Student nurses wow Memorial Regional Health providers
During the eighth annual poster presentation held recently at The Memorial Hospital, second-year nursing students from Colorado Northwestern Community College spoke to providers about their research and ideas to improve medical care.
“For the Peoples Choice, and most thought-provoking poster, the winner was Tiffany Ford, with her poster on genetic testing for choosing anti-depressants,” CNCC nursing faculty Julie Alkema wrote in an email. Alkema added that the recognition for the poster with “the Evidence-Based Practice you (providers) are most likely to incorporate” was a tie between Ford and Makala Sheridan. Sheridan’s research explored the use of clean versus sterile dressings.
At least two students provided ideas about affordable, non-opioid options for pain treatment, such as the use of a TENS device — a small, portable, and powerful electrotherapy unit — which student Amy Nielson believes would provide relief for some patients. Student Taylor Schmidt, who said she’d like to be an obstetrician-gynecologist, presented her research on using nitrous oxide instead of epidurals during childbirth. Student Natasha Goncalves presented on the pain-relieving power of yoga.
Some students used their posters to present population intervention comparison and outcomes. Student Allie Herring considered what is safer, eight or 12-hour nursing shifts, and concluded eight-hour shifts result in fewer nursing mistakes. The relationship between antibiotics and the development of food allergies was the topic of student nurse Megan Gerloff’s poster.
Student nurse Tessa Briggs took a look at the benefits of on-site daycare for hospital staff, while Kylee Rodriguez looked at the role of oral care in preventing “device infections,” which can lead to pneumonia. Sadye Morgan described patients’ increased propensity to bath when given the choice to use chlorhexidine wipes, and Yunira Gomez presented her finding on reducing “alarm fatigue.”
Alkema began the poster program eight years ago as a penultimate project for student nurses planning to graduate her advanced medical-surgical program for the care of acutely ill adults.
Hospital Transformation Project, physician contracts top Memorial Regional Health agenda
An update on the Colorado Hospital Transformation Project will be the topic of an educational presentation over dinner when the Memorial Regional Health Board of Trustees meets at 5 p.m. Thursday, March 21.
HTP is an initiative mandated by Senate Bill 17-267 and under development by Colorado Department of Health Care Policy and Financing Department.
According to HCPF, the HTP is “set to change health care delivery.” Delivery system reform incentive payments, or DSRIP, will be used to support hospital-led projects to:
• Improve patient outcomes through care redesign and integration with the community- based providers
• Improve the patient experience in the care delivery system and support appropriate care in appropriate settings
• Lower Health First Colorado (Colorado’s Medicaid program) costs through reductions in avoidable care
Staff at MRH have been working with community partners since September to develop the health system’s approach to meeting HTP goals, as reported in the Craig Press.
At their regular meeting, beginning at 6 p.m., board members will convene an executive session to discuss physician contracts.
The complete agenda is available below.
Living Well: When to seek medical treatment for the flu or common cold
Did you know flu season can last as late as May? It's not too late to get a flu vaccine, which can help reduce the risk of flu illness by up to 60 percent, according to the Centers for Disease Control and Prevention.
This flu season, patients around the region have presented flu symptoms with or without documented fever but with the sensation of feeling feverish and chills, said Allison Hamburger, Physician Assistant at Memorial Regional Health. Frequent symptoms this flu season also include headache, cough, sore throat, body aches, and fatigue. Often there is a lot of rhinitis (runny nose) or nasal congestion, and sometimes diarrhea and vomiting, she said.
Flu symptoms should be evaluated by medical providers to determine the best treatment options for each patient. Some symptoms require immediate medical attention (see fact box).
"I feel the best way to shorten the duration of flu symptoms is to get vaccinated. The goal is to prevent the flu, but if such happens, being vaccinated should still help reduce severity," Hamburger said. "If flu symptoms present, the quicker you are evaluated the better, as starting Tamiflu (Oseltamivir) ASAP will also help shorten the duration of symptoms."
This season's flu vaccine appears to succeed in reducing the severity of symptoms, according to Jennifer Schmitt, a Physician Assistant at MRH's Rapid Care Clinic. The vaccine can't guarantee flu prevention, but it can help minimize symptoms compared to those who didn't get a flu shot.
