Platinum(R) soft solid, prescription antiperspirants, iontophoresis (a water bath conducting a mild electric current through the skin's surface), and longer-lasting physician-administered sweat reducers like Botox(R) injections. Surgery may be an option if other therapies are not effective, but should only be considered after speaking with a dermatologist as there is a high risk of serious and permanent side effects.
The International Hyperhidrosis Society Web site, SweatHelp.org, includes a Physician Finder to help anyone with excessive sweating to find medical help, information on additional treatment options and a comprehensive collection of insurance and reimbursement tools, including downloadable forms, which can help sufferers work with their physician, health insurance plan and employer to get the correct coverage for necessary treatments. There are practical tips to make the most out of appointments with physicians and information on clinical trials and a free newsletter that will keep everyone current on hyperhidrosis news and medical breakthroughs. A self assessment tool is also available to help people determine how much sweat is too much. And because hyperhidrosis usually starts in the teenage years, the IHHS has created an online teen forum to help teenagers learn how to cope with the condition and find effective solutions.
The International Hyperhidrosis Society is a non-profit organization that strives to improve the quality of life for those affected by excessive sweating. The Society promotes research and conducts education on the physiological effects of hyperhidrosis, raises awareness about its emotional and economic impact and advocates for patient access to effective treatments. The International Hyperhidrosis Society is composed of members from all over the world, making it a true international network for people who treat or suffer from hyperhidrosis. Look for more Sweat Tips at http://www.SweatHelp.org.
(1) Results from a 2005 Harris Interactive Study are available upon request from the International Hyperhidrosis Society
(2) H Hamm, MK Naumann, JW Kowalski, S Kutt, C Kozma, C Teale. Primary Focal Hyperhidrosis: Disease Characteristics and Functional Impairment. Dermatology 2006; 212: 343, 353
(3) Results from a 2005 International Hyperhidrosis Society Online Survey are available upon request from the International Hyperhidrosis Society
International Hyperhidrosis Society (IHHS)
http://www.SweatHelp.org
[General
]
14 August, 2008 17:29
Lee Richardson, Member of Parliament for Calgary Centre, on behalf of
the Honourable Tony Clement, Minister of Health, and the Honourable
Diane Finley, Minister of Citizenship and Immigration, announced a
federal contribution of $536,000 to Alberta Health and Wellness to
pilot test an innovative off-shore assessment program for
internationally educated nurses immigrating to Canada.
"Projects such as this will help to alleviate Canada's nursing shortage, which in turn will lead to improved care and a reduction in wait times. This is a ground-breaking initiative, in which the Government of Canada is proud to take part," said Minister Clement.
"Canada has a skills shortage and skilled immigrants want to contribute to our country by working in the fields for which they've been trained. We want to help them do that and one of the best ways is to help them get their credentials assessed before they enter the country so that when they arrive, they can find work faster in their fields, " said Minister Finley.
Traditionally, internationally educated nurses who wanted to work in Alberta needed to travel to Mount Royal College in Calgary to take the assessment exams. Once this off-shore pilot project is fully implemented, thirty-six nursing candidates will be assessed overseas, with their language, knowledge and competencies measured against Registered Nurse (RN) competency standards. The nurses will be informed of any areas that require supplemental learning.
"I am thrilled that this project is taking place here in Alberta," said Mr. Richardson. "Internationally trained nurses can now be assessed before they arrive to Alberta, so that when they arrive they'll be able to start working as nurses sooner."
The newly funded project is a collaboration between Mount Royal College's Internationally Educated Nurses Assessment Centres in Calgary and The College and Association of Registered Nurses of Alberta. The project aims to speed up the licensure process by enabling internationally educated nurses to undergo a Substantial Equivalent Competency Assessment before they immigrate to Canada. Assessments are taking place in London, Dublin, Dubai, Qatar and elsewhere in the United Arab Emirates.
The overall goal of this initiative is to reduce the length of time between an internationally educated nurse's job offer and their first day of employment by identifying learning that may be required while they await immigration or write the Canadian RN licensing examinations. This will enable internationally educated nurses to put their skills to work more quickly once they arrive in Canada, while providing guidance to other jurisdictions who are considering offshore assessment processes. The project will also increase Alberta's capacity to assess internationally educated nurses with the training of additional assessors.
"We're delighted with this federal support that ensures increased access to nurses educated and registered in other countries who, through our program, are able to continue their careers as fully qualified and fully registered nurses here in Canada," said Mount Royal College President, Dave Marshall. "By working together we can help ensure the supply of health care workers necessary to ensure a high quality health care system in Canada."
The Alberta Health and Wellness project is one of over 40 initiatives funded by the Internationally Educated Health Professionals Initiative of the federal government. The initiative provides $75 million over five years to provinces and territories and non-governmental organizations to address barriers to integration for internationally educated health professionals. The goal of the initiative is to promote the assessment and integration of internationally educated health professionals into the Canadian health workforce. The initiative is an important component of the broader health human resources strategy, which is essential to ensuring timely access to care in communities across the country.
"Projects such as this will help to alleviate Canada's nursing shortage, which in turn will lead to improved care and a reduction in wait times. This is a ground-breaking initiative, in which the Government of Canada is proud to take part," said Minister Clement.
"Canada has a skills shortage and skilled immigrants want to contribute to our country by working in the fields for which they've been trained. We want to help them do that and one of the best ways is to help them get their credentials assessed before they enter the country so that when they arrive, they can find work faster in their fields, " said Minister Finley.
