Thursday, February 26, 2015

A Quicker, Possibly Better Measurement of Frailty Before Surgery

Young or old, one of the biggest concerns about having surgery is how well you are going to do after. Surgery is meant to cure a problem or to improve quality of life, but the outcome isn't always what we may hope for. While some people breeze through post-operative recovery, others struggle and have set backs. In some cases, the surgery and its effects start a downward spiral that is hard to stop.

Seniors are frequently considered to be at risk for surgical complications. Many have other medical problems, may be taking prescription medications, and may not have a support system at home to help them when they recover. However, it's not just seniors who can be at risk for post-surgery difficulties - young adults can be just as well.

Frailty tests are meant to help physicians understand which patients are at highest risk for complications after surgery. The most common test is the Fried Frailty Criteria.  "Frail means they don't have the physiologic reserve to bounce back after the operation, so they start down a path that they may not easy recover from," coauthor Kenneth Ogan, MD, said in a press release.

This assessment looks at five distinct features: shrinking (has the patient had any unexplained or unintentional weight loss of 10 or more pounds over the past year), grip strength, exhaustion (how tired is the patient?), activity level, and walking speed (how quickly can the patient walk 15 feet?). The assessment can take about 10 minutes to complete.

A study just published in the Journal of the American College of Surgeons looked patients who had major abdominal surgery and the researchers examined if there was a better way to assess the patients that was also less time consuming.

Of the 351 patients in the study, 36.7% of them had experienced a post-operative complication within 30 days of the surgery. Almost 25% were minor complications, but just over 14% were major, such as wound infections, pneumonia, and stroke. Some died.

The researchers went back and to see what the prediction would be if the testers had used just two of the five frailty factors, grip strength and weight loss. They found that the prediction results of post-surgery outcomes were the same using the two assessments as with the full five-point assessment.

The researchers then added two other factors (the patients' physical status for anesthesia and hemoglobin levels in the blood), and the ability to predict complications was better than with just the frailty test.

The advantage to this finding is that the preoperative testing for just two frailty factors, plus the physical status and blood tests cuts down the testing time to less than a minute, the researchers said. In addition, if there are issues like poor grip strength and weight loss, it might be possible to address these problems before surgery, perhaps reducing the risk of complications after.

Thursday, February 5, 2015

Medicine errors at home: all too common, especially for children

It's a common event in many households - a child has an ear infection and has to take antibiotics. A family member has an injury and needs to take analgesics, pain relievers. In other families, someone has a chronic illness that requires regular prescription drugs. Medicines are a part of modern life. They keep us alive and they make life more liveable for millions of people.

According to an article in Family Practice Management, in any given week, four out of five Americans take either a prescription drug, an over-the-counter (OTC) medicine, or a dietary or herbal supplement. That's a lot of people. The article goes on to say that nearly 1/3 of American adults take five or more drugs. But if you think about it, that's not too surprising. Let's say our friend Mr. Johnson has type 2 diabetes, arthritis, and hypertension. He may take one or two prescription meds for each condition - and then on top of it, he may have other medicines to take occasionally if he had an infection or some other short-term health problem. That's easily five or more medicines at one time.

Any time you take a prescription drug, there's room for error - if you take more than one, the chances of making mistakes multiply.

If you're a parent, giving medicine to a child, you know how easy it is to make a mistake. The journal Pediatrics, published a study last year that found that outside of the hospital environment, every eight minutes in the U.S., a child under the age of six years old is subjected to a drug error. One every eight minutes. The study looked at a period of 10 years. Almost 700,000 children had medication errors - 25 of the children died. Almost 2,000 were admitted to critical care units.

The most common drug error at home is dosage - the amount of the drug given or taken, according to that last study. Dosing mistakes like giving too much of a medicine or not enough. If you're giving or taking a liquid medicine, dosing errors usually come from incorrect measuring. Someone may use a tablespoon instead of a teaspoon or the other way around. Kitchen spoons aren't specific enough for medicines either, so the dose isn't precise. If parents or other caregivers are giving medicines to children, one caregiver may give a dose not realizing another already gave it.

Other common errors involve:

  • Chewing or breaking a pill or capsule that shouldn't be chewed or broken. This is a common mistake. Many pills shouldn't be broken because they have a special coating on them to prevent the medicine from being absorbed in the body too early in the digestive process.

  • Taking at the wrong time. Some pills must be taken with food, others on an empty stomach. Taking them incorrectly will affect how they are absorbed and how effective they are. And taking some pills on an empty stomach can cause serious irritation, leading to other problems.

  • Missing doses. Forgetting to take medicine is a common problem and just about everyone who has ever taken a prescription drug has forgotten a dose from time to time. 

  • Misunderstanding directions. Taking medicines can be stressful. You're not feeling well when you've gone to the doctor or nurse practitioner. You may feel rushed or you may not think to review the prescription - this can lead to misunderstanding the instructions. Unfortunately, this is more common than people realize.

