J.Adderton

Incredible Health recently conducted a study with input from 100 U.S. health system executives to better understand the challenges nurses face within the profession. The findings released on June 13, 2023, shed light on the disconnect between what incentives employers are offering and what nurses really want. Study Methodology During May 2023, Incredible Health surveyed executives from 100 U.S. hospitals and health systems The survey included executives from within and outside of the Incredible Health employer network and participant responses remained anonymous. Large health systems, academic medical centers, community hospitals and regional centers from both rural and urban areas were included in the study. Critical Shortage According to the National Council of State Boards of Nursing, approximately 100,000 registered nurses (RNs) left the workforce during the COVID-19 pandemic due to stress, burnout and retirement. The consequences of fewer nurses in the workforce weigh heavily, with 94% of surveyed executives describing the nursing shortage in their system as "critical". Alarmingly, 68% of participants also reported they would not have enough nursing staff to adequately manage another large-scale health crisis. Gap in Level of Experience Surveyed executives identified previous nursing experience (43%) and qualifications (43%) as the top two desirable factors when hiring nurses. However, study participants reported 53% of nurses had worked less than 5 years at their institutions. The gap between desired experience and current reality is further highlighted when considering that more than 25% of nurses working in the participants' institutions have less than a year of experience. Offering What Nurses Want The study also found a disconnect between what nurses want as hiring and retention incentives and what employers are actually offering. For example, health systems reported 80% of younger nurses wanted schedules with more flexibility. Yet, only 11% of executives offered flexible schedules as an incentive. Hospital executives reported using sign-on bonus (35%), pay increases (26%) and improved staff-to-patient ratios (16%) to attract nurses. However, Incredible Health's State of U.S. Nursing Report Study, 80% of nurses plan to stay in field until retirement | Incredible Health found that only 33% of nurses feel they are paid fairly for the work they do. Generational Gaps Nurses working in the U.S. represent a wide range of ages, with the average age being 52 years. The characteristics of each generation lead to differences in workplace preferences and expectations. The report findings uncovered significant generational differences in what supports workplace satisfaction among nurses. 78% of younger nurses requested compensation increases vs. only 48% of older nurses. 54% of younger nurses desire specialized roles vs. 14% of older nurses 74% of younger nurses request opportunities to advance their career vs. 8% of older nurses. 79% of executives noted a lower level of loyalty and tenure in younger nurses vs only 21% in older nurses. Moving Forward Are the employee incentives in your area of practice aligned with your own expectations?

On March 20, 2023, the Center for Disease Control issued an urgent press release about the antimicrobial threat, Candidas auris (C. auris). Data published in the Annals of Internal Medicine reported the rapid spread of the fungus in U.S. healthcare facilities from 2019-2021. Here is a quick look at the number of U.S. cases over a 4 year period (2008-2021). 329 cases reported in 2018 467 cases reported in 2019 718 cases reported in 2020 1,012 cases reported in 2021 The number of cases that were resistant to echinocandins, the medication used to treat the C. auris, tripled in 2021. A Mississippi outbreak that began in November 2022 infected at least 12 individuals and is potentially responsible for 4 deaths. Medicine-resistant fungal infection, C. auris, potentially linked to four deaths in Mississippi - Mississippi Today What Is C. Auris? You may be familiar with the term "yeast" infections, which are caused by a type of Candida fungus. C. auris is an emerging new species of Candida that was first identified in 2009 at a hospital in Japan. The fungus has been reported in 30 countries, with the first U.S. case reported in 2016. Infections are likely underdiagnosed and underreported because specialized laboratory equipment is needed to identify C. auris. Who Is at Risk? C. auris is most commonly spread to people who live in a nursing home or have had long or frequent hospital stays. It can be found in the body and on skin but is usually not a threat to healthy individuals. However, people with weakened immune systems have an increased risk of infection. Certain conditions are more likely to compromise our immune systems, such as cancers, diabetes and need for frequent antibiotics. The presence of invasive medical devices can also increase vulnerability to C. auris. These devices may include Ventilators Feeding tubes Central lines Urinary catheters Drains What Is the Danger? The CDC considers C. auris an urgent public health threat because it's often resistant to certain medications. In fact, some cases have been resistant to all three types of antifungal medications used to treat yeast. C.auris can also cause serious bloodstream infections and even death. According to the CDC, one in three patients die when the infection spreads to a part of the body that is normally free of pathogens. These areas may include the heart, blood, or brain. C. Auris spreads easily from person to person or by touching contaminated surfaces or equipment. The fungus can also live on surfaces for several weeks. What are the Symptoms of C. Auris? The symptoms of C. auris depend on what part of your body is infected. If the yeast has infected tissue in a wound, the symptoms could be tenderness, drainage, slow healing, and fever. With a bloodstream infection, you may experience fatigue, pain, chills, and fever. Unfortunately, the signs of C. auris are often missed since the people most likely to be infected are usually dealing with other medical problems. How Is C. Auris Diagnosed? C. auris is usually diagnosed through cultures of blood and body fluids. There are unique challenges to diagnosing C. auris. First, not all labs have the special equipment necessary to make an accurate diagnosis. Secondly, it can be difficult to identify C. auris from other types of yeast growth in the culture. C. Auris Treatment C. auris is treated with echinocandins, which is an antifungal drug. The drug is given intravenously and works by altering the cell wall of the yeast. What Is Being Done About C. Auris? The CDC is working on strategies to slow the spread and prevent future outbreaks. Working in collaboration with partners, the CDC has rolled out the following initiatives: Educating healthcare workers and infection control departments on how to stop the spread of C.auris and providing updates as new information is available. Working with state and local agencies, healthcare facilities and Microbiology labs to ensure appropriate methods are being used for detection. Monitoring emerging C. auris strains for resistance to medications. Studying the DNA of different C. auris strains to better understand how it spreads. Let Us Hear From You Have you encountered a C.auris case in your practice? What were the barriers, if any, to reaching an accurate diagnosis?

