Hyponatremia and short-term outcomes in patients with acute pulmonary embolism

BACKGROUND: Hyponatremia, a marker of neurohormonal activation, is associated with poor outcomes in acute cardiorespiratory diseases such as myocardial infarction, right and left ventricular heart failure, and pneumonia. The prognostic value of hyponatremia in patients with acute pulmonary embolism (PE) is unknown. We sought to assess whether hyponatremia at presentation was associated with mortality and hospital readmission in patients hospitalized with PE. METHODS: We studied patient discharges with a primary diagnosis of PE from 185 acute care hospitals in Pennsylvania (1/2000-11/2002). We defined hyponatremia as a serum sodium level ≤135 mmol/l, measured at the time of patient presentation. The study outcomes were 30-day all-cause mortality and hospital readmission. We used random-intercept logistic regression to examine the association between hyponatremia and mortality. We adjusted for baseline patient (race, insurance, severity of illness using the Pulmonary Embolism Severity Index) and hospital characteristics (region, hospital size and teaching status). We used the same approach to examine the association between hyponatremia and readmission among patients who were discharged alive. RESULTS: Among 13,728 patient discharges with PE, 2907 (21.1%) had hyponatremia at the time of presentation. Patients with hyponatremia were older (P<0.001) and more likely to have a history of cancer (P<0.001), heart failure (P<0.001), or chronic lung disease (P=0.002) than patients without hyponatremia. Patients with hyponatremia had a higher unadjusted cumulative 30-day mortality (15.2% vs 8.0%;P<0.001) and readmission rate (15.9% vs 11.8%; P< 0.001) than patients without hyponatremia (Figure). After adjustment for race, insurance, severity of illness, and hospital factors, hyponatremia was associated with a significantly greater odds of death (OR 1.71, 95% CI: 1.50-1.95) and hospital readmission (OR 1.29, 95% CI: 1.14-1.46). CONCLUSIONS: In this large, statewide sample of unselected patients with acute PE, hyponatremia was relatively common and was an independent predictor of short-term mortality and hospital readmission. Given that sodium is a low-cost, easily available laboratory parameter, it may be potentially useful in risk-stratifying patients with PE.

Project Newsletter Iowa Public Health Tracking, December 2013

The IDPH Public Health Tracking Program is an excellent way to collect data related to various indicators for Iowans, but those looking for national statistics or data from other states may want to check out the Health Indicators Warehouse (healthindicators.gov). Run and maintained by the CDC’s National Center for Health Statistics, this site is a centralized source for national, state, and county data for a wide variety of indicators. The data is available to the public, and can be accessed either through the tables and charts directly on the website, or indicators can be downloaded to use in a spreadsheet. Once on the site, users are able to search for their desired data either by topic or geographic region. Filters can then be applied to the chosen field to narrow down the user’s search and obtain the preferred statistics. In addition, users are also able to search for indicators derived from state and federal health indicator initiatives: County Health Rankings, Community Health Status Indicators, Healthy People 2020, and CMS Community Indicators. The warehouse provides an overview of each indicator after the user has made their selection. This overview includes information on how the data was calculated and what characteristics are being represented. For example, percent of binge drinking adults is prefaced in the overview that data was based on the question: “Considering all types of alcoholic beverages, how many times during the past 30 days did you have [5 for men, 4 for women] or more drinks on an occasion?" Data is viewable either in the basic table format, chart format, or for some indicators it is possible to view it in terms of a national map. The Health Indicators Warehouse updates indicators as data becomes available, but the collection of years varies amongst the indicators. Nonetheless, this site is a useful resource to anyone looking for comparative indicators throughout the nation or is interested in one of the hundreds of indicators housed by the site. For more information or to check out what the warehouse has to offer visit: http://healthindicators.gov/

Project Newsletter Iowa Public Health Tracking, January 2014

The IDPH Public Health Tracking Program is an excellent way to collect data related to various indicators for Iowans, but those looking for national statistics or data from other states may want to check out the Health Indicators Warehouse (healthindicators.gov). Run and maintained by the CDC’s National Center for Health Statistics, this site is a centralized source for national, state, and county data for a wide variety of indicators. The data is available to the public, and can be accessed either through the tables and charts directly on the website, or indicators can be downloaded to use in a spreadsheet. Once on the site, users are able to search for their desired data either by topic or geographic region. Filters can then be applied to the chosen field to narrow down the user’s search and obtain the preferred statistics. In addition, users are also able to search for indicators derived from state and federal health indicator initiatives: County Health Rankings, Community Health Status Indicators, Healthy People 2020, and CMS Community Indicators. The warehouse provides an overview of each indicator after the user has made their selection. This overview includes information on how the data was calculated and what characteristics are being represented. For example, percent of binge drinking adults is prefaced in the overview that data was based on the question: “Considering all types of alcoholic beverages, how many times during the past 30 days did you have [5 for men, 4 for women] or more drinks on an occasion?" Data is viewable either in the basic table format, chart format, or for some indicators it is possible to view it in terms of a national map. The Health Indicators Warehouse updates indicators as data becomes available, but the collection of years varies amongst the indicators. Nonetheless, this site is a useful resource to anyone looking for comparative indicators throughout the nation or is interested in one of the hundreds of indicators housed by the site. For more information or to check out what the warehouse has to offer visit: http://healthindicators.gov/

