The MammaCare Foundation recently issued a statement saying that according to recent studies, most breast cancers are found by hand. Mark Kane Goldstein, PhD, a MammaCare Foundation senior scientist stated, “A palpable lump, detected by hand is the most common symptom of breast cancer. Although mammograms—x-rays of the breast—can be useful, their images are masked by breast density in nearly 50% of women. Physical examination, however, is unaffected by density.”
Goldstein took time to answer questions for us about MammaCare and the foundation’s mission to help train every hand that examines a woman, including her own.
Why was the MammaCare Foundation established?
Our research on early breast cancer detection began at the University of Florida and Malcom Randall VA Medical Center because mortality from late stage breast cancer was an epidemic that continues to this day. We reported in a series of studies supported by the National Cancer Institute that properly trained hands will reliably detect small early, 3mm, pea-sized breast cancers (suspicious palpable tumors) without increasing false positive detections. Our original intention was simply to publish and promulgate the evidence and standards knowing they would enable clinicians and women to detect small early cancers.
We assumed, naively, that the training procedure would be
integrated into practice because it was an easily teachable skill that could
have a meaningful positive impact on women’s morbidity and mortality from
breast cancer without the dangers and expense or radiation. Sadly, resistance
from the imaging and radiological industries, and surprisingly from public and
private women’s health care agencies as well as U.S. Government health agencies
impeded training progress for a number of years as data accumulated.
Currently, breast cancers first detected continue to
remain 5 to 10 times larger and at a later stage than necessary. So, in
response, and with support from scientific agencies, the original research team
formed MammaCare to make the skills and standard for breast exam competency
What is MammaCare’s mission?
MammaCare’s mission is to train every hand that examines a woman for breast cancer. When the team of scientists, physicians, and biomaterial engineers began investigating the capability of fingers to detect breast cancers at the University of Florida, we were surprised that there were no prior evidence-based standards — no published research on the subject existed. We also learned that most women received clinical exams that were random or deficient, incapable of palpating small, suspicious tumors. We were puzzled by opinion and conclusions in the medical literature that the tactile sense was limited to feeling large, late-stage lesions. The only clinical papers published at the time reported that breast cancers discovered by hand and were late stage, large, 3-3.5 centimeters (about the size of a ping pong ball).
Our data from experiments found that with a brief training session using tactually accurate breast models, all hands were able to reliably detect 3-millimeter tumors, 10 times smaller than reported without increasing false positive detections. It was clear that breast cancer detection would be the province of the growing imaging, radiological industry. So, we created MammaCare to assure that a standard for a universal, safe, cost-effective standard of physical examination of the breast would be available.
Fingers feel and read sub-millimeter Braille dots
with absolute accuracy.
Many of the reports and studies on MammaCare are here.
Most women—and probably most nurses, female or male—believe that mammograms are the best way to find lumps. What does the MammaCare way offer that regular self-breast exams don’t?
Mammograms and increasing use of radiological imaging are widely available and most often used. It is puzzling, however, to note the evidence that indicates these technologies are not the most likely way breast cancer is first found. Moreover, numerous landmark studies by colleagues such as Joanne Elmore point out in a series of studies that mammography is only as good as the training and experience of the radiologist who reads them with his eyes. The same is true of untrained and trained hands with an important exception — the exam is free of ionizing radiation — an increasing concern — and mammograms often miss palpable tumors. Finally, between 40 and 50% of all women have dense breast tissue that clouds mammograms making interpretation difficult or impossible.
MammaCare training is now being installed in colleges of nursing and medicine providing breast exam skills and standards of practice for thousands of student nurses and physicians across the U.S. and elsewhere as indicated on the student login page.
What should nurses know about MammaCare?
That MammaCare has online and live training and certification programs, recognized continuing education courses and credits, and that new certification courses are conducted via live teletraining at the clinicians’ facility. There is a map on the front page of mammacare.org that should provide access to MammaCare certified nurses and their organizations.
Many of the colleges of nursing (and medicine) in the competency network are employing a new breast exam simulator that teaches and measures exam performance (the MammaCare Simulator Trainer) that was funded in part by the National Science Foundation.
In addition to improved detection of suspicious breast tumors, the MammaCare training protocol reduces false positive detections on clinical screening exams that are performed on well women screening.
An assistant professor at the University of Nevada Las Vegas is doing all that she can to help pregnant women get screened for perinatal depression. Marcia Clevesy, DNP, has been working at a Las Vegas clinic to improve screenings and documentation on a local level, particularly for postpartum depression.
