Quick Links
Main Menu
More Links

Latest Nursing Jobs &
Clinical Update Alerts!

Subscribe to get timely notifications.

Latest Nursing Jobs Vacancies
NCLEX & CGFNS Practice Questions

LASSA FEVER IN IN WEST AFRICA: THE PREVENTIVE HEALTH CONCERNS

LASSA FEVER IN IN WEST AFRICA: THE PREVENTIVE HEALTH CONCERNS

When we again look at preventive health contextually, we will rather refer to it as an approach by an individual, a family or a population group in taking proactive actions towards disease prevention. I would want us to take note of the words “Proactive Actions” which clearly tells us, we do not act in the face of the disease or illness but an action taken in advance to forestall possible occurrence of such diseases.

Taking a quick study of the recent outbreak of the dreaded Lassa fever which is a part of the haemorrhagic virus, I realised it has it traces and foot prints on same parts as Ebola virus, running within the four volatile Ebola virus susceptible Nations (Nigeria, Sierra Leone, Liberia and Guinea). I suddenly perceive there are a number of things we might not be getting right here and one of such things is obviously hygiene.

Hygiene is almost like the bedrock of preventive health, most of the common diseases arising in deaths are very preventable through effective and sustainable standard of hygiene. These four countries are characterised with a high level of compromised hygiene standards which suddenly gets better at the outbreak of a viral disease and drops as the disease and scare comes to an end. This totally makes us reactive and being reactive only deals with surface indicators which the root causes are never unveiled and neither are they attended to in right manner.
As a nation and as a population, we must first deal with our commonalities before taking advantage of our peculiarities and this is a workable approach to safe health. Travel Medicine has told us that one of the fastest ways to spread infection across international borders is through travelling. Infections travel with its host looking for other vulnerable people to infect.




I was in all honesty thinking that these countries that have been infected with Lassa fever over and over again should have made it an issue of National priority to create a lasting prevention to Lassa fever virus by collectively creating a joint framework agreement on this issue. According to the WHO, between 300,000 – 500,000 cases of Lassa fever happens in this sub region annually and about 5,000 deaths are recorded, this is 1% case fatality rate (CFR). This is not a good one, the need to stop the outbreak of the virus is important.
Studies have revealed that women who are in their third trimester of pregnancy are at a higher risk with only 1 in 10 fetal survival rate. When this happens, healthcare workers mainly bother to same only one person and that is the pregnant woman and this is most times through abortion. I think this can be prevented. We have it here with us now, but do not forget we also have women who are pregnant in our midst. Recommendations are focused on regular hand washing, keep all foods in rodent-proof containers, keep the home as clean as possible all the time (rats are attracted to dirty and unclean environment). Also keep your windows closed at night, this guides against possible inhalation of very light particles infected by faeces or urine of rodents. This is not the best of times to drink garri soaked in water, most Nigerians love this meal but we must understand our new abnormal situation which is avoidance of soaked garri in water as meal. The virus will not survive in temperature that is up to 55 degree centigrade, this means you can use your garri for Eba (Garri in Hot Water) and also ensure your food is adequately cooked.

As we all come together to battle this scare of Lassa fever, we must not forget the fact that all cases end up in hospitals and hospitals are not manned by ghost but healthcare workers who are also as human as we are. The case of the Late Dr. Ameyo Adadevoh and the national sacrifice she made during Ebola outbreak in Nigeria should still be fresh in our minds.

Healthcare workers will surely have secondary contact and this is part of the risks they have in their job, but the need to also know what precautions to take as healthcare workers will not only protect them but also reduce the spread of the virus as well as national incidence statistics. There are already establishment of transmission of the virus through body to body contact or nosocomial routes which can be avoided through barrier nursing methods, VHF isolation prevention and having an effective infection control process guidelines. These may include wearing of protective clothing (PPE) such as masks, gloves, gowns, goggles etc. Other control measures are complete sterilization of equipment, isolation of infected patients from contact with unprotected persons until the disease runs its course. We must not forget that Lassa fever has no vaccine yet through trials are on in this direction.




