H1N1 podcast round-up

With the H1N1 now making the rounds and a lot of misinformation or ignorance circulating about the flu and vaccines, I thought I would post some links to podcasts dealing with the flu. Do you like my grammaphone podcast symbol? No? Well, tough.

• Dos Lives, a blog of Latino life, interviewed swine flu survivors back in May and covered swine flu from the perspective of a school nurse in September [ RSS feed, May 11 + Sept 11 ].
• The latest issue of WIRED covered the vaccine controversies and they have posted a podcast on Storyboard as well [ RSS feed, episode 006 ].
• NPR has a swine flu special coverage RSS feed.
• ABC's Science covered new methods of vaccine development recently...
• and ABC's HealthReport covered flu research last spring.
• The CDC has a long list of short podcasts you can choose from that cover topics like s/s of H1N1 and anti-viral drugs.
• British Medical Journal has several podcasts covering swine flu issues.
• EMSResponder addressed emergency preparedness issues in April.
• Johns Hopkins Weekly Health New Podcast has regular updates on H1N1 in their Feedburner feed, such as October 11's coverage of vaccination best practices.
• Last but not least, Columbia virologist Vincent Racaniello's This Week in Virology has featured swine flu several times, such as "Swine flu returns," coverage of vaccine farming, and pandemic mortality and hand washing.

NCLEX exam this Monday

Gentle readers,

I have not forgotten you, nor have I failed the NCLEX exam. Yet. The orientation process at work has been so stressful and so literally tiring that I simply gave up blogging and reading my GoogleReader for the time being. At work, they tell me I'm doing well, but it doesn't feel that way. I have yet to go through a day and finish everything satisfactorily.

Also, I have made some mistakes. My worst has been with a patient who was playing games with us on a day when I didn't have time for it, and starting spitting out oral meds, then refusing everything. I eventually got the patient to agree to take crushed the very needed pills at the end of my shift and crushed some extended release pills without thinking about it. Luckily, no advserse results, but you know that was one of the days when I did not feel good after work.

Actually, for a period of about 3 weeks, I started drinking every day and probably drank more in that period than the entire year previous. Not good.

I'm sure most new nurses have the same feelings of inadequacy I do, but it has been very rough.

Anyhow, I am scheduled to take the NCLEX this Monday at the Pearson VUE office. I'm planning on holing up for a while--maybe calling in tomorrow and Friday (Do I dare?) and spending those days and the weekend in a motel or bed and breakfast. So far, I have studied about a total of 4 hours. I do not have high hopes. I find it almost impossible to combine the stressful floor orientation and the book studying, so heinous is the book studying to me. I don't know about other people, but I measure out my time in spoonfuls of anxiety, not spoonfuls of chronology. I have had very little time to study in other words. I have spent some time staring out the window, doing laundry, cleaning the house...

And when I am formulated, sprawling on a pin,
When I am pinned and wriggling on the wall,
Then how should I begin
To spit out all the butt-ends of my days and ways?
And how should I presume?

Anyhow, if I don't pass, I'll have to stop orientation and then I'll be back in the situation I wanted originally, which was to pass the exam before taking a job. I mentioned this to the HR department at work when I went in, but they wouldn't give me a position unless I started orientation right away. Well, they got their way, and now we'll see how things go.

Wish me luck.

Cath lab observation

For whatever reason, I was sent to do a cath lab observation today rather than the floor/ECCO routine. This is nice thing to do, but it wouldn't have been my first choice for the day.

Although the "main event" in the cath lab was an ablation, the most interesting was an ICD interrogation which afforded the first opportunities to see an actual defibrillation and real, live use of conscious sedation.

Isoproterenol: I had a frustrating experience of not being familiar with this med today. I've been reviewing meds every day trying to relearn (a) things I've forgotten and (b) things I learned in a warped, half-assed fashion in school. I had skipped isoproterenol because I never remembered hearing of its use in school or while working as a ward clerk. Today, I couldn't remember what class of drug it was. Sure, go ahead and yell it out: β1,2-agonist. Embarassing to have to look it up.

All day observation was a real downer. I felt like I was being punished by not being allowed to really participate. Like I had been sent back to school. It didn't help that one of the techs was ribbing me about it.

At the end of the day, I helped pick up a patient from ICU for a procedure and got to see excellent Lori (right), who I haven't seen but fleetingly since she left PCU and not at all since I graduated. I got a graduation fist pound. Cool.

