‘Alarm fatigue’ a factor in 2d death
The second patient death in four years involving “alarm fatigue’’ at UMass Memorial Medical Center has pushed the hospital to intensify efforts to prevent nurses from tuning out monitor warning alarms.
Nurses exposed to a cacophony of beeps may no longer hear them or begin to ignore them, and that’s what appears to have happened in the latest case: A 60-year-old man died in an intensive care unit after alarms signaling a fast heart rate and potential breathing problems went unanswered for nearly an hour, according to state investigators who reviewed records at the hospital.
The death occurred in August 2010 but was not reported to the state Department of Public Health until this spring. The state cited various violations by the hospital, including not responding to alarms “in a timely manner.’’
The fatality was remarkably similar to another at the Worcester teaching hospital four years ago, when nurses didn’t hear or ignored alarms indicating that the battery on an elderly woman’s monitor needed to be replaced. After the battery failed, 77-year-old Madeline Warner suffered cardiac arrest and the alarm didn’t sound.
Warner’s death in 2007 led the hospital to adopt aggressive measures to improve nurses’ responses and tackle alarm fatigue, which can occur when nurses hear alarms – many of them false – all day long. But the new death shows the problem continues, as it does at hospitals nationwide. It has led to at least 200 patient deaths since 2005 and likely hundreds more, according to a Globe investigation published earlier this year.
“I don’t think any hospital has fully solved this problem,’’ said Maria Cvach, an assistant director of nursing at Johns Hopkins Hospital in Baltimore and a specialists on alarm fatigue. At Hopkins, which is known for its intense focus on reducing false alarms and alarm fatigue, Cvach said she still sees nurses “not hearing or not answering alarms’’ because “they go off all the time.’’
Executives at UMass Memorial declined to comment about the latest death. The Globe obtained the Department of Public Health report on the case through a freedom of information request. The document does not say who disclosed the death to the state or provide a reason for the reporting delay, but the Globe’s stories on alarm fatigue, which included an account of Warner’s death, appeared several weeks before the health department was called.
The state inspectors’ report, which omits the patient’s name and other identifying details, indicates that the patient also was the apparent victim of a medication error. It does not make clear the extent to which that error or alarm fatigue contributed to the patient’s death.
The patient had been cutting down a tree and was struck in the head with a large branch in July 2010, breaking bones in his face and causing bleeding in his brain. After surgery at UMass Memorial, the patient was often restless and agitated. He kept removing a monitor that measured whether his blood had enough oxygen, triggering an alarm to sound much of one day – which could have been a factor in desensitizing nurses.
Read the entire article at Boston.com
In response to the many questions we receive about remote viewing and the perception process, we have decided to post a Q&A series of articles to answer the most commonly asked questions. We hope you will enjoy it.
This is part one of a five part question and answer series (Q&A) on perception based remote viewing, also known as Solo ERV or SERV.
Each article in the series will contain frequently asked questions about perception and remote viewing.
We will address questions on a variety of remote viewing experience levels. Some of the questions will be for those new to remote viewing, other Q&A will be for experienced and advanced remote viewers.
Visit ProjectJedi.net for answers to questions you may have never thought to ask! If you have questions about remote viewing that haven’t been answered you can always visit the new open group on Facebook. So far I’ve seen a lot of friendly people there heavily interested psychic abilities, health topics and sharing knowledge.
You can view a sample video from the Project Jedi Remote Viewing Training DVD Set here.
From Florida State University’s the “Science U” section:
1950’s to Present
A. Three important studies provide links between smoking and lung cancer:
1. On May 27, 1950 Journal of the American Medical Association: publishes first major study
2. In same issue, “Tobacco Smoking as a Possible Etiologic Factor in Bronchiogenic Carcinoma: A Study of 684 Proved Cases,” by Ernst L. Wynder and Evarts A. Graham is published.
