What Is the Role of a Health Navigator on the Health Care Team?


In 2015, Kay Perrin, PhD, MPH, joined us as a guest blogger for a series of five blog posts on the topic of the exciting new career field of the Health Navigator. This is the third of five.

The purpose of this blog series is to describe the concept of health navigators. In the first blog, I defined the basic role of health navigator. After having a few conversations with colleagues, I decided that it is time to write a blog about what role the health navigator does not play in the health care system. Some nurses have commented that health navigators should not work in hospitals because they will not have clinical training. Other colleagues have mentioned that health navigators may never find jobs, because no one knows how their role fits into the health care team. Now, you see the reason for writing this blog about the role of health navigators on the health care team.

My colleagues are correct. Health navigators lack the clinical background to be licensed to treat patients and health navigators are not employed as home health aides or certified nursing assistants. So the question remains: What is the role of health navigators on the health care team?

Before answering this question, let’s take a step back and review the impact of the Patient Protection and Affordable Care Act (PPACA) issues related to decreasing the 30-day hospital readmission rate among Medicare patients. Since its effective date in 2012, Section 3025 of the PPACA has targeted the high readmission rates by reducing payments to hospitals for Medicare beneficiaries readmitted within 30 days of a previous discharge from the same hospital including the applicable conditions of acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). In 2015, the list is extended to include acute exacerbation of chronic obstructive pulmonary disease (COPD), elective total hip arthroplasty (THA), and total knee arthroplasty (TKA) in 2015. Unlike other new programs created by the federal health law, the readmissions program offers hospitals no rewards for improvement or the opportunity to opt out. Effective October 2015, Medicare is increasing the final maximum penalty to a 3 percent reduction for all readmitted patient stays. The national average of readmission rates is 19% and in 2013, 53% of U.S. hospitals sustained penalties. As PPACA penalties increase, hospital administrators give greater scrutiny to all readmission costs. It is therefore critical to reduce Medicare patient hospital readmissions.

With this PPACA information in mind, the discussion starts with a focus on the role of health navigators in hospitals. Frequently, hospitals declare a chronic shortage of licensed physicians and nurses to adequately staff the insufficient number of hospital beds. This equation results in a vicious cycle: a) Low staffing of licensed health care personnel leads to high patient acuity to health care staff ratios; b) high patient acuity ratios leads to longer work hours, greater medical errors, reduction of quality patient care, increase in PPACA penalties linked to high patient readmission rates; c) overworked clinical staff leads to resignations and chronic shortage of licensed nurses and physicians – thus the cycle continues. When health navigators are inserted into the hospital care team, the problems associated with a shortage of licensed clinical staff is not solved; however, a few of the other problems might be reduced. Let’s propose the following case study.

Mary Smith, 76 years old, was admitted via ambulance with a fractured femur and moderate COPD. She lives with her husband, Charles (age 82). They have been married for 52 years and have lived in their one-story house for the last 40 years. They have no intention of moving at this time. Mary had surgery to repair her femur followed by four days of physical therapy. She is walking well with a walker and still needs pain medication at night. The hospital social worker stopped by yesterday for a brief assessment. Mary stated that she wanted a home health aide daily for the first few days after discharge. The social worker entered this request in the EMR for Mary’s physician. Mary’s physician stopped by around 6:00 a.m. and told her that she would be discharged later that morning. Mary was not completely awake during his visit. He wrote a few prescriptions and told Mary that the nurse would go over everything after Mary ate breakfast. He also mentioned that he would see her in his office in about seven days to remove the incision staples. Mary called Charles. He arrived in time to hear the nurse review the discharge orders and the two prescriptions of antibiotics and pain pills. The physical therapy assistant delivered the rented walker and the transporter was called after Charles helped Mary get dressed. On the way home, they dropped off the prescriptions at the local pharmacy for a pick-up later in a few hours. Once at home, Charles pulled into the garage and helped Mary out of the car. Using her walker, they both realized that there are three steps without a handrail from the garage into the house. With only one step into the front door, Mary was forced to walk much further to enter her home. She rested while Charles returned to the pharmacy. While he was gone, the home health agency called and told Mary that her Medicare supplement did not approve the request for home health. Mary was disappointed but her leg was hurting too much to continue the conversation. Charles returned and Mary took a pain pill. Later in the afternoon, she needed use the bathroom. Charles helped her, but they realized that the walker did not fit through the bathroom doorway. They decided that she could walk into the bathroom, lean on the vanity and inch herself a few feet to the toilet with Charles behind her for balance. However, due to the pain medication, being sleepy and only leaning on the vanity, she missed a step. When she began to fall, Charles was unable to maintain his balance. Mary fell. Charles called 911 and she was readmitted to the hospital.

