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

The story of Gypsy Rose Blanchard, as told through the HBO documentary "Mommy Dead and Dearest" and Hulu's docuseries "The Act", has raised awareness around factitious disorder imposed on another (FDIA), previously called Munchausen by proxy. Dee Dee Blanchard suffered from FDIA and acted like her daughter, Gypsy Rose, had various illnesses to gain sympathy and special attention. Unfortunately, Gypsy was subjected to years of painful tests, surgeries and life limiting restrictions. Now researchers are concerned about another fictitious condition that also twists the truth, Munchausen by internet (MBI). What is MBI? To understand Munchausen by internet, you need to be familiar with the conditions of Munchausen by proxy and Munchausen syndrome. These terms are often used interchangeably, however, there is a difference. Factitious Disorder Imposed on Another (FDIA) (Munchausen by proxy) Characteristics: A need for another person to be seen as ill. Want sympathy, special attention and praise The victim is usually a child, but could also be vulnerable adults (disabled, elderly) Factitious Disorder Imposed on Self (FDIS) (Munchausen syndrome) Characteristics: A person intentionally exaggerated or creates symptoms of medical conditions The person seeks attention through examinations and treatments Usually has a wealth of medical knowledge Munchausen By Internet (MBI) is a form of FDIS that was coined by Dr. Marc Feldman in 2000. Dr. Feldman is a professor of psychiatry at the University of Alabama in Tuscaloosa, Alabama and is considered one of the top experts in Munchausen disorders. In MBI, a person uses electronic media to "virtually" carry out their medical hoax. The Study Kathryn V. J. Newns, BA, a clinical psychologist in Cambridge, England, along with Dr. Feldman, investigated 5 cases that were brought to their attention by a doula. A doula is someone without medical training that is hired to provide guidance and support to someone who is pregnant during labor. The researchers found all 5 MIB cases studied to have the following characteristics: Targeted doulas working remotely during COVID-19 lockdown Lived in the United Kingdom Created elaborate stories with dramatic and immediate needs. For example, a patient could not go to hospital for delivery because the husband recently had a heart and lung transplant and COVID-19 risks too high. The perpetrators contacted the doulas through texts, phone and video calls, emails and communication apps. In one case, the perpetrator's "husband" sent hundreds of emails and texts. In all 5 cases, the doulas were not paid for their advice and support. You can read the details of the 5 investigated cases here. Internet Makes It Easy MBI has become more common largely because of how easy it is to find an online audience. Instead of visits to doctor offices and emergency departments, perpetrators can simply join online advice/support forums to communicate with a readily available "virtual" healthcare professional. And, fakers can join multiple groups, using different names and accounts, all at the same time. Signs of Munchausen By Internet There are certain red flags that may alert providers to potential hoaxers. These include: A disconnect between the severity of illness a person has and the duration, length and frequency of posts. For example, a person claims to be in septic shock but is still posting details of their illness. Posting about near-fatal exacerbations occurring in turn with miraculous recoveries. Personal claims that are over-the-top, but are contradicted or disproved in later posts. Others seemingly post on behalf of the perpetrator, but have similar patterns of writing and make the same grammatical errors. Reports having symptoms of a condition that are much more acute than typical cases Claiming to have seemingly endless dramatic life events, such as death of loved ones or being a victim of a violent crime, especially when someone else in the group is the focus of attention. Online Training The doulas in all five cases were not paid for the large amount of time they spent on the hoaxers. The police were unable to take any action because no money actually changed hands. It is understandable that some doulas experienced residual feelings of anger, grief and deception. One of the doulas decided to create an online training program to help protect other doulas from becoming a victim while they work online. What Do You Think? Do you think MBI is an actual condition that could potentially bottleneck certain medical specialties? Or, do you think the doulas contributed to the problem by blurring professional boundaries? References Factitious Disorders

Good to know.. Thanks!

Walkinon.... wow, they really put you through the ENTIRE process. Why did they even put you through the shadow?