Talking about the disease running its cause, it is important to know that the disease lasts for 4 weeks but it has 3 weeks incubation period. In Nigeria as at February 4, 2016, we have 212 suspected cases in 62 Local Government Areas, 63 deaths recorded in 6 months and 17 States out of the 36 States in Nigeria have already recorded the presence of Lassa fever.

What this tells us is that the need to increase awareness and advocacy on the prevalent of this disease is of crucial importance. We cannot sound and resound this enough; we need to take the message to children in schools, to churches and mosques, market places, offices, motor parks and every available public place. We need to create enough information oxygen within this space; the people need to be aware of the role expected of them to play in such a very sensitive time in the life of their nation.
We can only reduce the spread of this virus, reduce the casualty rate if we all can talk about this in all places. There is no need to wait for the next man to be infected; it is a preventive health approach and strategy if you tell the next man how to conduct himself from getting infected by this virus. Tell him all that there is about this disease, you will only be saving yet another life.

I do not like gossip but if we must gossip let it be about Lassa virus, it will be credited on to you as positive gossip in the right direction. Lives are at risk here.

Play your role!

The Best Apps for Nurses: Our Top 10 for 2016

The Best Apps for Nurses: Our Top 10 for 2016

By Yara Souza, contributor

A back pocket full of references and reminders has become a reality for today’s nurses, working every day in hospitals and health systems. Whether cross-referencing a specific drug or planning patient care, they can now enjoy an added level of convenience on the job with a variety of nursing apps.

Some of our picks featured below are revived favorites–others, new to the game. Either way, take a peek at our top 10 roundup of the best apps for nurses in 2016.



Apps for purchase

Micromedex Drug Reference Essentials (iOS and Android). For $2.99, nurses can access this popular drug guide with or without an Internet connection, and get quick info on more than 4,500 search terms, including drug interactions, dosage and side effects. It is worth checking if your employer already has access to Micromedex, which includes access to a free version of this app.

Nurse’s Pocket Guide (iOS and Android): Although the $39.99 may be a tad steep, nurses have the option to experience the guide in preview mode, which allows access to certain topics, including diagnoses and recommendations. Features behind the paywall include lists of more than 400 medical conditions with corresponding diagnoses, care plan guides and a very comprehensive index search for quick navigation.

Black’s Medical Dictionary (iOS and Android): This app updates a classic medical dictionary that’s been in use for more than 100 years. The $14.99 app price provides RNs and others with a user-friendly interface, social-media elements–and, of course, access to more than 5,000 definitions of medical terms and lingo.



Free apps for nurses

NurseJobs (iOS): Keeping a pulse–no pun intended–on your own career is handy with the NurseJobs app. You can scan through the latest permanent, per diem and travel nursing opportunities, across specialties and across the country. Applying for jobs is also a cinch, with one quick contact form.

PEPID – free trial (iOS and Android): Nurses can sign up for a free trial of this relaunched, new-and-improved app, and have the option to buy suites a la carte within the app. It offers everything from pill identification and dosing calculators to integrated clinical content from the top healthcare associations.

AllNurses (iOS and Android): AllNurses wants to “help you become a better nurse,” and connectedness is the name of the game. Nurses have access to an industry network and available support 24/7 from their colleagues, for those looking to swap stories or experiences, “from nurses for nurses.” This app is also available in a wide range of languages.

Medscape (iOS and Android): A favorite of healthcare professionals, Medscape is an all-inclusive resource that offers drug look-up, including a drug interaction checker, a disease and condition reference and other perks such as image collectors, formulary info, procedural articles and a medical calculator. The app also has a clean interface to boot.

Nursegrid (iOS and Android): Nursegrid simplifies the scheduling process for nurses on the floor, as the “first calendar built for nurses, by nurses.” They can see who is working with them on every shift, use group or one-to-one messaging, or easily request a shift swap, even across multiple work sites. Confused by logistics? Video tutorials can help navigate all the app’s functionality.