Overdose deaths from illegally manufactured fentanyl (IMF) have skyrocketed all across America. Statistics reported by the CDC’s National Center for Injury Prevention and Control in New Orleans paint a grim picture, with IMF overdose deaths increasing between 2019 to 2020 by: Nearly 50% in the west 65% in the south 33% in the mid-west New Mexico and Tennessee join a growing list of states that have added fentanyl test strips as a harm reduction tool, joining such programs as needle exchanges and distribution of naloxone kits to lay individuals. Fentanyl Facts Fentanyl is a scheduled II synthetic opioid that is around 100x more powerful than morphine. It is used legitimately in the medical treatment of severe chronic pain and post-surgical pain. Illicitly manufactured fentanyl (IMF) is produced in underground labs, unregulated and usually smuggled into the U.S. through Mexico to sell on the black market. Fentanyl can be mixed with other illicit drugs to increase the effects making it even more lethal. In fact, 2mg of fentanyl can be deadly for certain individuals. According to DEA analysis, 42% of counterfeit pills contained at least 2mg of the drug. Fentanyl Test Strips Fentanyl test strips were created in 2011 by BNTX, a Canadian biotech company. Initially, the strips were used by doctors to check clients' urine for prescription fentanyl. However, the tests eventually began being used “off-label” in harm reduction initiatives to lower overdose risk. The strips are able to identify the presence of fentanyl in unregulated drugs, including injectables, powders and pills. According to experts, the test strips are also helpful to people who use other illicit drugs, such as cocaine, methamphetamine and other stimulants. The number of illicit drugs being “laced”, or contaminated, with fentanyl is increasing at alarming rates. How FTS Are Used FTS are usually distributed at harm-reduction centers (such as needle exchange programs), distribution websites and even some dollar stores. The strips cost around $1.00, are easy to use and small enough to carry discreetly. The Prevent Overdose Rhode Island website provides specific instructions on how to use the test depending on how someone is taking the drugs, such as by injection, snorting or swallowing pills. The tests are quick, taking only a couple of minutes to result. Click here to read the "How To Test Your Drugs Using Fentanyl Test Strips" brochure available on nyc.gov. Are They Accurate? The reliability of FTS are backed by a 2018 research study conducted by Brown University, Boston Medical Center, and Johns Hopkins University. Researchers used the test strips on samples of street drugs provided by law enforcement and the strips did accurately detect fentanyl in the samples. In addition, the study found FTS were unlikely to provide a false positive result. You can read more about the study here. Limitations There are limitations associated with FTS, including: When a strip results positive, the test doesn’t measure how much or how strong the fentanyl is in the drug. The strip may detect an incidental contamination of a drug sample that isn’t a clinically significant amount. Impact on Safe Behaviors A 2018 study found drug users provided with FTS that recieved a positive result made safer behavioral changes, such as using with another person present, throwing the drug away, using less or using more slowly. You can read about additional research and studies related to the impact of FTS on safer behavior here. Let Us Hear From You Do you live in a state that has legalized fentanyl test strips? If so, what impact are FTS having in your community?

