LINCOLN â With a bill to legalize cannabis for medical use in Nebraska stuck in committee, medical marijuana advocates will try to put the issue before voters for the third straight election cycle.
NREMT-NRP action - NREMT National Registered Paramedic Updated: 2023
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NREMT National Registered Paramedic
When is a detailed head-to-toe assessment performed?
A. After the primary survey
B. After assessing vitals
C. After a sample history
D. After a wet check
The detailed head-to-toe check should be performed after vitals have been
The radio code that refers to position or location is coded as what?
D. Echo Bravo
To refer to position or location on a radio, 10/20 is used.
ETA is an acronym that stands for:
A. Emergency trust agreement
B. Enabled translation account
C. Estimated time of arrival
D. Enhanced tertiary airway
Estimated time of arrival is commonly shortened to ETA.
The acronym PERL is used to assess what?
A. Pupil dilation
B. Level of consciousness
C. Event history
PERL (pupils equal and reactive to light) assesses the equality and the size of
Which of the following assessments is not required when assessing the neck?
A. Tracheal deviation
B. Jugular vein distension
D. Paradoxical motion
Paradoxical motion occurs in the chest area. It refers to the unequal rise and fall of
What is most essential requirement when assessing a patients breathing with a
A. To listen for a heartbeat
B. To assess bilaterally
C. Check one side of the apex during a pneumothorax
D. Listen for wheezing
Checking the breath sounds bilaterally will tell you whether both lungs are
The acronym DCAP-BTLS is usually used in which of the following
A. The scene survey
B. The wet check
C. The detailed head-to-toe check
D. The sample history
DCAP-BTLP (deformities, contusion, abrasions, punctures, burns, lacerations,
and swelling) is used during a head-to-toe check.
What gland is assessed by a combination of bidigital palpation and circular
A. Pituitary gland
B. Hormone gland
C. Thyroid gland
D. Parotid gland
The thyroid gland is assessed by a combination of bidigital palpation and circular
compression. The assessment is for asymmetry and enlargement of the thyroid
gland. The assessment is done by having the client sit upright and by asking him
or her to swallow.
Which is not a pathogen route of transmission?
Vapor is not a pathogen route of transmission. The routes of transmission are
droplet, vector-borne, indirect, direct, airborne, and fecal-oral. For these routes to
function there must be a source of infectious microorganisms and a susceptible
When questioning a patient, it is important to gather as much information as
possible. What is not a question type?
Indirect is not a question type. When questioning a patient, it is important to
gather as much information as possible. Question types include open-ended,
direct, probing, leading, laundry list, and facilitating. When communicating, avoid
jargon that patients may not understand and confirm at the appointments end that
the patient understands what has been discussed.
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The National Nurses United union, which represents 900 registered nurses at Ascension Seton Medical Center Austin, voted May 31 and June 1 to authorize a one-day strike at Ascension Seton Medical Center Austin.
On June 2, the union announced the strike had passed with 98% support. The move follows contract negotiations that have dragged on since at least November, according to the union. The contract negotiations hinge on pay levels and other measures the union said are needed to fill vacancies and ensure retention.
âThis action is disappointing given that both bargaining teams continue to work towards an initial collective bargaining agreement and have multiple sessions scheduled through the end of June,â a representative for Ascension Seton said in a statement.
How we got here
Matthew Clark, a registered nurse in the intensive care unit and a member of the negotiating team, said nurses are "leaving in droves" due to ongoing staffing issues.
Clark said nurses are asking for several changes to increase staff levels and ensure safety for staff and patients, including adding updated staffing minimums to the contract and creating a professional practice committee of nurses who can elevate problems and propose solutions to management.
In his unit, Clark said there are daily requests to pull staffing from other departments to handle incoming patients. He said that the low staffing levels mean nurses often work longer shifts than scheduled and are drained by the work. He also said the frequent turnover means a lack of experienced staff.
Previously, the union has staged a candlelight vigil and picketed in an effort to convince the hospital administration to take them more seriously, Clark said.
Community Impact has reached out to Seton for additional comment and will update this story when it is received.
The nurses' strike would be the largest in Texas history and the first at Ascension Seton Medical Center Austin. The NNU said it would provide at least 10 days' notice to the hospital. The Ascension Seton representative said a plan is in place if that notice is received.
What nurses are saying
âOur patients canât wait any longer,â said Lindsay Spinney, a registered nurse in the neonatal intensive care unit, in a news release. âNurses are sending a message to management with this overwhelming strike authorization that we are ready to do what it takes to win a strong contract that protects our patientsâ safety.â
âItâs morally distressing to work tirelessly for a nonprofit, Catholic system that consistently puts profits over its own patients and staff. We believe it is our duty to exercise our union power to ensure Ascension invests its deep financial resources back into its staff, patients and the Austin community,â said Clark in the release.
What Ascension Seton is saying
âWe continue to bargain in good faith with National Nurses United (NNU) to come to a mutually beneficial agreement on an initial contract that supports all and will further our combined goal of providing safe, compassionate care to those we serve. We respect our associatesâ right to organize themselves through union representation and participate in a strike authorization vote,â the statement said.
What happens next
Clark said he hopes that the move will motivate management to take the union more seriously. If not, he said the union is prepared to hold the strike.
Stephen and Sandra Swanson were eating dinner beside their Christmas tree in 2017 when a Navy official rang the doorbell with alarming news: Hazardous chemicals from firefighting foam, used during training exercises at a nearby military airstrip, had seeped into their well water.
âWe were told, âDonât drink the water. ... Itâs toxic.â Then we were handed bottled water from Safeway,â Stephen Swanson, a 78-year-old retired emergency room physician, said in an interview from his home on Whidbey Island, Wash. âIt felt like a gut punch.â
Months later, Swanson provided the Washington state legislature with tests showing his blood was filled with high levels of contaminants found in the foam: per-and polyfluoroalkyl substances, commonly called PFAS or âforever chemicalsâ because they donât break down in the body or in nature.