Traditionally, internationally educated nurses who wanted to work in Alberta needed to travel to Mount Royal College in Calgary to take the assessment exams. Once this off-shore pilot project is fully implemented, thirty-six nursing candidates will be assessed overseas, with their language, knowledge and competencies measured against Registered Nurse (RN) competency standards. The nurses will be informed of any areas that require supplemental learning.
"I am thrilled that this project is taking place here in Alberta," said Mr. Richardson. "Internationally trained nurses can now be assessed before they arrive to Alberta, so that when they arrive they'll be able to start working as nurses sooner."
The newly funded project is a collaboration between Mount Royal College's Internationally Educated Nurses Assessment Centres in Calgary and The College and Association of Registered Nurses of Alberta. The project aims to speed up the licensure process by enabling internationally educated nurses to undergo a Substantial Equivalent Competency Assessment before they immigrate to Canada. Assessments are taking place in London, Dublin, Dubai, Qatar and elsewhere in the United Arab Emirates.
The overall goal of this initiative is to reduce the length of time between an internationally educated nurse's job offer and their first day of employment by identifying learning that may be required while they await immigration or write the Canadian RN licensing examinations. This will enable internationally educated nurses to put their skills to work more quickly once they arrive in Canada, while providing guidance to other jurisdictions who are considering offshore assessment processes. The project will also increase Alberta's capacity to assess internationally educated nurses with the training of additional assessors.
"We're delighted with this federal support that ensures increased access to nurses educated and registered in other countries who, through our program, are able to continue their careers as fully qualified and fully registered nurses here in Canada," said Mount Royal College President, Dave Marshall. "By working together we can help ensure the supply of health care workers necessary to ensure a high quality health care system in Canada."
The Alberta Health and Wellness project is one of over 40 initiatives funded by the Internationally Educated Health Professionals Initiative of the federal government. The initiative provides $75 million over five years to provinces and territories and non-governmental organizations to address barriers to integration for internationally educated health professionals. The goal of the initiative is to promote the assessment and integration of internationally educated health professionals into the Canadian health workforce. The initiative is an important component of the broader health human resources strategy, which is essential to ensuring timely access to care in communities across the country.
[General
]
14 August, 2008 17:26
Job Growth Not The Only Factor In Reducing Poverty In Large Metro Areas
A new study suggests that it may be easier for people living in small
metropolitan areas to get out of poverty than it is for those living in
large metro areas.
The study by researchers at Ohio State University and Oklahoma State University found that despite an increase in the number of jobs created during the 1990s, many people living in large metro areas across the United States failed to find jobs.
In contrast, many people who lived in smaller metro areas found jobs despite significantly less job growth over the same period of time. As a result, poverty levels in many large metropolitan areas stayed the same or slightly decreased, while poverty rates decreased in smaller metro areas.
The findings, which were compiled with data from the 2000 U.S. Census, suggest that job growth is not the only factor controlling job attainment and poverty rates. Many barriers limit how effective job growth can be in helping the poor living in large cities.
"Job growth matters, but only if you could get it where jobs are needed the most. We found that jobs had a bigger impact on reducing poverty in smaller metropolitan areas because if you live in a small area, you can get to where the jobs are. But if you live in Columbus or Cleveland or New York or Atlanta, it is going to be harder to get to the jobs," Mark Partridge said.
Partridge is a professor of agricultural, environmental and development economics. Partridge conducted the study with Dan Rickman, an economist at Oklahoma State University, to find why poverty rates in the United States stayed the same in many large cities despite increased job growth over the last 30 years.
The pair studied poverty rates and job growth in more than 300 metro areas in the United States. Metro areas with populations ranging from below 350,000 (small) to more than 1.5 million (large) were included in the study. The results were recently published in the journal Growth and Change.
Partridge and Rickman found that a 10 percent increase in job growth over five years reduced poverty in large and small metro areas differently. In the central county of a small metro area, job growth produced a drop in poverty rates one and a half times more than large metro areas with the same job growth. Likewise, the outer counties of a small metro area experienced a reduction in poverty three times that of large metro areas.
The results suggest that many barriers in large metro areas are inhibiting poor people from landing jobs. Problems finding reliable transportation can prevent the poor who live in the inner city from finding employment, Partridge said. New jobs are often created in the suburbs, but many large cities around the United States do not have reliable public transportation systems, limiting how far some people can travel to find work.
More importantly, the wage for someone who travels to the suburbs from the inner city may not always cover the costs of commuting. These limitations often leave those in poverty few options for work.
"Many lower-skilled workers are single mothers with children who don't have reliable transportation. Their kids get sick so they miss a couple of days of work and then they get fired. So finding ways of breaking down this kind of barrier so they can work can really make a difference," he said.
In addition, if people within the same urban neighborhood only have access to jobs close to home, this limits knowledge of what types of jobs are available in the suburbs. People within the neighborhood will then have fewer friends and relatives who work outside the city, hindering their ability to make connections with those who have knowledge and access to jobs, Partridge said.
"You tend to find out about jobs from your friends, coworkers, and neighbors. But if you live in an area that is downtown and the jobs are being created out in the suburbs, it will be more difficult to find out what jobs are available," he said.
Compared to people living in smaller metro areas, people living in the center of large metro areas are more dependent on nearby job growth and affected less by overall job growth in the entire metro area. Partridge said many people in large cities cannot afford to move to the suburbs or across town to where the jobs are located.
"In some suburbs, there are particular kinds of zoning that make it difficult to create affordable housing. Lot size requirements and zoning that keeps out apartments puts limits on where people can move if they have limited resources. All of these three barriers -- public transportation, information about new jobs, and housing barriers -- keep the people from low-income households from getting the jobs that are available far from home," he said.