I recently made a bold move by applying for a different job within my place of work. The hiring director (my current boss) voiced excitement at my interest and an interview was quickly scheduled. I was confident going into the interview, but midway … something felt off. Fast-forward three weeks, and I was not offered the position. I was disappointed, but it felt good to dip my toes back into the job hunt game. In hindsight, there were a few red flags suggesting I wasn’t going to be extended a job offer. Waiting Too Long I am ready for a change. But, I made the mistake of putting my job hunt on hold waiting to hear back from my manager. It’s an easy mistake to make. Unfortunately, you could wait weeks or even months when the decision has already been made to not hire you. Why would the hiring manager leave you dangling, even after a decision is made. Well, there are several possible reasons. For example: They are required to interview a set number of candidates, even if they already know who will fill the position. They may be fishing for new ideas and insights by scheduling multiple interviews. So what do the experts say? The answer is … don’t wait. Immediately shift your focus and efforts on getting the potential job interview. You Might Not Have The Job If ... As the clock ticked and days passed, I actually typed in “signs I don’t have the job” as an internet search. I’d like to share some of the signs I discovered and what made them relatable in my situation. RED FLAG #1 The potential employer told you they had an “urgent” need to fill the position and scheduled an interview within days. However, it seems the brakes are pumped hard after you interview. My experience: I was originally told the position would need to be filled within a matter of days. Two weeks later… still no word. RED FLAG #2 You arrive at your interview, but fewer people are sitting in than you were initially told. My experience: I was expecting 4 people to sit in on my interview, however, only 2 were actually present. One of the missing interviewers was from upper management and would give the final “OK”. RED FLAG #3 The interviewers share their concerns about your background, skills or cultural fit. My experience: During my interview, only a limited number of questions were asked about the actual job. I was asked several “sidebar” questions, such as “Will you be able to adjust to 5 days a week vs. three 12 hour shifts?” “Don’t you have a long commute?” “Can you adjust to working during the day?” RED FLAG #4 The interview was cut short. My experience: After about 20 minutes, one of the interviewers began to awkwardly check the time repeatedly. Even worse, she began to cut the 2nd interviewer's questions short. RED FLAG #5 The interview went great, but you’re seriously ghosted when trying to contact the hiring manager. My experience: My director became an apparition after the interview. Once I was able to follow-up with her, I was given a new “deadline” for their final decision. RED FLAG #6 You're told the hiring process has slowed down because “an internal candidate has come forward”. My experience: After 3 weeks, my director explained how shocked she was when a person who had previously held the position reached out to her. At that moment, all the red flags made sense. RED FLAG #7 The interview ends and you feel like you're being rushed to leave the building. RED FLAG #8 The interview abruptly ends and the manager seems more than ready to move on to the next meeting. RED FLAG #9 Your follow-up emails go unanswered. RED FLAG #10 You’re specifically asked for references, but they are never contacted. Hiring is a Process It’s important to remember that the hiring process takes time and patience. Even if you pick up on a few red flags, it doesn’t mean you are out of the game. Here are a few tips on what you can do after the interview to stand out from the rest. Send a thank-you email and outline 3 day reasons you're still interested in the job and what makes you a good fit. Don’t keep asking for updates. If you were told a decision would be made in 3 weeks and 4 weeks have passed… move on to your next potential interview. When you're feeling discouraged, remind yourself that every interview is great practice for continuing your journey towards a better job. Let’s Hear From You Tell us about a “red flag moment” you’ve experienced as part of the hiring process. Was the end-game worth the frustration? References 18 Signs You Didn’t Get the Job After Interview, According to 11 Experts Ten Unmistakable Signs You're Not Getting The Job 13 Telltale Signs You Didn’t Get The Job