Perinatal depression is the occurrence of a major or minor
depressive episode during pregnancy or up to one year after childbirth, and
affects as many as one in seven mothers. This term also includes postpartum
depression (PPD), a common complication that occurs after childbirth. But routine screenings for these occurrences is
not standard for most health care providers.
Recently, the U.S. Preventive Services Task Force published
a recommendation to provide or refer pregnant women with an increased risk of
perinatal depression to interventions. But while this report has just been released,
Dr. Clevesy has been working to progress research and care for those with PPD,
especially early on in pregnancy.
“It is important for a focus to be placed on detecting perinatal depression early on to prevent complications,” Dr. Clevesy shared with the UNLV News Center. “The earlier we can identify maternal depression the better, because we are then able to get patients into therapy and treatment sooner.”
Opening Up A National Discussion
Dr. Clevesy’s work has major positive impact both locally
and nationally, especially as discussions of mental health overall are becoming
more common and more open throughout the United States. As more people open up
about their mental health in media and online, women are feeling more
comfortable and secure discussing their own concerns and issues with their
healthcare providers, allowing Clevesy and her colleagues to help strengthen
their work in the Las Vegas area.
“I’ve been a women’s health nurse practitioner for many years, and want to continue to elevate the standard of PPD screening beyond simply asking patients if they’re depressed,” Dr. Clevesy told the UNLV News Center. “In collaboration with Dr. Tricia Gatlin, associate dean for undergraduate affairs at the School of Nursing, I recently implemented a system for providers at a local clinic to use an existing, reliable and validated screening tool — the Edinburgh Postnatal Depression Scale (EPDS) — to screen for PPD as a means of promoting best practice among the maternal-child population.”
Dr. Clevesy also shared that since implementing the new
system, PPD screening documentation rates have nearly doubled. Dr. Clevesy’s
work is crucial for enlisting more Las Vegas health care providers to provide depression
screenings for their pregnant patients, whether they use her screening tool or not.
“One tool is not necessarily preferred over the other. What matters is that health care providers are using a validated tool to effectively screen and promote a discussion regarding depression symptoms,” Dr. Clevesy said. “This assessment should start at the beginning of pregnancy and continue into the postpartum period.”
This month we celebrate family caregivers. The 2018 theme for National Family Caregivers Month is Supercharge Your Caregiving. President Clinton signed the first Presidential Proclamation in 1997 and every president since that time has followed his lead by issuing an annual proclamation to recognize caregivers each November, for an entire month. For this year, President Donald J. Trump says “We recognize the challenges of caregiving and celebrate the joys of bringing support and comfort to a loved one. We express our gratitude to them for the work they do daily to ensure their loved ones are able to live in their homes and communities.”
Nurses play an important role in patient care including caregivers, and this role of care will expand with the increasing number of patients needing this care. Nurses are also well-suited to assess, educate, and support family caregivers who care for their loved ones, as well as contribute to evidence-based nursing practice to improve the quality of care for family caregivers. Nurses serve as clinicians, educators, counselors, and researchers who provide support and conduct research that addresses family caregivers’ ability to care for their loved ones.
Demands on caregivers are currently growing as the health care environment changes. Additionally, the number of people with dementia and multiple chronic conditions is rising. Family caregivers can be overwhelmed by multiple responsibilities and seek guidance for taking on the responsibilities of caring and planning for a loved one. Nurses are well positioned to help family caregivers to become more confident and competent providers as they engage in the health care process. Nurses are also an excellent resource for families who need support, guidance, and encouragement. Nurses can connect family caregivers with key resources to simplify the care planning process.
Here are some useful resources to help family caregivers address and cope with the challenges of caring for a loved one.
1. Caregiver Action Network
The Caregiver Action Network (CAN) is the leading family caregiver organization to improve the quality of life for Americans who care for loved ones with chronic conditions, disabilities, diseases, or the frailties of old age. CAN is a nonprofit organization providing education, peer support, and resources to family caregivers across the country free of charge.
This is the leading online destination for family caregivers seeking information and support as they care for aging parents, spouses, and other loved ones. It offers helpful content, advice from leading experts, a supportive community of caregivers, and a comprehensive directory of eldercare services.
3. National Transitions of Care Coalition
The National Transitions of Care Coalition (NTOCC) is a nonprofit organization addressing the issues and concerns related to transitions of care. The NTOCC provides tools to help health care professionals, patients, and caregivers establish safer transitions; and resources for practitioners and policymakers to improve transitions throughout the health care system. Most of these resources are available free of charge.