In spite of these barriers, there are steps that state and local governments can take to help combat poverty. While creating better transportation systems can be one solution, it is often very costly and takes years to implement. Governments can also encourage job growth in areas where there is a need to work, but it takes time to see real results. Instead, governments should look to target the long-term causes of poverty and train adolescents with the skills they will need in work and in life, Partridge said.
----------------------------
Article adapted by Medical News Today from original press release.
----------------------------
Written by Jenna McGuire
Source:
Mark Partridg
Ohio State University
The study by researchers at Ohio State University and Oklahoma State University found that despite an increase in the number of jobs created during the 1990s, many people living in large metro areas across the United States failed to find jobs.
In contrast, many people who lived in smaller metro areas found jobs despite significantly less job growth over the same period of time. As a result, poverty levels in many large metropolitan areas stayed the same or slightly decreased, while poverty rates decreased in smaller metro areas.
The findings, which were compiled with data from the 2000 U.S. Census, suggest that job growth is not the only factor controlling job attainment and poverty rates. Many barriers limit how effective job growth can be in helping the poor living in large cities.
"Job growth matters, but only if you could get it where jobs are needed the most. We found that jobs had a bigger impact on reducing poverty in smaller metropolitan areas because if you live in a small area, you can get to where the jobs are. But if you live in Columbus or Cleveland or New York or Atlanta, it is going to be harder to get to the jobs," Mark Partridge said.
Partridge is a professor of agricultural, environmental and development economics. Partridge conducted the study with Dan Rickman, an economist at Oklahoma State University, to find why poverty rates in the United States stayed the same in many large cities despite increased job growth over the last 30 years.
The pair studied poverty rates and job growth in more than 300 metro areas in the United States. Metro areas with populations ranging from below 350,000 (small) to more than 1.5 million (large) were included in the study. The results were recently published in the journal Growth and Change.
Partridge and Rickman found that a 10 percent increase in job growth over five years reduced poverty in large and small metro areas differently. In the central county of a small metro area, job growth produced a drop in poverty rates one and a half times more than large metro areas with the same job growth. Likewise, the outer counties of a small metro area experienced a reduction in poverty three times that of large metro areas.
The results suggest that many barriers in large metro areas are inhibiting poor people from landing jobs. Problems finding reliable transportation can prevent the poor who live in the inner city from finding employment, Partridge said. New jobs are often created in the suburbs, but many large cities around the United States do not have reliable public transportation systems, limiting how far some people can travel to find work.
More importantly, the wage for someone who travels to the suburbs from the inner city may not always cover the costs of commuting. These limitations often leave those in poverty few options for work.
"Many lower-skilled workers are single mothers with children who don't have reliable transportation. Their kids get sick so they miss a couple of days of work and then they get fired. So finding ways of breaking down this kind of barrier so they can work can really make a difference," he said.
In addition, if people within the same urban neighborhood only have access to jobs close to home, this limits knowledge of what types of jobs are available in the suburbs. People within the neighborhood will then have fewer friends and relatives who work outside the city, hindering their ability to make connections with those who have knowledge and access to jobs, Partridge said.
"You tend to find out about jobs from your friends, coworkers, and neighbors. But if you live in an area that is downtown and the jobs are being created out in the suburbs, it will be more difficult to find out what jobs are available," he said.
Compared to people living in smaller metro areas, people living in the center of large metro areas are more dependent on nearby job growth and affected less by overall job growth in the entire metro area. Partridge said many people in large cities cannot afford to move to the suburbs or across town to where the jobs are located.
"In some suburbs, there are particular kinds of zoning that make it difficult to create affordable housing. Lot size requirements and zoning that keeps out apartments puts limits on where people can move if they have limited resources. All of these three barriers -- public transportation, information about new jobs, and housing barriers -- keep the people from low-income households from getting the jobs that are available far from home," he said.
In spite of these barriers, there are steps that state and local governments can take to help combat poverty. While creating better transportation systems can be one solution, it is often very costly and takes years to implement. Governments can also encourage job growth in areas where there is a need to work, but it takes time to see real results. Instead, governments should look to target the long-term causes of poverty and train adolescents with the skills they will need in work and in life, Partridge said.
----------------------------
Article adapted by Medical News Today from original press release.
----------------------------
Written by Jenna McGuire
Source:
Mark Partridg
Ohio State University
[General
]
08 August, 2008 13:50
Texas Travel Nursing Jobs Reign Supreme in Lone Star State
BOCA RATON, FL -- 08/05/08 --
With Texas hospitals ranking among U.S. News
and World Report best hospitals every year and advanced medical
technologies in the state laying a foundation for quality travel nurse
job work environments, Texas travel nurse jobs have made their way to top of
the preferred travel nursing list.
"Quality of life and lifestyle opportunities are a major component of travel nursing," said Robert L. Bok. "Cities like Austin consistently rank on lists of best places to live, work and play and the cost of living in Dallas, Houston and other Texas communities is below the national average. Annual earnings for Texas travel nursing jobs can exceed $85,000 with pay and benefits."
Travel nurse staffing experts say more and more nurses are considering economic factors, such as cost of living, when choosing a travel nursing destination. Texas is home to one of the largest faith-based, nonprofit healthcare delivery systems in the United States, with travel nurse pay high and the cost of living low, leaving nurses more disposable income to enjoy their surroundings and contribute to their 401(k).
"More practitioners entering the profession have been asking about Texas nurse jobs in cities with easy access to the Rio Grande and Mexico," said Deborah Bacurin, adding that "beautiful Gulf Coast towns like Galveston and Corpus Christi are no longer 'best kept secrets' among seasoned travel nurses."