Hamburger notes a 2018 CDC report as another case for getting a flu vaccine. The report showed that among adults hospitalized with the flu, vaccinated patients were 59 percent less likely to be admitted to the ICU than those who were unvaccinated. Another 2017 study showed that the flu vaccine reduced deaths, ICU admission, ICU length of stay and overall hospitalization among flu patients.
To prevent spreading the flu, Schmitt said it's important to wash your hands frequently and to stay home from work or school while contagious, which is usually the first 3 to 4 days after the symptoms began. The CDC also recommends staying home for 24 hours after a fever has resolved.
For those with flu or common cold symptoms, Hamburger said staying hydrated and rested are essential.
"I encourage patients and parents of young patients to have a very attentive focus on hydration. Fever can lead to dehydration and your body needs the extra fluids," Hamburger said.
"An electrolyte solution like Pedialyte or Gatorade is a good idea because the added salt and sugar will help maintain one's fluid balance. Control fever with Tylenol (Acetaminophen) or Ibuprofen as needed."
There are anecdotal remedies that can't hurt to try, either. Hamburger notes that warm baths help her children relax when they're feeling crummy,
For anyone who suspects they have the flu and medical treatment is desired, Hamburger said the ideal window to seek treatment is within the first 48 hours from the start of symptoms.
The Suction Clinic for babies and young children
Babies and young children who get upper respiratory tract infections often can't blow their nose or otherwise clear nasal secretions and mucus well on their own. That's where MRH's Suction Clinic can provide relief — for the kids as well as their parents.
The Suction Clinic's respiratory therapists use a nasopharyngeal suction machine to suck out secretions, and they evaluate children by counting the respiratory rate and checking for oxygen saturation.
The Suction Clinic is open 24 hours a day, 7 days a week. Hamburger said parents can get a prescription and it can be used up to 4 times a day for a week. There's no appointment needed and the cost is $128 per visit, which is billed to insurance. To check in, visit the emergency department's main desk and let them know you're there for the Suction Clinic.
WIC provides nutrition stepping stone
Good nutrition, a stepping stone to a healthy life, starts early. To establish a healthy diet during pregnancy and early childhood, families need access to nutritious foods as well as education and support to help them overcome barriers to healthy eating.
That is where WIC comes in. Established in 1974, the Women, Infants and Children program helps ensure women who are pregnant or breastfeeding, and children up to age five, have the food and nutrition education necessary for healthy growth and development.
Women who qualify for the program receive nutrition counseling and foods designed to supplement their diets with important nutrients. WIC-approved foods include fruits and vegetables, eggs, healthy dairy products, beans, and whole grain bread.
WIC, a federally funded program, is available at Northwest Colorado Health. In 2018, WIC served more than 800 women, babies, and children in Moffat, Routt, and Jackson counties.
Arin Daigneau, family nutrition, health and safety services manager at Northwest Colorado Health, attributes the program's success to the relationships WIC educators have with their clients.
"For our program to truly impact the nutrition and health of families in our community, they have to participate. If they didn't feel comfortable and supported they wouldn't continue with the program," she said. "We serve some families for many years, from the beginning of their first pregnancy until their youngest child turns five."
WIC has evolved to be relevant and user-friendly for modern moms. They use an app to find WIC-eligible foods in the grocery store, pay for them with an e-WIC card, and receive appointment reminders, program updates, and nutrition tips via text.
To qualify, women and children must meet income and state residency requirements and be nutritionally at risk. They may have medical risks such as anemia or a history of pregnancy complications or dietary risks such as poor nutrition.
Shania Gurr, a registered dietician at Northwest Colorado Health, works with WIC clients who have a particularly high risk of health problems.
Counseling sessions are an opportunity for her to check in with them about their eating and overall health, making sure they are up-to-date on immunizations and well-child visits and have a health care and dental provider.
"WIC is successful because it's basic," Gurr said. "We're giving them nutrition and guidance they might otherwise not be getting and having conversations to see if we can help them with other aspects of their health. If they stick with it, the benefits they receive from this program can significantly improve their health in the long term."