MediBabble Translator (iOS); It may not be a typical nursing app, but MediBabble is a top pick due to its adaptability in vital medical situations. Nurses can download the app with Spanish already included, and other languages such as French, Mandarin, Cantonese, Russian, German and Haitian Creole are available for free download as well. MediBabble is particularly useful for admissions, assessment and follow-up questions when nurses are caring for non-English patients, and in settings where interpreters may not be accessible.

CDC Vaccine Schedules (iOS and Android): In light of ongoing vaccine controversies, nurses working with infants, children and adults alike can scan the CDC app, including the immunization schedules recommended by the Centers for Disease Control and Prevention. Features such as the color-coding coordinates, automatic updates and hyperlinked vaccine information can help nurses quickly share resources and information to even the wariest of shot-takers.

Regardless of job stage or specialty, nurses can breathe a bit easier by having these mobile apps at their disposal to stay current and informed.

© 2016. AMN Healthcare, Inc. All Rights Reserved.

The Top 10 Things You Need to Know About Acquired Pigmentation Disorders

The Top 10 Things You Need to Know About Acquired Pigmentation Disorders
Chow, Maggie L.; Luke, Janiene; Jacob, Sharon E.

Disorders of pigmentation can be acquired or inherited. The acquired disorders present an opportunity for surveillance and treatment to prevent morbidity and improve quality of life. In this article, we delineate the acquired causes, pathogenesis, and treatment options of disorders of skin hyperpigmentation or hypopigmentation.

Click HERE To read more




Zika Virus: What You Need to Know

Zika virus is spread to people through mosquito bites. The most common symptoms of Zika virus disease are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting from several days to a week. Severe disease requiring hospitalization is uncommon.

Outbreaks of Zika have occurred in areas of Africa, Southeast Asia, the Pacific Islands, and the Americas. Because the Aedes species mosquitoes that spread Zika virus are found throughout the world, it is likely that outbreaks will spread to new countries. In December 2015, Puerto Rico reported its first confirmed Zika virus case. Locally transmitted Zika has not been reported elsewhere in the United States, but cases of Zika have been reported in returning travelers.




There is no vaccine to prevent or medicine to treat Zika. Travelers can protect themselves from this disease by taking steps to prevent mosquito bites. When traveling to countries where Zika virus or other viruses spread by mosquitoes have been reported, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

Click Here For further information

“Young Midwives in the Lead” – Midwifery Symposium and Scholarships

“Young Midwives in the Lead” – Midwifery Symposium and Scholarships

14 May 2016 – 16 May 2016, Copenhagen

This symposium will bring together young midwife leaders from around the world to explore ways to strengthen and improve sexual and reproductive health, maternal health, and child health in line with the new Sustainable Development Goals.

Organized by UNFPA, in collaboration with the International Confederation of Midwives, World Health Organization, H4+, Jhpiego, Johnson & Johnson, Amref Health Africa and others, the symposium will take place in the immediate lead-up to the 2016 Women Deliver Conference (16 to 19 May).




Scholarships are available for committed young midwife leaders under the age of 35 who have demonstrated leadership potential in their profession, for example through strengthening and improving midwifery workforce policies, improving midwifery service delivery, or enhancing access to quality midwifery services in remote rural communities.

Click HERE for scholarship document,selection criteria and how to apply.

Lassa fever kills 35, infects 76 in Nigeria

Friday Olokor,

The Federal Government has put the number of reported cases of Lassa Fever outbreak in eight states at 76 with 35 deaths already recorded and 14 cases confirmed by laboratories.

The government, which said measures had been put in place to curtail further spread and reduce mortality among those affected, however, ruled out placing travel restrictions from and to areas currently affected.

The Minister of Health, Prof. Isaac Adewole, who stated this in a statement he issued on Wednesday in Abuja, in response to the outbreak of Lassa Fever in the country, added that “the World Health Organisation is being notified of the cases confirmed.”




According to him, Nigeria has been experiencing Lassa fever outbreak in the past six weeks in Bauchi, Nasarawa, Niger, Taraba, Kano, Rivers, Edo and Oyo states.

“The Nigerian government will continue to enhance its surveillance and social health education, information and communication activities to prevent the disease from spreading further in Nigeria and I wish to call for the support and understanding of Nigerians, “ the minister said.

