WBEZ | medical school http://www.wbez.org/tags/medical-school Latest from WBEZ Chicago Public Radio en Hospital regulators let formula vie with breast milk http://www.wbez.org/content/hospital-regulators-let-formula-vie-breast-milk <p><div class="image-insert-image "><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/Vanessa3.JPG" style="margin: 4px 0px 0px; float: left; width: 266px; height: 199px;" title="Lactation consultant Vanessa Stokes says Cook County’s Stroger Hospital has a long way to go. (WBEZ/Chip Mitchell)"></div><p>A new French study shows that breastfeeding may have lasting benefits for a child’s metabolism. Other studies suggest breastfeeding helps prevent infections, chronic diseases and obesity. Evidence like this has moved the American Academy of Pediatrics to recommend giving babies no food or drink other than breast milk for their first six months. At many Chicago-area hospitals, though, breast milk competes with baby formula. At some of them, the real stuff usually loses. From our West Side bureau, we compare how the area’s hospitals approach breastfeeding and see whether watchdog agencies are paying much attention.</p><p>MITCHELL: Certified lactation consultant Vanessa Stokes landed a job in December.</p><p>STOKES: I was excited just to get to that place to really make a difference.</p><p>MITCHELL: That place was the maternity ward of Cook County’s Stroger Hospital. Stokes was there to encourage and train moms to breastfeed. But she noticed the hospital giving them signals it was OK to feed newborns formula.</p><p>STOKES: I saw bottles in the cribs.</p><p>MITCHELL: Then Stokes met one of the hospital’s newest mothers. Like many patients on the ward, she was young and black. What was less usual was her file. It showed she’d been planning to breastfeed.</p><p>STOKES: The baby was born and then, at night, she had some problems with latch-on, which happens. She said, ‘The nurse told me to give the baby a bottle.’ That’s what she told me.</p><p>MITCHELL: You believe her?</p><p>STOKES: Yes, I do. Most nurses, they just don’t want to take the time to help moms. They have a million other things to do.</p><p>MITCHELL: And there was no breastfeeding peer counselor or lactation consultant on duty overnight?</p><p>STOKES: No.</p><p>MITCHELL: One of Stokes’ supervisors at Stroger confirms that the hospital keeps bottles in cribs and that the nurses sometimes give out formula without any medical reason. <a href="http://www.wbez.org/story/baby-formula/breast-feeding-disparities-sharp-chicago-area-hospitals">Birth-certificate data</a> show that less than 60 percent of infants born at Stroger get to breastfeed there. And there are more places like this. A dozen Chicago-area hospitals have even lower rates. The data show there’s one on the South Side where just 10 percent of newborns start breastfeeding.</p><p>SOUND: Elevator door closes.</p><p>MITCHELL (on site): I’m inside that hospital now. It’s called Holy Cross. I’m taking an elevator to the 6th floor to see Anita Allen-Karriem. She directs what Holy Cross calls its Family Birth Center.</p><p>SOUND: Elevator door opens. Intercom voice. Birth Center door opens.</p><p>MITCHELL: Allen-Karriem shows me around the ward.</p><p>ALLEN-KARRIEM: And, as you can see, this is our rooming-in. And our moms are here and they can have their baby here 24/7...</p><p>MITCHELL: She says Holy Cross initiates breastfeeding within an hour of birth.</p><p>ALLEN-KARRIEM: My nurses have the tools that they need to assist with breastfeeding the mom. And we encourage breastfeeding on demand.</p><p>MITCHELL (on site): How many lactation consultants do you have on staff?</p><p>ALLEN-KARRIEM: We don’t have any. Our volume does not support that at this particular time.</p><p>MITCHELL (on site): Any peer counselors that come in as volunteers? Breastfeeding peer counselors?</p><p>ALLEN-KARRIEM: No, we don’t have that at the present.</p><p>MITCHELL: Allen-Karriem says convincing her patients to breastfeed is not always easy. She says most have not received any prenatal care before showing up in labor. Even more than Stroger Hospital, Holy Cross lets breast milk compete with formula. Allen-Karriem says her hospital sends moms home with a few days worth of formula. The idea’s to tide them over, until they get into a federal nutrition program that provides more.</p><p>ALLEN-KARRIEM: Is it the best method of nutrition? No, it is not. Breastfeeding is. However, it’s the mom’s choice. If she wants to exclusively breastfeed, we do not send her home with formula. However, because she has not chosen to breastfeed, would you send her outside your doors with no way to feed her infant and no way to buy any formula?</p><p>MITCHELL: Again, Holy Cross is at the bottom when it comes to breastfeeding rates in Chicago-area hospitals. Experts say that’s not a big surprise since it doesn’t have lactation consultants and gives out all that formula. But some hospitals are taking a different tack.</p><p>INTERCOM: Stroke alert for the Emergency Room...</p><p>MITCHELL: Like Stroger and Holy Cross, Mount Sinai on Chicago’s West Side serves mostly low-income patients. Last year about half the babies born at the hospital were getting breastfed there. To lift that rate, Mount Sinai says it’s planning to apply for a pro-breastfeeding designation from the United Nations called Baby Friendly.</p><p>SAIDEL: This is the room where the hearing screen is done...</p><p>MITCHELL: Lou-Ellen Saidel is one of two half-time lactation consultants on Mount Sinai’s maternity ward. She says you can see the effect of the Baby Friendly program right in this room. Saidel says the nurses used to quiet down babies for hearing tests by giving them formula. Now, she points to a big sign at eye level.