We have all experienced the discomfort of muscle pain. As nurses, we often overuse our musculoskeletal system during the workday and experience the consequences later. Intense pain can occur from simply sitting, standing or sleeping in the wrong position. Fortunately, most muscle aches and pains are usually relieved after a few days of rest and good self-care. But, some are not as lucky. Muscle pain can become chronic (myofascial pain syndrome) and significantly impact a person's function and quality of life. In these cases, trigger point injections (TPIs) may be used to help ease pain in muscles and surrounding tissue. What Are Trigger Points? Trigger points are focused areas of spasm and inflammation in skeletal muscle. You can often feel a knot in the muscle where the trigger point is located. The primary site and surrounding area is usually tender with pain that radiates when pushed. The upper back and behind the shoulder areas are common sites and can cause headaches and neck and shoulder pain. However, trigger points can be found throughout the musculoskeletal system. What Are Trigger Point Injections? TPIs are injections of medication given directly in the painful trigger point for pain management. The medication makes the trigger point inactive and relieves the spasming muscle. It is an outpatient procedure and performed by a doctor, usually in their office or clinic. Medications Used for TPIs Include Local anesthetics Used alone, mixed with other anesthetics or with corticosteroids Xylocaine (Lidocaine), bupivacaine (Marcaine) Corticosteroids- dexamethasone Used alone or mixed with an anesthetic Botox (botulinum toxin A) Interferes with nerve signals and prevents muscle contraction What Conditions Are Typically Treated With TPIs? TPIs are used to help relieve pain in conditions that affect our musculoskeletal and nervous systems. Myofascial pain syndrome TPIs may help relieve symptoms of myofascial pain syndrome, a chronic pain syndrome affecting muscles and their surrounding tissue (referred pain). Myofascial pain syndrome may be caused by: Muscle trauma or injury Repetitive motions Poor Posture Psychological stress Fibromyalgia Fibromyalgia is a chronic condition that has some of the same symptoms as arthritis, but affects our soft tissue instead of our joints. Headaches Trigger points in the shoulder, neck and head can contribute to tension headaches and migraines. Endometriosis A small study, published in PM&R, found TPIs may help with pelvic floor pain that is common with endometriosis. However, the authors recommend further research before firm conclusions can be drawn. A Word About Dry Needling Dry needling for easing muscle pain is gaining in popularity. The procedure uses filiform needles and is referred to as "dry" because it does not inject any medications into the body. The needles are inserted into the knot, or affected area, to relieve muscle pains or spasms. What Are The Side Effects? Some people experience pain and/or tenderness at the injection site that typically resolves after a few hours. Other side effects include: Lightheadedness, dizziness Discoloration or dimpling of skin around the injection site Bleeding at the injection site (rare) What Are The Risks? TPIs rarely cause serious complications, however, in rare cases they may lead to: Infection at the injection site Bruising Muscle or nerve damage Pneumothorax Needle breakage Who Should Not Have TPIs? TPIs should not be administered in the following circumstances: Presence of systemic or local infection In pregnant patients Person who feels or appears ill Precautions should be taken when administering TPIs in people with: Bleeding disorders or anticoagulation therapies Debility Diabetes Current steroid medications Do They Work? In people with chronic muscle pain, TPIs may provide immediate pain relief and improved range of motion. However, everyone does not respond to the injections the same way. Researchers have found that some people do not benefit at all. What do you think? Do TPIs have a place in pain management? Resources A New Look at Trigger Point Injections Trigger Point Injections Everything You Need to Know About Trigger Point Injections

Co-worker conflict can be uncomfortable, casting a dark cloud over the workday. Anyone can have a bad day and it is often played out with irritability, raw emotions and thin patience. But, if a co-worker conflict is affecting your work or causing discontent, it is time to take positive action. Your first reaction may be to avoid the issue or escalate it up to your boss. But, with these 8 tips, you can begin to address the situation yourself. Approaching a co-work may feel awkward at first, but your confidence will build with practice and experience. Tip #1: Take time to cool down and reflect. Engaging in conflict resolution with a co-worker when you are angry is the easiest way to shut down open communication. Anger takes away our ability to think and problem solve rationally. Walk away from the situation and take the time needed to cool off and reflect. Tip #2: Think about the problem. The old saying “there are two sides to every story” is true when you begin to reflect on both your own and your co-workers perspective of the problem. To explore your perspective, ask yourself: What is the conflict really about? What is it about the issue that has me upset and angry? Do I have underlying concerns, wants or needs that are not being met? What is needed to improve on my circumstances? To explore the other person's perspective, ask yourself: How might they see the situation? How might they view my actions? What needs might she/he have? What is important to the other person? Keep in mind that assumptions, misperceptions and unmet expectations is at the core of most conflict. Tip #3: Plan out the conversation. One strategy for not allowing your emotions to drive the interaction is to plan out the conversation. Start by removing the relationship you have with your co-worker from the equation and focus on the facts to better deliver the message. Practice describing the problem in a non-blaming and non-personalized way. Be sure to address the problem as mutual (our problem) and use “I” statements to communicate your perspective. Tip #4: Don’t gossip or vent to others. It is tempting to talk to other co-workers and seek validation that you are in the “right”. However, the person you are in conflict with may hear you are talking “behind their back” and escalate the situation. It is best to keep the matter confidential. Tip #5: Choose an appropriate time. Find a time (sooner than later) that is convenient to both you and your co-worker. Also, it is important to have the discussion in a private place with little to no interruptions. Tip #6: Communicate effectively. When you approach your co-worker, make your intentions clear, assuring them you want a good working relationship. Your colleague may initially become defensive and possibly assume you want to continue the disagreement. It helps to describe the problem without blaming, put downs and over-generalizations. Here are a few other tips for effective communication: If you feel you may have had a role in creating the conflict or regret how you handled the situation, sincerely apologize upfront. Ask the person to tell you how they see the situation before you share your grievances. This will help lower their defensiveness. Be ready to listen attentively to the other person’s concerns. You may not realize how you are contributing to the problem or how your behavior is being perceived. Having a face-to-face discussion with effective communication supports conflict resolution in the following ways: Gives the other person a chance to explain themselves Gives the other person a chance to apologize (when appropriate) Gives both of you an opportunity to understand how each views the working relationship Allows negotiation of ways to better work together Tip #7: Work toward a solution together Avoid focusing on who is right and who is wrong. Instead, work with the other person to identify possible solutions that work best, meeting the needs and wants of you both. This may take more than one meeting, so keep working at it. It is worth the effort in the long run. Tip #8: Ask for help when needed. Sometimes co-workers are unable to resolve workplace conflict between themselves and the working relationship takes a toll on productivity. In this case, you will need to identify the proper channel, such as the supervisor, to further discuss the problem and move forward. Conclusion Working together to solve conflicts within the workplace could lead to a closer and more effective working relationship. Down the road, when you or your co-worker have a bad day, you will find yourselves committed to a better way of handling any conflict situations that arise. Let us hear from you! What do’s or don’ts do you have to share with readers? Want to learn more? Check out these additional resources Seven Steps for Mending Relationships With Colleagues How to Handle Conflict in the Workplace