"Texas travel nursing jobs will be hot for a while," says Hospital Marketing Director, Dennis Urbanski. "Healthcare and high-tech are propelling economies around the state and access to top-ranked hospitals and outpatient centers is bar none. The pay is high and the benefits and housing great for Texas travel nurses."
[General
]
08 August, 2008 13:46
Travel Nursing the great career opportunity
Travel nursing is kind of a temporary work for experienced nursing
professionals especially for the United States. It is kind of an
arrangement for filling up the required nursing professionals from
outside locations. Smaller towns and places usually face shortages of
nurses, and on account of any sudden necessity like that of natural or
man-made disaster, needs to be aided by nurses from outside of the
locality. Travel nurse come to great help in restoring the normalcy of
an area after an event of great loss and misfortune.
Nurses who are passionate towards their work and enjoy exploring different locations are especially taking up such assignments. A travel nurse moves out to another area to take benefit of enjoy working in a different environment.
It has emerged as one of the preferred and lucrative job options in the medicine world. Working in different environment help nurses to gain better experiences for their career. Besides good experience, travel nurses can enjoy free benefits and allowance. In fact, salary remuneration of travel nurses is very high and often they are awarded with lucrative bonuses for their efforts.
How to Apply for a Travel Nursing Jobs?
Apply for different travel nursing assignments is not that difficult. Become smart by applying online and enjoy its outcome. There are many online travel agencies that provide option to fill up a simple form for nurses. Nurses can fill up the necessary documents and attach their bio-data with it.
After accessing a nurse's requirement and qualification details, these agencies will further contact to hospitals and medical institute who have openings for nursing professionals. These agencies will help in conducting interviews and negotiating the deal between a nurse and the health facility.
The role of travel nurse agencies does not end with signing of deal between a nurse and a hospital. They further look into matters related to the relocation of a nurse to her new workplace.
Looking for quality travel nurse information? Search through internet and get the desired results.
[General
]
08 August, 2008 13:42
Community Nurses More Worried About Their Travel Costs Than Their Workload, UK
A survey carried out by the Community District Nursing Association
(CDNA) has found that Nurses are being routinely left out of pocket
when using their own cars to visit patients. Almost every Nurse
questioned, 96.1%, expressed their concern about the cost of using
their own vehicle for work and the short-fall between the cost of fuel
and the amount they are reimbursed.
In the survey of members across England, Scotland, Wales and Northern Ireland, Nurses claimed to be more concerned about their car costs than their workload.
Fuel costs have increased by an average of 14% each year between January 2006 and January 2008, and this month saw petrol prices rise to 104p. The majority of CDNA members use their own cars to visit patients and have no realistic alternative open to them. Many are funding their employment out of their own pocket by hundreds of pounds each year and are effectively subsidising the running of the National Health Service.
The situation could be set to get even worse, when Chancellor Alastair Darling announces changes to the way in which any employee can claim back their expenses for running a car for work in his Budget on 12th March.
The HMRC's Authorised Mileage Allowance Payments (AMAPs) are under review and may be reduced in a misguided effort to encourage staff to driver fewer miles. The CDNA is concerned that members will be penalised even further just because of where their patients live and that the AMAPs rates, set back in April 2002 when petrol was 75p a litre, are long overdue for an increase.
Chair of the CDNA, Rowena Smith, comments: "Our members have been concerned for some time that their motoring costs are not being met by their expenses. This survey shows just how bad the situation has become. While we support any reasonable effort to reduce carbon emissions, it must not be done at the expense of nurses or their patients. Nurses along with many other British workers cannot simply change the way they use their cars for work - it is built into their contract and penalising them for not having a company car is nothing short of a stealth tax on employment."
- Approved Mileage Allowance Payments (AMAPs) allow employees to reclaim the costs of business travel in their own vehicles. The current rates were set in 2002 at 40 pence per mile for the first 10,000 business miles per year and 25 pence per mile thereafter. The AA estimates that between 3 and 5 million employees use their own cars for work.
- The 2007 Budget Report announced that 'ahead of the Pre-Budget Report, the Government will consider the case for changing the structure of AMAPs to align the tax/NICs treatment and to ensure that rates and thresholds are set at an appropriate level to promote environmentally friendly business travel'. The October Pre-Budget Report however did not contain any changes to AMAPs, instead it announced 'In advance of the Budget, the Government will continue to consider the representations received from industry'.
- The Community and District Nursing Association (CDNA) is a TUC & STUC affiliated union representing thousands of members, UK wide. The CDNA is the only specialised independent union and association that solely represents community and district nurses.
- Individual nurse case studies relating to personal car use for work are available from the CDNA.
Community & District Nursing Association
In the survey of members across England, Scotland, Wales and Northern Ireland, Nurses claimed to be more concerned about their car costs than their workload.
Fuel costs have increased by an average of 14% each year between January 2006 and January 2008, and this month saw petrol prices rise to 104p. The majority of CDNA members use their own cars to visit patients and have no realistic alternative open to them. Many are funding their employment out of their own pocket by hundreds of pounds each year and are effectively subsidising the running of the National Health Service.
The situation could be set to get even worse, when Chancellor Alastair Darling announces changes to the way in which any employee can claim back their expenses for running a car for work in his Budget on 12th March.
The HMRC's Authorised Mileage Allowance Payments (AMAPs) are under review and may be reduced in a misguided effort to encourage staff to driver fewer miles. The CDNA is concerned that members will be penalised even further just because of where their patients live and that the AMAPs rates, set back in April 2002 when petrol was 75p a litre, are long overdue for an increase.