Recently, I received one of the best “feel good” compliments of my nursing career. The compliment came from a co-worker during a long and chaotic workday. Everyone has most likely received an authentic compliment that continued to resonate in their memory long after it was spoken. January 24th was National Compliment Day and if you missed it…don’t worry. Every day presents a great opportunity to “pass it forward” and show support to someone else both in and outside of work. Win-Win Benefits Research has long shown that showing kindness to another person can improve our overall well-being. Here are just a few of the benefits of giving or receiving recognition at work. Provides an opportunity for you to see a situation or person in a less negative and more positive light. You’ll become more grateful for what qualities and skills your co-workers contribute to the team. Both you and the compliment receiver will experience a boost in confidence. Your co-workers will see you as more trustworthy and approachable. Helps you to overcome some of your own insecurities by recognizing good qualities in other people. This comes full circle when you receive a compliment yourself. Finally, a little positivity always goes a long way when working long days in a pandemic-stressed environment. Facts About National Compliment Day National Compliment Day1 was created in 1998 by Kathy Chamberlin, of Hopkinton, NH and Debby Hoffman, of Concord, NH. They wanted a way to let the people in their lives know how much they appreciate them and they created this day to give them the opportunity. Here are a few other interesting facts about National Compliment Day: According to Nick Haslam2, a professor at University of Melbourne’s School of Psychological Sciences, compliments enhance learning, persistence, engagement with tasks, and overall well-being. World Compliment Day3 is celebrated in March of each year. People who have low self-esteem may disregard compliments they receive because it contradicts how they feel about themselves. Tips for Giving Genuine Compliments Did you know that a fake compliment can actually have the opposite effect when compared to a heartfelt one? If you're perceived as insincere, then your praise loses its intended purpose. Here are a few guidelines to help avoid your compliment coming off as fake. Be Authentic One of the keys to giving a great compliment is to be genuine and sincere. You can do this best in person by speaking in a meaningful tone of voice, making eye contact and smiling. If your compliment is delivered through email or text, you can use first person to make it more personal. For example, “I wanted to let you know how much I appreciate your flexibility today when staff assignments were changed.” Consider the Recipient Be sure to consider a person’s role within the organization when complimenting a coworker. Understanding their job role will guide you in determining how to professionally compliment them and what strength/skill to compliment them on. Don’t forget your management team needs compliments too. It’s also meaningful to think beyond the job and recognize important achievements in a co-worker’s personal life. For example, going back to school, sending a child to college or participating in a marathon. Remember: People have different personalities and while some would love a public compliment, others may prefer to receive a compliment one-on-one. Be Specific Instead of vague compliments, get specific and tell someone exactly what they did to lift your spirits. For example, “I wanted to take a minute to let you know how much I appreciate you coming in early for me today”. The Compliment Checklist Here is a simple checklist for you to consider before you share a compliment. The more you practice using the checklist, the faster it becomes second nature. Is your compliment: Ask yourself: Authentic "Why am I recognizing this person?" Specific “What did I experience or observe?” Considering the recipient “What is the person’s job role within the organization.” Considering the impact “How did what they do positively impact me?” Let’s Hear From You! Have you received a compliment during your career that was especially meaningful? References/Resources 1 National Compliment Day 2 Compliments Are Good For Your Health, But Not If They're Fake 3 World Compliment Day 30 Genuine Compliments to Give Your Co-Workers How to Give and Receive Compliments at Work Five Tips for Celebrating Positively on National Compliment Day Giving compliments at work: 6 tips for a mental pat on the back

Researchers at the University of Alabama at Birmingham School of Medicine have announced peer-reviewed research that could alleviate the worldwide organ shortage crisis through xenotransplantation. For the first time, a person received 2 kidneys from a pig genetically modified to be compatible with a human. The transplanted kidneys filtered blood, produced urine and were not immediately rejected. Additionally, the kidneys remained viable during the study’s 77 hour timeframe. What is Xenotransplantation? Xenotransplantation is any procedure that puts live cells, tissues or organs from an animal into a human recipient. It’s a centuries old proposal that gains steam whenever new technology brings scientists closer to making xenotransplantation a reality. Besides kidneys, other potential xenotransplantation products include pigskin for burns and pig pancreatic islets for diabetes. Ten people die every day in the U.S. waiting to receive a donor organ. The demand for these life-saving procedures far exceeds organ availability. Xenotransplantation research offers hope to the thousands of people with organ disease, injury and failure. The Study In the study, published in the American Journal of Transplantation, UAB researchers tested the first human preclinical model for transplantation of genetically modified pig kidneys. The study replicated the steps that may be taken in a xenotransplant clinical trial. You can read the details of