His testimony helped convince the Democratic-controlled state legislature in 2018 to become the first in the nation to restrict the use of firefighting foam that contains the chemicals as well as PFAS-laced food packaging, which numerous studies have linked to cancer, infertility and a host of other diseases.
Since then, at least 106 similar laws have been enacted in 24 states, many with GOP-dominated legislatures, to ban or restrict the use of chemicals that are valued for their waterproof, stain-repelling, nonstick and fire-resistant properties and found in a vast array of everyday products including carpeting and rugs, outdoor apparel and stick-proof cookware.
This year alone, 195 new bills were introduced in dozens of state legislatures, seeking to require that an expanding list of products be PFAS-free. Some states have set deadlines that require all or most products made or sold in their states to be PFAS-free, with Minnesota the latest to pass such a measure last month.
The chemical industry argues that the tide of new legislation is a gross overreaction and that the majority of PFAS chemicals are safe. But the laws have received rare bipartisan support in an era when political divides have deepened in state legislatures, helped by lobbying pushes from broadly popular groups such as firefighters and farmers, and have prompted major companies like McDonaldâs, Ikea and Target to set deadlines for eliminating PFAS chemicals in all or most of their products.
âBy 2025, these state laws are going to reach a critical mass, and every industry is going to have to face what these other companies have already faced,â said John Gardella, a Boston-based lawyer who represents many of the companies and industries that use the chemicals.
This boom in state-level bans comes as federal regulators have lagged for decades on taking action. While the Agency for Toxic Substances and Disease Registry says the threat of long-term PFAS exposure is not fully known, activists and medical experts point to mounting evidence suggesting the chemicals are linked to liver and immune system damage, as well as other risks. The U.S. Environmental Protection Agency in March proposed for the first time a rule to set legally enforceable limits nationwide on six forever chemicals, although the regulations would cover only water contamination.
After decades of denying that any PFAS chemicals are hazardous, the American Chemistry Council, the industryâs primary trade group, now says at least two of the substances could be problematic at high levels. But the group also argues that the vast majority of the 5,000-plus chemicals in the group are safe and that states are going too far by banning or restricting all of them. The group also says the laws could block production of important products, such as semiconductors and medical devices.
âWe have strong concerns with overly broad state legislation that takes a one-size-fits-all approach to the regulation of these chemistries,â said Robert Simon, a vice president with the American Chemistry Council. âFurthermore, a patchwork of conflicting state-based approaches could jeopardize access to important products.â
Simonâs group has asked the federal government to set national standards but has also successfully fought congressional bills to restrict PFAS, including some legislation that died earlier this year, which the group argued went too far by restricting many chemicals the industry says are safe.
State lawmakers who have backed the bills say theyâve fought for broader PFAS bans because new versions of potentially dangerous PFAS chemicals are regularly introduced into the market. Following the industryâs advice would trigger a âwhack-a-moleâ situation, they say, forcing legislators to pass new laws each time a new PFAS chemical is developed.
The EPA said that its newly proposed ban on two chemicals and restrictions on four others are based on reviews of hundreds of scientific studies showing links to a variety of health problems and are focused on PFAS that can be reliably detected in water and for which there are âproven treatment technologies.â The agency noted that itâs continuing research on other PFAS chemicals and considering further regulations, enforcement actions and technologies that can remove them from the air, land and water.
Until the EPA and other federal agencies do set stricter policies on PFAS use in products and start levying fines to violators, some lawmakers say, state laws are the only recourse.
âWhat often happens when the federal government fails to act, states step in because we have to protect our citizens,â said Maryland state Del. Sara Love (D-Montgomery), who sponsored a bill signed into law last year that bans forever chemicals in firefighting gear and other products. âWe also know that the more states that passed legislation on this, the more it would really push the federal government to do something.â
Forever chemicals were invented in the 1930s and a decade later went to market in nonstick and waterproof coatings in cookware and clothing. By the 1960s, their unique resistance to water, oil and stains prompted a variety of industries to start using the substances, including in firefighting foam and electronics.
The health risks first received widespread notice in 2001, when attorney Robert Bilott sent a 19-page open letter detailing potential hazards and asking the EPA to investigate the disposal of the chemicals by E.I. du Pont de Nemours, commonly referred to as DuPont.
Five months later, Bilott filed a class-action lawsuit against DuPont. A settlement agreement in 2004 awarded affected residents $70 million in damages and created a scientific panel that reviewed existing research and conducted new studies on PFAS exposure, while also testing 69,000 people near a DuPont site in the Mid-Ohio Valley in West Virginia.
The panel released a series of reports in 2011 and 2012 that determined there were probable links from PFAS exposure to kidney and testicular cancer, ulcerative colitis, thyroid disease, pregnancy-induced hypertension and high cholesterol. More than 3,500 of the people tested were later diagnosed with one of the linked diseases.
At the time, DuPont argued the chemical in the study â which it has since phased out â was safe and denied any wrongdoing in the settlement agreement. In response to the panelâs reports, the company in some instances said it did not believe there was a link to health problems and in other instances emphasized reforms it had undertaken, such as the installation of water-filtration systems.
Today, âthe companyâs use of PFAS is limited,â according to DuPontâs website. âWe have systems, processes and protocols in place ensuring that PFAS is used safely, controlled to the highest standards and minimized.â
The EPA also sued DuPont in 2004 for violations of the Toxic Substances Control Act and settled with the company the following year for $16.5 million. Following the release of the panelâs scientific studies, the EPA began testing drinking water at sites across the country, revealing widespread contamination in 27 states that affected 15 million people. The Defense Department followed in 2016, checking water around its military bases and finding it, too, contained PFAS chemicals.
