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BostonFNP Guide 41,261 Views

Joined Apr 4, '11 - from 'Northshore, MA'. BostonFNP is a Primary Care NP. Posts: 4,650 (61% Liked) Likes: 11,237

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  • 5:49 pm

    Quote from mw73
    It seems that the majority of the comments indicate that nursing is a highly stressful career. Are any of the posters that have commented about this NPs in private practice?
    I believe some of the prior posters are NPs and others are student NPs or RNs.

    I am a private practice NP. Nursing is a stressful career. Nursing at the APN level is perhaps less physically stressful and more mentally stressful. You are responsible for the life of 1500-3000+ people in a job where one miss or one mistake could significantly impact the quality or quantity of life in any one of those people. Additionally, there is a significant amount of administrative red tape which is also stressful. As is just dealing with people at times

  • 6:06 am

    1. Are you glad you got your DNP? Why?

    I am glad I got it out of the way, it makes me more comfortable for whatever future lies ahead. The way I see it, it is never going to hurt me and may help me in some form or another down the road, either in practice or in academia.

    I also "just like" having a terminal degree. There is a feeling of completion there in a job where otherwise you can never stop learning.

    2. Are you glad you didn't get your DNP? Why?

    I wouldn't have done it if I had to pay for it.

    3. Does it really matter?! Why?

    It matters but not in many significant ways. It opens doors to academia. It prepares for the future. It engages practicing NPs in a number of different ways. I think it is good for the profession moving into independent practice from a purely superficial standpoint.

  • 12:13 am

    Quote from Drphillgood
    I couldn't find anything on a 100% crew Boston, but I was able to find a CDC article that had a crew on a small naval ship and 99% compliance which I think they may have been talking about. It's in my last post.
    Yeah and that one showed that 25 of 102 crew members sought care for ILI of which only 18 were LCIV in the setting of 99% vaccination rate (and only 17/ of the 18 were vaccinated). If you consider a VE of about 60% this seems like the vaccine was fairly effective in preventing illness in the majority of the crew. The strain appeared to be a good match that season, so it is interesting that 17 vaccinated people got LCIV, however they were all vaccinated via either intradermal or mist, not IM.

  • 12:13 am

    Quote from r1013
    Approx 2 years ago I was watching an interview with a chemist from a pharmaceutical company that produces the shot. All the typical questions were asked and responses were as expected except one. He was asked if it worked. With a smile and slight laugh he said "well... we can't prove it and we have never seen it work, but the science behind it is sound so we highly recommend it."
    Can you link to this interview, I'd like to see it.

    Quote from r1013
    A US Navy aircraft carrier with 100% flu shot compliance has out break of the flu.
    I don't see any news stories or published papers about this. Can you cite your source for us please?

    Quote from r1013
    I feel like I'm becoming a conspiracy theorist with the flu shot because to me things don't add up. What I have come to the conclusion of, is that it doesn't work. I am still trying to decide 100% but right now I am 90% leaning its all a bunch of bull.

    You can read more here: Flu Shot Remains Most Dangerous Vaccine Based on Injuries and Deaths Compensated by Government
    You are concluding the vaccination is not effective and 90% leaning on some anecdotal evidence and reports from sources like "Health Impact News". You seem to have the right gut reaction: you are becoming a conspiracy theorist, or at very least, a pseudo-scientist.

    Perhaps "things don't add up" because you are asking the wrong question: this is confirmation bias.

  • 12:09 am

    Quote from Cheyenne RN,BSHS
    I have to share a recent article on this topic. I have had an opinion that much of the vaccination-mask push is more hype than outright fact. I would appreciate any input from others. I included the link and a few sentences directly from the article.
    Mandatory flu shot policies may be based on flawed research, study suggests

    Mandatory flu shot policies may be based on flawed research, study suggests

    Written by Heather Punke February 01, 2017 |
    While the CDC urges everyone to get a flu shot, some hospitals take it a step further and mandate employees to get a flu shot or face possible termination. These mandatory flu shot policies are rooted in the belief the shot protects both workers and patients from the virus. However, a study published in PLOS says the policies may be built on faulty research. "The impression that unvaccinated [healthcare workers] place their patients at great influenza peril is exaggerated," according to the study.
    Actual study link: Influenza Vaccination of Healthcare Workers: Critical Analysis of the Evidence for Patient Benefit Underpinning Policies of Enforcement