Now let’s review the same scenario with the pre-discharge services of a health navigator employed by the hospital. The health navigator would: a) meet with Mary and Charles in the hospital two days prior to discharge; b) meet Charles at their home to determine steps, lighting, scatter rugs, access through bathroom doorway using a walker, height of bed and toilet, etc.; c) request that physical therapy teach Mary how to negotiate a few stairs with her walker; d) order a bedside commode since the bathroom door was too narrow for her walker; e) give Charles the prescriptions to fill prior to discharge; e) call several home health agencies to negotiate health insurance coverage for a few days of service; and f) move the physician’s follow-up appointment within three days after discharge rather than seven days. These non-clinical actions would have likely kept Mary from a readmission thus saving her additional pain, suffering and financial burden. In addition, the hospital would not have been accessed a PPACA penalty for Mary’s readmission with 30 days.

Although health navigators are not intended to solve the numerous problems facing hospitals, employing health navigators improve the chances of reducing Medicare hospital readmission rates. The health navigators will have time to sit and carefully listen and access the challenges of patients and caregivers. They will make home visits prior to discharge, arrange transportation for follow-up appointments, verify that prescriptions are understood and filled, and note simple suggestions that might be missed among other over-burdened health care team members. It should also be noted that reducing the rate of Medicare readmission by one or two patients annually would pay the salary of a health navigator working in a clinical setting.

 —Kay Perrin

KayPerrinKay Perrin, PhD, MPH, is an Associate Professor and Assistant Dean for the Office of Undergraduate Studies at the University of South Florida, College of Public Health. Dr. Perrin’s research focuses on adolescent health with a special interest in teen pregnancy. Dr. Perrin also serves on several community boards in the Tampa Bay Area. Dr. Perrin is the author of four titles from Jones & Bartlett Learning: Principles of Evaluation and Research for Health Care Programs, Essentials of Planning and Evaluation for Public Health (both published in 2014), and the upcoming Principles of Health Navigation, available in early 2017. Follow Kay Perrin on Twitter @KayPerrinPhD or watch a webcast of Dr. Perrin’s October 2014 Webinar on Teaching Health Research, Program Planning, and Evaluation.

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Healthy Snacking 101

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, lend their expert perspectives on healthy snacking.

Healthy snacking is an important part of the diet whether you consider yourself an athlete or not. Many people considering snacking to be an unhealthy habit when in actuality snacking helps manage weight, ensures adequate fuel for the muscles and brain, and it improves muscle recovery. Most people should consume 3 meals and 2-4 snacks/day. The number and type of snack is dictated by hunger, work schedule, athletic involvement, weight goals, and sleep.

To become a good snacker one must implement three strategies 1) recognize your hunger cues, 2) distinguish a snack from a treat, and 3) select nutrient rich-snacks.

It seems obvious; when you are hungry you should eat, but this isn’t always the case. Some people eat when they are not hungry and some people are poor at identifying their hunger. Most people only identify hunger as stomach pangs, but after stomach pangs have been sensed, too many hours have passed without feeding the body. Hunger cues can include fatigue, poor concentration, headaches, lightheadedness, irritability, shakiness, and sleep disturbances. These symptoms are usually felt before the stomach pangs and should be acted upon immediately to prevent more intense hunger and additional energy loss. Being able to detect your body’s hunger cues is important, as this will stabilize energy and metabolism throughout the day leading to better physical and mental performance. What are your hunger cues?

The ability to distinguish a healthy snack from a treat will allow for proper fueling of the body. Healthy snacks are nutrient-rich and provide whole grains, fiber, lean proteins and/or healthy fats. On the other hand, treats such as candy, chips, and fried foods, are “empty” calories. Snacks provide fuel and satisfy hunger while treats usually only satisfy a craving.

Selecting a snack is not always easy, but once you identify your level of hunger you will be able to choose more wisely. When you begin to feel hungry, rate it on a scale of 1-5 (1 = satisfied and 5 = starving). Your hunger level will help guide you in choosing a light, moderate or heavy snack. A light snack would include fresh fruit, raisins, dry cereal, low-fat Greek yogurt, low-fat pudding. A moderate snack would include fruit with peanut butter, oatmeal, cereal and milk, yogurt parfait. A heavy snack would include a peanut butter or lean protein sandwich, cheese and crackers, omelet.