âThis information bubbled up to the state legislatures, with state legislators taking notice that their districts were contaminated and grass-roots environmental groups forming to try to address the issue,â said Melanie Benesh, vice president of the Environmental Working Group, which in 2016 first released its map that pinpoints the locations of all the contaminated sites. The map now shows contamination in all 50 states, with about 200 million Americans potentially affected.
The possible health impact of exposure to the chemicals is still a subject of medical study. The EPA recently calculated that restricting six PFAS chemicals in water supplies could have a measurable impact on heart disease alone, preventing 6,000 nonfatal heart attacks, more than 8,800 strokes and 754 deaths. Another peer-reviewed study by Harvard and Chinese-based researchers determined that exposure to one PFAS chemical was associated with 382,000 deaths annually in the United States from 1999 to 2015.
In 2017, bills were introduced in nine state legislatures to ban the chemicals in certain products, with Vermont the first to pass a narrow restriction on one PFAS chemical tied to a single contamination site.
The number of bills quickly rose the following year to 38, with four passing, beginning with Washington state, the first with a broad ban on the entire class of PFAS chemicals in products, beginning with firefighting foam and food packaging.
Similar proposals have increased exponentially ever since, with a record high of 245 bills introduced last year. Two documentaries and the 2019 film âDark Watersâ starring Mark Ruffalo, about Bilottâs fight with DuPont, helped fuel the state legislative movement. (Bilott also wrote about the legal battle in his book âExposure.â)
In an interview with The Washington Post, Ruffalo credited the film with dispelling myths that poor diets or farming practices had caused the health problems highlighted by Bilottâs suit.
âThere is a lot of shame around illness. It showed them it wasnât them,â Ruffalo said. âIt wasnât their fault. It was done to them, and it was done knowingly.â
Ruffalo said the movie also helped to mobilize victims â along with firefighters and grass-roots environmental groups â to push state lawmakers to take action.
âItâs a case study in the power of film, and it is really what storytelling is all about,â he said. âIt is about reaching people where they are. It humanizes us. It humanizes the issue. And it transcends political bounds.â
As the number of state bills have grown, so too has the list of products they are seeking to make PFAS-free, including cookware, surf and ski wax, artificial turf, carpeting, rugs, furniture, outdoor apparel, cosmetics and menstrual products.
Ten states have implemented drinking-water standards with various PFAS limits well below the only existing national standard â a nonenforceable 2016 guideline from the EPA. The agencyâs new regulation proposed in March would put legally binding limits of 4 parts per trillion or less on six PFAS chemicals in drinking water, nearly 18 times less than the current guideline. The public comment period for the proposed rule closed May 30, and it could go into effect as soon as December.
âWhen you had multiple states setting drinking-water standards, that absolutely was part of the pressure that pushed the federal government to finally act,â said Sarah Doll, national director of Safer States, a coalition of environmental health groups focused on toxic chemicals that tracks PFAS legislation.
In other state actions, attorneys general in 17 states have also filed lawsuits to force companies that have produced or used forever chemicals to finance cleanup efforts and to provide medical monitoring to people with high PFAS levels in their bloodstreams.
Companies that make products using PFAS have argued they are not liable, since they didnât manufacture the substances. And many of the companies that make forever chemicals say their prevalence makes it difficult to pinpoint them as the source of health risks.
Several states have started to move beyond a product-by-product ban of the chemicals to more sweeping laws that set deadlines for removing PFAS from all products, with a few caveats. In 2021, Maine became the first state to do so. The law, which takes effect in 2030, bans any intentionally added PFAS in products. However, if there is not yet a PFAS-free alternative, it allows for exceptions in products deemed to be âessential for health, safety or the functioning of society.â
Minnesota Gov. Tim Walz (D) signed a similar bill last month, setting a deadline for some products to be made without the chemicals by 2025, with others facing a 2032 deadline.
In 2019, the Washington legislature ordered the state Department of Ecology to seek PFAS-free alternatives for a variety of products and then set phaseout deadlines. Last year, legislators expanded the scope of the rule and set a 2025 deadline for some products, including apparel and cookware.
âWe were able to speed up the timeline for eliminating PFAS, and it was a big fight,â said state Rep. Liz Berry (D). âThe chemical companies and their lobbying efforts were very strong.â
Gardella, the Boston-based attorney who represents many of the affected companies, said the new laws will be difficult to follow since many products made in the United States use materials from overseas.
âThese components and chemicals donât always come in containers that say âPFAS,â right?â Gardella said. âWhen companies ask if they contain PFAS, theyâll get a response thatâs very vague, like, âThis component that we sell has no hazardous substances in it.â Okay. Thatâs nice, but whoâs determining that?â
Some companies that are going PFAS-free are pledging to play a more active role in keeping the chemicals from their products. McDonaldâs said it is now conducting its own ârobust testing for chemicalsâ with the goal of using PFAS-free food packaging by 2025.
Simon, with the American Chemistry Council, said that many modern-day PFAS compounds are safe and made of shorter chemical chains, which allows them to break down more easily than older versions of the man-made chemicals. âNewer PFAS chemistries are eliminated from the body more quickly and do not accumulate in the body like the legacy products,â Simon said.
However, critics point to a 2020 peer-reviewed study by a team of scientists at Auburn University that found the short-chain PFAS compounds are âmore widely detected, more persistent and mobile in aquatic systems, and thus may pose more risks on the human and ecosystem healthâ than their long-chain predecessors. The EPA made similar determinations the following year.
Simonâs group disputes that the studies conclusively prove that modern PFAS are as significant a health threat. Simon also said that many products â crucial to everyday life â cannot be made without the use of PFAS. As state laws become more aggressive, he said, it may lead to a shortage of medical devices and semiconductors key for smartphones and computers.
Benesh, with the Environmental Working Group, said that even though important products cannot yet be made PFAS-free, the industry could be doing more to protect the public.
âThey should be capturing PFAS in their production processes, they should be filtering their wastewater, and they should be monitoring the release of PFAS into the air and water so they arenât making this problem any worse,â she said.