He added, “The total number of suspected cases so far reported is 76 with 35 deaths, and a Case Fatality Rate of 46 per cent. Our laboratories have confirmed 14 cases, indicative of a new episode of Lassa fever outbreak.”

The first case of the current outbreak was reported from Bauchi State in November 2015, followed by cases reported by Kano State and subsequently the other six states.

Adewole added that in response to the reported outbreak, the Federal Government had taken some drastic measures to curtail further spread and reduce mortality.

The measures, he said, included immediate release of adequate quantities of ribavirin, the specific antiviral drug for Lassa Fever to all the affected states for prompt and adequate treatment of cases; and deployment of rapid response teams from the Federal Health Ministry to all the affected states to assist in investigating and verifying the cases and tracing of contacts.

The minister also said clinicians and relevant healthcare workers had been sensitised and mobilised in areas of patient management and care in the affected states, while

“affected states have been advised to intensify awareness creation on the signs and symptoms and general hygiene.”

“Furthermore, it is important to note that Nigeria has the capability to diagnose Lassa Fever and all the cases reported so far were confirmed by our laboratories. However, because the symptoms of Lassa Fever are so varied and non-specific, clinical diagnosis is often difficult, especially early in the course of the disease,” Adewole stressed.




The minister added that in view of the steps so far taken, he had directed that all health facilities in the country should emphasise routine infection prevention and control measures and ensure all patients were treated free.

He said, “Family members and healthcare workers are advised to always be careful to avoid contact with blood and body fluids while caring for sick persons. No travel restrictions will be imposed from and to areas currently affected.

“Healthcare workers seeing a patient suspected to have Lassa Fever should immediately contact the epidemiologist in the State Ministry of Health or call the Federal Ministry of Health using the following numbers: 08093810105,08163215251, 08031571667 and 08135050005.

While expressing gratitude to the WHO and other partners for their support so far, Adewole said the Nigeria Centre for Disease Control “is already coordinating all our response activities and reporting to me on a daily basis.”

Lassa Fever is an acute febrile illness with bleeding and death in severe cases, caused by the Lassa Fever virus with an incubation period of six to 21 days.

About 80 per cent of human infections are asymptomatic, the remaining cases have severe multi-system disease, where the virus affects several organs in the body, such as the liver, spleen and kidneys.

The onset of the disease is usually gradual, starting with fever, general weakness, and malaise followed by headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and bleeding from mouth, nose, vagina or gastro-intestinal tract, and low blood pressure.

The reservoir or host of the Lassa virus is the “multi-mammate rat” called Mastomys natalensis which has many breasts and lives in the bush and peri-residential areas.

Source: Punch, Nigeria.

Benzodiazepine Use in Schizophrenia a High-Risk Practice

Benzodiazepine Use in Schizophrenia a High-Risk Practice
Megan Brooks

High cumulative exposure to benzodiazepines is common in patients with schizophrenia and is associated with a significantly increased risk for premature death, according to new data from Sweden.

Treatment guidelines recommend that benzodiazepines not be used for longer than 1 month. “Therefore, it is alarming that one-third of the population of patients with psychosis in Sweden had used on average more than 0.5 defined daily dose per day of benzodiazepines, which is equal to more than 5 mg of diazepam or 25 mg of oxazepam every day during the 5-year follow-up,” Jari Tiihonen, MD, PhD, of the Karolinska Institutet, Stockholm, and colleagues note.

“As common as long-term benzodiazepine use was in our study population, the literature indicates that it is probably more common among patients with schizophrenia in other developed countries, such as the United States,” they add.

“When starting benzodiazepine treatment, it would be wise to try to limit the duration up to 1 month and to use antidepressants for long-term treatment of anxiety symptoms,” Dr Tiihonen told Medscape Medical News.

The study was published online December 7 in the American Journal of Psychiatry.




Iatrogenic Cause of Early Death

The researchers investigated the association between mortality and cumulative exposure to antipsychotics, antidepressants, and benzodiazepines using two Swedish nationwide healthcare registers. Among roughly 7 million people aged 17 to 64 years, they identified 21,492 patients with schizophrenia, a prevalence of 0.34%.