Smart Snacking Tips:

  • Plan ahead: Spend a few minutes in the evening planning/packing snacks for the next day.
  • Establish a routine: Consuming regular meals and snacks helps prevent feeling overhungry, achieve weight goals, and allow proper energy for exercise.
  • Identify snacks versus treats: Healthy snacks are nutrient dense and satisfy hunger.
  • Keep snacks readily available: Place snacks in your gym bag, purse, or desk drawer at work for quick fuel when you need it.

Sample day:

Breakfast: English muffin with PB & J, fruit, yogurt and/or low-fat milk

Snack: Fresh fruit and/or low-fat string cheese

Lunch: Turkey sandwich on wheat, vegetables and hummus, pretzels, low-fat milk

Snack: Greek yogurt with fruit

Dinner: Grilled chicken, rice, vegetable, low-fat milk

* Note – If you exercise prior to breakfast, you should have a snack before the workout such as fruit and/or granola bar. If you exercise twice or more per day, including a snack after dinner, such as PB & banana on wheat bread with low-fat chocolate milk, is beneficial.

Healthy snacking is an important part of a fueling plan. Listen to your body and keep nutrient-rich foods readily available. When you are eating well, your body will react positively and you will be able to achieve your physical, mental and weight goals.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com . Questions will be answered on a monthly basis.

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What is This Thing Called Competency Based Education?

2014 Headshot_Short HairThe buzz in health care management education is all competencies, all the time. Your program, whether at the undergraduate or graduate level, must be anchored in a competency based framework. The framework selected must be based on your program’s mission, vision, and values, your target students and the outcomes, i.e., where do you expect these students to go. Every meeting you attend will touch upon competencies and the dreaded assessments. Some may ask, “Why the big push?” Others may say, “What was wrong with the old fashioned way?”

Despite the fact that many of our current CEOs, COOs, and CFOs, came from the lecture, test, and pass the courses until you graduate model, these same employers grew to question the ability of graduates to take on the brave new world of health care. No longer was it appropriate to give good content and launch students across the graduation stage into the real world. The employers were not pleased with the quality and skills of the students coming to them, no matter how high the student’s GPA. Higher education, in general, and health care management education, in specific, continues to be called on the deficiencies in skills of their graduates.

The fact that graduates struggle to find jobs combined with hard data on the declining traditional undergraduate student population (the baby bust, if you will), means higher education is fighting to maintain relevancy to employers and adult learners, alike. Enter competency based education (CBE), a notion that is based not on time to graduation, but on demonstration of the required knowledge skills and abilities. This means in some experimental sites the Department of Education (DOE) is watching to see how this new concept works out. The sticking point, as you can well imagine, is the definition of direct assessment required to demonstrate competencies.

One federal definition says:

“`direct assessment program”, an instructional program that uses or recognizes direct assessment of a student’s learning in lieu of credit or clock hours.”

The experiment sites guide states:

“A direct assessment program is an instructional program that, in lieu of credit hours or clock hours as a measure of student learning, utilizes direct assessment of student learning, or recognizes the direct assessment of student learning by others. The assessment must be consistent with the accreditation of the institution or program utilizing the results of the assessment.” https://experimentalsites.ed.gov/exp/pdf/CBEGuideSec1.pdf

So what does this mean to healthcare management programs? I anticipate a growing number of potential students who are already working in the field, but who do not have degrees (a rather large number, by the way) will be searching for programs that offer opportunities for portfolio review (direct assessment of learning by others) and direct assessment of their competencies by experts at the institution or partner institutions. I also suspect this will take longer to come to fruition in healthcare management, given some of issues surrounding those universities that thought they’d be approved by the DOE, then weren’t. As of July, 2014, only two universities have had success in negotiating the complicated federal application and approval process.

In the meantime, I recommend taking a good hard look at our own programs and asking some tough questions, some of which should include:

• Do we have a mission, vision and value statement that drives a competency based curriculum?
• Do we obtain input into the curriculum from all stakeholders, including employers, community partners, students, alumni, and advisory board members?
• Do we use this input to adjust our competencies and curriculum?
• Do we directly measure, i.e., assess, these competencies and address shortcomings in our program when students don’t perform well?
• Do we have a strategic plan that incorporates environmental factors, such as CBE?
• Are we relevant to the populations and communities we serve?
• Do employers tell us they want more of our graduates?