Lawsuits against the makers and users of PFAS chemicals have snowballed since Bilottâs original lawsuit, as have the size of the settlements. Last week, DuPont de Nemours Inc. and other companies announced a $1.185 billion settlement over pollution claims tied to the manufacture of the compounds.
Environmentalists are now pushing states to regulate another source of PFAS contamination â sewage sludge, which is widely used as fertilizer on cropland in all but two states. For decades, municipal sewer districts have partnered with farmers as a cheap and reliable way of disposing of the waste.
Connecticut has long banned use of the bio-waste as fertilizer over a variety of environmental concerns, and in 2021, Maine became the first, and so far the only, state to ban its use specifically due to PFAS contamination.
The move came after the state started testing groundwater on farms that were treated with the sludge, which is filled with human and industrial waste. State officials also put out a map of all the sludge-treated sites that contained high levels of PFAS in their groundwater, which included Fred Stoneâs dairy farm.
âThe map makes the state of Maine look like it has smallpox â itâs that prevalent,â said Stone, who had to close his dairy farm in Maine because of the contamination in his cowsâ milk. âIf I was operating in most any other state, Iâd still be shipping my milk â and that should scare the bejesus out of everyone.â
Alice Crites and Magda Jean-Louis contributed to this report.
Lake County General Health District officials continue to encourage residents to take action to prevent Lyme disease, a sickness caused by the bite of a black-legged or deer tick that carries the Borrelia burgdorferi bacterium.
According to the district, there has been a steady increase in the number of reportedÂ cases of Lyme disease over the past few years, which is common in the Northeastern and upper Midwestern UnitedÂ States.
Lake County has had five reported cases of Lyme disease so far in 2023, officials recently reported.
Since 2010, the number of black-legged ticks in Ohio has increased steadily, particularly in wooded areas.
Additionally, while humans cannot get the ailment from pets, they can bring the ticks into the home which could then bite and infect.
A Lyme disease vaccine is available for dogs through veterinarians, officials noted.
Typical symptoms of Lyme disease include fever, headache, tiredness, and a characteristic called âbullâs-eyeâ skin rash. If left untreated, the infection can spread to the joints, heart, and nervous system, causing long-term medical problems.
Health care providers can determine if an individual has Lyme disease based on symptoms and the possibility of exposure to infected ticks. Providers may also run blood tests.
Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics, but there is no human vaccine for Lyme disease, officials added.
âThere are several steps we can take to prevent Lyme disease, as well as otherÂ diseases caused by the bites of ticks and mosquitoes,â said BertÂ Mechenbier, environmental health supervisor with the Lake County General HealthÂ District.
Additionally, the district strongly encourages individuals visiting wooded or forested areas to adhere to the following suggestions:
â˘ Wear white- or light-colored clothing which makes it easier to spot any ticks; shirts and T-shirts should be tucked into pants and socks should be pulled up over the bottom of pants
â˘ Use insect repellents registered by the U.S. Environmental Protection Agency labeled for use against ticks on exposed skin for protection that lasts several hours
â˘ Treat clothing and gear, such as boots and tents with products containing 0.5 percent permethrin (anti-parasite insecticide), which remains protective through several washings; pre-treated clothing is available and may provide longer-lasting protection
â˘ Help younger children apply repellent and keep it away from their eyes, mouth, and hands
â˘ Avoid taking shortcuts through thick brush and grass
â˘ Check for ticks at the end of each day before returning home â check pets as well; shower to wash off unseen ticks
â˘ Remove any attached tick by grasping it with tweezers, as close to the skin as possible, and pulling it straight out
For more information on Lyme disease, visit the following websites: odh.ohio.gov/know-our programs/zoonotic-disease-program/diseases/lyme-disease; www.cdc.gov/lyme/index.html.
Contact the Lake County General Health District at 440-350-2543.
An ICB has been threated with legal action over its decision to close a 2,800-patient GP practice in Liverpool.
NHS Cheshire and Merseyside has informed patients at Park View Medical Centre, in Tuebrook, in North-East Liverpool, that their practice will be closing at the end of July.
It has now received a letter threatening judicial review proceedings over the decision.
Last year, the ICB ran a procurement process for the practiceâs APMS contract, which was due to expire on 31 March, but failed to find a new provider.
Patients have signed a petition to oppose the closure and the practiceâs patient participation group has held public meetings to voice their concerns.
A spokesperson for the ICB told Pulse: âWe were unable to secure a new provider to run Park View Medical Centre, so the decision was made to disperse patients to other local GP practices at the end of the contract term, subject to a short-term extension to enable safe transfer of patients.
âWe have written to all registered patients to inform them that the practice will be closing by the end of July, and that they will be transferred to another nearby practice, as there are 10 practices within a one-mile radius of the Park View site.
âWe have recently received a letter about a proposed claim for a judicial review, which has been responded to and we are awaiting any further responses.â
It is unclear who is threatening legal action and Pulse has asked the ICB for clarification.
In a statement on its website, the practice said: âNHS Cheshire and Merseyside is now talking to other local GP practices about arrangements for patients to transfer across to them.
âThere are a range of other GP practices located within a mile of Park View Medical Centre, so we are confident that all patients will still be able to access GP services close to where they live â just as they do now.â
Mersey Care NHS Foundation Trust, which owns the surgery building, is considering selling the property within the next one or two years, which means GP services cannot be contracted to run from the building in theÂ longer term.
Ian Byrne, the Labour MP for Liverpool West Derby, called for the ICB to âlook at every option availableâ to stop the closure.
Mr Byrne said: âPark View medical centre is under threat of closure â at a time when GP surgeries are under intense pressure and people are struggling to get appointments, the last thing we need in our community is a GP surgery to close.
