Eat Healthy to Beat Psoriasis

Though many patients find that certain diets help clear their skin, or that certain foods aggravate it, no studies have established a definitive link between nutrition and psoriasis, says Neil Korman, MD, clinical director of the Murdough Family Center for Psoriasis in Cleveland Heights, Ohio. “There’s no ‘Psoriasis Diet,’ but people with psoriasis should try to eat a healthy diet,” he says. “We do know that people who are obese are at increased risk for psoriasis, and that losing weight may help improve your psoriasis.”

“Achieving a healthy weight and eating more healthfully in general” are the goals when working with psoriasis patients, says Brenda Walsh, RD, an outpatient clinical dietitian at the Murdough center. Psoriasis is an inflammatory disease, she says, and “we know that weight loss can decrease levels of C-reactive protein (CRP), which is produced by the body in response to inflammation.” Increasing activity levels and dropping pounds can help lower CRP levels.

Emphasizing foods that contain antioxidants, such as fruits, vegetables, whole grains, and beans, which can reduce inflammation, may also help, says Deirdre Earls, RD, a dietitian in private practice in Austin, Texas.

Smll tweaks (eating more vegetables, trading white bread and rice for whole grains, eliminating processed food) can improve your health. “Proceed at your own pace and focus on the positive choices you make,” advises Earls.

Article courtesy of Health.com, edited for length.

Can Walking Prevent Dementia?

Dodging dementia may be as simple as slipping on a pair of walking shoes and heading out the door. A study from the University of Pittsburgh found that walking about six miles a week seems to protect against brain shrinkage, which in turn may slow the progress of cognitive decline.

Brain size typically shrinks in late adulthood and often heralds the onset of dementia. Earlier studies suggest that physical activity protects against the deterioration of brain tissue, but no long-term studies have been carried out to test that theory. These researchers set out to do just that.

At the start of the study, they asked 299 healthy, dementia-free men and women, average age 78, to keep track of the number of blocks they walked in a week.

After nine years, the researchers measured the brain size of the participants using high-resolution brain scans. It turned out that the men and women who walked more at the beginning of the study had more gray matter. Those who logged approximately six to nine miles a week fared best, even after taking into account variables such as age, sex, body mass index and education. Walking more than that didn’t provide extra benefits.

Four years later, testing showed that nearly 40 percent of the group had developed dementia or cognitive impairment, that is, problems with memory, language or concentration. After comparing the brain scans with walking patterns and cognitive function, the researchers found that the people who walked the most retained the most gray matter and cut their risk of developing memory and thinking problems in half.

“This research is unique in that we examined the brain itself rather than depending on what people tell us,” says epidemiologist Lewis Kuller, M.D., one of the study’s authors. “Looking at the relationship between brain changes and walking suggests that walking may be beneficial — and walking is the most common physical activity of older people.” Although the study doesn’t prove that walking prevents loss of brain function, it does suggest that people who walk do better down the road.

“Based on current evidence, physical activity stands as one of the best ways to lower the risk of dementia,” says neurologist Daniel Kaufer, M.D., of the University of North Carolina-Chapel Hill, adding that this study shows the long-term benefits.

“It connects the dots between being more physically active at the start of the study to having a bigger brain nine years later,” and shows that subjects who walked the most halved the risk of memory problems 13 years after the study began, continues Kaufer, who was not involved in the study.

A study published in August in the journal Circulation might help explain why: Researchers in that study found that people whose hearts pumped more blood had less brain shrinkage as they aged. It may be that increased blood flow to the brain helps keep it healthy by providing nutrients and removing toxic waste products.

Kaufer’s bottom line? “Walking a mile a day helps keep dementia at bay — but it’s no guarantee.”

The study appeared online in the Oct. 13 issue of the journal Neurology.

Article courtesy of Nissa Simon for AARP.

Gargling Can Help Throats, Sore or Not

Want a free, easy — but noisy — way to avoid catching a cold this winter? Try gargling with water three times a day.