Altogether, 1591 (7.4%) schizophrenia patients died during the 5-year follow-up period. Compared with 214,670 age- and sex-matched individuals from the general Swedish population, the mortality of the schizophrenia cohort was 4.8-fold higher. The most common specific cause of death was cardiovascular disease (32.7%), followed by neoplasms (16.5%), respiratory diseases (11.0%), and suicide (9.5%).

According to the researchers, any amount of antipsychotic and antidepressant use was associated with overall mortality rates 15% to 40% lower compared with no use of these medications. In contrast, benzodiazepine exposure was associated with a clear dose-response curve for mortality, with high exposure associated with a 70% higher risk for death compared with no exposure.

To date, two studies have assessed the relationship between benzodiazepine use and mortality in schizophrenia. In both studies, current benzodiazepine use was associated with an increase of 80% to 90% in mortality, Dr Tiihonen and colleagues note in their article.

“While it is probable that patients who need additional benzodiazepine treatment have more anxiety, insomnia, and depressive symptoms than other patients, it is also likely that high-dose chronic use of benzodiazepines, in violation of treatment guidelines, may have become an iatrogenic cause for excess mortality in this patient population,” they point out. “On the other hand, patients who need add-on antidepressant treatment may also suffer from anxiety and depressive symptoms, which increase cardiovascular morbidity, suicidal behavior, and mortality.”

“Physicians treating patients with schizophrenia should acknowledge the high mortality associated with chronic high-dose benzodiazepine use,” the researchers conclude.

“It is important to realize that although monitoring of patients with moderate or high-dose antipsychotic treatment is relevant, it is essential to focus the preventive interventions on those patients who have an even higher risk of death, that is, patients not using antipsychotics and patients using high doses of benzodiazepines,” said Dr Tiihonen.

Reached for comment, John Kane, MD, senior vice president, Behavioral Health Services, North Shore-LIJ Health System, Glen Oaks, New York, said that the study was important and provides “further evidence of an overall favorable benefit-to-risk ratio of antipsychotic medications in the treatment of individuals with a diagnosis of schizophrenia.

“In addition, antidepressant use was also associated with a reduction in overall mortality rates, whereas benzodiazepine use was associated with higher mortality. It is difficult to draw conclusions about the potential mechanism(s) of the benzodiazepine effect, but it should remind clinicians to be cautious in the long-term use of such agents in patients with schizophrenia,” Dr Kane said.

The study was supported by the Karolinska Institutet (Stockholm); Niuvanniemi Hospital (Kuopio, Finland); and a grant from the Sigrid Juselius Foundation (Finland). Dr Tiihonen has served as a consultant, adviser, or speaker for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Hoffman-La Roche, Janssen-Cilag, Lundbeck, Novartis, Organon, Otsuka, and Pfizer and has received a grant from the Stanley Foundation. The other authors report no relevant financial relationships.

Am J Psychiatry. Published online December 7, 2015. Abstract

Warning Symptoms Can Often Precede Sudden Cardiac Arrest: Cohort Study

Warning Symptoms Can Often Precede Sudden Cardiac Arrest: Cohort Study

By: Pam Harrison

Warning symptoms, notably chest pain and dyspnea, occur during the 4 weeks preceding sudden cardiac arrest (SCA) in at least half of cases involving middle-aged adults, suggests a new study. The warnings are usually ignored, observe researchers, with few patients phoning 911 in response to what is almost always a fatal event.

The analysis based on the Oregon Sudden Unexpected Death (SUD) cohort was published online December 22, 2015 in the Annals of Internal Medicine.

“We always thought that SCD was so unexpected that there wouldn’t be any time to act,” senior author Dr Sumeet Chugh (Cedars-Sinai Heart Institute, Los Angeles, California) told heartwire from Medscape.