Prescription and over-the-counter drugs are serious products and while we may take them every day, it's really important not to ever take them for granted. Mistakes happen and they happen every day. So know your prescription and how it should be taken. If you have any questions about any drugs you take, ask your pharmacist. Your pharmacist is your best resource when it comes to medications - it's his or her specialty.

Friday, January 16, 2015

Just the Right Dose - Helping people understand their prescription drugs

Prescription drugs are an important part of life for millions of people. Some drugs are literally lifesaving, while others make life more comfortable. But these medications have become so commonplace and easily available that they might not be taken as seriously as they should be. And that is very dangerous.

When I began working as a nurse, I was often surprised at how little some of my patients knew about their prescription drugs. When taking a nursing history (an intake interview of sorts), we would ask about what drugs the patients took at home, how they took them, and so on. So many patients would say something like, "oh, I take that little white pill for my diabetes - well, just a half of one really because I don't need to take the full one all the time." Other patients would bring in their medicine bottles, but with several prescriptions in one bottle, all mixed up. Sometimes, I would be handed bottles of expired drugs. I was even told a few times to "look at my records," when I asked about prescriptions.

It wasn't unusual for some of my patients to be there because they had not taken their drugs properly. Often, it was that they didn't take their medications as frequently as they should have, but others took too many pills or didn't follow the instructions. Some combined medicines that shouldn't have been combined, others took pills on an empty stomach rather than with food, causing damage. The stories were endless.

Why did so many people not know anything about their pills? Some of it goes back to "doctor knows best," and not feeling they needed to question their prescriptions. And I believe that part of it goes back to just not realizing how important this information and knowledge is.

Last month, I wrote a blog post about prescription drug use in North America and the errors that occur because patients don't understand their medicines properly (Over 200 Billion Dollars For Prescription Meds in U.S. Alone). I found that information as I was doing research for my new book, Just the Right Dose: Your Smart Guide to Prescription Drugs & How to Take Them Safely.

The book, now available at Amazon and Kobo, covers topics such as how to read a prescription (What do those abbreviations really mean?), how to take or give medicines - including tips for people who have trouble swallowing pills, why certain pills should never be broken or crushed, why over-the-counter drugs should be used as carefully as prescription drugs, and more.

Who should read this book? Anyone who takes prescription drugs and anyone who gives them to someone else - such as a parent who has to give medicines to a child, or a family caregiver, looking after a parent or sibling.

To learn more about the book please visit You can also go directly to Amazon or Kobo to purchase it.

Tuesday, December 30, 2014

Setting Goals versus Resolutions

It's that time of year again - New Year's Eve is around the corner and people are planning their resolutions for 2015. Gyms will be packed with people who have the best intentions of getting fit again, diet programs will see an uptick in memberships, stores will sell more organization tools, and many people will be making lists of things that they plan on improving on. I'm not one of them.

I've never made resolutions for the new year - at least I can't recall ever doing so. My new year always seems to be in September, when children go back to school and work places return to normal after employees have returned from summer vacations. January 1 doesn't seem like a new year to me. The week before and the week after are the same - not like September when the season is changing and new opportunities seem to be everywhere.

But what about setting goals? Is that different? I think it is. Setting a goal means you want to accomplish something over the course of the upcoming year. The goal could be related to health (losing weight, getting fit, eating better), personal life (learning a new skill, traveling, saving money), or business life (landing a new client, starting a business, changing jobs). A goal seems to be a more practical way of approaching a new year.

Last year, I set a goal to save money for Christmas 2014, starting in January. I used the 52-week savings plan that was circulating on Facebook. But I did it with a twist. The plan said to save one dollar for the number week of the year - so in week one, you saved one dollar. In week two, you saved two dollars, in week 32, you saved 32 dollars, and so on. But I thought that it might be harder to have more money at the end of the year than at the beginning, so I flipped it. Week one, I saved 52 dollars. Week two, I saved 51 dollars, and so on. Sure enough - by the time shopping for Christmas came around, I had a nice sum in my savings account to pay cash for everything. It worked. It may not work for everyone, but it worked for me. I met my goal and I was quite proud of myself!

So, what's my goal for 2015? I have a book coming out early next year. It's for the general public on a health issue that most people should find helpful. My goal is to ensure the book is off to a great start, and that marketing and publicity push it to a point that people will see it and think, "hmm, I need this book."

I also want to increase my number of clients. I have some great regular clients for whom I write site content and articles for online and print use, but I'd like to add to that group for a bit more variety. To do that, I need to do more marketing and networking. So, my goal is to get out a certain number of letters of introductions (LOIs) and applications over the course of the year.

For the personal part of my life, I want to learn more about different quilting techniques that are interesting me. I started a new-to-me skill project just before Christmas and am happy with how it is going. But there is so much more I want to learn! My goal is to read, learn, and practice until I feel I've accomplished the new skills.

Do you have goals? What are your goals for the upcoming year?