each step here. Approval was obtained from an Institutional Review Board and an Institutional Animal Care and Use Committee prior to the surgery. World’s Firsts UAB’s researchers achieved several “world’s firsts” through the study. These included: First peer-reviewed study of a genetically modified pig kidney transplanted into the body of a brain-dead recipient. First study on a pig-to-human transplant using kidneys with 10 key gene modifications that make the kidneys suitable for direct clinical-grade therapeutic use in humans First validation of a UAB-developed test for compatibility before xenotransplantation. First peer-reviewed/published study to establish brain death as a viable preclinical human model. About the Recipient The recipient, Jim Parsons, was a 57 year- old registered organ donor through Legacy of Hope; however, his organs did not meet the criteria for donation. Mr. Parson’s ex-wife and children agreed to participate in the study after being approached by Dr. Jayme Locke, director of UAB’s Comprehensive Transplant Institute, and a representative with Legacy of Hope. The family agreed for UAB to keep him on a ventilator to allow his body to continue functioning for 77 hours, the total length of the study. Dr. Locke stated, “Mr. Parsons and his family allowed us to replicate precisely how we would perform this transplant in a living human.” In honor of Parson’s gift, the researchers have proposed the preclinical model to be known as “The Parsons model”. UAB Transplant and Xenotransplant Team UAB medicine, as a world leader in organ transplantation, performed 9,055 kidney transplants from 1988 to 2021. The xenotransplantation program at UAB was implemented in 2016 with a focus on addressing the organ shortage crisis. UAB’s program is also conducting focus groups with local religious, business, political and community leaders to study attitudes toward future clinical trials. You can read more about the program here. Organ Donation Options Needed Did you know that kidney disease kills more people each year than breast or prostate cancer? About 5 to 15 percent of dialysis patients die every year and the 8-year survival rate is only around 35 percent. In comparison, more than 95% of kidney transplants are successful in curing end-stage renal disease. More than 90,000 people are waiting on a kidney and fewer than 25,000 transplants are performed each year. The wait for a donor kidney can be as long as five to ten years. Let’s Hear From You What moral or ethical concerns do you have around xenotransplantation (I.e. animal rights, genetic coding issues and potential zoonosis infection)?l References First clinical-grade porcine kidney xenotransplant  using a human decedent mode Xenotransplantation The 10-gene pig and other medical science advances enabled UAB’s transplant of a pig kidney into a brain-dead human recipient Aging and Kidney Disease Frequently asked questions about xenotransplantation

It does seem like a small number but there are many conditions that can lead to blindness, such as macular degeneration, refraction errors that are not corrected by appropriate glasses, untreated cataracts, diabetic retinopathy and strabismus. I am looking for a reference that breaks down percentages by condition and will share if I am able to find.

January is National Glaucoma Awareness Month and a great time to learn more about the leading cause of vision loss and permanent blindness in the U.S. Let's look at a few eye-opening statistics around the condition. More than 3 million people in the U.S. have Glaucoma 120,000 people are blind from glaucoma (accounts for 9% to 12% of all cases of blindness) Over 60 million people worldwide have glaucoma WHO estimates 4.5 million people worldwide are blind due to glaucoma You can do your part to raise awareness by simply learning more about this sight-stealing condition. What is Glaucoma? Glaucoma is a group of eye conditions that can cause damage to your optic nerve. The optic nerve is made up of millions of nerve fibers that run from your retina and meet at the optic disc. In most types of glaucoma pressure abnormally builds up in the eye; causing damage to the optic nerve leading to vision loss. What causes pressure buildup? Aqueous humor is the clear fluid that carries nutrients to the eye's lens and cornea. It also plays an important role in maintaining normal pressures within the eye. This fluid usually drains out of the eye at the angle where the iris and cornea meet. If the drainage system isn't working or there is too much aqueous humor being produced, then fluid can't flow out properly and internal eye pressure increases. Who is at Risk? Everyone is at risk for glaucoma, regardless of age. However, there are people who carry a higher risk, including individuals who: Are over age 60 Are of African, Asian or Hispanic descent Have a family history of glaucoma Are very nearsighted, or Are very farsighted Take steroid medication Have high pressure Have had an eye injury Primary Open Angle Glaucoma (POAG) The most common form of glaucoma is Primary Open-Angle Glaucoma and occurs when pressure builds up in the eye slowly over time. Unfortunately, you typically don't notice any symptoms until a significant amount of vision has been permanently lost. This is why the disease is sometimes referred to as the "sneak thief of sight". When symptoms do appear, they may include: Blurred vision Eye and head pain Nausea and/or vomiting Advanced symptoms Patchy blind spots Tunnel vision Health Conditions that Increase Risk of POAG Certain health conditions can increase your risk of developing POAG. These include: Too high or too low blood pressure Type 2 diabetes Atherosclerosis Obesity Sleep apnea Migraine Stress and anxiety Optic disc hemorrhage Thinned cornea Raynaud syndrome Other risk factors for POAG: Using birth control pills Alcohol use Smoking/Tobacco products Treatment If caught in the early stages, treatments and regular check-ups can slow or prevent vision loss. Treatment