This is so true!

In my home state of Alabama, only 33% of residents are fully vaccinated against COVID-19. The state's healthcare workers are feeling a punch to the gut as new coronavirus cases have climbed 574% over a short period of time. Fueled by the delta variant, the state's hospitalization rate has tripled in a few short weeks. I echo the words of many in the medical community by saying "I don't know if I can do this again". Universally Affected I work in a hospital, but not on a unit that provides direct care to COVID-19 positive patients. Earlier in the pandemic, I felt guilty whenever burn out began to creep in. I often thought "Shouldn't burn out be reserved for those caring for COVID patients day after day?” Today, Alabama's new daily case rate mimics the same numbers as 12 months ago. And, I now realize everyone working in healthcare has been affected both personally and professionally by coronavirus. What led up to my own professional mic drop moment? Caring for patients with devastating long hauler syndrome Maintaining a high standard of care without adequate staffing, supplies and other resources Working routine overtime because of your own personal responsibility to support your peers Facing the words "there is no one", "you'll have to make do" and "you have no choice" when asking the house supervisor for additional help No pay increase in the past 18 months Hope that disappears when large numbers of new hires resign within the first 4 weeks Frequent floating with high nurse patient ratios Alarming number of rapid response calls and code blues Nurses are only part of an exhausted healthcare community. We are joined by food and environmental services, respiratory therapists, pharmacists, physicians, nursing assistants, patient services... and the list goes on. Public Pleas A string of public pleas have been issued throughout the state, imploring the unvaccinated to seek vaccination. The frustration is almost palpable in each plea. Governor's Harsh Words Alabama Governor Kay Ivey had harsh words for the state's unvaccinated, stating "these folks are choosing a horrible lifestyle of self-inflicted pain". Ivey went on to blame the state's unvaccinated population for the rising coronavirus cases. Alabama received billions in relief funds as part of the stimulus package passed the year. However, the state is not using the federal relief for incentive programs like scholarships and lotteries. According to the National Governors Association, Alabama is offering a few small incentives: The Talladega Superspeedway is offering the opportunity to drive 2 laps behind a pace car for being tested and/or vaccinated. The Alabama Department of Public Health is sponsoring a TikTok contest to encourage vaccination before the start of the new school year. Four winners will be selected and each will receive a $250 Visa gift card. Doctor's Emotional Plea Dr. Brytney Cobia, a hospitalist at Grandview Medical Center in Birmingham, Alabama, posted an emotional plea for vaccination on facebook that has made news across the U.S. Cobia wrote the post after caring for young healthy patients with very serious COVID infections. She describes patients begging for the vaccine right before they are intubated. She writes, "I hold their hand and tell them that I'm sorry, but it's too late". You can read Dr. Cobia's full post here. Tuskegee Tragedy Lingers Many Black Alabamians have a deep seeded mistrust of the medical community stemming from the Study of Untreated Syphilis in the Negro Male. In 1932, the U.S. Public Health Service recruited hundreds of rural Black men to participate in a syphilis study, but never explained that the study was designed to withhold medical treatment. Study participants were not injected with syphilis, but those who had it were not treated, even when penicillin was available. The suffering caused by the unethical study still echoes today, despite federal laws that prohibit this from occurring again. This tragedy contributes to vaccination hesitancy within the state. Mounting Personal Toll I'm not alone in questioning my ability to withstand another COVID-19 surge in my current nursing position. Healthcare workers are experiencing burn-out in high numbers and reporting significant psychological distress. Many are responding to the stress and trauma by misusing alcohol and other substances. It's time for professional organizations and the healthcare industry to do more to support workers moving forward. What About You? Are you considering a mic-drop departure from your workplace? What do you need to reverse your burn-out? References In Tuskegee, Painful History Shadows Efforts To Vaccinate African Americans