3. A Sept 30 British Medical Journal, study by Richard Doll and Bradford Hill reports that heavy smokers fifty times as likely as nonsmokers to contract lung cancer
B. P. Lorillard introduces Kent cigarettes, with an asbestos filter. 1952
C. Dr. Ernst Wynder paints tar on mice backs and causes cancer—first definitive biological link in 1953.
D. 1954 Phillip Morris hires David Hardy to defend against law suit by Missouri smoker who lost larynx to cancer in 1954. Same year, Marlboro man created and advertised as “Delivers the Goods on Flavor”
E. “See It Now”—CBS—First television show on tobacco in 1955, which resulted in TIRC Tobacco Industry Research Committee
F. First Surgeon Generals report: Smoking and Health in 1964.
G. Marlboro Country ad campaign launched in 1964 as “Come to where the flavor is. Come to Marlboro country. Marlboro sales grow at 10% per year in 1964.
H. Women allowed to roll cigars in Cuban factories in 1960’s
I. Phillip Morris controls Miller Brewing Co. in 1969.
J. Surgeon General confirms link between maternal smoking and low birth weight in 1969.
K. RJ Reynolds Tobacco becomes RJ Reynolds Industries, Inc. in 1970.
L. TV ads for tobacco products banned in 1971
M. 1971 Cigarette companies begin sponsoring major sports events.
1. NASCAR’s Winston Cup series
2. Virginia Slims Tennis
I wonder what a much older Don Draper would have to say when he found out there would be no more cigarette ads on TV…
Read the remainder of the 20th C. timeline as well as significant events dating back to 6000 B.C.
The Florida State University Research Foundation has an excellent section on their website for Tobacco Education called Science Tobacco & You. There’s a Hangman game that threatens you with tobacco tar instead of a noose. In the teacher’s edition of the timeline are highlights of tobacco history, from pre-15th C. to the present, nicely summarized.
There is a wealth of information on this website and it’s easy to become sidetracked. Before diving in, it might be a good idea to read the navigation guide, which explains what structure was used to amass the available information.
Science, Tobacco & You is based on the premise that science is a learning processes that involves looking, thinking, asking, and sharing. The organization of this Website utilizes this idea.
Teachers may also want to check out the National High Magnetic Laboratory resource section for teachers.
Products containing ethyl mercury thiosalicylic acid as a preservative:
Cosmetics, including makeup removers, mascara, and eye moisturizers
Ear, eye, and nose drops
Merthiolate topical antiseptic
Some contact lens solutions
Topical medicated sprays
Vaccines (including most influenza vaccines and Sanofi’s avian flu vaccines)
Other common sources of mercury:
Air conditioner filters
Amalgams (silver fillings)
Calomel (talc, body powders)
Cinnabar (used in jewelry)
Drinking water (tap and well), plumbing and piping
Floor waxes and polishes
Paint pigments and solvents
Vegetables and fruits exposed to pesticides
Other names for this ethylmercury:
Ethyl (2-mercaptobenzoato-S) mercury sodium salt
[(o-carboxyphenyl)thio] Ethylmercury sodium salt
Examples of products containing thimerosal
|Antibiotics for the Eye|| Cortisporin® Ophthalmic Suspension
Neosporin® Ophthalmic Solution
|Nasal Preparations|| Nasal Moist® AF
Neo-Synephrine® Pediatric Formula, Mild Formula, Regular Strength, and Extra Strength Nasal Spray
|Ear Preparations|| Coly-mycin® S Otic
Cortisporin® Otic Suspension
|Cosmetics|| L’Oreal® Miracle Wear Mascara
Tetanus and diphtheria toxoid
Examples of Products Free of Thimerosal
|Eye Preparations|| Bausch & Lomb® Dry Eye Therapy
Murine® Lubricating Eyedrops
Tobrex® and Tobradex® Solution or Ointment
Polysporin® Ophthalmic Ointment
|Contact Lens Products|| Renu® Enzymatic Cleaner
Opti-One® Rewetting Drops
Bausch & Lomb® Sensitive Eyes Sterile Saline Spray
|Nasal Preparations|| Afrin® Nasal Spray and Drops
NTZ® Nasal Spray and Drops
| Ear Preparations
||Cortisporin® Otic Solution|
|Cosmetics|| All Almay® products
All Physicians Formula® products
|Vaccines||Most live-virus vaccines including influenza vaccine|
If you are sensitive to mercury, you will also be sensitive to:
Piroxicam (Feldene®), an non-steroidal anti-inflammatory drug
Thimerosal Patient Counseling Center, www.truetest.com
Alternative & Complementary Therapies, June 1997
This list is also available in PDF format for easy printing.