is aimed at lowering the pressure within your eye and may include prescription eye drops, oral medications, laser treatment, surgery, or any combination of these options. You can learn more about each specific treatment here. Glaucoma Prevention There are things you can do to reduce your risk of vision loss from glaucoma. Be sure to have an annual eye exam. If you are at high risk, you will need a comprehensive dilated eye exam in order to diagnose and treat glaucoma early. Medicare covers a glaucoma test yearly for people in high-risk groups. Talk to your family members about their own vision help, especially since glaucoma runs in families. Maintaining a healthy weight and keeping physically active will help to control your blood pressure. Avoid smoking or using other tobacco products Take eye drops and/or oral medications prescribed for your glaucoma as directed by your doctor. Four Key Take-Aways Glaucoma Awareness Month gives us an opportunity to help clear any misconceptions about glaucoma. Here are 4 key facts to help you remember why it goes undetected and who is at greatest risk. Glaucoma is the leading cause of blindness. Even when properly treated, approximately 10% of people with glaucoma experience loss of vision Glaucoma is not curable and vision loss is irreversible. Early diagnosis and treatment is the first step in safeguarding vision. Everyone is at risk for glaucoma Senior citizens are at a higher risk. There may be no symptoms to warn you. In POAG, vision loss begins with peripheral or side vision. Let Us Hear From You What information about glaucoma would you like to share with readers? References January is Glaucoma Awareness Month CDC Website- "Don't Let Glaucoma Steal Your Sight!” Glaucoma.org- "Understanding and Living With Glaucoma" Glaucoma.org- "Glaucoma Awareness Month"Mayo Clinic Glaucoma Glaucoma: Mayo Clinic

Most of us are familiar with the age-old remedy "hair of the dog that bit you" that is said to miraculously cure the morning after hang-over. On New Year's Day, I would love a penny for every person that conducts an internet search for a little magic on easing the nausea, dry mouth and headache that often accompanies celebrating a new year. Out of curiosity, I conducted my own search and there was no short supply of recommendations- everything from herbal supplements to businesses that offer the day after intravenous therapy. The big question is "Do they work?" and new research may give us the answer. What is a Hangover? A hangover is the lousy discomfort you experience as the end result of drinking too much. There isn't a hard and fast rule to how much you can drink and still avoid hangover symptoms. Typically, the more you drink, the higher the risk of unpleasant consequences. Hangover Symptoms Fatigue Weakness Thirst/Dry mouth Headache Nausea Vomiting Headache Light sensitivity High blood pressure Sweating Poor sleep Muscle aches Dizziness Light and sound sensitivity Anxiety Irritability Difficulty Concentrating **Symptoms can vary from person to person How Long Do Hangovers Last? Hangover symptoms are at their worst when blood alcohol concentration in your body returns to around zero. Symptoms usually last 24 hours or longer, but the time frame can be different for everyone. The Study The study was conducted by researchers in addiction medicine at King's College London and results were published in the December 2021 edition of Addiction. Method Researchers conducted a systematic review of 21 placebo-controlled clinical trials cures endorsed to relieve hangover symptoms, such as ginseng, clove extract, Korean pear, and artichoke extract among others. Some branded cures like Rapid Recovery and Morning-Fit were also included in the reviewed trials. A total of 386 participants were included in the research analysis. Findings Emmert Roberts, the paper's lead author, stated the following about the study findings, "Only very low quality evidence of efficacy is available to recommend any pharmacologically active intervention for the treatment or prevention of alcohol-induced hangover". Although the study did not uncover a hangover "cure", some of the treatments did show a statistically significant improvement in common hangover symptoms. The research paper pointed to 3 treatments as possibilities for further research- clove extract, tolfenamic acid and pyritinol. How to Avoid Hangovers Hangover cures may just be a myth, but it is possible for someone to avoid getting one in the first place. The most foolproof method ... don't drink or drink in moderation. But for those special celebrations when you may overdo it, here are a few tips for avoiding the morning after discomfort. Drink plenty of water along with alcoholic beverages. This will help you stay hydrated and without feeling the symptoms of dehydration. Get a good night's sleep (at least 7 hours) to decrease hangover symptoms in the morning. Avoid alcoholic beverages high in congeners. Congeners are chemical impurities that can contribute to hangover symptoms. Drinks high in congeners: Whisky, especially bourbon Cognac Tequila Drinks with low levels of congeners: Vodka Rum Pace yourself and be sure to drink water along with your adult libations. Try measuring your drinks and be aware of how much you are actually drinking. Don't drink on an empty stomach. Having food in the stomach can slow down the absorption of alcohol into your bloodstream. Food can help lower your blood alcohol level and reduce the risk of hangover symptoms. Hangover Don'ts There is no shortage of "myths" concerning what to do to avoid and cure hangovers. Here are a few hangover "don'ts" to help you navigate through the misinformation. Don't drive or operate heavy machinery. Being hung-over can slow your reaction times and alter your decision-making. Although the effects are not as severe as when you are actively drinking, hangover effects can last for up to 16 hours. Don't take acetaminophen. It slows down your body's metabolism of alcohol and can damage your liver in high doses. Instead, take an NSAID pain reliever, like ibuprofen or aspirin, to treat hangover symptoms. Don't keep drinking to excess. Drinking heavy enough to have hangovers regularly puts you at greater risk for alcoholism. Let's Hear From You Have you experienced an increase in patients seeking treatment for hangovers during the past 2 pandemic years? References/Resources The 6 Best Hangover Cures (Backed by Science) The efficacy and tolerability of pharmacologically active interventions for alcohol-induced hangover symptomatology: A systematic review of the evidence from randomised placebo-controlled trials Hangover Cures 'Lack Scientific Evidence'