For more information about WIC, visit northwestcoloradohealth.org/wic or call 970-871-7653.
No more: Moffat County commissioners declare March 24 to 30 domestic violence week
The Moffat County Board of County Commissioners wants to do its part to combat domestic violence in the Yampa Valley.
During their Tuesday, March 19 meeting, commissioners declared March 24 to 30 as "No More" week in Moffat County. The week will be spearheaded by Beka Warren, executive director of Open Heart Advocates, which helps battered residents in abusive relationships get the help and services they need to change their lives for the better. Warren will travel to schools across Moffat County to serve food and educate kids about domestic violence.
According to Warren, one in three American women have been victims of domestic violence while one in four women are victims of sexual assault. She said men are also often victimized.
Warren also maintains at least two people on call at all times to answer a hotline for domestic or sexual abuse victims.
“Our service is really to be with them and work with them and let them know what their choices are,” Warren said.
County Commissioners also currently lease an 11-bed shelter facility to Open Heart Advocates for $1 per year, where residents seeking protection can escape potential abusers and get back on their feet.
"Our advocates right now have a caseload of about 56 families that we work with on a regular basis," Warren said at Tuesday morning's commissioner meeting.
Considering the staggering number of domestic violence victims across the country, especially children, Commissioner Ray Beck thanked Warren.
"15.5 million children were exposed to domestic violence every year. That's horrific," Beck said. "Thank you for all you do for our community."
Commissioner Don Cook also thanked Warren for her dedication.
"She's a very dedicated community servant," Cook said. "She's been our deputy coroner for many years, which means many times she was the acting coroner."
City officials excited about $150,000 award for Breeze Park improvements
Craig residents and their families who frequent Breeze Park may be happy to know the park will get a six-figure facelift this year.
In a recent news release, Great Outdoors Colorado announced its board awarded the city of Craig a $150,000 grant to update Breeze Park, one of the city’s main municipal parks.
“This is the fourth time we have applied to GOCO for a Breeze Park Development Grant,” said Dave Pike, parks and recreation director with the city of Craig. “Since 2011, when the MCSD donated the Breeze Street property to us, we have been applying to Great Outdoor Colorado for some financial assistance. Each time we were unsuccessful, our feedback indicated that we needed to update our parks and recreation master plan. We finished that process last fall and throughout the project we heard from the public that completing Breeze Park was a top priority. With our updated plan in place we applied again last fall and we finally hit the jackpot.”
City officials have been making improvements to the park since at least 2015, but the GOCO grant will offer additional upgrades to the park, including a second construction phase on the park’s 35-year-old irrigation system, a concrete rail compliant with the Americans with Disabilities Act, new picnic shelters, a new 720-square-foot gazebo, new shade canopies, trash receptacles, park benches, and picnic tables.
“This phase of development will include a picnic shelter large enough to accommodate family gatherings, weddings or class reunions,” Pike said in an email. “Also there will be several smaller shade shelters, a walking path, a new irrigation system, and a poured-in-place safety surface throughout the playground system. In addition, we will be doing some more landscaping and installing some permanent corn hole boards.”
Great Outdoors Colorado noted in the release that the park sees about 5,300 visitors per year, many of whom live within walking distance for events like weddings, festivals, farmers markets, movies in the park, the Arbor Day Tree Celebration, and other programs.
“To date, GOCO has invested $8.8 million in projects in Moffat County and has conserved more than 37,400 acres of land there,” the news release said. “GOCO funding has supported the Moffat County Loudy-Simpson Soccer Field expansion, Elkhead Reservoir Recreation Facility, Dinosaur Sports Field and Ice Rink, Ridgeview Park playground, and Moffat County Fairgrounds, among various other projects.”
Completion of the Breeze Park upgrades are expected to be completed late this summer or early fall, according to Pike, who will continue to work towards providing a better quality of life for Craig residents.
“It seems like every time we talk about economic diversification recreation, trails and improved river access is always in the mix,” Pike said. “I think it is very important to continue improving our recreation amenities every chance we get. If we want to make Craig an attractive place to live and raise families we need to offer exceptional recreation opportunities.”