From ultrasound powered by artificial intelligence to image-sharing tools on the cloud, technology advancements are improving the quality of health care at an unprecedented rate. Yet, when it comes to one of the most universal and compelling health care needs – a smooth and successful pregnancy and childbirth – we still have a long way to go.
Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. The United States accounts for the highest maternal death rate in the developed world, and the number has been steadily increasing over the last two decades. What should be a moment of joy and celebration can become an unbearable tragedy.
The operative word in these troubling statistics is “preventable.” And one of the keys to avoiding these tragedies is more closely monitoring the health of the mom and baby. The idea that you can’t manage what you don’t measure rings particularly true in pregnancy and childbirth.
Fetal and maternal health monitors provide invaluable data that can support clinicians and health care providers as they need to make quick and accurate clinical assessments throughout a pregnancy and during labor and delivery. However, these health care needs are at odds with recent trends in labor preferences.
For example, increasingly, expectant mothers want to take a more active role in their birth plans, not simply turn over the reins to the care staff. A growing trend among these patients is the desire for more mobility during labor.
The ability to get out of bed, walk around and even bathe can improve their overall comfort and experience – and may help decrease the length of labor. Not only do patients feel a sense of empowerment by choosing their birthing process, increased mobility may also decrease the length of labor.
During labor, women are often entangled in a sea of cords and monitors, significantly limiting their movement. Fortunately, expectant moms now have the option for cordless monitors that replaces the traditional, cumbersome belts, cables to support the traditional transducer system.
But as with many things, there’s still a role for “traditional” practices – including, in the case of childbirth, more movement and engagement on the part of the mother. Pairing this focus on the patient with advanced technology, we can achieve the best of both worlds: safer, smoother births with lower maternal-infant mortality.
The University of Texas at Arlington (UTA) College of Nursing and Health Innovation recently added five new nursing graduate degrees to its online catalog for the spring semester. The new online programs include a doctor of nursing practice (DNP) degree and four nurse practitioner master’s degrees in pediatric primary care, pediatric acute care, adult gerontology acute care, and adult gerontology primary care.
After drastically increased enrollment from UTA’s master of science in nursing (MSN) education and nursing administration courses were offered in an online format, the university decided to further expand its online nursing degrees. The additional online degrees will provide advanced nursing education access to students who are unable to attend on-campus courses.
The new online DNP program provides advanced practice registered nurses (APRNs) with the information, knowledge, and skills to transform healthcare from the local to global level. With an online learning system that doesn’t require specific class times, the program’s goal is to provide the rigorous standards of a DNP program in a flexible and affordable way for professional working nurses.
Adding new online programs supports UTA’s mission to improve health and human condition by making advanced nursing programs more available so that UTA students can have a broader impact on the health and lives of people in their own state, country, and around the world. To learn more about UTA’s new online nursing programs, visit TheShorthorn.com.
Our Nurse of the Week is Loretta Bledsoe, a critical care nurse from Longwood, FL who helped deliver a 2-pound, 4-ounce baby on her flight home to Orlando before the plane made an emergency landing in Charleston.
Bledsoe was an hour into her flight from Philadelphia when the flight attendant made an announcement about a medical emergency and asked if any doctors or nurses were on board. A nurse for more than 40 years with a range of experience from intensive-care to pediatrics, Bledsoe was well qualified to help deliver a baby. She turned on her call light to let the flight attendant know she could help and was brought to the front of the plane where a young woman was hunched over in a window seat.
The pregnant woman didn’t look very far along but said that her water had broken and minutes later Bledsoe was holding a tiny baby boy in her arms. Another passenger, an emergency-room doctor from Pennsylvania, helped stabilize the mother while the flight attendants and pilot planned for an emergency landing to get the new baby and his parents to a local hospital.
Surprisingly, the mom and dad had already added ‘Jet’ to their list of baby names and they decided it was the perfect fit after baby Jet was born mid-flight. Bledsoe later found out that the mom whose baby she had delivered was also a nurse. Talking about the events of that day, Bledsoe told OrlandoSentinel.com, “But you always use your nursing background, always. It’s like riding a bike: You never forget.”
Bledsoe has spoken to the mother a few times since about updates that the baby is doing much better. She hopes to meet the family again when they return home to Central Florida. To learn more about Bledsoe’s courageous mid-flight baby delivery, you can view her interview with OrlandoSentinel.com.