We cannot sit on the sidelines and wait for the brave new world of competency based education to go away quietly. It’s time to take a critical look at who we are and what we contribute to our students’ education and the field of health care management. If we don’t, we will be the architects of our own demise.

Sharon B. Buchbinder, RN, PhD

Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

Here are some references if you are interested in this topic:
Everhart, D., Sandeen, C., Seymour, D. & Yoshino, K. (n.d.) Clarifying competency based education terms. American Council on Education and Blackboard. Retrieved from http://images.email.blackboard.com/Web/BlackboardInc/%7B2a4b9de0-d95f-4159-98a2-b5b305affdcc%7D_Clarifying_CBE_Terms.pdf

Fain, P. (2014, July 23). Experimenting with aid. Retrieved from https://www.insidehighered.com/news/2014/07/23/competency-based-education-gets-boost-education-department

Fain, P. (2014, February 21). Taking the direct path. Retrieved from https://www.insidehighered.com/news/2014/02/21/direct-assessment-and-feds-take-competency-based-education

Federal Register. (2009, October 217). 34 CFR Parts 600 and 602: Institutional Eligibility Under the Higher Education Act of 1965, as Amended, and the Secretary’s Recognition of Accrediting Agencies; Final Rule. Retrieved from https://www2.ed.gov/legislation/FedRegister/finrule/2009-4/102709a.html

Kamenetz, A. (2014, October 7). Competency-based education: No more semesters? Retrieved from http://www.npr.org/sections/ed/2014/10/07/353930358/competency-based-education-no-more-semesters

U.S. Department of Education (2015, September). Introduction to competency based education. CBE experiment guide. Retrieved from https://experimentalsites.ed.gov/exp/pdf/CBEGuideSec1.pdf

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Visit Us At APTA-ELC

Stop by the Jones & Bartlett Learning Booth #9 to learn  more about our new and best-selling resources for your Physical Therapy courses.

Qualified instructors may request a review copy at APTA-ELC, or online.

shamusBarrett josborne






Contact your Health Professions Account Specialist to consult on our full list of resource or visit Jones & Bartlett learning website at go.jblearning.com/PhysicalTherapy.

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New Instructor Resources & Case Studies for Pharmacogentics, Kinetics, and Dynamics for Personalized Medicine


Pharmacogenetics, Kinetics, and Dynamics for Personalized Medicine provides a primer to understand pharmacogenetics in the applied context of pharmacokinetics and pharmacodynamics. This valuable foundation illuminates how these principles and scientific advances can create optimal individual patient care, that is, “personalized medicine.” Through specific drug examples, this resource explores how the genetic constitution of an individual may lead to the need for an altered dose or in some cases alternative drug therapy.

New Instructor Resources and Case Studies!

Chapter 5

Patient Case 1: Carbamazepine/HLA-B*15:02

Patient Case 2: Carbamazepine/HLA-B*15:02

Chapter 6

Patient Case 1: Clopidogrel/CYP2C19

Patient Case 2: Clopidogrel/CYP2C19

Chapter 7

Supplemental Patient Case 1:5-Fluorouracil (capecitabine 5-Fluorouracil capecitabine 5-Fluorouracil prodrug)/DPYD

Chapter 10

Patient Case 1: Warfarin/CYP2C9/VKORC1

Patient Case 2: Warfarin/CYP2C9/VKORC1

Instructors: If you have adopted this text, request these Case Studies for your course.

Contact your Account  Specialist to learn more or visit our website, www.go.jblearning.com/Kisor.



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New eBook Highlights Undergraduate Public Health Education

9-11-2015 3-20-13 PMFrontiers, one of the world’s largest open-access publishers in the health field, just released a new eBook entitled Undergraduate Education for Public Health in the United States. Faculty from accredited schools and programs across the nation have contributed to the 20 chapters.

Dr. Cheryl Addy, senior associate dean for academic affairs at the University of South Carolina Arnold School of Public Health, and Dr. Daniel Gerber, associate dean of academic affairs at the University of Massachusetts at Amherst School of Public Health and Health Sciences, served as topic editors for the eBook, along with former SPH deans Dr. David Dyjack and Dr. Connie Evashwick.