Chair of the CDNA, Rowena Smith, comments: "Our members have been concerned for some time that their motoring costs are not being met by their expenses. This survey shows just how bad the situation has become. While we support any reasonable effort to reduce carbon emissions, it must not be done at the expense of nurses or their patients. Nurses along with many other British workers cannot simply change the way they use their cars for work - it is built into their contract and penalising them for not having a company car is nothing short of a stealth tax on employment."
- Approved Mileage Allowance Payments (AMAPs) allow employees to reclaim the costs of business travel in their own vehicles. The current rates were set in 2002 at 40 pence per mile for the first 10,000 business miles per year and 25 pence per mile thereafter. The AA estimates that between 3 and 5 million employees use their own cars for work.
- The 2007 Budget Report announced that 'ahead of the Pre-Budget Report, the Government will consider the case for changing the structure of AMAPs to align the tax/NICs treatment and to ensure that rates and thresholds are set at an appropriate level to promote environmentally friendly business travel'. The October Pre-Budget Report however did not contain any changes to AMAPs, instead it announced 'In advance of the Budget, the Government will continue to consider the representations received from industry'.
- The Community and District Nursing Association (CDNA) is a TUC & STUC affiliated union representing thousands of members, UK wide. The CDNA is the only specialised independent union and association that solely represents community and district nurses.
- Individual nurse case studies relating to personal car use for work are available from the CDNA.
Community & District Nursing Association
[General
]
01 August, 2008 16:10
Texas Nurse-Midwife Receives Highest Honor From American College Of Nurse-Midwives
Nancy Jo Reedy, CNM, MPH, FACNM, a certified nurse-midwife from
Arlington, Texas, is the recipient of the 2007 Hattie Hemschemeyer
Award from the American College of Nurse-Midwives (ACNM). The "Hattie"
is the College's most prestigious award and was presented to Ms. Reedy
on May 26, 2007 at the ACNM 52nd Annual Meeting & Exhibit in
Chicago, IL.
A 1973 graduate of the Mississippi Medical Center Nurse-Midwifery Education Program, Reedy has spent over 30 years contributing to midwifery and women's health. Reedy founded four midwifery practices, including the practice at Parkland Memorial Hospital, which is the largest midwifery practice in the United States. Reedy is currently the Director of Nurse-Midwifery Services at Texas Health Care, PLLC in Fort Worth, Texas. Reedy received an MPH from the University of Illinois in 1977 and has exemplified dedication to midwifery, in clinical practice, policy, advocacy, mentorship, education, leadership, and service.
"Over the years this midwife's dedication to midwifery, in all its aspects, including practice, policy, advocacy, mentorship, education, leadership and service, has been outstanding," said Katherine Camacho Carr, CNM, PhD, former ACNM President, during the award presentation. "I would venture to say that she even has celebrity status among us, not only because of her legendary midwifery contributions, but also because of her wit, her sense of humor and her honest, if not opinionated approach to everything."
Reedy has had a long standing commitment to underserved women. She currently has plans to move to a new women's hospital supported in part by an endowment to ensure care for vulnerable populations.
Reedy has played key roles in ACNM. She served on the ACNM Board of Directors as Region V Representative from 1994-1997 and as Region IV Representative from 1980-1984. She served on the ACNM Nominating Committee, the Bylaws Committee, the Political & Economic Affairs Committee, the ACNM Summit on Nurse-Midwifery Education, the ad hoc Committee to Revise the Ethical Code for Midwives, and the National Commission on Nurse-Midwifery Education, in addition to playing many roles in her local chapters. Currently, Reedy serves as an ACNM Division of Accreditation site visitor.
Reedy supported the development of the service Directors Network, and the A.C.N.M. Foundation. Her wisdom and guidance as the President of the A.C.N.M. Foundation turned the Foundation into a dynamic, fiscally sound, and successful fund-raising endeavor. She has tirelessly worked for sister organizations, including the March of Dimes, the National Certification Corporation for Obstetric, Gynecologic and Neonatal Nursing Specialties and the Association of Women's Health, Obstetric and Neonatal Nurses (formerly NAACOG).
The Hattie Hemschemeyer Award, named in honor of ACNM's first president and a pioneer of the profession, is given annually to an ACNM member who has been certified for at least ten years, has not previously been selected for the award, and has fulfilled one of the following categories: continuous outstanding contributions or distinguished service to midwifery and/or maternal child health; or, has made contributions of historical significance to the development and advancement of midwifery, ACNM, or maternal-child health.
http://www.midwife.org
A 1973 graduate of the Mississippi Medical Center Nurse-Midwifery Education Program, Reedy has spent over 30 years contributing to midwifery and women's health. Reedy founded four midwifery practices, including the practice at Parkland Memorial Hospital, which is the largest midwifery practice in the United States. Reedy is currently the Director of Nurse-Midwifery Services at Texas Health Care, PLLC in Fort Worth, Texas. Reedy received an MPH from the University of Illinois in 1977 and has exemplified dedication to midwifery, in clinical practice, policy, advocacy, mentorship, education, leadership, and service.
"Over the years this midwife's dedication to midwifery, in all its aspects, including practice, policy, advocacy, mentorship, education, leadership and service, has been outstanding," said Katherine Camacho Carr, CNM, PhD, former ACNM President, during the award presentation. "I would venture to say that she even has celebrity status among us, not only because of her legendary midwifery contributions, but also because of her wit, her sense of humor and her honest, if not opinionated approach to everything."