</p><p>SAIDEL: It says, ‘Bottles should only be given for a documented medical reason.’ So now they don’t use formula on breastfeeding babies anymore in here.</p><p>MITCHELL: Saidel says Mount Sinai puts almost every staffer who comes into contact with new mothers or infants through breastfeeding training...</p><p>SAIDEL: ...from registered nurse to secretary. This is a process of people acquiring skills that were not taught in nursing school and medical school.</p><p>MITCHELL: For the Baby Friendly designation, some Sinai staffers will need more training. The sessions won’t cost the hospital much money but will eat up staff time. That could explain why no Chicago hospital has applied for the designation. But a lot of breastfeeding experts say the hospitals should give it a try.</p><p>ABRAMSON: Breastfeeding is one those priority areas that are life-and-death for their patients.</p><p>MITCHELL: Rachel Abramson is a former post-partum nurse who heads a Chicago nonprofit group called HealthConnect One.</p><p>ABRAMSON: Those of us who grew up thinking that formula feeding is the norm and perfectly adequate have a hard time shifting our vision to see the risks of illness in the first year of life, juvenile diabetes, of breast cancer for mother, of obesity and diabetes — lifelong — for mothers and babies.</p><p>MITCHELL: Abramson says the costs for treating these diseases often ends up on the shoulders of taxpayers. If that’s the case, you might think the government and hospital oversight groups would push hard for better breastfeeding rates. But they don’t push. They mostly nudge.</p><p>MITCHELL: One group with some accountability is the Oakbrook Terrace-based Joint Commission. It accredits hospitals. Ann Watt helps direct the commission’s quality-evaluation division. Watt says about a year ago the commission published some standards for hospitals to measure whether newborns were breastfeeding.</p><p>WATT: Our medical experts have indicated to us that this is a best practice.</p><p>MITCHELL: But these commission standards are voluntary. In fact, just three Illinois hospitals have adopted them.</p><p>MITCHELL (on phone): Could a hospital be performing poorly by these measures and still get accreditation?</p><p>WATT: Yes.</p><p>MITCHELL: Another group with some say is the Illinois Hospital Association. I asked the group whether it would support more public oversight of hospital breastfeeding practices. A spokesman declined to answer on tape but sent a statement saying the rules should not be rigid. The statement says breastfeeding management should begin with prenatal care, not the mother’s hospital stay. The hospital association also points out that the decision to breastfeed is personal.</p><p>MITCHELL: The folks with the most to say about hospitals breastfeeding rates are at the Illinois Department of Public Health. The department is in charge of enforcing the state’s hospital-licensing code. The code requires hospitals to follow basic breastfeeding guidelines that two physician groups published in 2007. In a statement to WBEZ, the Illinois Department of Public Health says it investigates breastfeeding infection-control issues. Otherwise, though, the department says it does not enforce the guidelines. That leaves public policy on breastfeeding largely up to individual hospitals — places like Stroger, Mount Sinai and Holy Cross.</p><p><em>Correction: An earlier version of this story misstated the status of Mount Sinai Hospital’s Baby Friendly effort. Chicago officials announced in August 2010 that Mount Sinai was seeking the international designation. The hospital registered to begin that four-phase process in September 2011.</em></p></p> Thu, 05 May 2011 16:23:00 -0500 http://www.wbez.org/content/hospital-regulators-let-formula-vie-breast-milk Mastery through simulation at Northwestern medical school http://www.wbez.org/episode-segments/mastery-through-simulation-northwestern-medical-school <img typeof="foaf:Image" src="http://llnw.wbez.org/P1000303.JPG" alt="" /><p><p>Technology and medicine go hand in hand. Now Northwestern University&rsquo;s <a target="_blank" href="http://www.feinberg.northwestern.edu/">Feinberg School of Medicine</a> is taking this relationship one step further.</p><p>There, students train in a real live clinical environment with real equipment. Their patients, on the other hand, are anything but.</p><p><em><br /></em></p><p><em><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> </em></p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!--[if !mso]><object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object> <style> st1\:*{behavior:url(#ieooui) } </style> <![endif]--><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} </style> <![endif]--> <p style="" class="MsoNormal"><em><span style="font-style: normal;">At a community hospital, two medical residents--Charles and Eunice--care for Haley, a 19 year old who gave birth two days ago.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Hayley&rsquo;s blood pressure is elevated and she complains about pain in her upper right abdomen. Her diagnosis is preeclampsia, and if she doesn&rsquo;t receive proper treatment, she&rsquo;ll start to experience seizures.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">In the room next door, another patient is suffering from postpartum hemorrhaging.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Within a half an hour, Charles and Eunice have stabilized both the &ldquo;patients.