The purpose of this compilation is to describe current curricular approaches to undergraduate education for public health, and to facilitate analysis and discussion of what makes quality education and builds a competent workforce.

The eBook addresses wide-ranging topics, including:

  • The history of undergraduate public health education
  • Recent development of accreditation criteria
  • Description of specific programs
  • Broader curriculum issues
  • The evolving career opportunities in public health

Originally published as individual articles of a Frontiers Research Topic, the complete eBook is now available free of charge here.

Jones & Bartlett Learning is also offering printed copies as part of an information kit on undergraduate Public Health and the Essential Public Health series. To request this free information kit, visit www.essentialpublichealth.com and click “Request a Free Info Kit” at the top right.

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Top Ten Tips for Publishing a Textbook

2014 Headshot_Short HairAs someone who has published three textbooks over the course of a decade, and has another edition of our most popular one in the works as we speak, I frequently am asked two questions: “How much do you earn in royalties?” And, “How can I get a textbook published?” If you think you are going to earn a bazillion dollars in royalties with a textbook, you will be disappointed. That is not the reason for heading down this publishing road. The idea of writing a book is exciting. The thought of your name emblazoned on every bookstore shelf and online distributor is heady stuff. However, I am here to tell you, it is hard work and not for the dabbler or faint of heart. Herewith, I share my top ten tips for publishing a textbook.

1. Be dissatisfied with what’s available. The only reason Nancy Shanks and I wrote our textbook is because we were not happy with what was available. I hasten to tell people we were having coffee, not alcohol, when we came up with this crazy idea. As we sucked down caffeine at breakfast at an AUPHA annual meeting, we tossed back names of texts for our introductory course. Like Goldilocks, we complained that each text was too big, too small, too erudite, too watered down, too hard to read, too easy to read, on and on. Nothing was just right. At last, I looked at Nancy and said, “You need to write a book.” She laughed, shook her head and said, “No, YOU need to write a book.” This went back and forth ten times. Then we said, almost at the same time, “WE need to write a book.” That morning, we sketched out a table of contents on a paper napkin. Our work had begun.

2. Have a course the book will go with. We knew we had a course this book would go with, and that is what the publisher needs to know. If you have a one-off class on a topic only one person in the world wants to teach, then you do not have a course for a book. If you look at curricula around the country (yes, you must do this) find out if other programs have the same course you are trying to fix up with the book love of its life. That will give you a rough estimate of demand. Write down the number of programs in the U.S. that have your course. You will need it for your proposal. Publishers want to know if they will sell more than one class of books.

3. Find a writing partner. A good one. If you have not already done so, find a good writing partner. Not the one who sits there and tells you how WONDERFUL your work is. And not the one who RIPS your work apart, either. You want a thoughtful critique partner who complements your style. Preferably, someone with a sense of humor. Someone who will call you and say, where are we on this project while you are drowning in grading and prod you to get back on track. Good critique partners are very hard to find. Think about your colleagues and consider carefully who you invite to your party. No, you can’t have Nancy Shanks. She’s taken.

4. Talk to the end users. Find out what they really really really want. Willy Sutton was asked why he robbed banks. He said, “Because that’s where the money is!” You have to go to your end users and ask them what they are using for a textbook for that topic and what they like or don’t like about the book(s). Ask them, in an ideal world, what would you like this book to do for you? What are the features they are missing? What are the benefits they would like to see for them as the end users? What would they like to see in a Table of Contents? You can do this in person, or in an online survey. You may even find some volunteers who would LOVE to contribute to your textbook. Take names and emails and phone numbers!

5. Research your competition. The biggest book emporium in the world is at your fingertips. You need only enter the Amazon jungle, and type in the key words for your textbook idea to find out who is doing what. Carefully research your competition. You may even need to buy a book or two so you can do the same Goldilocks routine Nancy and I did. You will need sales rankings, review ratings, and an idea of what the leaders of the pack are missing for your proposal.

6. Find a publisher who fits with your vision and style. Publishing is a tough business. Companies are merging and going under, some because they failed to keep up with the eBook boom. Find a company that is innovative and has books in your line. See what they have on the shelf. If you can chat with a book representative at a professional meeting, that is optimal. They are looking for hot, new products, and you might just have the next big thing. While not a marriage, you may be working with them for a long time, so choose wisely.