Childhood obesity is a major problem in the U.S. and the pandemic has made healthy eating even harder. A recent study found kids are now eating more pizza, burgers, fries and other fast-food items than in previous years. According to the National Center for Health Statistics, more than a whopping third of U.S. kids and teens eat fast food on any given day. The Study Research has shown a strong link between childhood obesity rates and increases in fast-food advertisement. New research, recently published by the Rudd Center for Food Policy and Obesity at the University of Connecticut, found fast-food advertising has really changed over the past few years. The full study details, published in Fast Food FACTS 2021, can be accessed here. Study Method Researchers reviewed Neilson data to determine how 274 fast-food restaurants spent their advertising dollars and how often kids were exposed to the ad campaigns. Data from the top 27 fast-food advertisers was also analyzed to better understand how they targeted white, Hispanic and Black consumers under the age of 18. The researchers analysis included: Advertising spending in all media, including TV, radio, outdoor and digital; How much children and teens were exposed to TV advertising for fast food; TV advertising targeted to Black and Hispanic youth, including advertising on Black targeted and Spanish-language TV; Disproportionate exposure by Black vs. White youth; and Changes in advertising spending and exposure from 2012 to 2019. Study Findings The fast-food industry has made changes to help address the problem of poor diets among U.S. children and teens. These changes include: Introducing healthier menu items Healthier choices in kids’ meal side items Removing soda from kids’ meal menu Some restaurants have pledged to advertise only healthier items to children The study findings shed light on the question “Has advertising to youth changed and if restaurants are now advertising healthier menu items?”. Advertising Not Improved Researchers found that over the 8 year study period, no significant improvements were made in advertising targeting children or to Hispanic and Black youth. Key findings from 2012 to 2019 include: Spending on advertisement increased by most restaurants and ads targeting Black and Hispanic youth was even greater. All youth age groups were exposed to fewer TV ads, but the decline was less than expected. A high number of restaurants continued to run ads targeting children under 12 on children and preschool TV channels. Healthy Items Not Promoted Data analysis revealed restaurants did not live up to their pledge of promoting healthier foods. High-calorie menu items continued to be promoted in ads geared to children in teens. For example: Low-cost menu items and bundles were advertised 4 to 6 times as much when compared to healthier items. Spending on Spanish-language and Black targeted TV ads promoting value meals/bundles was higher when compared to total ad budgets. McDonald’s was the only restaurant that spent more than 1% of its advertising budget to promote healthier kids’ meals. Other Key Findings Other study findings found restaurants need to do a much better job of advertising healthy menu options to kids, teens and minority communities. Findings include: In 2019, fast-food restaurants increased advertising spending by over $400 million dollars compared to 2012. In 2019, Black preschoolers, youth and teens viewed 75% more fast-food ads compared to their white peers. A total of 274 fast-food restaurants advertised in 2019. However, approximately 55% of fast-food TV ads aimed at kids and teens were from these 6 restaurants: Domino’s McDonalds Burger King Taco Bell Little Caesar’s Sonic Recommendations The study report identified ways the fast-food industry advertise to youth more responsibly. Here are a few recommendations: Restrict unhealthy food ads to youth 14 years old and older No longer advertising on preschool and children’s TV channels. Stop disproportionately promoting unhealthy foods to Black and Hispanic youth. Policymakers at local, state and federal governments could also play a role by: Implement policies that set nutrition standards for kids’ meals. Develop campaigns to increase awareness of advertising that promotes unhealthy foods and targets minority communities. All of the study’s recommendations can be found here. How have you seen fast-food advertising impacting our youth negatively over the past year? References Fast food equity problem:  Black and Hispanic youth unfairly targeted by ads