Triage your regular duties and determine what you can let slide. You could even discuss with your boss what is of lesser priority. I think picking up a few shifts would be a tremendous show of support for your staff. I agree with others that moving forward, you need to find a better work/life balance. Also, ask to be paid. Where I work, salaried nurses are being paid "critical bonus pay" for picking up extra shifts (additional base hourly rate plus 25.00)

Researchers from Cedars Sinai have found the incident of Takotsubo syndrome (TTS), or broken heart syndrome, is on the rise, especially in middle-aged and older women. The findings1 come on the heels of a 2020 Cleveland Clinic study that found a link between TTS and increased levels of stress during the COVID-19 pandemic. You can read about the Cleveland Clinic study here2. The Study Researchers analyzed data pulled from the National Inpatient Sample Database (NIS)3 provided by the Healthcare Cost and Utilization Project4 to find trends in TTS incidence from the years 2006 to 2017. Patient Sample Criteria Age 18 or older Primary or secondary diagnosis of ICD-9-CM code 429.83 Takotsubo Syndrome, or ICD-10-CM code 51.81Takotsubo Syndrome The following patients were excluded from the study: Patients without coronary angiography, or With coronary angiography, or With coronary angiography and later percutaneous coronary intervention Over the study period, researchers found 135,463 documented cases of TTS. Findings According to findings, the incidence of TTS was growing even prior to the COVID-19 pandemic, especially in women. In fact, most of the study's cases (88.3%) were represented by women, particularly women age 50 and older. Below is a breakdown of women ages and case incidence per year. Middle-aged: 128 cases per million/year Older women: 96 cases per million/year Younger women: 15 cases per million/year Overall, researchers found TTS diagnoses have steadily increased in both sexes and across all ages. What is Broken Heart Syndrome First described by a Japanese cardiovascular specialist in 1990, Takotsubo syndrome is a temporary type of acute heart failure. Symptoms, such as chest pain and trouble breathing, often mimic a heart attack. The condition is considered rare, however, collected data suggests 6-7% of all heart attacks treated by a cardiology department are actually attributed to broken heart syndrome. TTS and Triggers TTS, also called stress cardiomyopathy, is the heart's over-reaction to emotional or physical stress or something traumatic. Here are a few examples: The loss of a loved one An acute medical illness, such as a stroke, exacerbation or major operation Experiencing an economic hardship Being physically or emotionally abused Some people can have triggers that are milder and in 30% of cases5, no obvious trigger can be identified. Regardless of the underlying cause, the human body releases a surge of hormones as part of the "fight or flight" response. Different From a Heart Attack Although the symptoms of TTS mimic a heart attack, there are several differences in the diagnostic work-up. Much lower troponin levels Often an absence of blocked coronary arteries Usually no permanent heart damage Recovery within few days to weeks There are factors that may reduce the chances for a full recovery from TTS. These include: Having a physical trigger, such as a stroke Being male (men make up 20% of cases with long-term damage) Having chronic or serious conditions such as renal disease, lung disease, cancer, or anemia Who's At Risk Women biologically respond differently to stress and are at a higher risk for TTS. Menopause also increases risk because lower estrogen levels prevent arteries from dilating during the fight or flight response. Therefore, females over 60 may not be getting as much blood flow to the heart when experiencing acute stress. Other risk factors include: History of anxiety or depression Alcohol abuse High cholesterol Hypertension Smoking Obesity Chronic stress Study Limitations The research data analysis was dependent on correct ICD-9 or ICD-10 coding of patient diagnosis and procedures. Additionally, NIS data doesn't include biomarkers, electrocardiogram and angiogram measures that are usually used to evaluate TTS cases. Discussion In conclusion, researchers found that TTS cases steadily increased from 2006 to 2017, especially among women 50 and older. The study authors found other contributing factors to the rise in cases in the rise. These include: Advancements n diagnostic testing Improved documentation of TTS diagnosis Increased size of the at-risk population- aging adults, especially aging women 50 and older Secular changes in socioeconomic and environmental changes Let's Hear from You Have you seen an uptick of TTS cases in your area of practice during the pandemic? References 1 Sex‐ and Age‐Based Temporal Trends in Takotsubo Syndrome Incidence in the United States 2 Broken Heart Syndrome Increase During Pandemic | Knowledge is Power 3 Overview of the National (Nationwide) Inpatient Sample (NIS) 4Healthcare Cost and Utilization Project (HCUP) 5Understanding Broken Heart Syndrome

Thank you for having the courage to write this article and share your experience. You will definitely touch the heart of someone who needs to read this and relate to another person.