Fitness Tip: Apps to help keep your resolve
It’s the middle of March, but when the weather turns nice many people are turning away from the fitness resolutions they made at the beginning of the year. Some health experts recommend using an app to stay on track.
The All Home Connections from AT&T data team compiled a list of the top nine free health and fitness apps featured on both the iTunes and Google Play stores, then used Google Trends from the past year to determine the search volume for each app by state. Coloradans’ top pick: the 30-Day Fitness Challenge.
Google Play says of the app, “The 30 Day Fit Challenge Workout, designed by a professional fitness coach, is scientifically proven to help improve fitness and health. Also, this app can synchronize with burned calorie data on Google Fit. Stick with the program, and you will see amazing results.”
Superfood Tip: Colorado beef in spotlight
Moffat County ranks as one of Colorado’s largest beef producers. Lean beef can be a healthy part of a balanced diet, according to health experts.
“Meat is one of the most complete dietary sources of protein, the amino acid profile being almost identical to that of our own muscles,” states Atli Arnarson for Healthline.com. “For this reason, eating meat, or other sources of animal protein, may be of particular benefit after surgery and for recovering athletes, or during other conditions where muscle tissue is being built.”
He also notes:
• Beef contains varying amounts of fat (mainly saturated and monounsaturated), which contributes substantially to its energy content. • A part of the fat content of beef is made up of ruminant trans fats, including conjugated linoleic acid (CLA). Ruminant trans fats have been linked with several health benefits, such as weight loss. • Meat is an excellent source of various vitamins and minerals. These include vitamin B12, zinc, selenium, iron, niacin, and vitamin B6. • Animal meat contains a number of bioactive substances, such as creatine, taurine, conjugated linoleic acid (CLA) and cholesterol. • As a rich source of high-quality protein, beef may contribute to the maintenance and growth of muscle mass. • Beef is high in carnosine, which may reduce fatigue and improve performance during exercise. • Beef is an excellent source of iron and may help prevent anemia when eaten regularly.
Choosing the right quality of beef and eating the properly cooked, wise portions is important in reaping these health benefits
Studies have shown that: • It is unclear whether meat consumption increases the risk of heart disease or not. Some studies have found a link, but not others. • Fatty beef is a rich source of saturated fats, which may increase blood cholesterol. However, the link between saturated fats and heart disease has been disputed in several recent high-quality studies. • High consumption of well-done (overcooked) meat may increase the risk of several types of cancer. • In some countries, raw (or rare) beef may contain beef tapeworm, an intestinal parasite that may lead to weight loss and stomach pain. • As a rich source of iron, high beef consumption may contribute to excess iron accumulation in people with hemochromatosis.
Wednesday, March 20 is Colorado’s Agriculture Day at the Capitol, a part of National Agriculture Week celebrations, the event recognizes the contributions of ranchers and farmers across the nation including many from Moffat County.
In Colorado, ag producers feed, fuel, and cloth the state's more than five million residents and stewards resources. The industry’s economic impact makes it a top three contributor to the state's economy, bringing in more than $40 billion annually and providing over 173,000 jobs.
Northwest Colorado veteran fights for better health care in rural Colorado and nationally
STEAMBOAT SPRINGS — Health care benefits for veterans aren’t just handed over. They must be constantly fought for, as Jim Stanko knows firsthand.
Today, Stanko, who served in the U.S. Army after being drafted in the early 1970s, dedicates a significant amount of time and energy to ensuring veterans receive the health care they need — and earned.
Stanko is a third generation rancher, operating a centennial ranch, with a cattle and hay operation, on Routt County Road 33, but it has been addressing the challenges facing veterans in rural areas, in particular, that is the work closest to Stanko’s heart.
It was in the 1980’s, when he was working at the Routt County Extension Office, Stanko became involved in health care issues facing veterans. His office was next door to the local Veterans Affairs office. He soon joined the American Legion and became commander of Post 44 in 1995. He also became a member of Veterans of Foreign Wars.
One of the first issues Stanko worked on was bringing a telehealth clinic to Craig.
With the closest VA hospital being Grand Junction, Stanko saw a need for veterans, especially the World War II vets, to get care closer to home.
