"Bring your own device" to work tech trend helps nurses provide improved patient care

Main Category: Nursing / Midwifery
Also Included In: IT / Internet / E-mail
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
"Bring your own device" to work tech trend helps nurses provide improved patient care

Not long ago, hospital IT departments supplied and maintained the hardware and software that nurses used to perform work-related tasks. Then came the mobile revolution, when consumers increasingly began carrying smartphones and tablets to assist them in their personal lives as well as in business. As a direct result, many nurses today are following the trend known as BYOD - bring your own device.

"RNs have greater familiarity with their own devices and the more familiar they are, the greater the tendency there is for nurses to optimize the use of the device to its fullest capacity for improved patient care," says Judith Church, DHA, MSN, faculty member in the health care and health care informatics programs at American Sentinel University.

A recent survey by Fierce Mobile Healthcare found that 61 percent of hospitals and health systems responding said that half their employees use personal mobile devices for work. Fifty percent said this use was limited to email and calendar applications, but 36 percent said that employees were accessing patient data.

Another report, Point of Care Computing for Nursing 2012, examined the BYOD patterns of nurses and found that 69 percent of hospitals say their nursing staff is using personal devices at work.

The Pros and Cons of BYOD in Nursing
Church says that BYOD can increase productivity or job performance because people are more comfortable with their own device, have more control over the computing environment and enjoy an enhanced sense of work-life balance, to name a few benefits.

The nurses surveyed in the report specifically stated they use their own mobile devices to improve patient safety and reduce the risk of medical errors. They believe their personal devices enable them to fill in critical communication gaps with the technologies provided by the hospital - for example, allowing them to easily access clinical reference materials at the point of care or quickly communicate with other clinicians to coordinate care.

Yet, BYOD can put IT departments in the difficult position of having to provide support for all these personal devices.

For example, IT might have to build a platform that will ensure hospital software works on all four mobile operating systems (Apple, Android, Microsoft Windows and Blackberry). These diverse devices also create security and HIPAA issues associated with mobile technology.

"The drawback to BYOD in nursing is that it contributes to a non-standardization of a work arena's equipment," says Church. "Nurses should realize that IT policies exist for a reason to protect data integrity and security and should adhere to them at all times when participating in a BYOD initiative."

Using BYOD to Improve Nursing Workflows
Integrating BYOD with nursing call systems can improve both staff and patient satisfaction. Call systems based on overhead paging or lights that can only be seen from the nursing station may soon become obsolete in favor of newer systems that can wirelessly transmit alerts right to a nurse's smartphone when the patient pushes a button.

Alerts can take the form of text messages, emails, pages or phone calls. In some cases, patients may be able to send a specific type of alert - a request for bathroom assistance or pain medicine, for example - that are then routed to the appropriate staff person.

"BYOD can play a significant role in nursing to improve workflows," says Church. "The individual device and user prowess will contribute to optimal standardization of devices across the physical and electronic work environment."

Church points out that BYOD is a trend that will continue in health care because of its financial implications.

"The BYOD trend will thrive in nursing because health care organizations save money when the employee purchases the device. Since nurses are most familiar with their own devices, they will work more effectively and efficiently. Equipment - no matter what it is - is only as effective as its setup and use," adds Church.

It's clear that health care must find ways to reap the benefits of mobile technologies, while reducing the risks and protecting patient data.

"BYOD initiatives should be expanded to include nurses as well as physicians in order to increase nurse productivity and improve patient care and satisfaction," adds Church.

For more information about American Sentinel University's MSN, nursing informatics specialization, please visit http://www.americansentinel.edu/health-care/m-s-nursing/m-s-nursing-nursing-informatics.

Article adapted by Medical News Today from original press release. Source:

American Sentinel University

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Reinforcing commercial host liability helps reduce excessive alcohol consumption

Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Public Health
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
Reinforcing commercial host liability helps reduce excessive alcohol consumption

Fewer states are holding alcohol retailers liable for harms caused by customers who were served illegally, according to a new report from researchers at Alcohol Policy Consultations and the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health. Published online by the American Journal of Preventive Medicine, the legal research study documents the gradual erosion of commercial host liability (also referred to as dram shop liability) from 1989 to 2011.

Commercial host liability holds alcohol retailers liable for alcohol-attributable harms resulting from illegal alcohol sales to patrons who are intoxicated or underage at the time of service. It applies to both on-premise (bars, restaurants and clubs) and off-premise locations. The Community Preventive Services Task Force recently determined that commercial host liability was effective in reducing a range of harms from alcohol in states that have it, including a median six percent drop in alcohol-related motor vehicle crash deaths.