Project Newsletter Iowa Public Health Tracking, February 2014

The IDPH Public Health Tracking Program is an excellent way to collect data related to various indicators for Iowans, but those looking for national statistics or data from other states may want to check out the Health Indicators Warehouse (healthindicators.gov). Run and maintained by the CDC’s National Center for Health Statistics, this site is a centralized source for national, state, and county data for a wide variety of indicators. The data is available to the public, and can be accessed either through the tables and charts directly on the website, or indicators can be downloaded to use in a spreadsheet. Once on the site, users are able to search for their desired data either by topic or geographic region. Filters can then be applied to the chosen field to narrow down the user’s search and obtain the preferred statistics. In addition, users are also able to search for indicators derived from state and federal health indicator initiatives: County Health Rankings, Community Health Status Indicators, Healthy People 2020, and CMS Community Indicators. The warehouse provides an overview of each indicator after the user has made their selection. This overview includes information on how the data was calculated and what characteristics are being represented. For example, percent of binge drinking adults is prefaced in the overview that data was based on the question: “Considering all types of alcoholic beverages, how many times during the past 30 days did you have [5 for men, 4 for women] or more drinks on an occasion?" Data is viewable either in the basic table format, chart format, or for some indicators it is possible to view it in terms of a national map. The Health Indicators Warehouse updates indicators as data becomes available, but the collection of years varies amongst the indicators. Nonetheless, this site is a useful resource to anyone looking for comparative indicators throughout the nation or is interested in one of the hundreds of indicators housed by the site. For more information or to check out what the warehouse has to offer visit: http://healthindicators.gov/

Project Newsletter Iowa Public Health Tracking, May 2014

The IDPH Public Health Tracking Program is an excellent way to collect data related to various indicators for Iowans, but those looking for national statistics or data from other states may want to check out the Health Indicators Warehouse (healthindicators.gov). Run and maintained by the CDC’s National Center for Health Statistics, this site is a centralized source for national, state, and county data for a wide variety of indicators. The data is available to the public, and can be accessed either through the tables and charts directly on the website, or indicators can be downloaded to use in a spreadsheet. Once on the site, users are able to search for their desired data either by topic or geographic region. Filters can then be applied to the chosen field to narrow down the user’s search and obtain the preferred statistics. In addition, users are also able to search for indicators derived from state and federal health indicator initiatives: County Health Rankings, Community Health Status Indicators, Healthy People 2020, and CMS Community Indicators. The warehouse provides an overview of each indicator after the user has made their selection. This overview includes information on how the data was calculated and what characteristics are being represented. For example, percent of binge drinking adults is prefaced in the overview that data was based on the question: “Considering all types of alcoholic beverages, how many times during the past 30 days did you have [5 for men, 4 for women] or more drinks on an occasion?" Data is viewable either in the basic table format, chart format, or for some indicators it is possible to view it in terms of a national map. The Health Indicators Warehouse updates indicators as data becomes available, but the collection of years varies amongst the indicators. Nonetheless, this site is a useful resource to anyone looking for comparative indicators throughout the nation or is interested in one of the hundreds of indicators housed by the site. For more information or to check out what the warehouse has to offer visit: http://healthindicators.gov/

Iowa Department of Public Health Women’s Health-Related Programs Summary,January 2012

The Iowa Department of Public Health (IDPH) Office of Women’s Health has compiled an inventory of IDPH programs that address the unique health care needs of women. Twenty-four programs incorporate women’s health services into their public health programming. The following summaries provide an overview of current programs.

Mental Health & Disabilities Workforce Workgroup, December 12, 2012

The Iowa 2012 General Assembly charged the Iowa Department of Public Health with creating a mental health and disabilities group to make workforce recommendations in support of services to Iowans (Senate File 2315, Division II, Section 24). The Department of Human Services Mental Health Redesign Initiative was already underway since 2010. Workforce supply is a critical element of service capacity. IDPH leadership reviewed the legislative language, conferred with DHS leadership, appointed the workforce, and began deliberations in fall 2012.

