Announcements and featured resources for Library Users of Ascension Wisconsin Health Intranets (including legacy Affinity/Ministry/Fox Valley, Columbia-St. Mary's, and Wheaton-Franciscan).
Voting is a fundamental right and responsibility of American citizens.
Go to My Vote Wisconsin to make sure you are registered or to make changes. There is info on how to register online, where to go if you need to register in person, and how to vote early or absentee.
I LOVE voting absentee because there is no standing in line; No rushing to get to the polling place; I can study the ballot and make informed decisions at my leisure. It makes me a better citizen. ;-)
For information on candidates and ballot questions, Vote411.org offers nonpartisan voter guides. Type in your address to see what's on your local ballot.
WK's Clinical Editor selects 10 of the most important journal articles from over 70 nursing journals that we publish and compiles them monthly. In Recommended Reading for Nurses, we offer access to the hottest topics in nursing and healthcare, as well as other “must-read” content.
Instructions on how to access CE are available on the respective search tips pages.
Ascension Interprofessional Continuing Education
Over 400 on-demand CE modules are available from Ascension IPCE. The calendar lists
upcoming live courses across our system. You can filter by specialty and/or location.
Medscape.org
Medscape provides clinical tools, medical news and updates, and CME courses, all available
online for free. Free registration is required.
Becoming Better Ancestors is a free virtual learning series produced by the
Task Force for Global Health. It examines the successful effort to eradicate smallpox - the first
time a human disease was wiped off the face of the earth. Nine lessons are drawn from that
incredible achievement. The lessons can be applied to other diseases and, beyond, to the biggest
problems facing humanity.
The principles are proven, simple, and reliable. Each is explained in a 20-minute video
featuring interviews with global health leaders. Case studies help to illustrate how the lessons
can be applied in practice. By learning and embracing these methods, we can tackle our major
challenges and promote positive change. Becoming Better Ancestors offers a hopeful, empowering message for problem-solving and collaboration.
* Special thanks to Jennifer Barlow, Ascension Librarian in Kalamazoo, MI, for sharing this item.
ECRI’s SALUTE Program https://home.ecri.org/pages/ecri-salute-program ECRI launched the SALUTE program to improve health care for veterans, wherever they seek it. The free toolkit is available to all providers and others in the healthcare space. It promotes a Total Systems Safety approach to veteran care. Materials include training on “60 Seconds of Listening to Improve Diagnostic Safety,” webinar and white paper for caregivers, and a checklist for veterans.
BADGERLINK https://badgerlink.dpi.wi.gov/ Badgerlink offers trusted e-books, journal articles and databases for Wisconsin residents of all ages, provided by our State Library. There’s full text coverage for a wide variety of topics, from current events to academic resources to career guidance and test prep.
The Pudding https://pudding.cool/ A digital publication with fascinating graphics, The Pudding deals with all manner of quirky questions. Its label as “the best Internet rabbit hole” is well-earned.
Black women doctors share their perspectives on medicine, equity, patient care and the
physician’s experience. Ob-gyn residents collaborated with listener poets and artists to produce this inaugural zine and interactive website from Health4Equity and The Good Listening Project. This website is artistic and very much embodies our ABIDE concepts.
* Special thanks to Ascension Librarian Jennifer Barlow in Kalamazoo, MI, for sharing these worthy finds.
The Ascension WI Library Services Request Form is the best way to ask for articles, books, literature searches, and all other types of library assistance. The online form is submitted to the AW Librarians' in-box immediately and includes everything we need to get to work on our request.
When your local librarian is not available, the in-box is covered by colleagues, so you will always get speedy service. Data collected from the online form is meaningful for library leadership and helps measure our impact on patient care and operations.
Watch the progression of real-life clinical cases, walking step-by-step through an evolving patient history including the clinical presentation, differential diagnosis, laboratory studies, and treatment — culminating in the final diagnosis.
Inspired by our short Quick Take videos, Double Take videos provide a second, deeper look at medically important topics, examining their scientific, clinical, and social consequences. Explore the full library at NEJM.org/double-take.
The July 2024 Art In Medicine topic is about specimen donation and museums like The Mutter in Philadelphia.
Lucinda Bennett, the Medical Librarian at Ascension St Agnes Hospital in Baltimore, MD, publishes a regular series on Art in Medicine and The Health Humanities.
It's only 1-2 pages with gorgeous images, so it won't take you long to read
... and just might enrich your life.
