Noisy Operating Rooms May Jeopardize Patient Safety

WEDNESDAY, May 15 (HealthDay News) -- Background noise in the operating room -- such as the sounds of surgical equipment, chatter or music -- can affect surgeons' ability to understand what is being said to them and might result in a breakdown of communication among surgical team members, according to a new study.

This is particularly worrisome since miscommunication is cited as a common reason for medical errors that could have been prevented, the study authors said. Surgeons have critical conversations during operations, and information on medications, dosing and blood supply could sound similar. The researchers emphasize that clear communication during surgical procedures is essential to ensure the safety of patients.

The study was published in the May issue of the Journal of the American College of Surgeons.

"The operating room is a very fast-paced, high-demand, all-senses-running-on-all-cylinders type of environment," study co-author Dr. Matthew Bush, an assistant professor of surgery at the University of Kentucky Medical Center, in Lexington, said in a journal news release. "To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the operating room."

The researchers gave an example of a possible miscommunication: A request for heparin might be heard as "Hespan," an entirely different drug.

In conducting the study, the researchers simulated a noise environment similar to the noise levels found in an operating room. Fifteen surgeons with between one and 30 years of experience were tested on their ability to understand and repeat words under four different conditions: quiet, noise filtered through a surgical mask, background noise without music and background noise with music.

The surgeons were tested while performing a specific surgical task as well as when they were not engaged in a task.

Noise interfered with the surgeon's speech comprehension when the words spoken to them were unpredictable, the study showed. This interference with speech comprehension was worse when there was noise in the operating room.

Background music also impaired the surgeons' ability to understand what was said to them while they were performing a surgical task.

The researchers concluded that background noise in operating rooms could impair surgeons' ability to process what they hear, particularly when music is being played. The situation becomes even more problematic when surgical teams are trying to communicate critical and unpredictable information.

"Our main goal is to increase awareness that operating room noise does affect communication and that we should foster the best environment in which we can communicate better," Bush said. "This effort means that the surgical team needs to work diligently to create the safest environment possible, and that step may mean either turning the music off or down, or limiting background conversations or other things in the environment that could lead to communication errors and medical mistakes."

The researchers plan to continue their research on a larger scale and also examine the effects of operating room noise on anesthesiologists, nurses and surgeons who are hearing impaired.

"I think it's important to demonstrate the effect of environmental operating noise on communication on a variety of different players in the operating room setting," Bush said. "Another step from here is to not only see how noise affects our understanding of speech, but how it affects our tasks and how it affects our ability to perform surgical procedures efficiently and effectively."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Journal of the American College of Surgeons, news release, May 10, 2013

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What to eat when working out

I´ve been going to the gym for about a month and i think im not eating enough, because last week while i was doing cardio y felt really dizzy and i thought i was going to faint. what shoul di be eating during the day, my friend tells me im eating too little (i eat about 900 calories per day) and i workout 4 to 5 days a week 2 or 2.5 hrs. I think that what i eat is enough for me, so i would like to know your opinions. 

Edited Jun 28 2013 13:10 by coach_k
Reason: Moved to fitness as more appropriate, I think...

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Doctors Reluctant to Expand Nurse Practitioners' Role: Survey

By Amy Norton
HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- The United States has a shortage of primary care doctors, and some policymakers want to fill the gap by expanding the role of nurse practitioners. But the two professions are engaged in a turf war over who can do the job better, a new survey finds.

The results of the survey were reported in the May 16 issue of the New England Journal of Medicine.

Experts expected some controversy, but said they were surprised at how far apart doctors and nurse practitioners were in their opinions.

The nearly 1,000 doctors and nurse practitioners surveyed were most divided on the question of who gives the higher quality of care: Two-thirds of physicians said if a doctor and nurse practitioner provided the same service, the doctor would do it better.

Perhaps predictably, few nurse practitioners agreed with that. And although 82 percent of nurse practitioners felt nurse practitioners should lead their own practices, only 17 percent of doctors did.

"We weren't surprised that there were differences in their opinions, but we were surprised by the magnitude of the difference," said lead researcher Karen Donelan, a senior scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital, in Boston.

Dr. David Blumenthal, co-author of an editorial published with the study, agreed.

"It's striking how different their perceptions are, even though they work in the same physical environment," said Blumenthal, president of the Commonwealth Fund, a New York-based foundation that supports research on health policy.

So what does all of that mean? Blumenthal and Donelan said the divide between doctors and nurse practitioners has implications for how U.S. health care looks in the future.

Based on a number of studies, Americans' demand for primary care providers is straining the limited supply. The Association of American Medical Colleges estimates that by 2015 the United States will face a shortage of more than 33,000 primary care practitioners.