Health in Iowa Annual Report: Behavioral Risk Factor Surveillance System, 2013

The Iowa Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing telephone survey. It is financially and technically supported by the CDC with further financial support from public and private sources. The BRFSS is designed to collect information on the health conditions, health-related behaviors, attitudes, and awareness of residents age 18 and over. It also monitors the prevalence of these indicators over time. The indicators surveyed are major contributors to illness, disability, and premature death. This report focuses on the data collected during calendar year 2013. Some of the health-related issues discussed are general health status, health care access, cancer screening, tobacco use, alcohol consumption, body weight, physical activity, oral health, diabetes, respiratory conditions, immunizations, and HIV/AIDS awareness.

Health in Iowa Annual Report: Behavioral Risk Factor Surveillance System, 2014

The Iowa Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing telephone survey. It is financially and technically supported by the CDC with further financial support from public and private sources. The BRFSS is designed to collect information on the health conditions, health-related behaviors, attitudes, and awareness of residents age 18 and over. It also monitors the prevalence of these indicators over time. The indicators surveyed are major contributors to illness, disability, and premature death. This report focuses on the data collected during calendar year 2013. Some of the health-related issues discussed are general health status, health care access, cancer screening, tobacco use, alcohol consumption, body weight, physical activity, oral health, diabetes, respiratory conditions, immunizations, and HIV/AIDS awareness.

Financial Power of Attorney

A financial power of attorney (FPOA) is a document authorizing someone else (an agent) to manage your finances on your behalf if you (the principal) become incapacitated and are unable to make financial management decisions for yourself. If you become unable to decide for yourself and you have not prepared a financial power of attorney, a court proceeding will likely be required before a loved one will be able to assume authority over at least some of your financial affairs. Your FPOA can be drafted to go into effect as soon as you sign it or it can become effective at a later date or only in the case that a physician certifies that you have become incapacitated.

Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives" training in Catalan hospitals accredited as centers for normal birth

Background: The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives" level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. Methods: A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Results: Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. Conclusions: Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives" training in Catalan hospitals accredited as centers for normal birth

Background: The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives" level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. Methods: A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Results: Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. Conclusions: Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

The Changing Face of Psychiatric Nursing –Care or Control?

This report has been written as part of the project “Toward improved quality – developing nurse’s continuing vocational training in hospitals and inpatient units”. Its overall goal is to ensure high quality, ethically appropriate and therapeutically effective interventions to enable nurses to manage distressed and disturbed patients in European psychiatric hospitals and inpatient units. In this large-scale, multinational projects there are all together six European countries involved: Finland, Ireland, England, Portugal, Italy and Lithuania. The project work plan were during autumn 2006 and spring 2007. The content of this publication was produced in the first stage of the project aiming to collect the preliminary source material for the project. The literature review was carried out in the project stage, providing the groundwork for the next steps for the project. This project aims to develop an interactive multinational portal with training material. Therefore, it is important to share an understanding of basic information, psychiatric nurse’s continuing vocational education, laws and ethical codes and patient restriction used in mental health care. In this publication, the purpose of the material produced here is to understand nurses’ educational need related to vocational continuing education and to be used in further project stages as an empirical data collection. The data were collected as a preliminary source material for latter phases where nurse’s perceptions of the current practice, nurse’s attitudes to mental illness, prevalence of use of seclusion room and existing and desired vocational training provision will be collected in six different European countries. The following organisations are involved in this project: University of Turku, Dublin City University, St. Vincent Hospital, National Council for the Professional Development of Nursing and Midwifery, University of Padova, Klaipeda College - Health Faculty, Klaipeda Psychiatric Hospital, Escola Superior de Enfermagem de Lisboa, Centro Hospitalar Psiquiátrico de Lisboa, Omnia Vocational Institution the Espoo Region, Kellokoski psychiatric hospital, Hyvinkää hospital area, Pirkanmaa Hospital District, Kingston University & St. George’s Medical School and South West London & St. George’s Mental Health NHS Trust. A wide variety of different countries, organisations and individuals in this project give us a strong confidence that theoretical, practical, ethical and political issues around the topic of interest will be taken account during this project lifetime. We are aware the content of this book will be partially outdated almost as soon as it has been published. We still hope that this publication will encourage nurses and different professions working in mental health care field to have a basic understanding of similarities and differences between different European countries related in mental health care. We also hope that this publication will inspirate and motivate nurses in maintaining and developing the quality of psychiatric care in Europe.