Donated Specimens & Museums
“Chang and Eng were the original “Siamese Twins.” They were born in Siam (now Thailand) in 1811. After spending much of their lives on exhibition tours, the Bunkers settled in Mount Airy, North Carolina…They married sisters and raised a total of 21 children. Doctors from Philadelphia went to Mount Airy after the twins’ death on January 17, 1874, and received permission from the families to examine the bodies. They wanted to settle the question of whether or not they could have been separated during life. The doctors transported the bodies to The College of Physicians of Philadelphia, where the autopsy was done in The Mütter Museum. This plaster cast shows the incision, which revealed that the band connecting the twins included portions of the peritoneal cavities of each twin and that their livers were joined by a thin strip of liver tissue. The doctors concluded that the twins could not have been safely separated because of the blood loss that would have resulted from the operation. The joined livers are on display in the Museum, right below this cast.” (The Mütter Museum)
When you hear the word ‘museum’ what is the first thing that comes to your mind? An art gallery? A display of ancient artifacts? Rows of broken pottery, taxidermied animals, silent halls or rooms full of kids on school field trips? How often do you consider human specimens when thinking about museums? Exhibitions dedicated to famous historical figures are common throughout the museum world, but the inclusion of humans as a tool of study for the public is often relegated to the occasional mummy. In recent years the ethical acquisition of such remains has come under scrutiny.
Just how have museums come to hold such specimens and do they have the right to do so? For all the academic artistry that goes into a museum, how should the collections process be performed, and what should the public know about the ethics of donation?
First and foremost, how did museums as we know it come to be? “Modern museum collections date to the 1600s in Europe, where they were formed as “cabinets of curiosity” that included small displays of objects and specimens. They evolved into something of far greater significance. The collection and organization of biological specimens allowed early naturalists to study the characteristics of and relationships among living organisms and to establish the foundation for modern biological science. The study of cultural objects allowed the development of a detailed understanding of human similarities and differences, their archaeological histories, and transformative processes.” (The Value of Scientific Collections) From the 17th century onward, the museums of Europe and eventually North America became filled with the artifacts of distant lands - more often than not the products of colonial expansion. In the contemporary era, the repatriation of stolen art and human remains from these institutions back to their native soil continues across the museum world. Yet the growth of collections also goes as it ever did.
Renowned organizations such as the Smithsonian outline their collections policies for public view on their websites. “The acquisition of collections is fundamental and critical to the mission and vitality of the Smithsonian. Most collection items are donated to the Smithsonian by individuals and private collectors or through transfers from federal agencies such as the National Aeronautics and Space Administration (NASA), the U.S. Postal Service and others. Thousands of items also come to the Smithsonian through field expeditions, bequests, purchases, and exchanges with other museums, and, in the case of living plants and animals, by propagation and birth.” (Smithsonian Collections) Do the same guidelines then apply to human bodies as well? With such a tragic history of academic institutions taking bodies without consent, and the stigma of donating oneself over traditional inhumation still palpable in the modern era, it is curious just how museums walk the line with appropriate display or examination. New regulations within living memory not only permit broader donation, but emphasize consent.
“It was not until 1968, that the Uniform Anatomical Gift Act was passed to protect the interest of whole body donors and their families. During the latter part of the 20th century, different parts of the world started to promote whole body donation for the purpose of anatomical studies and the successful promotion led to the stabilization of willing body donors. This satisfied the demands of most medical schools across the United States, this also led to a change in social beliefs about whole body donation and medical professionals were frequently donating their own bodies because they knew the value of cadavers…To remain ethical and in the best interest of donors, most whole body donation programs stress informed consent, emphasis on an openness with donor and family and most donors receive commemoration for their selfless donation in the name of science.” (A Deep Dive into the History of Cadaver use & Whole Body Donation)
Over the past two years, a simple but baffling request has preceded most of my encounters with medical professionals: “Rate your pain on a scale of zero to 10.”
I trained as a physician and have asked patients the very same question thousands of times, so I think hard about how to quantify the sum of the sore hips, the prickly thighs, and the numbing, itchy pain near my left shoulder blade. I pause and then, mostly arbitrarily, choose a number. “Three or four?” I venture, knowing the real answer is long, complicated, and not measurable in this one-dimensional way.
Pain is a squirrely thing. It’s sometimes burning, sometimes drilling, sometimes a deep-in-the-muscles clenching ache. Mine can depend on my mood or how much attention I afford it and can recede nearly entirely if I’m engrossed in a film or a task. Pain can also be disabling enough to cancel vacations, or so overwhelming that it leads people to opioid addiction. Even 10+ pain can be bearable when it’s endured for good reason, like giving birth to a child. But what’s the purpose of the pains I have now, the lingering effects of a head injury?
The concept of reducing these shades of pain to a single number dates to the 1970s. But the zero-to-10 scale is ubiquitous today because of what was called a “pain revolution” in the ’90s, when intense new attention to addressing pain — primarily with opioids — was framed as progress. Doctors today have a fuller understanding of treating pain, as well as the terrible consequences of prescribing opioids so readily. What they are learning only now is how to better measure pain and treat its many forms.
About 30 years ago, physicians who championed the use of opioids gave robust new life to what had been a niche specialty: pain management. They started pushing the idea that pain should be measured at every appointment as a “fifth vital sign.” The American Pain Society went as far as copyrighting the phrase. But unlike the other vital signs — blood pressure, temperature, heart rate, and breathing rate — pain had no objective scale. How to measure the unmeasurable? The society encouraged doctors and nurses to use the zero-to-10 rating system. Around that time, the FDA approved OxyContin, a slow-release opioid painkiller made by Purdue Pharma. The drugmaker itself encouraged doctors to routinely record and treat pain, and aggressively marketed opioids as an obvious solution.