Yes, gargling. That old-fashioned thing your mom used to make you do when you had a sore throat (and your kids would do in the bathroom just because it sounds so hilarious) — it actually works.

In Japan, where gargling is revered as a way to stay healthy, a 2005 study found that gargling regularly with plain tap water during the common-cold season helped prevent more upper respiratory tract infections than even gargling with a mild antiseptic mouthwash.

Plus, if you catch a cold anyway, gargling with warm salt water can ease your misery. The new Mayo Clinic Book of Home Remedies, due out at the end of this month, says the homespun remedy for sore throats really has medical merit. The salt helps draw out excess fluid from the throat’s inflamed tissues, says the book’s medical editor, Philip Hagen, M.D., “and warm water is more comfortable on sore tissues and it may help cleanse them a bit better.”

The Mayo Clinic suggests dissolving 1/4 to 1/2 teaspoon of salt in eight ounces of warm water for gargling, but if you don’t like the taste of salty water, a little lemon juice and honey mixed with warm water would have the same effect, says Hagen.

While there’s still no cure for the common cold, which can be caused by any one of 200 viruses, there are simple, inexpensive steps that older Americans can take to stay healthy during the coming cold season. Washing hands, of course — that’s an easy one but too often ignored. And a quick gargle every day certainly can’t hurt, and could even help, agrees Hagen.

In the Japan study, nearly 400 healthy volunteers ages 18 to 65 were assigned to three groups: gargling three times a day with tap water; gargling three times daily with a diluted iodine mouthwash (popular in Japan for preventing illness); and a control group whose members were told to keep doing whatever they normally did.

After 60 days, researchers found that those who gargled had fewer colds, but, surprisingly, it was those who used just plain water who remained the healthiest — getting 36 percent fewer respiratory infections than those in the control group. (The iodine garglers had only slightly fewer respiratory infections than did the control group.) The study also found that when subjects did get sick, gargling helped lessen their symptoms.

Precisely how gargling helps prevent upper respiratory tract infections is still unclear. The study’s authors noted that maybe the chlorine levels in the tap water helped. Others hypothesize that perhaps gargling helps cleanse the throat of viruses.

Whatever the reason, tipping your head back and letting water burble noisily in the back of your throat can help relieve cold symptoms and may even help you avoid getting those germs in the first place.

Just remember, if you’re gargling with warm salt water, be sure to gargle and spit — not swallow — says Hagen. “We tend to get too much salt in our diet anyway.”

Candy Sagon writes about health and nutrition for the Bulletin.

Binge Drinking and Marijuana May Harm Teenaged Brains

Even teenagers know that downing 12 beers in a single night isn’t good for their bodies and can be dangerous. But a new study suggests that routine binge drinking like this may cause mental problems—including a reduced ability to think—that can last long after the hangovers have worn off.

In the study, researchers interviewed 48 teens between the ages of 12 and 18 about their alcohol use and then gave them a battery of attention and cognition tests at least two days after they’d had their last drink. The more drinks the teens reported consuming in their drinking sessions, the poorer they performed on the tests. (Some of the teens had known substance abuse problems.)

Frequent marijuana use also appeared to damage memory, according to the study, which was published in the journal Alcoholism: Clinical and Experimental Research.

It’s too early to say whether the mental deficits seen in the study are permanent or if they might be reversible with long-term abstinence from alcohol and drugs. Regardless, the findings suggest that the lingering effects of binge drinking could wreak havoc during a pivotal time in a young person’s life.

“The most important thing in kids’ lives is school,” says the lead author of the study, Robert J. Thoma, PhD, an associate professor of psychiatry at the University of New Mexico, in Albuquerque. “If you have a problem with sustained attention, then how are you going to do in math class?”

“These kids are making things more difficult for themselves,” he adds.

However, the study couldn’t show that binge drinking directly caused cognitive problems. It could be that preexisting cognitive problems—such as poor decision-making—lead to binge drinking, rather than vice versa.