The report found that in recent years many states enacted legislation to protect retailers from commercial host liability by increasing the evidentiary requirements, limiting the amount of liability awards and/or protecting certain retailers from liability. For example, between 1989 and 2011, the number of states that recognized liability for serving intoxicated adults without restrictions declined from 25 to 21, and states with one of these major restrictions increased from 11 to 16. Maps illustrating the erosion of these laws can be accessed at the CAMY website here.

"The erosion of commercial host liability in recent decades is a public health failure that directly contributes to the exorbitant human and economic costs of excessive drinking," said lead study author James F. Mosher, JD, of Alcohol Policy Consultations, a public health legal consultancy in Felton, California. "Alcohol retailers who operate negligently and engage in illegal serving practices should not receive special protection, denying those who are injured their day in court."

The report also examined states' adoption of the Responsible Beverage Service (RBS) practices defense, an optional provision in commercial host liability laws first developed in 1985 as part of a project funded by the National Institute on Alcohol Abuse and Alcoholism. In states that have adopted it, retailers can avoid liability if they show that they adhered to RBS practices at the time of the alcohol service leading to the injury and lawsuit.

RBS practices include instituting effective ID checks, training staff on identifying signs of intoxication and discontinuing marketing practices that encourage intoxication, among others. The report found that only six states had adopted the RBS defense provision despite the potential benefits to both public health and retailers.

"These findings underscore the critical importance of commercial host liability laws," said David Jernigan, PhD, co-author of the report and CAMY director. "These laws have been proven to prevent alcohol sales to underage and intoxicated persons, and should be a priority for public health."

Excessive alcohol consumption is responsible for approximately 80,000 deaths in the U.S. each year. The economic cost of excessive drinking was an estimated $223.5 billion in 2006, or approximately $1.90 per drink consumed. Most binge drinkers (54.3%) who reported driving after their most recent binge drinking episode drank in an on-premises retail alcohol establishment such as a bar, club or restaurant, and 25.7 percent of this group reported consuming 10 or more drinks before getting behind the wheel. On- and off-premise alcohol retail outlets are also sources of alcohol for underage drinkers, particularly those aged 18 to 20 who have high rates of binge drinking and associated public health and safety problems.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alcohol / addiction / illegal drugs section for the latest news on this subject.

Efficacy and the Strength of Evidence of U.S. Alcohol Control Policies, Toben F. Nelson, ScD, Ziming Xuan, ScD, Thomas F. Babor, PhD, Robert D. Brewer, MD, MSPH, Frank J. Chaloupka, PhD, Paul J. Gruenewald, PhD, Harold Holder, PhD, Michael Klitzner, PhD, James F. Mosher, JD, Rebecca L. Ramirez, MPH, Robert Reynolds, MA, Traci L. Toomey, PhD, Victoria Churchill, Timothy S Naimi, MD, MPH, American Journal of Preventive Medicine Volume 45, Issue 1 , Pages 19-28, July 2013, doi:10.1016/j.amepre.2013.03.008

This research was supported with funding from the Centers for Disease Control and Prevention.

Johns Hopkins University Bloomberg School of Public Health

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Innovation in mouse model helps researchers distinguish disease mechanisms and biomarkers

Main Category: Urology / Nephrology
Article Date: 30 Jul 2013 - 2:00 PDT Current ratings for:
Innovation in mouse model helps researchers distinguish disease mechanisms and biomarkers

A team led by researchers at the National Institutes of Health has overcome a major biological hurdle in an effort to find improved treatments for patients with a rare disease called methylmalonic acidemia (MMA). Using genetically engineered mice created for their studies, the team identified a set of biomarkers of kidney damage - a hallmark of the disorder - and demonstrated that antioxidant therapy protected kidney function in the mice.

Researchers at the National Human Genome Research Institute (NHGRI), part of NIH, validated the same biomarkers in 46 patients with MMA seen at the NIH Clinical Center. The biomarkers offer new tools for monitoring disease progression and the effects of therapies, both of which will be valuable in the researchers' design of clinical trials for this disease.

The discovery, reported in the July 29, 2013, advance online issue of the Proceedings of the National Academy of Sciences, paves the way for use of antioxidant therapy in a clinical trial for patients with MMA. It also illustrates the mechanisms by which dysfunction of mitochondria - the power generators of the cell - affects kidney disease. Mitochondrial dysfunction is a factor not only in rare disorders, such as MMA, but also in a wide variety of common conditions, such as obesity, diabetes and cancer.

MMA affects as many as one in 67,000 children born in the United States. It can have several different causes, all involving loss of function of a metabolic pathway that moderates levels of an organic compound called methylmalonic acid. Affected children are unable to properly metabolize certain amino acids consumed in their diet, which damages a number of organs, most notably the kidneys.