âSo Iâm calling on the ICB to look at all options that are on the table, and revisit the position that they are now in, which is to close the medical centre.â
Earlier this month, researchers at the University of Manchester found that practice closures are linked with reduced patient satisfaction with services at the surviving practices, which end up having more patients, as well as proportionally less GPs and funding.Â
California's reparations task force is recommending as part of its set of proposals to make amends for slavery and anti-Black racism that state lawmakers address what it calls "racially biased" artificial intelligence used in health care.
The task force, created by state legislation signed by Gov. Gavin Newsom in 2020, formally approved last weekend its final recommendations to the California Legislature, which will decide whether to enact the measures and send them to the governor's desk to be signed into law.
The recommendations include several proposals related to health care, including some concerning medical artificial intelligence (AI), which the task force describes as "racially biased" and contributing to alleged systemic racism against Black Californians.Â
Specifically, the task force calls for the legislature to fund either state universities or government agencies to study the "potential for harmful biases" in medical AI.
CALIFORNIA REPARATIONS COMMITTEE CALLS FOR MANDATORY 'ANTI-BIAS' TRAINING TO GRADUATE MEDICAL SCHOOL
"The task force recommends that the legislature provide state funding to the California Department of Public Health, a University of California school, a California State University school, or another appropriate entity to study the potential for harmful biases in commercial algorithms and AI-enabled medical devices," the committee writes in the final report outlining its proposals, adding that the study should also recommend how best to regulate medical AI tools in California.
The report additionally suggests the study should probe "'evidence-based research into the use of devices and tools that recommend adjusting patients' treatment or medication based on broad racial categories in the absence of information on genetics or socio-cultural risk factors.'"
The task force quotes from a recent American Civil Liberties Union (ACLU) paper that it cites several times. The paper provides examples of alleged racial bias in medical AI, such as a tool meant to decide how to best distribute the limited resource of extra care to new mothers at risk of postpartum depression that, according to the ACLU, directed care away from Black mothers and favoring White mothers.Â
In California, meanwhile, the reparations committee recommends that the legislature require the state's Department of Public Health to issue guidance to hospitals and other medical systems to ensure that AI-enabled medical devices "are not used for clinical applications without FDA approval or clearance, are not used on patient populations they were not intended for, and that cleared tools are not used outside of their intended use cases." That recommendation is also in the ACLU paper.
The task force additionally wants the California Department of Public Health "to make and maintain a public list of software as a medical device (SaMD) products and provide demographic information about the subjects in which the devices were calibrated or trained."
NEW AI TOOL HELPS DOCTORS STREAMLINE DOCUMENTATION AND FOCUS ON PATIENTS
A fourth proposal is to allocate positions and funding to the California Department of Justice to pursue claims against AI medical device manufacturers if their products have a "disparate impact" when providers use them according to manufacturers' instructions or if the products "misleadingly promise fairness."
Despite the task force's claims, however, new AI tools have helped medical professionals treat patients in a variety of ways.
One such tool called RestoreU, for example, helps physicians create personalized care plans for patients with Alzheimerâs and other types of dementia. Another tool known as DAX Express streamlines the note-taking process, a benefit that has reportedly helped doctors Excellerate patient outcomes, work more efficiently, and reduce costs.
Beyond AI, the California Reparations Task Force is pushing several controversial health-related proposals, such as mandating "anti-bias training" and an assessment based on that training as graduate requirements for medical school.
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The task force is also pushing a universal, single-payer health care system as a way to achieve health "equity" for Black residents in California.
Kenya's Dadaab refugee camp is facing a serious outbreak of cholera: according to the World Health Organization, as of March 2023, Kenya had recorded more than 7,800 cholera cases and over 127 deaths. The outbreak, which began in October 2022, has seen more than 2,700 occupants of the Dadaab camp contract gastrointestinal illness.
One of the satellite complexes, Dagahaley, has been hardest hit: it accounts for around 1,100 infections alone.
"We have already seen the worst cholera outbreak in five years and the risk of other epidemics breaking out is high," Hassan Maiyaki, the country director for the French medical charity Doctors Without Borders or Medecins Sans Frontieres (MSF), told DW.
"If this occurs, it would outstrip medical capacity in the camps, with potentially catastrophic consequences. Maiyaki warned.
Poor sanitary conditions at the camp
Some factors that have exacerbated the situation include poor sanitary conditions within the camps, influx of refugees, overstretched resources, and dwindling donor funds.
Dr. Kapil Sharma, a medical doctor and the project coordinator for MSF in Dadaab, blamed the seventh-month-long cholera outbreak on the camp's unhygienic conditions.
"One of the main reasons for cholera, as we all know, is poor sanitary situation," Sharma told DW, adding that the camp also lacks access to latrines. "There is rampant open defecation in the camp, and less than 50% of the people have access to the latrines, so these are all compounding factors for this outbreak to increase."
Call to Excellerate camp conditions
The medical practitioners in the area are now advocating for improvements in water, sanitationÂ and hygiene to contain the outbreak.
Kenya's Ministry of Health and other humanitarian agencies have conducted a cholera vaccination campaign since February. They also conducted health promotions, but medical practitioners in the area say it was insufficient.
"More needs to be done in terms of water, sanitation and hygiene for this population," Kapil said, calling on more substantial support from the international community to organizations providing water, hygiene, and sanitation services in the camp.
Influx of refugees from neighboring countries
According to the UN Refugee Agency (UNHCR), Dadaab camp hosts over 43% of Kenya's refugee population.
The humanitarian crisis in neighboring countries has led to a further growth in the number of refugees at the Dadaab camp. In 2022 alone, about 100,000 refugees came into the country, 67,000 of whom foundÂ their way to Dadaab.
The new arrivals have put more pressure on the camp's capacity. "The camps are already overstretched, and the humanitarian conditions there are already at its limit," Dr. Nitya Udayraj, MSF's medical coordinator in Kenya, told DW.
Tens of thousands of unregisteredÂ refugeesÂ
There are currently more than 124,000 refugees within the Dadaab refugee complex who have yet to be registered.