To be fair, in an era when pain was too often ignored or undertreated, the zero-to-10 rating system could be regarded as an advance. Morphine pumps were not available for those cancer patients I saw in the ’80s, even those in agonizing pain from cancer in their bones; doctors regarded pain as an inevitable part of disease. In the emergency room where I practiced in the early ’90s, prescribing even a few opioid pills was a hassle: It required asking the head nurse to unlock a special prescription pad and making a copy for the state agency that tracked prescribing patterns. Regulators (rightly) worried that handing out narcotics would lead to addiction. As a result, some patients in need of relief likely went without.
After pain doctors and opioid manufacturers campaigned for broader use of opioids — claiming that newer forms were not addictive, or much less so than previous incarnations — prescribing the drugs became far easier and were promoted for all kinds of pain, whether from knee arthritis or back problems. As a young doctor joining the “pain revolution,” I probably asked patients thousands of times to rate their pain on a scale of zero to 10 and wrote many scripts each week for pain medication, as monitoring “the fifth vital sign” quickly became routine in the medical system. In time, a zero-to-10 pain measurement became a necessary box to fill in electronic medical records. The Joint Commission on the Accreditation of Healthcare Organizations made regularly assessing pain a prerequisite for medical centers receiving federal health care dollars. Medical groups added treatment of pain to their list of patient rights, and satisfaction with pain treatment became a component of post-visit patient surveys. (A poor showing could mean lower reimbursement from some insurers.)
But this approach to pain management had clear drawbacks. Studies accumulated showing that measuring patients’ pain didn’t result in better pain control. Doctors showed little interest in or didn’t know how to respond to the recorded answer. And patients’ satisfaction with their doctors’ discussion of pain didn’t necessarily mean they got adequate treatment. At the same time, the drugs were fueling the growing opioid epidemic. Research showed that an estimated 3% to 19% of people who received a prescription for pain medication from a doctor developed an addiction.
Doctors who wanted to treat pain had few other options, though. “We had a good sense that these drugs weren’t the only way to manage pain,” Linda Porter, director of the National Institutes of Health’s Office of Pain Policy and Planning, told me. “But we didn’t have a good understanding of the complexity or alternatives.” The enthusiasm for narcotics left many varietals of pain underexplored and undertreated for years. Only in 2018, a year when nearly 50,000 Americans died of an overdose, did Congress start funding a program — the Early Phase Pain Investigation Clinical Network, or EPPIC-Net — designed to explore types of pain and find better solutions. The network connects specialists at 12 academic specialized clinical centers and is meant to jump-start new research in the field and find bespoke solutions for different kinds of pain.
A zero-to-10 scale may make sense in certain situations, such as when a nurse uses it to adjust a medication dose for a patient hospitalized after surgery or an accident. And researchers and pain specialists have tried to create better rating tools — dozens, in fact, none of which was adequate to capture pain’s complexity, a European panel of experts concluded. The Veterans Health Administration, for instance, created one that had supplemental questions and visual prompts: A rating of 5 correlated with a frown and a pain level that “interrupts some activities.” The survey took much longer to administer and produced results that were no better than the zero-to-10 system. By the 2010s, many medical organizations, including the American Medical Association and the American Academy of Family Physicians, were rejecting not just the zero-to-10 scale but the entire notion that pain could be meaningfully self-reported numerically by a patient.
In the years that opioids had dominated pain remedies, a few drugs — such as gabapentin and pregabalin for neuropathy, and lidocaine patches and creams for musculoskeletal aches — had become available. “There was a growing awareness of the incredible complexity of pain — that you would have to find the right drugs for the right patients,” Rebecca Hommer, EPPIC-Net’s interim director, told me. Researchers are now looking for biomarkers associated with different kinds of pain so that drug studies can use more objective measures to assess the medications’ effect. A better understanding of the neural pathways and neurotransmitters that create different types of pain could also help researchers design drugs to interrupt and tame them.
Any treatments that come out of this research are unlikely to be blockbusters like opioids; by design, they will be useful to fewer people. That also makes them less appealing prospects to drug companies. So EPPIC-Net is helping small drug companies, academics, and even individual doctors design and conduct early-stage trials to test the safety and efficacy of promising pain-taming molecules. That information will be handed over to drug manufacturers for late-stage trials, all with the aim of getting new drugs approved by the FDA more quickly.
The first EPPIC-Net trials are just getting underway. Finding better treatments will be no easy task, because the nervous system is a largely unexplored universe of molecules, cells, and electronic connections that interact in countless ways. The 2021 Nobel Prize in Physiology or Medicine went to scientists who discovered the mechanisms that allow us to feel the most basic sensations: cold and hot. In comparison, pain is a hydra. A simple number might feel definitive. But it’s not helping anyone make the pain go away.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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