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By now, you probably know of actress Angelina Jolie’s choice to undergo preventive double mastectomy, and her must-read op-ed in Monday’s New York Times.

In her specific case, the decision was a tough, but logical one given that the benefits of the procedure dramatically reduced future risk of breast cancer. It’s never an easy decision to undergo surgery. It must have been even more difficult for someone like Jolie, whose income is partly tied to her looks.English: Angelina Jolie at the Cannes film fes...

Double mastectomy isn’t the answer for everyone. Jolie was at very high risk because she is among the small percentage of women who carry the BRCA 1 and BRCA 2 gene mutation.

As Jolie points out, genetic testing is expensive, currently not covered by all insurance plans, and therefore only viable for a small segment of the population. “The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.” There are other forms of breast cancer – which may be more difficult to detect and treat.

What are the choices for those women who do not have the resources for such gene testing? Disparities along racial, education, and socioeconomic lines in both incidence and screening are well documented. Women who have other risk factors, who are without access to the top oncologists, plastic surgeons, and other care providers need to know their choices.

This is a repost from KevinMD.com

 | PHYSICIAN | MAY 8, 2013

As of early April, you can walk into Walgreens in 18 states (plus D.C.), and along with a gallon of skim milk, a pair of photo mugs, a six-pack of toilet paper, and a flu shot, you can meet your new primary care provider, get your cholesterol checked, pick up your statin, and schedule a return visit. That primary care provider will not be a physician but a nurse practitioner (or a physician assistant, but that’s for another article). Those states, and now Walgreens, have recognized that nurse practitioners can handle a lot more than antibiotics for urinary tract infections: They can practice primary care just fine without physician oversight. And it’s a pretty smart move.Lagging behind are the other 32 states (this map lays it out), in which nurse practitioners are supervised to varying degrees by physicians, the scope of their practice restricted by laws that vary from state to state. In some states, nurse practitioners can’t enroll a patient in hospice, order a wheelchair, or prescribe certain medicines without a doctor’s signature. This is true even when it’s impractical geographically and financially, not to mention belittling. Nurse practitioners in a number of states, including Connecticut, Nevada, and West Virginia, are currently pushing forlegislation for the right to practice independently and improve access to care.

This guest post was written by Jasmin Zaman, a student at the Hunter-Bellevue School of Nursing and the Macaulay Honors College at the City University of New York. Last fall Jasmin took a course in narrative writing for nursing students at Hunter taught by CHMP senior fellows Joy Jacobson and Jim Stubenrauch.

11:46 PM … 12:45 AM … 3:30 AM …

Here we go again. As I toss and turn I lose my hopes of getting eight hours of sleep. It’s Tuesday night. That means tomorrow morning I have to meet my classmates at the lobby of the Hunter dorms to make it to our 7:55 AM meeting for clinicals next door. We have our psychiatric rotations at Bellevue, and I am desperate to catch up on as much sleep as I can.

I was against caffeine when I first entered college but on Tuesday morning I haul my fatigued body to the nearby caffeine watering hole—Dunkin Donuts. My mother always warned me about the evil grasp of coffee and energy drinks, as she believed they were the culprits of my unexplained heart palpitations.

Nursing student Jasmin Zaman and friend

Nursing student Jasmin Zaman and friend

Suffering from insomnia is something I have come to accept. I share this constant battle with my classmates, and it is comforting to know I am not alone. We become so consumed by the day’s activities and by tomorrow’s schedule that it is almost bizarre to just stop—and sleep. Not sleeping the day before clinical days, especially, is a recipe for disaster. An internal disaster. My body fights itself to understand the cause of this sleep deprivation. Without the stimulant effects of coffee my body shuts down. I have often caught myself dozing off on the floor. But if I move into the maintenance phase of caffeination with stimulants like Red Bull or other energy drinks, I’m contributing to my sleeplessness throughout the night.

Studies have shown that the classic theory of sleeping one-third of the day does not correlate with feeling well-rested. Factors such as age and lifestyle contribute to the quality of sleep and feeling rested. It does not matter how much sleep you get, but rather the quality of it. Quality over quantity is best. Rapid eye movement, or REM, sleep, considered one of the most crucial stages of the sleep cycle, is “the only phase of sleep during which the brain is as active as it is when we are fully conscious, and seems to offer our brains the best chance to come up with new ideas and hone recently acquired skills,” says David Randall in a an op-ed, “Rethinking Sleep.”