Thoma and his colleagues looked at three groups of teens: 19 who had been diagnosed with substance abuse, 14 who had a family history (but no personal history) of problem drinking, and 15 with no history of alcohol problems.

Kids with substance abuse problems reported consuming an average of 13 alcoholic beverages on days when they drank. The other two groups of teens averaged one drink or less for each day they chose to consume.

The teens’ apparent cognitive problems increased with the extent of their alcohol use. Heavy drinkers scored significantly lower than the other groups of kids on measures of attention and the ability to make good decisions, multitask, and plan for the future (known as executive function). It didn’t seem to matter how often the teens drank, but only how many alcoholic beverages they consumed on days when they did drink.

In addition, smoking marijuana frequently appeared to have a negative impact on memory, the researchers found.

“We know an awful lot about how alcohol affects adults, but we know very little about how it impacts kids,” Thoma says. “I expected kids to be more resilient than adults. But it turns out that’s not really the case.”

Susan Tapert, PhD, a professor of psychiatry at the University of California, San Diego, says that research suggests that the adolescent brain is more vulnerable to some of alcohol’s effects, and less vulnerable to others.

Teens “may be less likely to get sleepy with a certain amount of alcohol than an adult,” says Tapert, who was not involved in the current study. “This is risky since it means a teen could stay up later drinking and possibly doing more dangerous things.”

These findings may serve as a wake-up call for teenagers who drink heavily (and their families), Tapert adds. “If we have data like these that suggest the kids who were using substances performed much worse on some important measures, then I think that information is important to pass along to young people.”

It’s still not clear how lasting the cognitive effects of binge drinking might be. Thoma and his team continued to follow the study participants for a year, and found that test scores continued to decline for every one of the kids who continued to drink. (That follow-up data has yet to be published.)

“I’m really hoping that the resilience of the adolescent brain will allow them to reverse the trend,” Thoma says.

Article courtesy of Health.com.

Crunchy Romaine Toss

Ingredients

  • 1/2 cup sugar
  • 1/2 cup vegetable oil
  • 1/4 cup cider vinegar
  • 2 teaspoons soy sauce
  • salt and pepper to taste
  • 1 (3 ounce) package ramen noodles, broken
  • 2 tablespoons butter or margarine
  • 1 1/2 cups chopped broccoli
  • 1 small head romaine lettuce, torn
  • 4 green onions, chopped
  • 1/2 cup chopped walnuts

Directions

  1. In a jar with a tight-fitting lid, combine the sugar, oil, vinegar, soy sauce, salt and pepper; shake well. Discard seasoning packet from noodles or save for another use. In a skillet, saute noodles in butter until golden. In a large bowl, combine noodles, broccoli, romaine and onions. Just before serving, toss with dressing and walnuts.

 

Recipe courtesy of Allrecipes.com.

Doctor–or Nurse? Rethinking Appointments

When Douglas Peterson called to make a doctor’s appointment recently, he was given a choice. He could see the doctor in three weeks, or a nurse practitioner the next day.

“I had a couple of questions about a medication I was taking,” says Peterson, 61, a business consultant in northern California. “I made an appointment with the nurse.”

He’s not alone. In doctor’s offices, walk-in clinics, emergency rooms and long-term care facilities throughout the country, nurses are increasingly the front line of primary care — the healthcare professionals we’re most likely to see first when something ails us.

Nurse practitioners, who have advanced degrees and specialized training, examine patients, diagnose diseases, order tests and, in some areas, even write prescriptions. Some 250 clinics around the country are staffed entirely by nurse practitioners. Even where nurses work closely with doctors, they are taking on a growing range of roles and responsibilities.

That’s how it should be, many experts say. “Nurse practitioners can deal with about 80 percent of the problems that show up in primary care settings,” says Marla Salmon, ScD, RN, FAAN, dean of nursing at the University of Washington. “Allowing advanced practice nurses to do what they do well improves efficiency and increases access to health care. And when nurse practitioners encounter a problem they can’t deal with, they can refer patients to the appropriate doctor.”