“So the first surprise was that sudden death may not be as sudden as we thought,” he said. “But we were also surprised by the fact that there were people who had their symptoms not only in the 24 hours that preceded the arrest, but some who had symptoms in the 4 weeks that preceded their event.” Women and men didn’t differ in their likelihood of having symptoms, he added, but the nature of symptoms was different by sex.

“The whole study was a surprise, and the findings could open a new window of opportunity for the prevention of SCD in middle-aged adults, [in whom] the arrest hits society the hardest because most . . . breadwinners are in this age category.”

The Oregon SUD study is a large, prospective, community-based study of deceased and surviving patients who had an SCA in the Portland, Oregon metropolitan area.

As reported by Dr Eloi Marijon (European Georges Pompidou Hospital, Paris, France) and colleagues, the analysis included 839 patients between 35 and 65 years of age with SCA whose prodromal symptoms could be comprehensively assessed.

Data on symptoms were collected by the Oregon SUD investigators based on information documented by the emergency medical services (EMS) team in the field, intensivists or cardiologists at 16 local hospitals, and physicians in the community.

Of the 839 patients, 430 patients or 51% of the cohort experienced at least one symptom within the 4 weeks preceding their arrest. Men and women experienced prodromal symptoms with equal frequency at 50% vs 53%, respectively.



CLICK HERE for more resources on Fundamentals of Nursing
CLICK HERE for more resources on Laboratory & Diagnostic Test

Symptoms also started more than an hour before SCA onset in 80% of patients; but in 147 of these patients, symptom onset occurred more than 24 hours before their arrest. Among this subgroup of patients, 93% had recurrent new episodes of symptoms during the 24 hours preceding their arrest.

“The main symptom was chest pain, documented in 199 patients,” or 46%, Marijon observed. Of those, 76% had “intermittent typical angina,” he said.

Another 18% of patients had dyspnea as their apparent prodromal symptom; about one-third of this group had established congestive heart failure or a pulmonary condition. Only 5% of the cohort developed syncope or palpitations as presumed prodromal symptoms.

“Men experienced more chest pain than women, whereas women experienced more dyspnea (P<0.001)," write Marijon and colleagues. However, even when the analysis was restricted to patients with documented CHD, chest pain rates at 32% among women were still lower than they were for men at 58% (P=0.001).



Calling 911 and Survival

Among the 430 patients who experienced symptoms prior to SCD, 19% had called EMS before SCA onset. Among the 81 patients who made a 911 call, over three-quarters of them arrested prior to arrival of the EMS team and 22% arrested while in transit to the hospital.

Importantly, however, 32.1% of those who called 911 survived to hospital discharge, compared with only 6% of patients who did not call 911 (P <0.001). In adjusted analysis, making a call to 911 increased the likelihood that patients would survive to hospital discharge by almost fivefold, at an odds ratio (OR) of 4.82 compared with those who did not call (P<0.001). What Can Be Done

“We do have ways to prevent SCA, the most important being the implantable defibrillator,” Chugh said. However, the ability to select appropriate candidates for an implantable defibrillator is still very limited, he added, “so it is going to take us some time to get to this goal.”

That an early call to 911 was associated with better survival odds in the current study suggests there is a potential to enhance short-term prevention of SCA by targeting public awareness of SCA. But, “right now, we can’t say that everybody who has chest pain or shortness of breath should call 911—that would be a disaster,” Chugh said.

“But we do know that we have the potential to make a novel dent in the burden of SCD, and we need to move to the next step where we identify patterns of risk—perhaps a combination of circumstances, clinical profile, and symptoms—that denotes high risk. And if we can identify these patterns, then it could be in that time window, which is 27 days and 23 hours longer than we expected, when patients could reach out to their healthcare provider and something could be done to nip SCA in the bud.”

The study was funded by the National Heart. Lung and Blood Institute. Chugh reports grants from the National Heart, Lung, and Blood Institute, Philip Foundation, Bettencourt Schueller Foundation, French Society of Cardiology, Foundation for Medical Research, and French National Institute of Health and Medical Research outside the submitted work. Marijon and the other coauthors have no relevant financial relationships.