7. Write the best proposal you can. Every publisher has different submission requirements. Some might want the first few chapters of the book, others might just want the proposal. Whatever the publisher wants, FOLLOW THE INSTRUCTIONS. I know, I sound just like a teacher, don’t I? Read the instructions, ask questions for clarity before you start writing. This is not a back of the envelope task. It’s a bit like writing a dissertation proposal. Did I scare you? Good. Use the data you collected from the end users and the research you completed on the competition to build your proposal, in whatever format the publisher wants. And make it a CLEAN submission. No typos, no slang. This isn’t a peer-reviewed journal with APA formatting, but it is a business document. Be respectful of those who will be reading it and write the best proposal you can. Then get someone you trust to read it and comment on it before you submit it.

8. Get rejected. Do not whine. Be persistent. Yes, you read that right. Get rejected. No one, and I do mean no one, likes a whiner. If you get rejected, allow yourself no more than 24 hours to cry, stomp your feet, and have a pity party. After 24 hours, STOP. Don’t take it personally. While this is your baby and you know this is the best (fill in the blank) textbook proposal ever written, publishing is a business. The publisher is in business to make money. If it does not fit, keep moving, keep tweaking, tweaking, tweaking. You will learn from those rejections what works and what doesn’t. Our first textbook (Introduction to Health Care Management) was rejected by a well-known publisher. Not only did I listen closely to the feedback, the experience taught me to look at other publishers. Michael Brown of JBL saw what the other publisher did not see and offered us a contract.

9. When you get a contract, read it. Be reasonable in your requests for changes. This is a business. The contract will spell out not only the royalty rate, but also the due dates for deliverables, and the penalties if you don’t hand your work in on time. The publisher has a timeframe that is even more drawn out into the future than our teaching schedules. Once the book is in the queue, time marches on and you had better, too. Nancy and I have conference calls to keep our work on track. Sometimes life happens. But you must get back on track as soon as possible to keep on deadline.

10. Produce a squeaky clean manuscript and deliver it and all the ancillaries on time. If you’ve read any of the Jasper Fforde Thursday Next novels, you will know there are living creatures in books that go around catching typos, fixing grammar, and cleaning up the author’s work. Sadly, these lovely beasts only live in his novels. We mere humans must take the time to be attentive to our work and the work of others, if you decide to create a contributed text. Set high standards for yourself and your co-authors. Establish deadlines and stick to them. Be punctual and picky about what you submit. It is your reputation and the publisher’s on the line. Sloppy submissions mean someone has to clean them up, which delays the process. If your text is scheduled for a spring release and your manuscript is messy, you may be putting copy editors and yourself into overtime. Not a pretty picture. Treat each page like a student’s paper and be ruthless in your editing.

After the book is released, you can raise an adult beverage and toast your accomplishment. But don’t stop there! Listen to feedback from your end users. Tweak, tweak, tweak, and repeat.

Happy writing!
Sharon B. Buchbinder, RN, PhD

Sharon Buchbinder is Professor and Program Coordinator for the MS in Healthcare Management at Stevenson University in the Graduate and Professional School and former chair of the Association of University Programs in Health Administration (AUPHA). She is also the author of three books from Jones & Bartlett: Introduction to Health Care Management, Cases in Health Care Management, and Career Opportunities in Health Care Management.

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Webinar Recording for Navigate 2 Advantage Access for Respiratory Care: Principles ad Practice, Third Edition

Hess Navigate 2If you were unable to join us for the webinar demonstration of Navigate 2 Advantage Access for Respiratory Care: Principles and Practice, Third Edition, please view the link to the recorded session and the presentation slides.

Navigate 2 Advantage Access for Respiratory Care: Principles and Practice, Third Edition webinar provides:

  • More information about Navigate 2 Advantage Access
  • Sample animations and activities
  • How to add resources
  • How to add quizzes and edit settings

To learn more about Respiratory Care: Principles and Practice, Third Edition, please visit our website.

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Understanding and Preventing Endurance Injuries

Lilah Al-Masri, MS, RD, CSSD, LD

Lilah Al-Masri, MS, RD, CSSD, LD

Simon Bartlett, PhD, CSCS, ATC

This week, our special guest bloggers, Lilah Al-Masri, MS, RD, CSSD, LD, and Simon Bartlett, PhD, CSCS, ATC, authors of 100 Questions and Answers about Sports Nutrition & Exercise, offer expert insights on understanding and preventing endurance injuries.