The drought that has plagued the Horn of Africa region has exacerbated things further, since most of those coming into the camp are either malnourished, tired, or susceptible to the disease. In addition, the worsening drought in Somalia and the crises in the neighboring Sudan, South Sudan, and Ethiopia have all forced more people to seek refuge in Kenya.
Despite having a holding capacity of 35,000 people, the satellite camp of Dagahaley hosts about 140,000 refugees. Meanwhile, more continue to stream in.
Few doctors for thousands of people
The medical doctors are not only providing care to people within the camp, but also to an additionalÂ 14,000 people within the host community, who also require their services. This has left the medical facilities overstretched and almost running on empty if help comes in late.
"MSF calls on the international community, donors and aid agencies to respond urgently to the unfolding crisis in Dadaab, taking immediate action to address the alarming sanitary conditions and prevent the further spread of disease," Maiyaki said.
The global economic crisis has also played a part in the worsening of the situation at the camp. As a result, many aid organizations have delayed remitting funds.
"What is important is the allocation of appropriate resources for organizations responsible to provide these services as fast as possible," Kapil said.
Kenya plans new refugee camp
The Kenyan government has announced plans to reopen a fourth camp, Ifo 2, to accommodate new arrivals and alleviate the strain on resources in the existing camps.
"MSF calls on the government of Kenya and the UNHCR to find durable solutions for the refugees confined within the camps at Dadaab," Maiyaki said.
Even as MSF calls on the government to fulfill the promise urgently, other interventions like water distribution and sanitary facilities supply to the refugees have been in top gear to prevent the further spread of the disease.
"We are providing 50,000 liters of water to the outskirts population of 9,000 people," Kapil said, stressing that the organization had facilitated the construction of 150 latrines for the population. It has also provided them with plastic sheeting and maps.
The MSF health practitioner said he remains optimistic that the situation can improve. "I feel really very sad when I see this number which has really increased over the last few months," Kapil said, calling on all stakeholders to collaborate and provide essential human services "to prevent people from contracting these disease which should not happen actually."
Edited by: Chrispin Mwakideu
NEW DELHI: After derecognising 38 medical colleges, the National Medical Commission (NMC) has also issued show cause notices to 102 medical colleges for failing to fulfil mandatory requirement of marking attendance by all registered faculty members and staff.
The apex body for medical education took the action after it was found that these colleges werenât following the NMC regulations for mandatory biometric attendance. These colleges can rectify the mistake themselves to abide by the NMC regulations, said a senior health ministry official.
After the formation of NMC in 2020, provision of biometric attendance and CCTV cameras were added in the minimum requirement for medical colleges to eliminate any possibility of fake faculty. Thereafter, the NMC has been continuously issuing notices to all stakeholders, including management of the medical colleges, to strictly implement these provisions.
READ ALSO: Three medical colleges in Tamil Nadu, 1 in Puducherry lose recognition
âWhile examining the data available, it was observed that most of the faculty members of medical colleges, even Dean, principal and medical superintendents of pioneer institutes do not mark their attendance on the biometric system. In respect of installation of CCTV cameras at medical colleges, either they are offline or not connected at all,â a source said.
READ ALSO: Faridabad medical college barred from admitting students this year
There are over 390 medical colleges that are due for recognition. Of them, 256 have applied for the same. Health ministry sources said the authorities concerned have assessed 175 applications and 25 have been approved. âTotal 38 such applications have been disapproved, 102 have been issued show cause notices and applications of 10 other medical colleges is currently being evaluated,â the source said.
Recently, NMC had written to the department of medical education of all states on the transfer of faculty on a temporary basis to fulfil faculty requirements during inspection.
Two top congressional progressives are joining forces with leading health care activists to pressure Washington officials to help ease the burden of patients&rsquo; medical debt and predatory practices.
The upcoming &ldquo;Freedom From Medical Debt&rdquo; initiative, led by&nbsp;Our Revolution,&nbsp;Rep.&nbsp;Ro Khanna&nbsp;(D-Calif.) and Sen.&nbsp;Bernie Sanders&nbsp;(I-Vt.) and first reported by The Hill, is intended to push Democrats from the White House to Congress to address what liberals see as one of the most pressing national problems: the cost of care.&nbsp;
&ldquo;Health care is the third rail in American politics,&rdquo; said Joseph Geevarghese, who leads Our Revolution, a coalition of grassroots&nbsp;members spearheading the debt-relief campaign.&nbsp;
&ldquo;The truth is, even after the expansion of the ACA, efforts to expand Medicaid through the states, we&rsquo;re still seeing a significant amount of patients, even patients with health insurance, struggling under the burden of medical debt,&rdquo; Geevarghese said.&nbsp;
Close ideological allies and personal friends, Khanna and Sanders are authoring forthcoming legislation in the House and Senate this month, while activists are preparing to&nbsp;push President Biden to use executive action to help stop price gouging for vulnerable patients, end a variety of predatory debt collection tactics, and ensure that people seeking medical assistance have financial aid and free or reduced price care available.&nbsp;&nbsp;&nbsp;&nbsp;
The progressive lawmakers are making their case as Biden kicks off his 2024 reelection campaign and after he recently signed a bill announcing the end of the national emergency for the COVID-19 pandemic, leaving many in a financially vulnerable spot around treatment.
Expanding access to health care and patient protections continues to poll as a reliable and popular position nationally, encouraging Democrats &mdash; from former presidents Clinton and Obama to Sanders himself &mdash; to lean heavily into the issue during election time.
Our Revolution and Khanna&nbsp;are holding a&nbsp;virtual forum&nbsp;Monday evening alongside advocates from the National Consumer Law Center and Tzedek DC and patients whose lives have been significantly impacted by medical debt and related systematic burdens.&nbsp;
The event is expected to draw testimonies from&nbsp;patients&nbsp;who have suffered long-term harm as a result of the industry&rsquo;s most pernicious practices, including racking up life-altering debt from cancer diagnoses to strokes and traumatic brain injuries.