CLICK HERE for more resources on Fundamentals of Nursing
CLICK HERE for more resources on Laboratory & Diagnostic Test

New Guideline: Diagnosis of Fetal Alcohol Spectrum Disorder

New Guideline: Diagnosis of Fetal Alcohol Spectrum Disorder

By: Marcia Frellick

A new Canadian guideline for diagnosing fetal alcohol spectrum disorder (FASD) updates recommendations last issued in 2005 and is specifically designed for multidisciplinary diagnostic teams.

The guideline, published online December 14 in the Canadian Medical Association Journal, includes a change in terminology. Previously, the cluster of birth defects (including restricted growth, craniofacial abnormalities, and intellectual disabilities) caused by prenatal exposure to alcohol was known as fetal alcohol syndrome (FAS). The new terminology includes a wider spectrum of disabilities and presentations.

Estimates put the number of people with FASD at 1 in 100, translating to more than 330,000 people in Canada who are affected.

Primary Care Role Critical

Primary care physicians play a crucial role in diagnosing FASD, Christine A. Loock, MD, a developmental pediatrician at Children’s and Women’s Health Centre of British Columbia, Vancouver, Canada, said in an accompanying podcast conducted by the journal.

“The primary health provider is the medical home,” she said. “The trust and relationship that is key to that medical home is the foundation for making a referral.”

Dr Loock added, “alcohol does not just affect the brain but can affect other aspects, including fetal growth and other birth defects. Most important, there may be interventions that may mitigate alcohol’s effects, including nutritional interventions.”

She said primary care physicians should ask all women about alcohol use. “We should not confine this to times of pregnancy or postpartum, but to be asking young women and providing support…. Interventions do work.”

The Canada Fetal Alcohol Spectrum Disorder Research Network led the effort to update the guidelines with funding from the Public Health Agency of Canada.




New in This Version

The updated guidelines include special considerations for diagnosing FASD in infants, young children, and adults.

They recommend that infants and young children with all three sentinel facial features and small head circumference be diagnosed with “FASD with sentinel facial features.” These children are at high risk for neurodevelopmental disorder.

The three facial features are palpebral fissure length of at least two standard deviations below the mean (below the third percentile), philtrum rated 4 or 5 on the 5-point scale of the University of Washington Lip–Philtrum Guide, and thin upper lip rated 4 or 5 on that scale.

Growth is no longer a diagnostic criterion.

One of the study’s coauthors, Valerie Temple, PhD, from Surrey Place Centre in Toronto, Ontario, Canada, said during the podcast, “Growth deficits are not as common as we initially believed, and they are clearly not specific to FASD.”

The authors include a detailed flow chart in the new guidelines for help in making a diagnosis.

Infants and young children who do not meet the criteria for FASD, but have confirmed prenatal alcohol exposure, should be designated as, “At risk for neurodevelopmental disorder and FASD, associated with prenatal alcohol exposure,” the new guidelines advise.

The guidelines also stress the need for a multidisciplinary support team.

“Just as diagnosing FASD is important, so too is ensuring the patient and their caregivers receive the support they need to obtain necessary services that may improve quality of life,” lead author Jocelynn Cook, PhD, director of the Society of Obstetricians and Gynaecologists of Canada, said in a news release. “They will need specialized support from a team of experts such as child development specialists, occupational therapists, speech-language therapists, psychologists and specialized physician supports, depending on their ages.”

This project was funded by the Public Health Agency of Canada and the Canada Fetal Alcohol Spectrum Disorder Research Network. The authors have disclosed no relevant financial relationships.

CMAJ. Published online December 14, 2015.

Click HERE for Full text

Antidepressants in Pregnancy Linked to Increased Autism Risk

Antidepressants in Pregnancy Linked to Increased Autism Risk

By: Nancy A. Melville

“Serotonin inhibition during brain cell development is therefore likely to have an impact on cognitive function in general, and in the case of this study, it appears to affect the risk for ASD.”

Although previous studies have also suggested an increased risk for ASD in association with maternal use of antidepressants, this study is the first to stratify the risk according to drug class and trimester exposure, Dr Bérard noted.