Over my 35-year career as an exercise physiologist and athletic trainer, I have treated numerous athletes with acute and chronic injuries. Injuries in endurance sports including running, cycling, swimming and walking are usually the result of overuse. Overuse is a chronic condition that occurs when the athlete’s body cannot stand up to the regular stresses of training and competition without breaking down.

Before we delve further into this topic, I would like to dispel the common misconceptions regarding endurance injuries. Research shows that

  • Males do not have higher injury rates than females.
  • Training speed, racing speed, running surface and body weight are not related to injury risk.
  • Foot strike pattern – heel versus forefoot has no impact on injury rate.
  • Warm-up, cool-down and stretching before exercise do not reduce injury risk.

In this article, we will focus on running since it is classified as high injury sport. Statistically, 65% of runners are injured in an average year. This breaks down to one injury per 100 hours of running thus runners miss approximately 5-10% of their workouts due to injury. This rate could be significantly lower if runners knew more about the causes of injuries, made simple adjustments in their training schedules, and routinely strengthened their muscles and joints. In fact, research indicates that running injuries could be reduced by 25% with these recommendations.

Studies have shown that a runner who trains three hours per week will take 33 weeks to get injured. If the runner increases running to five hours per week then the injury rate would be once every 20 weeks. More training means more repetitive stress to the “weak link” in the body, which equals more frequent injuries. It is not surprising that the highest injury rates in runners occur with a training volume of 40 miles or more per week. Additionally, the more consecutive days one trains the higher the chances of getting hurt. The obvious solution would be to avoid too many consecutive days. For example, someone training Monday through Friday for an hour each session would be training on five consecutive days before their first rest day on Saturday. Training this way substantially increases the runner’s potential for an overuse injury. If this runner changed the training program to four days a week for 75 minutes per session with one day of recovery between each training day the runner would significantly lower their risk for getting injured. Meaning, training on Monday, Wednesday, Friday and Sunday would give much more average recovery time between workouts.

Half of sports injuries are actually reoccurrences of previous problems. This indicates that athletes are not taking care of their injuries properly. An injury should be more than just a hindrance; it should be an indication that a body part is simply not strong enough and needs to be addressed/taken care of properly. Most athletes who are injured use the typical ice, rest and anti-inflammatory treatments. However, these treatments are not a cure, but a short-term remedy thus resulting in 50% of injuries reoccurrence. Athletes need to strengthen – not just rest and ice – vulnerable body parts, so that those areas will hold up to future training stresses. Athletes should strength train as an injury preventer. In fact, there is very strong scientific evidence to support the strength training recommendation. Studies have consistently demonstrated an inverse relationship between strength and injury; the stronger the muscle and joint the less likelihood of injury and vice versa. Strength training should be specific to the movement patterns of the sport, weight bearing in nature, and involve the large muscle groups of the body forcing the muscles to function powerfully and in synchrony.

Don’t allow an overuse injury to prevent you from being physically active and competitive. By following the above recommendations and working with exercise physiologists and certified strength and conditioning specialists, you can avoid the common setbacks associated with injury and continue an active lifestyle for many years to come.

Thank you to our readers for submitting this question. We have had many wonderful questions/comments, which have resulted in several of the articles written thus far and questions that have been submitted in the last few months will be answered in the upcoming months.

http://www.jblearning.com/catalog/9780763778866/More information can be found in 100 Questions and Answers About Sports Nutrition and Exercise by Lilah Al-Masri, MS, RD, CSSD, LD and Simon Bartlett, PhD, CSCS, ATC.

Do you have a nutrition or exercise question? If so, submit them to adefronzo@jblearning.com . Questions will be answered on a monthly basis.

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Just Published: Communication Sciences and Disorders, Third Edition

Communication Sciences and Disorders: From Science to Clinical Practice, Third Edition is an introductory text for students enrolled in their first communication sciences and disorders course. This text contains basic information about speech disorders that are related to impairments in articulation, voice, and fluency; language disorders in children and adults; and hearing disorders that cause conductive and sensorineural hearing losses.


  • Updated content with new information on evidence-based practice
  • New online video segments that clearly demonstrate a variety of communication disorders at different ages and severities
  • New chapter on cleft lip and palate
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  • New information on spoken language approaches to audiologic habilitation

Instructor Resources:                                 

Slides in PowerPoint Format, Test Bank, and an Image Bank

Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, students practice activities and assessments, a full suite of instructor resources, and learning analytics reporting tools.

Interested in learning more?  Visit our website or preview a sample chapter!

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