The telehealth clinic in Craig was the first of its kind in Colorado, Stanko said, and “set a standard for the state and the country.” It provided a place where a nurse practitioner covers basic care and can draw blood and monitor vital signs but can teleconference with VA doctors in Grand Junction for additional needs.
Because of his work with the telehealth clinic, Stanko was appointed to the Colorado Board for Veterans Affairs in 2006. He served as chairman for the past two years.
Through his work on the state board, they were able to utilize money from tabacco lawsuits to establish a veteran trust fund for grants.
Stanko and Post 44 applied for one of the first grants, allowing them to provide transportation for veterans to and from Grand Junction or wherever they received treatment.
They’ve gotten that funding for about 15 years, Stanko said, though it is never guaranteed and must be applied for on an annual basis.
Six years ago, Stanko was appointed to the American Legion’s Veteran Affairs and Rehabilitation Commission.
He just returned from his sixth lobbying trip to Washington D.C., where Stanko and a group of other veterans from across the country held meetings with every congress member.
He personally met with Reps. Scott Tipton, Cory Gardner, Doug Lamborn and Ken Buck — thus “covering almost all of rural Colorado.”
While there are numerous legislative issues the American Legion advocates for, Stanko pointed to three at the top of his priority list.
First is support for the VA’s suicide-prevention efforts. An estimated 20 veterans end their lives every day, and most were not receiving care or support through the VA — support that may have saved them — according to the American Legion’s Legislative Agenda.
Access to mental health care isn’t readily available, Stanko said. And they are seeing a lot of younger veterans returning with post traumatic stress disorder and traumatic brain injuries.
While there may have not been any veteran suicides in Routt County in recent years, there are a lot of young veterans returning from service, and the “potential is there.” Stanko wants to be proactive on the preventative measures, like expanding mental health treatment.
A second important issue is improving health care for female veterans. Women now make up about 30 percent of the military, Stanko said. And a large percentage don’t enroll for benefits, according the American Legion, with one of the factors being “limited gender-specific treatment services.”
Stanko has been involved in visits to hospitals with suggestions on how they can “better accommodate women veterans.” And hospitals in Denver and Grand Junction have responded as a result, he said. They’ve created separate areas within the VA hospitals and adapted other components to better serve women. “I can say I’ve been a part of the group getting the VA to recognize and establish better health care accommodations for women,” he said.
Stanko’s biggest push is for the implementation of the VA Mission Act. In 2014, the Veterans' Access to Care through Choice, Accountability and Transparency Act, known as the Choice Act, was passed, but it was rife with problems, Stanko said.
In order to get care from chosen or local providers, there were numerous layers through which to navigate — both for veterans and providers. And providers often weren’t seeing the reimbursements they were promised.
The intent was to allow veterans to choose their health care providers, but the actual execution was poorly designed, Stanko said.
“The implementation was sort of on the spur of the moment to make people feel better. It just didn’t work.”
It has since been replaced with the 2018 Mission Act, which addresses many of the insufficiencies, Stanko said. But, it still has to be funded.
The hope is to see implementation by June, he said. And under the Mission Act, veterans will first go to the VA hospital. If the VA hospital can’t provide the immediate and necessary services, then the VA will assign the patient to a local or outside provider.
Another important component of the Mission Act, Stanko said, is the stipend provided to at-home caregivers. But, part of that battle has been getting the stipend to apply for older, pre-September 11, 2001, veterans.
For decades, Stanko has put in countless hours toward advocating for his fellow veterans, in addition to running a ranch.
“It’s a passion for me,” he said. “I’ve always felt living in rural areas has often given us the short straw in getting the benefits veterans deserve.”
In addition to his annual trip to D.C., Stanko keeps track of everything happening legislatively as the state and national level and attends town halls with local representatives.
Looking forward, he wants to see more young veterans get involved. “They don’t always realize the benefits they are getting are because of the veterans who came before.”
Memorial Regional Health: Feeling tired, fatigued? It could be a lack of quality sleep
Editor’s note: The following article is sponsored by Memorial Regional Health. A few portions of this article previously appeared in a separate MRH-sponsored article in the Craig Press.
Do you feel excessively tired or unrefreshed during the day? Does your partner complain of loud snoring or notice pauses in breathing during sleep?