&ldquo;In 2010, I was hit by a car on my bike. I barely survived, had a brain injury, my hand amputated and reattached &mdash; costing nearly $1 million,&rdquo; said Kristin Noreen, a patient from Washington. &ldquo;Even with insurance, some of that went on credit cards. Now, instead of paying it down, I&rsquo;m incurring more costs for pain treatments that aren&rsquo;t covered,&rdquo; she said. &ldquo;It&rsquo;s a vicious cycle.&rdquo;&nbsp;
Elizabeth McLaughlin, a resident from Indiana, said she was debt-free until one experience at the emergency room left her reeling.
&ldquo;I had no debt until I went to the ER for an injury in 2015 and got hit by a $20,000 bill,&rdquo; McLaughlin said ahead of the meeting. &ldquo;Even with insurance and working all my life, I still got saddled with debt.&rdquo;
Khanna, who is leading the effort&nbsp;in the House,&nbsp;has become a prominent voice within the Congressional Progressive Caucus with an elevated national presence, often tying together a range of policy concentrations with their real-world financial impact for middle- and working-class Americans.&nbsp;
His former role as Sanders&rsquo;s campaign co-chair in 2020 allowed him to work alongside the Vermont senator on his signature issue, where he attracted massive crowds for his commitment to Medicare for All and railing against what many on the left say are the medical industry&rsquo;s most damaging anti-patient practices.&nbsp;
As the progressive lawmakers prepare to work through the legislative process on Capitol Hill &mdash; and face the political difficulties of the GOP-controlled House &mdash; activists are amassing support from dozens of states and key congressional districts that they hope will catch the attention of the White House.&nbsp;
Their goal is to pressure the Biden administration to explore what&rsquo;s possible through executive action. They also plan to target the Department of Health and Human Services and the Centers for Medicare &amp; Medicaid Services for their support to, as Geevarghese puts it, &ldquo;get beyond the band-aid&rdquo; of debt forgiveness and to tackle the broader problem.&nbsp;
&ldquo;Medical debt is the number one reason for personal bankruptcies in the United States,&rdquo; Geevarghese said. &ldquo;We can stop that and the president has the power.&rdquo;
LINCOLN â With a bill to legalize cannabis for medical use in Nebraska stuck in committee, medical marijuana advocates will try to put the issue before voters for the third straight election cycle.
Nebraskans for Medical Marijuana filed two initiatives with the Secretary of Stateâs Office Thursday with the goal of qualifying the measure for the November 2024 general election ballot.
Crista Eggers, the statewide campaign coordinator for Nebraskans for Medical Marijuana, earlier told state senators on the Judiciary Committee that if the Legislature failed to take action that parents like her would.
âFor 10 years this has been talked about and advocated for by patients and caregivers like myself,â said Eggers, whose 8-year-old son, Colton, has intractable seizures. âI would have hoped our legislative body had decided it was important enough, but unfortunately that has not happened.â
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Two separate petitions have identical language to a pair of measures that were circulated in 2022. Both seek to force the Legislature to change state statute and legalize cannabis for medical use instead of amend the Nebraska Constitution.
The first petition will enact a new state statute protecting doctors who recommend cannabis and patients who use it for medical reasons, and the second requires the Legislature to legalize the production, supply, and distribution of cannabis for medical purposes.
âWe know the people support this,â Eggers said. âWe are going to execute and put that into motion to have safe and regulated medical cannabis in Nebraska.â
Once the petition language has been accepted by Secretary of State Bob Evnen, Eggers said Nebraskans for Medical Marijuana are planning to launch their campaign in June, with the goal of exceeding the signature-gathering requirements outlined in state law.
Nebraskans for Medical Marijuana will need to submit a number of signatures equal to 7% of registered voters in the state, including 5% of voters in 38 of Nebraskaâs 93 counties.
The renewed effort comes after the two petitions fell about 9,000 signatures short of qualifying for the November 2022 general election ballot and after the Nebraska Supreme Court found a 2020 ballot violated the single-subject rule for ballot initiatives after nearly 200,000 signatures were submitted.
The decision to pursue a ballot initiative also comes as the Legislature once again failed to act on Lincoln Sen. Anna Wishartâs attempt (LB 588) to pass a medical marijuana law in Nebraska.
Wishartâs bill, which was heard by the Judiciary Committee in February, outlined a narrow list of qualifying medical conditions for which patients could seek medical marijuana, and also detailed the steps physicians must perform before they can recommend cannabis to a patient.
Patients recommended cannabis were allowed to purchase and possess up to 2.5 ounces or 2,000 milligrams of tetrahydrocannabinol â better known as THC â from state-licensed dispensaries, which were required to contract with licensed pharmacists trained in medical cannabis.
LB 588 also would have prohibited patients from smoking or vaping cannabis, cultivating their own marijuana plants, operating a motor vehicle while under the influence of cannabis or from using cannabis while riding as a passenger.
The bill, which Wishart said would have been one of the most conservative medical marijuana laws in the country, was the result of agreements between doctors, pharmacists and state senators who voiced concern about past efforts they found too broad.
But even after emotional testimony from a handful of parents of the roughly 19,600 Nebraska children who live with severe epilepsy and other individuals who described living with chronic pain, Wishartâs bill remained stuck in committee.
Wishart said turnover in the Legislature and on the Judiciary Committee resulted in a membership that did not follow the actions of past committees which had advanced medical marijuana legislation to the floor for debate.
Attorney General Mike Hilgers, who opposed medical marijuana when he was a state senator, and Nebraskaâs chief medical officer also added to the opposition at the committee hearing earlier this year.
Wrestling with how to proceed, Wishart tried to narrow the bill further than it had already been narrowed, eventually landing on a âright to tryâ proposal for parents of children with severe epilepsy only.