    This was talked about above. Having read it a few times, my thoughts:
    • The analysis is interesting in an academic sense.
    • It presents a competing perspective and a critical analysis on a small part of the extant data.
    • I am not an epidemiologist, so I confess that some of the calculations and assumptions made are above my comfortable understanding, though they seem theoretically sound.
    • It is clear there is a clear difficult-to-describe all-cause mortality result; this has been seen in many other studies and always warrants further evaluation as it is suggestive of selection bias. It suggests the use as a primary endpoint is concerning.
    • The reduction in LCIV (where studied) is significant and more consistent with the predicted data.
    • This was only 4 trials reviewed and no new data was created.
    • There is a lot of data manipulation in this case by the very nature of the analysis.
    • This is not a blinded study and several of the authors have a clear historical bias as well as the funding sources having pending legal actions on the topic.
    • I am still not sure I understand the "generalized" extrapolation nationwide; the numbers don't seem to add up and it is not clear how they arrived where they did and they make a large assumption that the previous study data would be linear.
    • The authors' conclusion is exaggerated.

  • 12:05 am

    Quote from mrl3fnp
    Dionne B, Brett M, Culbreath K, Mercier RC. (2016). Limited Effect of Healthcare Worker Influenza Vaccination Rates on the Incidence of Nosocomial Influenza Infections. Infection Control Hospital Epidemiology, 37(7). 840–844. Retrieved from DOI: Potential Ceiling Effect of Healthcare Worker Influenza Vaccination on the Incidence of Nosocomial Influenza Infection | Infection Control & Hospital Epidemiology | Cambridge Core
    I don't disagree with this study, which showed increasing influenza vaccination rates initially decreased influenza rates by nearly 50% prior to plateauing and maintaining the reduced rate. I think we all understand there is a ceiling that is less than 100%.

    What this is not is a citation to a study showing mask use superior to influenza vaccine in the reduction of lab-confirmed influenza virus.

  • 12:04 am

    Quote from mrl3fnp
    I have yet to see an unbiased and financially uncorrupt influenza vaccination study showing the effectiveness at reducing the risk of spreading influenza comparable to that of wearing a mask. If health care facilities were really concerned about patient health and reducing the spread of hospital-acquired influenza why do they not implement a mandatory mask wearing policy for everyone? Especially when the flu vaccination is so controversial and so many health care workers have legitimate objections.
    You haven't seen a "unbiased and financially uncurrupt" influenza vaccination study because you chose to call every study that is at odds with your point of view both of those things. Ironically, while calling the extant data biased, you so excellently demonstrate the confirmation bias that is ripe through the pseudoscience movement. Your arguments use the same logical fallacies that we see all the time from anti-vaxxers, including this ad hominem about author disclosures (thankfully the term "shill" has yet to be played). Tell us, do you support other vaccines?

    I don't inherently disagree with you that if a hospital system truly wanted to prevent disease spread there are potentially better/boarder ways to accomplish that, and I do think there are other factors at play. Truth be told I think that the influenza vaccine has the least amount of supporting data when compared to other vaccines.

  • 12:04 am

    Quote from mrl3fnp
    These are the biased, financially corrupt, exaggerated, and mathematically impossible studies the CDC uses to influence hospitals to implement policies that mandate forced influenza vaccinations on health care workers at the risk of getting fired if they do not comply.
    Again, disclosed information about one or more authors does not invalidate a study. In example, the study you just cited was funded in part by the Ontario Nurses Association, which strongly opposes mandatory vaccination of nurses and was in a concurrent legal battle regarding it.

  • 12:02 am

    Quote from mrl3fnp
    Thank you once again for making my point about bias and financial corruption.......
    Your point hasn't been made; you have provided zero evidence perhaps aside for conspiracy theory.