A Commonwealth Fund survey found that 16 percent of U.S. adults have to wait at least six days for a doctor's appointment when they have a health problem that needs attention. And experts expect the shortage to worsen with health care reform, which will extend insurance coverage to about 30 million more Americans.

Some policymakers think nurse practitioners offer a way to address the problem.

Nurse practitioners go through advanced education and training beyond the requirements to become a registered nurse. In about 16 states, they can do most of what doctors do -- including heading their own primary care practices, prescribing drugs and performing medical procedures unsupervised.

In other states, nurse practitioners may be required to work with a doctor.

On paper, it makes sense to expand the role of nurse practitioners in primary care because their education and training is shorter -- an average of six years versus 11 or 12 years for doctors, including residency training. By some estimates, anywhere from three to 12 nurse practitioners can be educated for the price of producing one doctor.

Donelan said there also is evidence that nurse practitioners do just as well as doctors when it comes to primary care -- and that patients needing urgent care actually give nurse practitioners better marks on communication.

But what is not known, she said, is how well nurse practitioners measure up against doctors when things get more complicated, such as in cases in which a patient's diagnosis is unclear or a patient has multiple chronic health conditions.

In those cases, Blumenthal said, "there's no literature as to the superiority of one profession over the other."

If nurse practitioners are to gain an expanded role in primary care, laws in many states will have to change, Blumenthal said.

In 2010, the Institute of Medicine, an independent panel that advises the federal government, issued a report saying that many states' regulations on nurse practitioners were "overly restrictive" and based on politics.

The two professions' national societies see the issue differently. Some doctors' groups, including the American Medical Association and American Academy of Family Physicians, have said that nurse practitioners should be able to practice only under the supervision of a doctor.

But the trend seems to be going against those groups. According to the American Association of Nurse Practitioners, bills have recently been introduced in 10 states to expand nurse practitioners' scope of practice.

Donelan said both sides need to "be at the table" in figuring out what primary care will look like in the future. "Achieving collaboration will take a lot of work, and it needs to be based on data rather than rhetoric," she said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Karen Donelan, Sc.D., senior scientist, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston; David Blumenthal, M.D., president, Commonwealth Fund, New York City; May 16, 2013 New England Journal of Medicine

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Exercising and recovery

Right now i'm trying to recover from anorexia.
i'm a 20 year old female with a BMI of 16 ish.
I feel like if i dont exercise everyday then i shouldn't be eating as much.
is exercising with a BMI this low actually super dangerous? should i completely stop exercising until i reach a healthy BMI? 

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Tom Odell at the BBC Radio 1 Studios in London

Daft Punk day finally arrives… But does it live up to its astronomical hype? Plus, the latest from Maya Jane Coles, London Grammar, Laura Marling, Eddie Berman and a special Virgin Records announcement »

Read more »

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ADHD, Food Dyes, and Additives: What's the Link?

Reviewed by Patricia Quinn, MD

You might have read that artificial food colorings can worsen ADHD symptoms such as inattentiveness and hyperactivity. And if you have a child with ADHD, you may have considered cutting out dyes and other additives from their diet.

Before you make any dietary changes, here are a few things you should know about the link between food colorings and ADHD.

The possible connection between ADHD symptoms and food dyes started with San Francisco pediatrician and allergist Benjamin Feingold. In the early 1970s, Feingold noted that hyperactive kids became calmer when they ate a diet free from artificial colors, flavors, and preservatives.

Since then, several studies have tried to confirm the link. What they've found is that, although dyes don't cause ADHD, a small percentage of kids with ADHD do seem to be sensitive to the effects of food dyes and other additives.

After looking at 34 different studies, "We concluded that there is a small association of food dyes with ADHD," says Joel Nigg, PhD, a professor of psychiatry and behavioral neuroscience at Oregon Health & Science University and author of What Causes ADHD?

In Nigg's review, about 8% of children showed symptoms related to food dyes, and about 30% responded well to a dye-free diet.

Yet Nigg says there are still some open questions. The studies that have been done so far have mostly included small numbers of children: in some cases, just 10 or 20 kids. Plus, many of the children ate foods that had both dyes and other additives, making it hard to pinpoint the exact cause of their behaviors.

Researchers also aren’t sure exactly how artificial food colorings might impact ADHD symptoms. It could be that these substances affect children's brains. Or, it's possible that some kids are hypersensitive: They have a kind of allergic reaction when exposed to dyes and additives, Nigg says. Many of the kids who are sensitive to dyes are also sensitive to other foods, like milk, wheat, and eggs.