That proposal would not have allowed for dispensaries to open in Nebraska â âthere would have been no industry here,â Wishart said â but would have allowed those patients, at the recommendation of their doctor, to travel to other states to buy cannabis.
It also would have decriminalized possession of marijuana for those individuals, she added.
âI think I could have gotten that out of committee,â Wishart said, âbut I didnât feel confident I would have enough votes on the floor and because of that and because it was so narrow, we decided we needed to go back to the ballot.
âThere are more people than those with epilepsy that would benefit from having access,â she added.
Eggers said she likely would have stepped aside had the Legislature acted on the âright to tryâ legislation, which she says would have helped her son.
But with the bill still sitting in committee and with its paths closed this year, she said sheâs prepared to throw herself behind the ballot initiative again, even as she acknowledges that doing so will mean she misses out on precious time with her ailing son.
âI voiced this to several senators that if the Legislature does not do something, anything to show progress, that we would do it ourselves,â Eggers said. âIt was a straight-up threat, and I intend to follow through with that threat.â
The new ballot initiatives revive what Wishart called the âbattle-testedâ language reviewed by local and state attorneys used in a previous effort that fell just short of gathering the needed votes in 2022.
Wishart, who is one of the sponsors of the initiative, said filing the petition language more than a year ahead of the July 2024 deadline for qualifying for the ballot will supply the campaign a long runway to collect the necessary number of signatures.
âWhat weâve learned is that we donât have to wait for a major donor to start,â she said. âWe basically collected 180,000 signatures on a volunteer-led, shoestring budget campaign the last time around, and now weâve got a year and a half to do what we did in three months last time.â
Eggers added the lessons learned from falling just short in two campaigns over the last two years have been used to adjust the strategy moving forward.
âWe have signers who have signed this petition, not once but twice,â she said. âWe have a lot going for us, and I think we have the ability to get it done.â
Reach the writer at 402-473-7120 or email@example.com.
On Twitter @ChrisDunkerLJS
A new paper published in The Lancet Psychiatry has called for radical action on a global scale to put an end to the growing mortality rates of people with mental illness and mental distress.
The paper, written by 40 global expertsâincluding the University of Glasgow's Prof Rory O'Connor, Chair in Health Psychologyâfollowed an extensive road mapping process of evidence reviews and consultation with mental health researchers, clinicians, policy experts and people with lived and living experience of mental illnesses and suicide.
The group mapped the range of factors which increase the risk of early mortality for people who are suffering from mental health conditions. These include adversities such as traumatic life events, unemployment, stigma and marginalization, lack of meaningful societal relationships, and poor access to health care, education, housing, and income security.
Although these factors are widely acknowledged, more research is urgently needed into the ways we can reduce these risks and deliver changes to both medical and wider government policies, to Excellerate the life expectancy for people diagnosed with mental health conditions or in mental distress.
The paper, produced by MQ Mental Health Research, sets out ambitious goals for implementing concrete solutions, and calls on government policymakers to coordinate their response to the mental health challenges we face nationally and globally. The paper also challenges the private sector such as social media companies and employers to make changes now to save lives in the future.
The 18 recommendations outlined in the paper include delivering integrated health care, community-based interventions, restriction of access to lethal means of suicide, reduction of inequalities as well as increased investment in mental health services and research.
The paper's lead authors are Professor Rory O'Connor, Director of the Suicidal Behavior Research Laboratory at Glasgow University and Professor Carol Worthman from the Anthropology Department at Emory University in the U.S.
Professor O'Connor, from the University of Glasgow's School of Health and Wellbeing, said, "Globally, too many people die prematurely from suicide and the physical health problems associated with mental illness and mental distress. These devastating losses are preventable.
"For this first time, we have brought together a multidisciplinary global team of academic, policy, clinical, and lived and living experience experts with the specific aim of understanding the driving forces behind these deaths together with what needs to be done to tackle this public health crisis.
"The time to act is now, to rebuild health-care systems, to prioritize mental health funding, and address the effects of stigma, discrimination, marginalization, gender violence, and victimization."
The paper offers a practical roadmap for implementing the solutions, but the authors are eager to make it clear that any solutions must be co-designed by people with lived and living experience of mental illnesses, in order to be successful. The paper's authorship itself integrated many people with first hand and family experience of mental illness.
Mental health campaigner and contributor to the paper, James Downs, said, "From the very start, Gone Too Soon has prioritized the knowledge and expertise that comes from having lived and living experiences of mental illness.
"As someone with longstanding serious mental illness, comorbidity, and suicidality, it has been meaningful to have an active role in this ambitious research alongside world-leading experts. By integrating experts by experience on an equal footing, we have aimed to create a fuller, more representative knowledge of the problems that underpin why people like me are likely to live shorter and more difficult lives as a result of mental illness. I hope the solutions we have proposed are more impactful as a result of lived experience being included in the project, and that we have set an example for how to co-produce knowledge and co-design more effective solutions together."
The authors recognize that this is an ambitious paper, and the solutions must be implemented across all levels of society, including at a global political level.
Professor Carol Worthman said, "The Gone Too Soon road mapping process revealed cross-cutting factors behind mortality from both suicide and mental health comorbidities.
"We also discovered that many of these factors operate across the social-ecological spectrum, from individuals through families, communities, and society.
"These insights open possibilities for common solutions that reduce premature mortality from both suicide and comorbidities and suggest opportunities to leverage ramifying effects via strategic interventions.
"That our global team combined diverse expertise and living and lived experience was crucial for identifying common cross-cutting factors and recognizing the local forms they take, thus advancing inclusive efforts to promote human welfare."
More information: Rory C O'Connor et al, Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress, The Lancet Psychiatry (2023). DOI: 10.1016/S2215-0366(23)00058-5
Citation: Researchers call for action to end mental-health-related deaths (2023, May 12) retrieved 6 June 2023 from https://medicalxpress.com/news/2023-05-action-mental-health-related-deaths.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
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