Nurses week: celebrating GeriPal nurse scientists

Diagram by Florence Nightingale showing that deaths in the British Army during the Crimean war due to preventable infectious diseases (blue wedges) far outnumbered deaths due to wounds (red) or other causes (black).

by: Alex Smith @AlexSmithMD

It's nurses week! Please take a moment to thank the nurses in your life for the extraordinary work that they do.

For GeriPal, let's take a few moments to focus this year on thanking the many amazing nurse scientists in geriatrics and palliative care.

This is a list of a few of the many nurse scientists who have pushed hard on the boundaries of what is known in geriatrics and palliative care. I've just listed a first few to get the ball rolling.

Mary Naylor - Developed the Transitional Care Model, research focuses on helping older adults with chronic conditions receive high quality care and avoid unnecessary hospitalizations.
June Lunney - Described and provided empirical evidence for functional trajectories toward the end of life. People with cancer have a clear downward functional trajectory, whereas people with dementia slowly dwindle.
Meg Wallhagen - Put hearing loss on the map as a major but often overlooked issue in the elderly, not to mention the elderly in palliative care.
Marie Bakitas - Pioneer in palliative care in rural settings. Developed project ENABLE, a telephone based support intervention for people with advanced cancer.
Betty Ferrell - THE big name researcher in the field of pain and quality of life for patients with cancer.
Chris Miaskowski - Remarkable work in symptoms, symptom clusters, and translational research.
Mary Ersek - National leader in palliative care in the nursing home and palliative care for Veterans.
Judy Paice - Leading pain researcher nationally and internationally.

This list is by no means exhaustive! Not even close. But with your help it could be - please add to this list in the comments and via twitter.

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The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers. Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis. This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis. Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?). This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here).

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Survival from severe sepsis: The infection is cured but all is not well

Severe sepsis is a syndrome marked by a severe infection that results in the failure of at least one major organ system: For example, pneumonia complicated by kidney failure. It is the most common non-cardiac cause of critical illness and is associated with a high mortality rate.

But what happens to those who survive their hospitalization for severe sepsis? An important study published in JAMA from Iwashyna and colleagues provides answers and tells us all is not well. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits.

Iwashyna examined disability and cognitive outcomes among 516 survivors of severe sepsis. These subjects were Medicare enrollees who were participants in the Health and Retirement Study. The average age of patients was 77 years.

When interviewed after discharge, most survivors were left with major new deficits in their ability to live independently. …

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