Reedy has had a long standing commitment to underserved women. She currently has plans to move to a new women's hospital supported in part by an endowment to ensure care for vulnerable populations.
Reedy has played key roles in ACNM. She served on the ACNM Board of Directors as Region V Representative from 1994-1997 and as Region IV Representative from 1980-1984. She served on the ACNM Nominating Committee, the Bylaws Committee, the Political & Economic Affairs Committee, the ACNM Summit on Nurse-Midwifery Education, the ad hoc Committee to Revise the Ethical Code for Midwives, and the National Commission on Nurse-Midwifery Education, in addition to playing many roles in her local chapters. Currently, Reedy serves as an ACNM Division of Accreditation site visitor.
Reedy supported the development of the service Directors Network, and the A.C.N.M. Foundation. Her wisdom and guidance as the President of the A.C.N.M. Foundation turned the Foundation into a dynamic, fiscally sound, and successful fund-raising endeavor. She has tirelessly worked for sister organizations, including the March of Dimes, the National Certification Corporation for Obstetric, Gynecologic and Neonatal Nursing Specialties and the Association of Women's Health, Obstetric and Neonatal Nurses (formerly NAACOG).
The Hattie Hemschemeyer Award, named in honor of ACNM's first president and a pioneer of the profession, is given annually to an ACNM member who has been certified for at least ten years, has not previously been selected for the award, and has fulfilled one of the following categories: continuous outstanding contributions or distinguished service to midwifery and/or maternal child health; or, has made contributions of historical significance to the development and advancement of midwifery, ACNM, or maternal-child health.
http://www.midwife.org
[General
]
01 August, 2008 15:42
Where Do You Want Travel Nursing To Take You?
Selecting Assignments Where You Desire
No one else can tell you where to go as a travel nurse--well, not unless you're married. You are free to fly with the wind to the most exotic and out-of-the-way places like the rural areas of Oklahoma, Texas, Nebraska or Iowa, or enjoy an assignment in the metropolis of New York City, Miami, Los Angeles, or Phoenix. Travel to the beaches of Southern California, Atlantic City or Hawaii. Assignments can also be found ranging in areas from the Virgin Islands to the great state of Alaska.
You might have to change companies, but so far I have gone every place that I have wanted to visit. This is easier done if you have more than one specialty, like medical intensive care, surgical intensive care, cardiovascular intensive care, and emergency room, or telemetry, medical, surgical, step-down and rehab.
What other career will allow you to be a snowbird when you are thirty-five years old instead of sixty-five years old? When it comes time to make a move, my husband selects what state he would like to go to, then I put my state into the mixture and we submit to those hospitals and see who gives us the best deal. My son would have a choice, but he just wants to go to Washington, where his girlfriend is. For the summer, I wanted Nebraska and hubby wanted Iowa; we went to Iowa. For the winter, I wanted Florida, hubby wanted southern Texas: I'm writing this chapter in Florida. And yes, next summer we plan on spending it in Washington State.
Miniature Vacations
One of my favorite aspects of travel nursing is the mini-vacations. These are little two nights away to some place a little farther than you could go on a day trip.
When I was in Central California, my family and I went to San Francisco one day then up the Pacific coast highway to the Redwoods. The first night we stayed at a small motel on the outskirts of San Francisco in an older fishing village.
The second night we stayed in the Redwoods. The trees were gorgeous, with their red and green colors. The Redwood Trail is also the site of the road picture on my first travel nursing book, Highway Hypodermics: Your Road Map to Travel Nursing.
While on assignment in Iowa, we toured the bridges of Madison County and John Wayne's birthplace on one road trip, and later made a trip to Minneapolis, Minnesota to watch the Twins play baseball and visit the Mall of America.
One assignment in Tupelo, Mississippi not only took us to the site of Elvis's birthplace, but a day adventure took us to the place where he lived and died, at Graceland, in Memphis, Tennessee. On a bigger adventure, we spent some time a week before Christmas at the Opryland Hotel in Nashville and had the extraordinary experience of Christmas in Nashville. While in Nashville we explored many sites, such as the Ryman Auditorium, the Country Music Hall of Fame, and took in a show at the Grand Ole Opry.
See The United States
When I started out as a traveling nurse, I had been east of the Mississippi River once, and that was for less than twenty-four hours. Now I can say that I have not only crossed the mighty Mississip, but I have even made it to the Eastern Time Zone. In the last two years alone I have been from the beaches of Pismo, California to Southern Miami Beach, and from the swamps of Louisiana to the lakes of Minnesota.
If water and beaches are not your thing, then how about an amazing sunset in the Arizona sky? Or you can take in the breath-taking view from the top of the Colorado mountains.
How about a goal of seeing all the National Parks that the United States has to offer? You can visit the Everglades, the Appalachians, The Rocky Mountains, Yellowstone, The Grand Canyon, and Yosemite.
Are you into history? How about a trip through the history of the United States, from Washington D.C. to the Battle of New Orleans, the Battle of Shiloh, or the Alamo. Don't forget to visit the many military museums, including the Smithsonian, the Air Force Museum in Pensacola, FL, and there are several battleships to visit.
[General
]
25 July, 2008 13:57
The Best of Travel Nursing in California: Orange County
Travel nursing in California has been such an amazing experience. I love the weather, the people, and everything is just so beautiful and beachy. The facility I worked out of Hoag Memorial is one of the nicest looking facilities I’ve ever seen.