There was a debate in the post-traumatic stress disorder (PTSD) for some time about whether the shrinkage observed in the hippocampus — a structure involved in learning and memory — was the result of the stress or was a vulnerability factor for the disease.
We know that high levels of cortisol — a stress hormone — can kill neurons. So you could argue that the stress and stress hormones that cause PTSD could also result in the reduction in hippocampal volume. This is the so-called neurotoxicity hypothesis.
On the other hand, individuals who get PTSD could have some underlying genetic or structural susceptibility, one characteristic of which could be an already smaller hippocampus. This is the so-called vulnerability hypothesis.
Researchers at Stanford have published a paper that adds credibility to the neurotoxicity hypothesis.
The researchers followed a cohort of 15 recently diagnosed PTSD patients age 7 to 13 over the course of 12 to 18 months. They tracked the sizes of their hippocampi at the beginning and the end of the interval using MRI images and also measured their cortisol levels.
The researchers found that over the interval the sizes of the hippocampi in the patients went down.
Our results support the hypotheses that PTSD symptoms and cortisol levels at baseline are associated with changes in hippocampal volume over an ensuing 12- to 18-month interval. Specifically, we found that severity of PTSD symptoms and cortisol levels predict a reduction in hippocampal volume from baseline to follow-up when controlling for pubertal maturation and gender in children with a history of traumatic stress. This is the first longitudinal study in PTSD to document an association between hippocampal changes with PTSD symptoms and with a marker of stress, cortisol levels. These longitudinal findings help elucidate previous cross-sectional reports of smaller hippocampal volumes in PTSD populations. Our results are also in accord with animal literature reporting on the neurotoxic effects of glucocorticoids in the hippocampus. Our results stand in contrast, however, with studies identifying hippocampal volume as a vulnerability factor. Although, this study was not designed to address the vulnerability factor hypothesis, our exploratory analyses suggest that hippocampal volume was not a risk factor for development of PTSD symptoms….
Our cortisol findings address a potential mechanism by which stress can alter the hippocampus. There is substantial animal literature demonstrating the neurotoxic effects of glucocorticoid in the glucocorticoid receptor-rich hippocampus. Glucocorticoids can also exert their neurotoxicity indirectly via accumulation of extracellular glutamate. High levels of glucocorticoids have been reported in children with history of maltreatment and PTSD. Elevated cortisol levels suggest that high levels of stress lead to activation of the HPA axis and cortisol production and that this leads to hippocampal toxicity, which results in poor inhibitory activity from the hippocampus unto other centers, such as the HPA axis itself. The putative neurotoxic effects of cortisol on the hippocampus may depend on at least 3 factors: (1) the developmental stage of the structure (the hippocampus glucocorticoid receptors density may change throughout development), (2) the level and sustainability of cortisol released, and (3) the severity and/or chronicity of the stressful events.
Other studies have attempted to follow patients with PTSD, but they have been done on older patient populations that have often had PTSD for much longer. This is a confound in the ability to measure hippocampal volume changes because chronic stress may not cause changes and stress that is far removed may have given the brain time to recover.
The recognition that stress does shrink the hippocampus rather than that a small hippocampus is a susceptibility factor for PTSD may have consequences in terms of patient treatment. In theory, we would like to short circuit the shrinkage of the hippocampus by some pharmacological means, or maybe we could improve function by providing cognitive training.
The wafting of delicious meaty scents from every direction and the overwhelming repeated blasts of gunshots and fireworks accompanied by bright lights and excited voices is enough to send animals over the edge.