In a report released today called “Leading Change, Advancing Health,” the Institute of Medicine and the Robert Wood Johnson Foundation outline the many ways in which nurses are key to solving many of the challenges facing health care. “Given their education, experience, and unique perspectives and the centrality of their role in providing care, nurses will play a significant role in the transformation of the health care system,” the report states.

For many years nurse practitioners have helped make up for a growing shortage of primary care and geriatric physicians. They’ll continue to play that role as health care reform brings coverage and access to more Americans.

But the contribution of nurses goes beyond filling in when doctors aren’t available. Nurse practitioners can play a key role in improving the quality of health care for older patients with chronic illnesses. “Nurses are positioned across the health care system to provide high quality health care, increase access to health care services, and keep costs down,” notes the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation and Robert Wood Johnson Foundation.

Nurse practitioners are part of a larger category called advanced practice registered nurses, which also include nurse anesthetists, nurse midwives and clinical nurse specialists, who often work in acute care. Advanced practice nurses have education and training beyond that of standard registered nurses. (Unlike RNs, all of whom have college degrees, licensed practical nurses, or LPNs, graduate from accredited nurse training programs that are not part of college or university degrees. Physician assistants, commonly referred to as PAs, perform some of the functions of a nurse practitioner, such as examining patients and diagnosing illness, but they typically work directly under a doctor’s supervision.)

The field of advanced practice nursing arose in the 1960s —a time when, like today, health care faced enormous challenges. In 1965, Medicare and Medicaid expanded coverage to low-income women, children, seniors and people with disabilities, dramatically increasing demand. In addition, rapid advances in medicine meant more doctors were going into specialties, creating the shortage of primary care physicians that continues today.

At the time, advanced practice nursing had plenty of critics. Physician groups worried that the quality of medical care would suffer, since nurses receive less training than doctors. Some professional nursing groups voiced concerns that nursing’s unique role would be diluted.

Many of those concerns have been allayed. Since the early 1970s, dozens of studies have shown that the quality of primary care from nurse practitioners is equal to that of medical doctors. In a 2002 report in the British Medical Journal that reviewed 34 studies, researchers found that patients fare equally well whether they were seen by a nurse practitioner or a primary care physician. Indeed, patients were typically more satisfied with care from nurse practitioners, perhaps in part because they spent more time with patients.

One proving ground has been the Veterans Administration, which has long made extensive use of nurse practitioners. Findings reported in 2009 showed that the V.A.’s Home Based Primary Care Program, run entirely by advanced practice nurses, reduced hospital stays from 14.8 days to 5.6 days and kept many patients out of nursing homes by helping them live independently.

Some of the crucial roles nurse practitioners fill are less easy to measure but just as important, advocates say. One is providing information. “I can’t tell you how often patients see the doctor and then sit down with the nurse practitioner and say, ‘Would you please explain what’s going on,’ ” says Salmon. In their role as teachers, nurses tend to stress preventive care, encouraging patients to follow healthier lifestyles.

Nurses also provide continuity of care in an increasingly fragmented medical system. “Older patients with chronic illnesses may see a doctor once every three months,” says Salmon. “In between, it’s often the nurse practitioner who follows-up, who makes sure patients comply with treatment, who watches for adverse reactions or new problems.”

The culture of nursing has traditionally addressed not only the physical needs but also psychological and even spiritual needs of patients. “They see the larger context,” says Carol Hall Ellenbecker, PhD, RN, a professor at the College of Nursing & Health Sciences at the University of Massachusetts in Boston. “That’s especially important when you’re talking about older patients with chronic illnesses.”

In many underserved rural and poor urban areas, nurse practitioners represent the only health care providers available. When the sole physician in Mount Morris, Pennsylvania, retired in 1990, people in this rural and relatively poor community on the border of West Virginia had to travel long distances to get medical care — until nurse practitioner Mona Counts, PhD., RN, , who is now a professor of nursing at Pennsylvania State University, started the Primary Care Center of Mt. Morris.