    Quote from mrl3fnp
    The European Centre for Disease Prevention and Control (ECDC) is the European equivalent to America’s CDC and those conducting the research work for the ECDC. Consequently, there is a strong potential for bias and financial corruption influencing the conclusions……….

    So to post this research as if it proves a point isn’t being intellectually honest……….
    Again, cite your evidence that there is any financial corruption or bias by the ECDC or CDC in this peer-reviewed study.

    I don't think many people will be surprised that you have once again posted a slew of opinions as if they are fact without citing a single source. You want to talk about intellectual honesty? Then why don't you cite your source on this statement you made a few posts prior that mask-wearing is "more efficacious compared to the flu shot".

  • 12:02 am

    Quote from mrl3fnp
    To argue for or against the efficacy of the flu shot is futile when the other person doesn't recognize or understand statistical power, bias, and financial corruption. But, I regress because my argument is not relating to the efficacy of the flu shot........It's relating to mask-wearing being more efficacious compared to the flu shot and the hypocrisy of nurses and healthcare organizations when it comes to patient safety.
    More sources, less opinions. Can you cite the trial comparing mask use to influenza vaccine in preventing confirmed influenza?

    bin‐Reza, F., Lopez Chavarrias, V., Nicoll, A., & Chamberland, M. E. (2012). The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza and other respiratory viruses, 6(4), 257-267.

  • 12:01 am

    Quote from StarletRN1
    There's also a "wealth of information" showing a link between the flu vaccine and neurological disorders. Misinformation would be telling my patients that the flu vaccine is perfectly safe.
    First off, nothing is perfectly safe, including both being vaccinated and not being vaccinated.

    Second, please share some of the wealth of information regarding the flu shot causing neurological disorders.

  • Mar 23

    Quote from mrl3fnp
    How can we have a productive discussion if you continue to ignore my questions and deflect? I am still waiting for you to provide me with unbiased and uncorrupted evidence that shows the flu shot to be more efficacious than mask-wearing.
    I am providing peer-reviewed data, including the Cochrane Library report that is widely considered one of the most critical publications on influenza vaccine efficacy from the global standard in international and independent reviews.

    You are, thus far, providing opinion. Because authors of a study have disclosed interests does not invalidate the study, if you have evidence to data manipulation than please share it. We are waiting for your sources.

    So here's another meta-analysis published in a non-American major peer-reviewed journal including 34 RCTs over 47 seasons and almost 100,000 patients including two independent reviewers which rated each RCT for bias.

    Tricco, A. C., Chit, A., Soobiah, C., Hallett, D., Meier, G., Chen, M. H., ... & Loeb, M. (2013). Comparing influenza vaccine efficacy against mismatched and matched strains: a systematic review and meta-analysis. BMC medicine, 11(1), 153.

  • Mar 23

    Quote from mrl3fnp
    Most American studies showing the efficacy of the flu vaccination are weak, biased, and financially corrupted by influencing interests. In contrast, non-American studies showing the ineffectiveness and counterproductiveness of the flu vaccination and that it increases the risk of the transmission of influenza never get published in American Journals.....Why is that?
    I don't know why that is, you didn't cite any sources. If they are not getting published at all I would say the most obvious reason is that they lacked scientific vigor.

    Cite some so we can evaluate.

  • Mar 23

    Quote from mrl3fnp
    Do you have any unbiased research supporting your opinion?

    Just a note on professionalism, it's not intellectually honest nor does it promote further discussion by taking out of context what a poster said when you are replying to the post.
    I have lots of peer-reviewed, multinational studies. I would be happy to list a dozen. Will you list a dozen of your sources please.

  • Mar 23

    Quote from mrl3fnp
    Thank you for making my point........Jefferson, T. owns shares in Glaxo SmithKline and received consultancy fees from Sanofi Synthelabo and Roche.

    Jefferson, T. designed the update, wrote the protocol, applied inclusion criteria, extracted data, and wrote the final report.
    You do realize that Tom Jefferson is one of the most vocal scientists AGAINST the influenza vaccine right?

    Cite your source on Tom owning GSK stock. Also, doesn't GSK make Tamiflu? Would he not benefit from having more flu?