Imagine not having a clue what was going on during this Independence Day Weekend. What would you think of these unusual events?
What if you are an animal and your owners are not there to comfort you and keep you from harm? As is the case with some animals, try to understand the anxiety of not being able to protect your owners, or not knowing where they are, when there is certain mayhem knocking at the door.
Put yourself in their innocent position. Animals often get lost, hurt or killed when running from perceived danger or toward the confusing and undeniable scents of a neighborhood full of BBQs.
You can’t explain to them the reasons behind the activities, but you can think ahead and, at the very least, keep your pets from getting loose.
From the Human Society Website:
“Returning home from a holiday celebration, Sharon Moore and her family discovered feces on their living room floor.
The sliding glass door to their backyard was open, and a hole had been dug under their fence.
The Moores were gone for only four hours, but D.O.G., their 2-year-old, aptly-named white German Shepherd, was gone. Left on her own to face the tumult of fireworks and loud celebrations, she escaped, apparently to seek the familiar—her family—even if she had no idea where to look.
‘From what we can tell, when D.O.G. heard the fireworks she freaked out and pooped on the floor inside—for the first time ever—then she opened the sliding glass door with her paw, and dug a hole outside our fence…. She went searching for us,’ said Moore, of Maitland, Fla.
The Moores’ search for D.O.G. ended when she was found dead alongside a road where she was often walked.
Moore believes that D.O.G., who wasn’t normally scared of thunder or other loud noises, panicked from the cumulative effects of the fireworks, the excited voices outside, and being left alone inside the house.
The Moores’ tragic loss isn’t unique. Pets often become frightened and frantic by the noise and commotion of Independence Day. In fact, animal shelters across the country are accustomed to receiving “July 4th” dogs—dogs who run off during fireworks celebrations and are rescued by animal control officers or good Samaritans who take them to the safety of a local shelter.
Leave Them At Home
Fortunately, preventing pet problems on Independence Day is possible by simply planning ahead and taking some basic precautions.
‘With a little bit of planning and forethought, you can enjoy the excitement of the Fourth of July and know that your animal companion is safe, sound, and enjoying a little peace and quiet,’ said Nancy Peterson, an issues specialist with The Humane Society if the United States.
To protect your pet on the Fourth of July, take these precautions:
- Resist the urge to take your pet to fireworks displays.
- Do not leave your pet in the car. With only hot air to breathe inside a car, your pet can suffer serious health effects—even death—in a few short minutes. Partially opened windows do not provide sufficient air, but they do provide an opportunity for your pet to be stolen.
- Keep your pets indoors at home in a sheltered, quiet area. Some animals can become destructive when frightened, so be sure that you’ve removed any items that your pet could destroy or that would be harmful to your pet if chewed. Leave a television or radio playing at normal volume to keep him company while you’re attending Fourth of July picnics, parades, and other celebrations.
- If you know that your pet is seriously distressed by loud noises like thunder, consult with your veterinarian before July 4th for ways to help alleviate the fear and anxiety he or she will experience during fireworks displays.
- Never leave pets outside unattended, even in a fenced yard or on a chain. In their fear, pets who normally wouldn’t leave the yard may escape and become lost, or become entangled in their chain, risking injury or death.
- Make sure your pets are wearing identification tags so that if they do become lost, they can be returned promptly. Animals found running at-large should be taken to the local animal shelter, where they will have the best chance of being reunited with their owners.
- If you plan to go away for the holiday weekend, read our information on Caring for Pets When You Travel.
If you follow these simple precautions, you and your pet can have a safe and happy Fourth of July.
Updated June 23, 2009.”
Original article (retrieved July 2, 2010): http://www.hsus.org/pets/pet_care/summer_care_tips_for_you_and_your_pets/keep_your_pet_safe_on_july_4th.html
Original Article: http://www.selfhelpmagazine.com/article/insomnia
by Marlene M. Maheu, Ph.D.
About the Author:
Revised 8/31/09 by Marlene M. Maheu, Ph.D.