Here is a run down of my little travel nursing awards in Orange County:
Best meal in town for the traveling nurse: Javiers -its fantastic Mexican food in Laguna Beach and Irvine
Top travel nursing choice for grocery store: Whole Foods & Trader Joes-healthy selections for travel nurses who are always on the go
Top travel nurse choice for fun activity: Surfing & Disneyland-every travel nurse needs to hit the beach once and make a trip to the happiest place on earth
Top travel nurse choice for mini getaway trip: Catalina Island-there are no cars-but enjoy the go carts
Top travel nurse choice for beach: Laguna Beach-no wonder there was a reality show, there are so many beautiful beaches, shops, and restaurants
Top choice for travel nurses who want to enjoy their artistic side: Sawdust Festival and Pageant of the Arts-watch people turn into paintings and make crafts and buy pottery at the festical
Favorite travel nursing job assignment: Hoag Memorial-truly one of the most beautiful hospitals I’ve worked at.
Favorite travel nurse shopping area: Irvine Spectrum-great shopping, top restaurants, amazing 24-hour fitness gym, there is even a ferris wheel
Favorite travel nurse night out: Newport Beach bars
Favorite travel nurse lounge scene: Kimera in Irvine-it’s a classy place so don’t go crazy on drinks.
[General
]
13 July, 2008 19:03
About Me:
My name is Thalia Farah, and I have 2 careers! First and foremost I am a traveling nurse. Travel nursing allows me to travel all around the country and meet new people and experience different things. Travel nurses only have to work three days out of the week, leaving four days to explore and experience the area they are living in. And while I absolutely love being a travel nurse, I love travel nursing even more because it allows me to enjoy my other passion oriental dance (belly dancing). Please feel free to “shimmy” through my site and see some of the things that I love in life!
Dancing:
I have been a belly dancer for the last 15 years now, and my career has been going better than ever! I have built a highly extensive network of restaurants and clubs that I have performed at, and it is still growing. Not only do I get to perform at some of the coolest Middle Eastern, Moroccan, and Greek restaurants but the food is excellent (one of my other passions)!
Travel Nursing in the US:
I have traveled to New York, California, New Mexico and I am currently in Arizona. California and New York are some of the best places to be a travel nurse. I love the atmosphere of New York and the fact that you never run out of things to do. They also have the best and most authentic Middle Eastern and Mediterranean food! California travel nursing is awesome because it is like a big vacation. The weather is perfect, the facilities are very nice, and the clubs and restaurants have a great vibe- no matter where in California you go.
Travel Nursing in San Diego, California:
It doesn’t matter if you have lived in California your whole life, or you are just visiting, you will never want to leave. San Diego has a great energy to it and a lot of really neat places to dine out. Travel nurses love San Diego because its laid back, it has many different and fun areas that everyone will find a place where they fit!
Travel Nurse Dining Guide in San Diego:
Aladdin in Hillcrest (Middle Eastern)
EXY in Downtown San Diego (Mediterranean)
Cafe Athena in Pacific Beach (Greek)
San Diego Restaurants- for more great dining suggestions
Dancing Resources:
Oriental Dancer- a great site about everything from oriental dance news to instructional DVDs.
Learn how to Belly Dance!- a good site for beginners and learning to perfect your craft
B Dancer- a great place that links to a lot of other cool sites!
Travel Nursing Resources:
Travel Nurse Jobs- If you are already are a travel nurse or interested in becoming one
[General
]
06 June, 2008 13:12
Travel Nursing - A Great Way Of Life
What is travel nursing and why should you consider it? Travel nursing
is almost like temp work. Managers looking for more nurses to hire are
experiencing shortages, especially in certain areas. As a result,
they've been forced to look for nurses from outside locations. A travel
nurse temporarily moves to another area to take advantage of a great
working opportunity. Smaller towns often experience a shortage of
nurses and have to hire outside help.
Travel nurses take on short-term assignments, getting work through agencies that have been set up to deal with the travel nursing demand. The benefits of travel nursing are many. The agency will find and supply you with housing, and cover travel expenses. They help travel nurses with licensing, benefits, and payroll. Because these positions are on a temporary basis, and the travel nurses have to come from out of town, you have the opportunity to make a very good income. Travel nurses get paid above market wages and have a bit of an adventure at the same time.
The length of time traveling nurses work depends on the situation. The amount of time you work varies with the agency and the healthcare institution that employs you. An assignment can last anywhere from 8 weeks to 26 weeks. Often you are given the opportunity to extend an assignment and stay for a longer period of time, but this isn't always plausible.
Travel nurse jobs are typically 8-13 weeks in length with most contracts. Traveling nurses get to see different parts of the country and earn a good amount of money while doing so. And because travel nurse jobs are cropping up all over the place, there is no shortage of opportunity.
Travel nursing jobs afford nurses the opportunity to travel for a short amount of time, save a good amount of money, and come back home to follow their dreams. The extra money may be perfect for the down payment on a house, or to collect interest in a savings account. Whatever the situation, travel nursing jobs are everywhere, so it's easy to take advantage of the opportunity if you want to.
Nursing shortages keep getting worse, especially in rural areas of the country. Vacancies can't always be filled and nurses are in high demand. There has been no better time to be a nurse - it's a rewarding and fulfilling job that helps others, but it also pays well. Travel nursing is growing, and will continue to grow into the future.
Travel nursing does more than just offer adventure, a change of pace, and higher pay. It's also a chance to hone and expand your skill base, and learn more about nursing and the healthcare industry in general. As you're exposed to a wide variety of healthcare situations, you learn more about the field and continue to improve your skills and working knowledge of nursing practices.
The practical side of travel nursing shouldn't be overlooked. Plus, you can add some great experience to your resume and become even more appealing on future job applications. Your experience as a travel nurse has the potential to set you apart from other candidates looking for a nursing job.