One of her first patients was Jeanne Roush-Russell, 73. Fifteen years ago, when Roush-Russell suddenly collapsed at work, Counts was there in minutes. Bedridden after a string of surgeries, Roush-Russell receives regular home visits from Mt. Morris’s nurse practitioners. “I wouldn’t be able to stay at home if it weren’t for them.”

Although nurse practitioners continue to provide care to many underserved communities, they’re also at work in suburban doctor’s offices and major medical centers, in hospitals and long-term care facilities around the country. “When I started as a nurse practitioner in the 1970s, there were 7,000 of us,” says Eileen Sullivan-Marx, PhD, CRNP, FAAN, who is now an associate dean at the University of Pennsylvania School of Nursing. “Today there are 160,000. The profession has become mainstream.”

Although nurse practitioners have come to play so vital a role, disagreement about expanding their scope of practice remains.

“Nurses are critical to the health care team, but there is no substitute for education and training,” states American Medical Association board member Rebecca J. Patchin, M.D., in the organization’s response to the October 5 Institute of Medicine report. “Physicians have seven or more years of postgraduate education and more than 10,000 hours of clinical experience, most nurse practitioners have just two-to-three years of postgraduate education and less clinical experience than is obtained in the first year of a three year medical residency.”

Differing views also exist at the state regulatory level, which determines what care nurse practitioners can and can’t provide. Some states require nurse practitioners to work directly under a doctor’s supervision. Others allow them far greater autonomy. Some states allow nurse practitioners to write a full range of prescriptions. Others don’t.

Many of the regulations that limit nurses responsibilities date from before the rise of advanced practice nursing, says Sullivan-Marx. “Until the laws change, they will go on limiting the contribution that nurse practitioners can make.”

Not surprisingly, professional nursing organizations would like to see more uniform state regulations and greater autonomy for advanced practice nurses across the country. So would many nursing professionals. “Frankly, it’s a waste of time and money to require a nurse practitioner to get a doctor’s signature to order a blood test or send a patient to physical therapy,” says Tara Cortes, PhD, RN, FAAN, executive director of the Hartford Institute for Geriatric Nursing at New York University College of Nursing.

The Institute of Medicine report concurs.”Restrictions on scope of practice and professional tensions have undermined the nursing profession’s ability to provide and improve both general and advanced care,” it states. The report calls on both states and insurance companies to change regulations so that patients can choose from a range of providers, including advanced practice nurses, to meet their health needs.

Uniform regulations would also make it easier for the general public to understand exactly who nurse practitioners are and what they do.

Again not surprisingly, physicians groups still emphasize the overriding importance of doctors. “Patients with complex problems, multiple diagnoses, or difficult management challenges will typically be best served by physicians working with a team of health care professionals, that may include nurse practitioners and other non-physician clinicians,” the American College of Physicians emphasized in its 2009 position paper on nurse practitioners.

Especially at a time when the landscape of medical care is changing rapidly, such turf battles are likely to continue. But as doctors and advanced practice nurses increasingly work side by side, there’s also a growing sense of trust and collaboration.

Nurse practitioner Eileen Sullivan-Marx knows that first hand. For a time she shared a private practice with her husband, a pediatrician. “Sometimes patients wanted to see me. Sometimes they preferred to see him,” she remembers. “The choice wasn’t always what you’d expect, either. My husband treated lots of female patients. I did most of the routine physicals for the volunteer firemen in town. Patients are pretty good at deciding who they want to see for a particular problem.”

In an ideal world, most patients would have that choice. “Doctors and nurses come to medicine with different skills sets, different approaches,” says Connie Ulrich, PhD, RN, FAAN, associate professor of bioethics and nursing at the University of Pennsylvania School of Nursing. The work of advanced practice nurses complements the work of doctors, she maintains, vastly improving the quality of health care. “All of us have the same thing in mind, after all, which is what’s best for the patient.”


Article courtesy of Peter Jaret for AARP.com.