Sleep apnea can be a serious disorder due to complications that can include high blood pressure, heart problems, type 2 diabetes, metabolic syndrome, liver problems and more, according to the Mayo Clinic. It can also cause sleep deprivation for the partners of those with the condition, and it can cause complications with medications and surgery.
Sleep disorders such as sleep apnea and narcolepsy, which is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep, are more prevalent than people realize, said Selena Hafey, Polysomnographic Technologist and Certified Sleep Study Technologist at Memorial Regional Health.
"Sleep is important, and people need to value their sleep," she said. "I hear the phrase often, 'sleep is for the weak,' and I could not disagree more. Sleep is for everyone. People need sleep to function, and it needs to be a priority."
Obstructive sleep apnea
Obstructive sleep apnea is the most common of all sleep disorders. The airway collapses or is blocked during sleep, causing shallow breathing or a pause in breathing. Pauses can last a few seconds or minutes and can occur 30 or more times in one hour. The person starts breathing again, sometimes with a choking sound or loud snort as they gasp for air.
Because of interrupted sleep, they are left tired and drowsy during the day — often relying on stimulants like coffee or soda to stay awake. Sometimes with sleep apnea, people have no energy so they don't want to do anything, and their doctors mistakenly treat them for depression. In addition, people commonly have morning headaches from the decrease in oxygen.
"Quality sleep helps repair the mind and body. A lack of quality sleep can take a toll on the body, which can lead to things such as cardiovascular disease, diabetes, obesity, and depression," Hafey said. "Please make time for sleep — it is important!"
Diagnosis and treatment
Sleep apnea is diagnosed with a sleep study, which Memorial Regional Health can provide nearly every night of the week. Sleep studies are also available during the day for people who work unconventional shifts.
The room is set up like a bedroom in a home to make patients feel comfortable. Hafey begins by wiring the patient with leg EMG wires, EKG wires, chest and abdomen belts, and EEG and EOG wires on the head that can read the patient's sleeping and waking brain waves.
"After the wires are applied the patient is allowed to read, watch TV or pass time until 10 p.m. By then, the test needs to be started. The lights are turned out and the patient attempts falling asleep," Hafey said. "I may try different therapies on the patient such as CPAP, BiPAP or supplemental oxygen depending on patient needs. The test will continue until around 5 a.m., after which I will wake the patient up and begin taking the wires off."
If a patient has sleep apnea, the main treatment will usually be Continuous Positive Airway Pressure or CPAP. Hafey said this treatment keeps the patient's airway open while they sleep to avoid airway collapse, which aids breathing and helps prevent frequent awakenings.
If this CPAP pressure can't be tolerated or more advanced therapy is needed, Hafey said Bilevel Positive Airway Pressure (BiPAP) treatment might be more successful.
CPAP and BiPAP machines are common solutions for sleep apnea because they help to keep airways open. The machine, about the size of a toaster, has a tube with a mask attached and is relatively quiet. If you are diagnosed with sleep apnea, you will likely receive a prescription for a CPAP or BiPAP machine to help regulate your breathing. The machine sits by your bed and you wear a mask all night. It sounds strange, but people get used to it quickly. The tradeoff of good sleep is well worth it.
If these treatments don't work, another treatment option might be supplemental oxygen.
"Patients may have low oxygen saturation while asleep without breathing problems (pauses or shallow breathing), and in this case, oxygen might be necessary to bring their saturation levels up while asleep," she said. "One to two liters usually helps."
Why quality sleep should be a priority
Hafey said good, sound sleep is extremely important — as important as eating right or exercising.
"Good quality sleep is different from getting enough sleep. People can sleep for 8 or more hours but still not feel rested. This is because they are not getting quality sleep," she said. "Quality sleep is the sleep that makes you wake up feeling refreshed in the morning."
Deep, REM sleep is what restores a person's tissue, muscles, and body, Hafey said.
"REM sleep is restorative for the mind. Getting REM sleep repairs memory and cognition. Not getting this deep sleep makes one's mind not as sharp and leaving them feeling foggy throughout the day," she said. "Studies have also shown that it is more or just as dangerous to drive sleep-deprived as it is drunk."