It was estimated that approximately 6% to 10% of pregnant women in the Quebec cohort were treated with antidepressants. Dr Bérard noted that higher rates have been reported in the United States.

“The US data show rates can be as high as 15% or more, depending on the practice,” she said.

Dr Bérard noted that research has shown that 80% to 85% of depressed pregnant women have mild to moderate depression ― similar to rates in the general population. In those cases, more treatment options are available, including nonpharmacologic ones.

“I believe [US physicians] may overestimate the benefit and minimize the risks of use of antidepressants in pregnancy, and women may not even be aware of the risks because the information isn’t disseminated to them.

“We would never advocate not treating depression, but particularly in pregnancy when the depression is mild, it’s important to consider that antidepressants are just one treatment option,” Dr Bérard said.




Balancing Risks and Benefits

In an accompanying editorial, autism expert Bryan H. King, MD, agreed but added that the data on the many potential causes of autism cloud the issue of the risk associated with antidepressant use.

“It does seem a given that nonpharmacologic approaches will be first line in pregnancy, for any condition,” he told Medscape Medical News.

“[However,] the issue of weighing risks and benefits is very complicated, and this study only looks at autism,” said Dr King, who is professor and vice chair of psychiatry and behavioral sciences and director of Seattle Children’s Autism Center, Seattle Children’s Hospital, in Washington.

Dr King noted that the increased risk observed in the study “cannot be uncoupled from a possible genetic risk for autism that might be shared with that for depression, [and] this study does not look at risks to the mother and child from untreated depression or anxiety,” he said.

In his editorial, Dr King noted that several studies have shown a potential overlap in risk factors for depression and ASD, including a recent study showing genetic overlap in some patients with both depression and ASD.



In addition, he cited another recent study involving a large cohort in Finland in which exposure to SSRIs during pregnancy was found to be associated with various benefits. For children born of mothers who had been exposed to SSRIs, there was less risk of being born preterm and there were fewer cases of cesarean delivery compared with children whose mothers had not been exposed to psychotropic medications but who had been diagnosed with psychiatric illness. However, exposure to antidepressants in utero was associated with lower Apgar scores and an increased need if monitoring.

As data mount on the risks of the treatment as well as nontreatment of depression with antidepressants in pregnancy, “it makes no more sense to suggest that antidepressants should always be avoided than to say that they should never be stopped,” Dr King wrote.

Importantly, clinicians should work to keep patients aware of the risks and benefits.

“I think it is worth being reminded that clinicians and their patients know how severe the depression that they are treating is or was, and they also know the degree to which medication has been helpful,” Dr King said.

“This knowledge should frame the discussion of risks of changing what presumably is an effective treatment, and of potential illness exacerbation for both mother and fetus, against risks of possible adverse developmental outcomes that might accrue from medication exposure.”
CLICK HERE for more resources on Fundamentals of Nursing
CLICK HERE for more resources on Laboratory & Diagnostic Test

No Causation

Nada Stotland, MD, professor of psychiatry with Rush University, in Chicago, added her concern that the study may unnecessarily raise alarm among patients and parents alike.

“The study doesn’t prove any causation, and what concerns me is that having a child with autism is a very hard situation to be in, and parents always seem to look to something they did or something to blame that may have caused it, such as vaccinations,” she told Medscape Medical News.

“So these are two very vulnerable populations ― parents of children with autism, and women with depression in pregnancy, and we have to be extremely careful about clarifying what the study really shows.”

Dr Stotland also noted what she said were methodologic weaknesses in the study, such as details of patient treatment and severity of depression.

“The findings go back to whether this changes anything, and the answer is no.”

The study received funding from the Canadian Institutes of Health Research and the Quebec Training Network in Perinatal Research. Dr Bérard’s has served as a consultant for plaintiffs in litigation involving antidepressants and birth defects. Dr King has disclosed no relevant financial relationships.

JAMA Pediatr. Published online December 14, 2015.




CLICK HERE for more resources on Fundamentals of Nursing
CLICK HERE for more resources on Laboratory & Diagnostic Test

WhatsApp No.: +2348055338879
Website Design Company in Lagos, Nigeria - CKDigital