Surgical Errors Too Common

Unthinkable errors by doctors and surgeons—such as amputating the wrong leg or removing organs from the wrong patient—occur more frequently than previously believed, a new study suggests.

Over a period of 6.5 years, doctors in Colorado alone operated on the wrong patient at least 25 times and on the wrong part of the body in another 107 patients, according to the study, which appears in the Archives of Surgery.
So-called wrong-patient and wrong-site procedures accounted for about 0.5% of all medical mistakes analyzed in the study. Although these serious errors are rare overall, the numbers seen in the study are “considerably higher” than previous estimates, researchers say.

In fact, the surgical blunders reported in the study are probably “the tip of the iceberg,” says the lead researcher, Philip Stahel, MD, a surgeon at Denver Health Medical Center. The actual number of patient and site mix-ups is likely much higher, says Dr. Stahel, describing those mistakes as “a catastrophe.”

Catastrophic surgical errors are “a lot more common than the public thinks,” says Martin Makary, MD, a professor of surgery and public health at Johns Hopkins University, in Baltimore.

“Each hospital, whether they publicly admit it or not, and whether or not it’s discoverable in a lawsuit, has an episode of wrong-site or wrong-patient surgery either every year or once every few years,” says Dr. Makary, who wrote an editorial accompanying the study. “Almost every surgeon has seen one.”

Dr. Stahel and his colleagues analyzed 27,370 records from a database of medical errors maintained by a company that provides malpractice insurance to about 6,000 physicians in Colorado. (The physicians themselves reported the incidents.)

The errors in the database—some of which originated with other doctors or support staff, rather than surgeons—were caused by a range of slipups, including mixing up patient medical records, X-rays, and biopsy samples. All of the mistakes could be traced back to some form of miscommunication.

In one wrong-patient procedure, hospital staff confused two patients with the same first and last name who were in a doctor’s office at the same time; in another, staff members brought the wrong child into the operating room. Examples of wrong-site errors included removing the wrong ovary or irradiating the wrong organ.

“One of the worst cases I saw in this study was two patients who had had prostate biopsies,” Dr. Stahel says. “One had cancer and one did not. Clinicians mixed up the samples and the patient without cancer had a radical prostatectomy—which is a huge surgery, removal of an organ for nothing—while the patient with cancer [was] still walking out in the community, not knowing his true diagnosis.”

Overall, one-third of the mistakes led to long-term negative consequences for the patient. One patient even died of lung complications after an internist inserted a chest tube in the wrong side of his body.

Only about 22% of the mistakes led to malpractice claims or lawsuits. The database is unusual in that it contains information on all incidents (not just those that resulted in a claim), and for that reason the rate of surgical mix-ups reported in the study is likely more accurate than those in previous studies, Dr. Stahel says.

The main culprit in cases such as these is human error, Dr. Makary says. “We rely on the nurse to tell us the side of a hernia repair, and the nurse can make mistakes. We rely on the surgeon’s memory, which is fallible.” Even the best surgeons can be expected to make mental errors occasionally, he says.

Health organizations have tried to put an end to surgical mix-ups. The American Academy of Orthopaedic Surgeons has launched an initiative called “Sign Your Site” that encourages surgeons to initial the actual surgical site before operating. And the Joint Commission, a nonprofit group that accredits hospitals and other health-care facilities, has developed a protocol for surgeries that includes having a presurgery “time out”—a pause during which the surgical team double-checks that the patient and site are correct.

But these protocols “are not sufficient,” Dr. Stahel says. They only apply to the operating room, he says, and nearly one-third of the botched procedures in the study took place in doctor’s offices. Moreover, the study showed that many operating-room mistakes start out in biopsy labs or during the imaging and diagnosis process.

“A lot of wrong-side, wrong-patient errors occur outside of the operating room,” Dr. Stahel says. “We should have time-outs for labeling for samples. If the lab mixes up the sample, the consequences may be worse than erroneously cutting off the wrong leg. I think we should extrapolate time-outs to internal medicine [and] laboratories.”

Article courtesy of Amanda Gardner for Health.com.