&rdquo;</span></em></p> <p style="" class="MsoNormal">&ldquo;Actually if you strip these particular mannequins down, they&rsquo;re actually a small computer running Windows XP, at the very core of things,&rdquo; says<em><span style="font-style: normal;"> Brian Florek, a simulation specialist. He manipulates the mannequins to react like a human patient.</span></em></p> <p style="" class="MsoNormal">&ldquo;So for example, if the physician decides to give a certain amount of fluids, we would tell the computer&nbsp;that the physician has given let&rsquo;s say 1000cc bolus of a certain fluid, and we would make sure the mannequin reacts representative of the treatment given.&rdquo;</p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Florek and fellow specialist Scott Murcko have a hand in implementing the exercises at the simulation center. According to them, this month&rsquo;s simulations focus on OBGYN procedures and last month was gastroenterology. They&rsquo;ve also covered neurology and toxicology.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">&ldquo;Every month the cases are a little bit different based on what [the students] are actively learning at the time,&rdquo; Florek says.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">But both Murcko and Florek agree, the &ldquo;wildest&rdquo; scenarios are the trauma situations, the ones that deal with multiple system failures, advanced airway placement, management of blunt trauma, chest tube insertion, management of hypovolemic shock, and massive blood loss.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">For the sake of realism, the mannequins are voiced by staff members from within the control rooms, but often times creating that realism is no easy task. </span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">The center is one of the largest buyers of fake skin outside of Hollywood, and they&rsquo;ve employed engineers to help design some of the more difficult anatomical recreations.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Dr. John Vozenilek, the director of simulation technology and immersive learning, explains that recreating anatomic structures like a premature newborn&rsquo;s ribcage has necessitated embedding architects and engineers into the simulation center.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">&ldquo;This newborn simulation is very challenging because we&rsquo;re dealing with a very small space. The newborns, particularly the premature newborns, sometimes they&rsquo;re only the size of a can of Coke,&rdquo; says Vozenilek. &ldquo;Sometimes it&rsquo;s like MythBusters, sometimes it&rsquo;s a little bit like the Keystone Kops, but one way or another, we wind up building body parts.&rdquo;</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">But Dr. Vozenilek says the mannequins are only one piece of the simulated environment.</span></em></p> <p style="" class="MsoNormal">&ldquo;We use real defibulators, real ventilators, real ultra sound equipment. We even stock our carts here so that if they reach into the second drawer of a cart here in the sim-lab, in the real clinical space, there&rsquo;s a cart that has the second drawer stocked exactly the same, so their motions, even their motions are trainable.&rdquo;</p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Watching and evaluating the learners from behind a two-way mirror is a whole team of medical and simulation experts.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Training in the simulation center is required of all Northwestern medical students in years one through four, and of residents from both the school and the hospital.</span></em></p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">But it&rsquo;s also available for practicing professionals, for those who want refreshers on certain procedures, or for those who want to keep up to date on the latest in medical technology, something that even experts like Dr. Vozenilek can benefit from.</span></em></p> <p style="" class="MsoNormal">&ldquo;The best example is ultra sound,&rdquo; says Vozenilek, &ldquo;ultrasound came in, really towards the end of my residency, I&rsquo;m forty years old now, and I'm getting ready to go through maintenance certification, ultrasound for me was a new technology. I know there are colleagues out there that haven&rsquo;t had the same opportunity to practice with ultrasound that would really have great benefit. We have an opportunity to provide a very nonthreatening environment for that learning.&rdquo;</p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Technology is at the center of simulation&rsquo;s emergence in medical school curriculum. Dr. Vozenelik says it&rsquo;s more than just a teaching tool, it&rsquo;s an ethical consideration.</span></em></p> <p style="" class="MsoNormal">&ldquo;We now have excellent tools to solve the problems of clinical education, tools that we didn't have before. Why would we not apply these excellent tools?&rdquo;</p> <p style="" class="MsoNormal"><em><span style="font-style: normal;">Simulation learning has already paid dividends at Northwestern hospital. Studies indicate that simulations have helped drastically reduce infections in Medical Intensive Care Units, creating a net cost-savings of over $700,000 in just one year.</span></em></p> <p class="MsoNormal">&nbsp;</p><p class="MsoNormal"><em>Music Button: Ima Robot, &quot;Swell&quot;, from the CD Another Man's Treasure, (Werewolf Heart Records) </em></p> <p class="MsoNormal">&nbsp;</p> <p class="MsoNormal">&nbsp;</p> <p class="MsoNormal">&nbsp;</p> <p class="MsoNormal">&nbsp;</p> <p class="MsoNormal">&nbsp;</p></p> Mon, 29 Nov 2010 15:30:00 -0600 http://www.wbez.org/episode-segments/mastery-through-simulation-northwestern-medical-school