"Metabolic disorders like MMA are extremely difficult to manage because they perturb the delicate balance of chemicals that our bodies need to sustain health," said Daniel Kastner, M.D., Ph.D., NHGRI scientific director. "Given that every newborn in the United States is screened for a number of inherited metabolic disorders, including MMA, there is a critical need for better understanding of the disease mechanisms and therapies to treat them."

MMA is the most common organic acid disorder and invariably impairs kidney function, which can lead to kidney failure. The most common therapy is a restrictive diet, but doctors must resort to dialysis or kidney transplantation when the disease progresses. MMA patients also suffer from severe metabolic instability, failure to thrive, intellectual and physical disabilities, pancreatitis, anemia, seizures, vision loss and strokes.

"There are no definitive treatments for the management of patients with MMA," said Charles Venditti, M.D., Ph.D., senior author and investigator in the Organic Acid Research Section of NHGRI's Genetics and Molecular Biology Branch. "This study is the culmination of collaboration with the patient community. It uses mouse modelling, coupled with innovations in genomics and biochemical analyses, to derive new insights into the causes of renal injury in MMA. Our studies have improved our understanding of the basic biology underlying MMA, created a novel animal model for testing interventions and, now, led us to the promise of a new therapy."

The researchers performed the studies using mice bred to carry gene alterations that disrupt the production of the same mitochondrial enzyme that is defective in patients with MMA. These are called transgenic mice. The enzyme, called methylmalonyl-CoA mutase (MUT), is an important component of the chemical process that metabolizes organic acids, specifically methylmalonic acid.

By measuring gene expression in the transgenic mice using DNA microarrays, researchers discovered 50 biomarkers of gene expression that each indicated declining kidney function. DNA microarrays are silicon chips with many spots to which a given molecule may bind. In this case, the DNA microarrays were used to precisely generate, with the aid of a computer program, a profile of gene expression in a kidney cell.

The researchers chose one of the biomarkers, called lipocalin-2, to test how it correlated with kidney function in 46 MMA patients. Plasma levels of this biomarker rose with kidney deterioration in patients with MMA, and may serve as a valuable indicator of MMA kidney disease progression in the clinic.

"The detection of biomarkers through microarray technology is immensely helpful in pointing to downstream pathways affected by the defective MUT activity," said Irini Manoli, M.D., Ph.D., lead author and a physician scientist and staff clinician in NHGRI's Genetics and Molecular Biology Branch. "The biomarkers provide new plasma or serum tests to follow disease progression in our patients."

Having discovered these important biomarkers of kidney function, the authors turned to kidney physiology experts on their team to explore the structural changes that occur in MMA disease. They analyzed the rate at which the kidneys filter waste from the blood. Co-author and renal physiology expert Jurgen Schnermann, M.D., and members of his laboratory at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), also part of NIH, demonstrated the early and significant decrease in this rate in MMA mice.

With further studies, the researchers identified increased production of free radicals in tissues from the mice, as well as in the MMA patients. Detection of free radicals indicates chemical instability in cells, which the researchers sought to remedy with antioxidant therapy. After treating the mice with two forms of dietary antioxidants, the researchers observed that the biomarkers of kidney damage diminished and the faltering kidney filtration rate tapered off. The findings demonstrated that readily available antioxidants can significantly affect the rate of decline of kidney function in transgenic mice, which replicate the kidney disease of MMA.

"The next step will be to translate these findings to the clinic," Dr. Venditti said. "With a progressive disorder like MMA, we are hopeful that we have achieved a laboratory success that our patients will benefit from in the near future."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our urology / nephrology section for the latest news on this subject.

Irini Manoli, Justin R. Sysol, Lingli Li, Pascal Houillier, Caterina Garone, Cindy Wang, Patricia M. Zerfas, Kristina Cusmano-Ozog, Sarah Young, Niraj S. Trivedi, Jun Cheng, Jennifer L. Sloan, Randy J. Chandler, Mones Abu-Asab, Maria Tsokos, Abdel G. Elkahloun, Seymour Rosen, Gregory M. Enns, Gerard T. Berry, Victoria Hoffmann, Salvatore DiMauro, Jurgen Schnermann, and Charles P. Venditti, "Targeting proximal tubule mitochondrial dysfunction attenuates the renal disease of methylmalonic acidemia", Published online before print July 29, 2013, doi: 10.1073/pnas.1302764110

For information about the MMA clinical trial, go to ClinicalTrials.gov and search with NCT00078078.

Learn more about the study

NIH/National Human Genome Research Institute

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