The World Health Organization (WHO) has officially classified Omicron (SARS-CoV-2) as a Variant of Concern (VOC). As of this writing, there have been no cases of the new variant identified in the U.S., but experts warn it's only a matter of time. There's a lot to be learned about how Omicron spreads, how symptoms present and its response to vaccines. Researchers around the globe are working to get a better understanding of the variant. Let’s look at what is currently known about the virus and the expected impact on public health. Variant of Concern (VOC) WHO’s Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) found Omicron meets the definition of a Variant of Concern (VOC) after an extensive comparative analysis of available data. TAG-VE, an independent group of experts, found Omicron to be associated with one or more of the changes that could impact global health: Increase in how easily it spreads or detrimental change in COVID-19 epidemiology; OR Increase in virulence (severity) or change in clinical presentation; OR Decrease in effectiveness of public health and social measures or available diagnostics, vaccines, or therapeutics. You can learn more about the VOCs here. Omicron Timeline Here is a snapshot of Omicron’s timeline: November 9, 2021 The first known infection of Omicron, then known as B.1.1.529, was confirmed from a specimen collected in South Africa. November 24, 2021 South Africa announced the detection of a new variant after studying its DNA sequence. November 26, 2021 WHO designated Omicron a VOC. The U.S. issued a travel ban for non-U.S. citizens travelers from South Africa, Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, Mozambique and Malawi. November 27, 2021 A recorded 115 cases have been identified, primarily from Botswana and South Africa. However, cases were also reported in Hong Kong, Belgium, Israel, Germany, Netherlands and the United Kingdom Transmission According to WHO, it is not yet known if Omicron spreads more easily from person to person when compared to Delta and other variants. Epidemiologists are conducting studies to determine if the rising number of people testing positive in certain areas of South Africa are due to Omicron or other factors. Severity of Omicron Infection It’s not yet known if an Omicron infection will present with more severe symptoms when compared to other COVID-19 variants. It was initially reported that Omicron infections were associated with mild symptoms. However, early infections were among college students and people who are younger tend to have milder illness. It will take days to weeks for experts to understand Omicron’s level of severity. Vaccine Effectiveness WHO has not yet determined if Omicron will have an impact on our current COVID-19 vaccines, but is working with other partners to find the answer. WHO emphasizes vaccines remain effective against severe COVID-19 disease and death. Test Effectiveness COVID-19 PCR tests have been able to detect Omicron infection. Studies are ongoing to determine any impact on rapid antigen testing. However, the FDA reported in a recent media statement that rapid antigen tests used in the U.S. show a “low likelihood of being impacted and continue to work”. Treatments Corticosteroids and IL6 Receptor Blockers remain effective treatments for patients with severe COVID-19. However, further assessment is needed to determine if other treatments are still effective in treating the Omicron variant. Virus Protection The CDC recommends prevention strategies that have proved effective in the prevention of COVID-19 to protect yourself and others from the virus and the Omicron variant. Wear a mask in public indoor settings with substantial to high community transmission. Wash your hands frequently and practice good hand hygiene. Continue to practice social distancing. If age 5 or older, get fully vaccinated and a vaccine booster dose for those who are eligible Returning From Another Country The CDC recommends the following for travelers returning from South Africa, Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, Mozambique and Malawi Test for COVID-19 within 3-5 days after arrival Quarantine for 7 days Isolate and test if experiencing COVID-19 symptoms Let’s Hear From You What (if anything) is your employer doing differently in response to the Omicron threat? References / Resources World Health Organization - Tracking SARS-CoV-2 Variants World Health Organization - Update on Omicron Coronavirus (COVID-19) Update: FDA Actively Working to Investigate, Address Potential Impacts of Omicron Variant; Urges Vaccination and Boosters

Recently, I wrote an article about the rising cases of needle spiking at bars and nightclubs in England. Houston police are now are investigating reported cases of needle spiking at the Astroworld festival where eight people died and hundreds of others injured. Police Chief Troy Finner said one victim was a security guard that told police he felt a "prick" in his neck as chaos broke out at the festival. The victim became unconscious while being assessed by first responders and was revived by Narcan. As police continue to investigate, hopefully more will be known about the deaths and injuries occurring at the festival.