In 2007 study linked six different food dyes to increased hyperactivity in children. After the study's release, the European Union started requiring warning labels on foods containing the dyes tested in the study:

quinoline yellow (yellow #10)ponceau 4R (not available in the U.S.)allura red (red #40)azorubine (not approved for food in the U.S.)tartrazine (yellow #5)sunset yellow  (yellow #6)

The U.S. didn't set similar requirements. In 2011, an FDA Food Advisory Committee concluded there isn't enough evidence to prove food dyes cause hyperactivity in children.

Although the link between food dyes and ADHD symptoms is still not clear, some parents say they have seen an improvement after eliminating these and other additives from their children's diet.

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Fitness in Middle Age May Help Shield Men From Cancer Later

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 16 (HealthDay News) -- Men who are physically fit in middle age have a lower risk of developing and dying from certain cancers, new research indicates.

"Fitness is a huge predictor of [cancer] risk," said Dr. Susan Lakoski, an assistant professor of internal medicine at the University of Vermont, in Burlington. "You need to be fit to protect yourself against a cancer diagnosis in older age."

Men who were fit in their 40s, 50s and 60s were less likely decades later to get lung or colorectal cancer, she found. Those who were fit were also less likely to die from prostate, lung or colorectal cancers.

She is scheduled to present her research, supported by the U.S. National Cancer Institute, on June 2 at the American Society of Clinical Oncology annual meeting in Chicago.

While other studies have found physical activity protects against certain cancers, Lakoski said fewer studies have looked at the importance of fitness to predict whether men would develop or die from cancers.

For the study, Lakoski and her colleagues evaluated more than 17,000 men who had a single cardiovascular fitness assessment as part of a preventive health checkup at the Cooper Clinic, in Dallas, when they were 50, on average.

The men walked on a treadmill under a regimen of changing speed and incline. Their results were categorized into five groups, from lowest fitness level to highest.

Later on, the researchers analyzed Medicare claims data to identify the participants who had developed three common cancers among U.S. men -- lung, colorectal or prostate.

The average follow-up period was 20 to 25 years. During that time, 2,332 men developed prostate cancer, 276 developed colorectal cancer and 277 developed lung cancer.

During the follow up, 769 men died -- 347 of cancer, 159 of heart disease and 263 of other causes.

The men who were most fit on the treadmill test, when compared to the least, had a 68 percent lower risk of lung cancer and a 38 percent lower risk of colorectal cancer. Their prostate cancer risk didn't decline with increasing fitness, but the risk of death from it did.

Even a small improvement in fitness helped, the researchers found. For instance, a 50-year-old man who increased fitness so he could last three more minutes on the treadmill, Lakoski said, could reduce cancer death risk by 14 percent and heart disease death risk by 23 percent.

Low fitness levels increased the risk of cancer and heart disease even in men who weren't obese, the researchers found.

They also took into account other factors that could increase risk, such as age and smoking habits.

The good news, Lakoski said, is that, "You don't have to be highly fit to get protection." The most protection against cancer and heart disease was found in moving out of the least fit group.

And how unfit were those men? The men in the least fit group who were 40 to 49 when they took the test could walk on the treadmill less than 13.5 minutes. Those who were 50 to 59 lasted less than 11 minutes. Those 60 and older in the least fit group only lasted less than 7.5 minutes.

The findings make sense, said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

"While you can't tell just how much activity these guys were doing over time, it makes sense that the most fit would have better cancer-related outcomes -- because they are likely the most active." While the new research did not find a link between fitness levels and a diagnosis of prostate cancer, a recent review of other published studies did show a modest reduction in that risk, Doyle said.

Lakoski can't explain the protective effects of fitness for sure, but can speculate. "We know that fitness modulates several important pathways also related to cancer risk," she said. These include, among other pathways, reducing inflammation and oxidative damage in the cells, she said.

Doyle agreed that many mechanisms are probably at work. Activity can improve immune function, for instance, and help control weight, and that in turn can decrease inflammation, she said.

To achieve cardiovascular fitness and reduce cancer risk, be moderately active 150 minutes a week or vigorously active for 75 minutes, or some combination, Doyle advised.

Because this study is being presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Lakoski found a link between fitness and cancer protection, not cause and effect. She also can't say whether the findings would apply to women. She hopes to study that next.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Susan Lakoski, M.D., assistant professor, internal medicine, University of Vermont, Burlington; Colleen Doyle, M.S., R.D., director, nutrition and physical activity, American Cancer Society; June 2, 2013, presentation, American Society of Clinical Oncology annual meeting, Chicago

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