The FDA recently noticed an increase in hospitalizations and deaths linked to using nitrite “poppers”. On June 24, 2021, the agency issued a statement warning consumers not to buy or use poppers that are typically sold on-line and in adult novelty shops. They are marketed under the brand names of Super RUSH, Jungle Juice, Extreme Formula, Quick Silver, Premium Ironhorse and Super Rush Nail Polish Remover. What Are Poppers? Poppers are usually sold as a liquid and packaged as room deodorizers or leather cleaner. They are usually packaged in 10mL to 40mL bottles that look like energy shot products. The chemicals in the liquid produce a vapor that causes vasodilation in the body when inhaled. It is actually related to the nitrate inhalation medications that are prescribed by physicians for angina attacks. Street names may include: Aimes Aimees Snapper Bold Liquid gold Rush Purple haze Buzz How Are They Used? Poppers are usually used by inhaling the vapors from the bottle. Some people dip the end of a cigarette into the bottle and inhale through the cigarette to avoid sniffing the chemicals directly from the packaging. Why Are They Used? Poppers are typically used recreationally to produce a feeling of euphoria or to enhance sexual experiences. Instant High People often use poppers for the “head rush” that is caused by the sudden increased blood flow. This can cause a euphoric feeling or instant high that general lasts only a few minutes. Some have described the rush as a “warm fuzzy” feeling that is caused by the side effects of vasodilation, including: Sudden drop in blood pressure Dizziness Increase in heart rate Lightheadedness Warm sensation throughout the body Sexual Enhancement The vasodilation effects of amyl nitrites also relax smooth muscles in the orifice and lady parts, making sex more comfortable and sensations more intense. Some men also take use poppers to prolong erections. Serious Side Effects The FDA released the warning against poppers based on an increase in hospitalizations and deaths with problems such as Severe headaches Dizziness Increased body temperature Shortness of breath Extreme hypotension Methemoglobinemia Brain death Here is a look at other problems people may experience when using poppers. Respiratory problems (sinus issues, respiratory infections, wheezing) Chemical burns around lips or nose Allergic reactions Increased eye pressure Heart palpitations Nausea Poor coordination Nosebleeds Lowered inhibitions Impaired judgement Dangerous With Other Drugs Poppers are often used in combination with other illegal drugs to increase the high, including, cocaine, marijuana, methamphetamines and hallucinogens. This increases the risk of both psychiatric and physiological side effects. The following medications when taken with poppers can cause a dangerously low blood pressure: Viagra Monoxidil (Rogaine) Diuretics (I.e. furosemide, hydrochlorothiazide) Beta Blockers (I.e. carvedilol, atenolol) Calcium channel blockers (I.e. diltiazem, nicardipine) Angiotensin II receptor antagonist (I.e. losartan, valsartan) Vasodilators (I.e. terazosin, apresonline) There is also research that suggests amyl nitrate can reduce the effectiveness of certain HIV medications, particularly protease inhibitors, such as indinavir, saquinavir mesylate and ritonavir. Who Uses Poppers? Amyl nitrite began being used for a recreational drug in the gay community during the 1960s. Its use became widespread throughout the 70s, 80s and 90s in the club scene. Today, people of all ages, races and sexual orientations use poppers. Are Poppers Addictive? Repeatedly using poppers can lead to a substance use disorder (SUD). This occurs when someone continues to use poppers despite health problems or issues in everyday life. Signs of a SUD including failing to meet personal responsibilities at home, work or school. A SUD be mild to severe, and an addiction would be the most severe. People who have tried to quit using inhalants may have the following withdrawal symptoms: Nausea Poor appetite Sweating Sleep problems Mood changes For more information on inhalants and addiction, visit this National Institute on Drug Abuse website. Do you have a clinical or personal experience with inhalants you are willing to share? References Is amyl nitrite safe? Who uses poppers? Nitrite ‘Poppers’: Here’s Why FDA Warned Against Their Use For Fun, Sex

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