The prevalence of drink spiking has made us hesitant to leave a drink unattended in public places. It's a scary thought that someone could put alcohol, "date rape drugs" or other substances into your drink without you having a clue. Now, reports of an alarming variation of drink spiking are coming out of England, spiking by injection with a syringe. This disturbing trend adds another layer of concern to the country's already high rate of violence against women. What is Needle Spiking? Lizzie Wilson1, 18, felt a sharp pinch (like a needle prick) in her back while she stood in a crowded nightclub with friends. Moments later, she began having trouble standing. After being rushed to the hospital, she spent the next hours disoriented and without sensation in her legs. Wilson isn't alone. Other women have reported finding a pinprick on their body after waking up and being unable to remember what happened the night before. Wilson's experience isn't isolated as women in Scotland, Nottingham, Exeter and Northern Ireland have reported similar experiences. Reasons Why There are numerous reasons2 why a person would spike another person with a dangerous drug. Common reasons may include: To sexually assault To physically assault To carry out a theft For entertainment In Wilson's case, the physician suggested she was injected with ketamine, a powerful anesthetic. It's also important to note that anyone, not just women, can become a victim of spiking. Date Rape Drugs It's not yet known what drugs are most commonly used for needle spiking. However, date rape drugs used for drink spiking are likely being used. The three most common3 date rape drugs include Rohypnol (flunitrazepam), GHB and ketamine. Let's look at a few facts about each drug. Rohypnol (flunitrazepam) Also known as roofies, forget-me-pill, R-2 A benzodiazepine that requires a prescription Not approved for use in the U.S. Effects felt within 30 minutes and last for several hours May cause severe drowsiness, confusion, difficulty moving body and memory of what happened after the drugs take effect GHB Also known as cherry meth, scoop, goop A central nervous system depressant that is prescribed for narcolepsy. Can take effect in 15-30 minutes and effects may last 3-6 hours. Can cause vomiting, slow heart rate and difficulty breathing High doses can cause coma or death Tasteless and odorless drug and colorless when dissolved in a drink Ketamine Also known as cat valium, k-hole, purple A dissociative drug used as an anesthetic in surgery (human and animal) Distorts hearing and vision, causes hallucinations and a feeling of detachment from the environment Can increase heart rate, blood pressure and cause nausea Effects last for 30-60 minutes. Incident Numbers As of October 37th, 56 cases4 of needle spiking were reported by police in England, Scotland, Wales, and Northern Ireland during September and October. During this same time period, 198 confirmed cases of drink spiking were reported. Andrea Simon, coalition director for End Violence Against Women, warns cases of needle spiking are likely5 underreported. Simon explains two reasons why victims may be reluctant to report being drugged. First, victims may not remember what happened the previous night. Secondly, some people may not think authorities will believe their story. Bars and Clubs Boycotted Concerned individuals boycotted bars6 in cities across Britain during the week of October 2nd. Students led the "Night In" protest and called for bar staff to be better trained in how to protect customers from spiking. Clubs in Nottingham and Oxford closed to show support for the protestor's cause. The University of St. Andrews in Scotland implemented bag searches, safety patrols and drink testing at its venues in support of the campaign. Moving Forward Yvette Cooper, chair of the Home Affairs Select Committee, recently called the incidents "obviously vile crimes" and tasked police to review recent reports. Cooper directed police to submit a comprehensive countrywide assessment to better understand the problem's scope. Update According to Independent, two men were arrested8 this week on suspicion of spiking victims by both injections and in drinks. The men, ages 19 and 28, were charged with poison with intent to injure. Both men are currently out on bail. What have you seen on the job or through social media about injection spiking? References 1,6,7Needle Spiking' of Women in Britain Stirs Alarm Over New Kind of Assault 2Drink spiking and date rape drugs 3Date-Rape Drugs 4Demonstrators take to streets across UK to protest against 'spiking epidemic' 5'Spiked by injection’: Women's group says spiking victims are reluctant to speak out as they feel shame 8Two men arrested on suspicion of spiking by injection and in drinks