[General
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04 April, 2008 18:13
Texas Nurse-Midwife Receives Highest Honor From American College Of Nurse-Midwives
Nancy Jo Reedy, CNM, MPH, FACNM, a certified nurse-midwife from Arlington, Texas, is the recipient of the 2007 Hattie Hemschemeyer Award from the American College of Nurse-Midwives (ACNM). The "Hattie" is the College's most prestigious award and was presented to Ms. Reedy on May 26, 2007 at the ACNM 52nd Annual Meeting & Exhibit in Chicago, IL.
A 1973 graduate of the Mississippi Medical Center Nurse-Midwifery Education Program, Reedy has spent over 30 years contributing to midwifery and women's health. Reedy founded four midwifery practices, including the practice at Parkland Memorial Hospital, which is the largest midwifery practice in the United States. Reedy is currently the Director of Nurse-Midwifery Services at Texas Health Care, PLLC in Fort Worth, Texas. Reedy received an MPH from the University of Illinois in 1977 and has exemplified dedication to midwifery, in clinical practice, policy, advocacy, mentorship, education, leadership, and service.
"Over the years this midwife's dedication to midwifery, in all its aspects, including practice, policy, advocacy, mentorship, education, leadership and service, has been outstanding," said Katherine Camacho Carr, CNM, PhD, former ACNM President, during the award presentation. "I would venture to say that she even has celebrity status among us, not only because of her legendary midwifery contributions, but also because of her wit, her sense of humor and her honest, if not opinionated approach to everything."
Reedy has had a long standing commitment to underserved women. She currently has plans to move to a new women's hospital supported in part by an endowment to ensure care for vulnerable populations.
Reedy has played key roles in ACNM. She served on the ACNM Board of Directors as Region V Representative from 1994-1997 and as Region IV Representative from 1980-1984. She served on the ACNM Nominating Committee, the Bylaws Committee, the Political & Economic Affairs Committee, the ACNM Summit on Nurse-Midwifery Education, the ad hoc Committee to Revise the Ethical Code for Midwives, and the National Commission on Nurse-Midwifery Education, in addition to playing many roles in her local chapters. Currently, Reedy serves as an ACNM Division of Accreditation site visitor.
Reedy supported the development of the service Directors Network, and the A.C.N.M. Foundation. Her wisdom and guidance as the President of the A.C.N.M. Foundation turned the Foundation into a dynamic, fiscally sound, and successful fund-raising endeavor. She has tirelessly worked for sister organizations, including the March of Dimes, the National Certification Corporation for Obstetric, Gynecologic and Neonatal Nursing Specialties and the Association of Women's Health, Obstetric and Neonatal Nurses (formerly NAACOG).
The Hattie Hemschemeyer Award, named in honor of ACNM's first president and a pioneer of the profession, is given annually to an ACNM member who has been certified for at least ten years, has not previously been selected for the award, and has fulfilled one of the following categories: continuous outstanding contributions or distinguished service to midwifery and/or maternal child health; or, has made contributions of historical significance to the development and advancement of midwifery, ACNM, or maternal-child health.
A 1973 graduate of the Mississippi Medical Center Nurse-Midwifery Education Program, Reedy has spent over 30 years contributing to midwifery and women's health. Reedy founded four midwifery practices, including the practice at Parkland Memorial Hospital, which is the largest midwifery practice in the United States. Reedy is currently the Director of Nurse-Midwifery Services at Texas Health Care, PLLC in Fort Worth, Texas. Reedy received an MPH from the University of Illinois in 1977 and has exemplified dedication to midwifery, in clinical practice, policy, advocacy, mentorship, education, leadership, and service.
"Over the years this midwife's dedication to midwifery, in all its aspects, including practice, policy, advocacy, mentorship, education, leadership and service, has been outstanding," said Katherine Camacho Carr, CNM, PhD, former ACNM President, during the award presentation. "I would venture to say that she even has celebrity status among us, not only because of her legendary midwifery contributions, but also because of her wit, her sense of humor and her honest, if not opinionated approach to everything."
Reedy has had a long standing commitment to underserved women. She currently has plans to move to a new women's hospital supported in part by an endowment to ensure care for vulnerable populations.
Reedy has played key roles in ACNM. She served on the ACNM Board of Directors as Region V Representative from 1994-1997 and as Region IV Representative from 1980-1984. She served on the ACNM Nominating Committee, the Bylaws Committee, the Political & Economic Affairs Committee, the ACNM Summit on Nurse-Midwifery Education, the ad hoc Committee to Revise the Ethical Code for Midwives, and the National Commission on Nurse-Midwifery Education, in addition to playing many roles in her local chapters. Currently, Reedy serves as an ACNM Division of Accreditation site visitor.
Reedy supported the development of the service Directors Network, and the A.C.N.M. Foundation. Her wisdom and guidance as the President of the A.C.N.M. Foundation turned the Foundation into a dynamic, fiscally sound, and successful fund-raising endeavor. She has tirelessly worked for sister organizations, including the March of Dimes, the National Certification Corporation for Obstetric, Gynecologic and Neonatal Nursing Specialties and the Association of Women's Health, Obstetric and Neonatal Nurses (formerly NAACOG).
The Hattie Hemschemeyer Award, named in honor of ACNM's first president and a pioneer of the profession, is given annually to an ACNM member who has been certified for at least ten years, has not previously been selected for the award, and has fulfilled one of the following categories: continuous outstanding contributions or distinguished service to midwifery and/or maternal child health; or, has made contributions of historical significance to the development and advancement of midwifery, ACNM, or maternal-child health.