The rest of this week is the cardiac arrhythmia class, which I feel pretty good about. But I'm anxious about being back on the floor after that. There's still a lot to learn, not just cardiac-specific but basic nursing. I don't know what I'm supposed to know. They kept telling us in school not to worry about things because we would pick up skills on the job, but when I'm getting ribbed by the cath lab techs about shit it makes me wonder...

Floor Orientation: 1st day

I was fairly anxious all weekend about my first day on the floor, today. My clinical immersion in April, at the end of school, didn't exactly go textbook. From managing 2 patients to managing 5-6 over night was not easy for me. I was worried that today might also be getting thrown into a 5-6 patient assignment.

Actually, it went fairly well, or I should say easily. Patients were not complex, and there weren't that many of them. At 11:00, I left for the computer room to do computerized education and orientation. My unit has purchased AACN's Essential's of Critical Care Orientation (ECCO) program for new nurse orientees. I guess orientation will generally involve a few hours on the floor and then a few hours of ECCO each day until orientation is over. ECCO looks like it'll be a good review for the NCLEX, too.

Re-living Bush vs. Gore

At 13:15, I filmed a TV spot for public relations. A cameraman/producer came from the local NBC affiliate and taped me describing how I came to be a nurse at the hospital. The spot features new grads who have previously worked at the hospital in other jobs. I had tried to plan a statement that'd make all parties look good, but I had trouble remembering it in the blazing lights of the camera. I thought it sort of stumbled out rather than coming out velvety smooth. However, the pro said I was a "one-take kind of guy," which I think is praise in TV speak.

I'm eager to see how it turns out as I have a complex about appearing on TV. During Bush vs. Gore in 2000, I was living in DC and stayed up all night outside the Supreme Court so I could get a chance to watch the proceedings. It was quite an experience. After I came out, I was pulled aside by television crews and asked about what I saw and what was going on. I gave some lame answers that never aired on TV. I blew my 15 minutes! Can you believe it! I realized later that they must have pulled me aside because I was a wearing a nice suit, and they probably assumed I was a lawyer rather than a jobless undergrad. In the grand theme, it doesn't matter, but I can see still the disappointed look on the face of the pretty reporter who was expecting not to waste her time on me.

Orientation: order entry

Back in the computer room today to go over the "order entry" system. This was a little redundant for me since I've been working as a ward clerk, but it was relaxing. The new tele/clerk/aide was with me, so I tried to give some pointers.

Orientation: MAK, allergies, hx

Okay, so yesterday I felt guilty for being one of two people taking up hospital education resources. Today, it was just me. I spent the day in a computer class going over the hospital's "Medication Administration Check" system. This is a computerized med pass. Apparently, the company wasn't able to call their system MAC due to Apple, so it's called MAK. This has led to jokes about "med k'checking". But I guess you got what you wanted, Steve Jobs. Also covered was the computerized allergy and administration history systems.

My educator for this part of orientation is a former ob nurse who I remember from float ward clerk days as having a super short buzz cut, but not being willing to give me the time of day. Sheesh. What's a guy gotta do to get attention from a woman with a buzz cut? Oh well, water under the bridge.

Anyhow, we got to discussing certification and continuing ed today, and she convinced me to sign up for Medscape, from which you can acquire CE's.

Orientation: module 2

On day 1 of general orientation, you're in with everybody in your GO class, from administrators to nurses and food service workers. On day 2, you get just those people doing direct patient care. We were down to four yesterday. On day 3, we start something called "module 2," which is just for nurses. This brought us down to two people: myself and an LPN going to work in the renal center. I feel pretty guilty about this. There's a lot of resources in time that get expended on orientation. I guess they expect they'll have to do module 2 only a couple times a year. Since I wanted to pass the NCLEX first, I guess I screwed things up. Thank goodness for the LPN.

Module 2 is an introduction to IV therapy, beginning Healthstream (computerized) education, etc

GO day 2

General Orientation day two, today. CPR, mandatory reporting of abuse, back safety, etc...

After lunch was a medication usage and calculation test. As I always performed well--and well ahead of the rest of the class--on med calc in school, I thought I was prepared. Plus, last Sunday, I went to the food court at the mall and did the practice exams provided by HR just to be sure. But there ended up being a lot more on the exam about general medication knowledge. Luckily, it was open-book and a Lippincott's nursing drug book was available. Even as an open-book test, I got a couple wrong. However, I did get right a dopamine gtt calc question that George said a lot of people miss.

Listen, nursing students. To do medication calculation, you just have to lay out the formulas and plug in the numbers. It's all ratios; don't sweat it, just do it methodically.

Following the med calc test was competencies in the glucometer, occult blood testing, and a couple other things. There were four of us: myself, an LPN who will be working in the renal center, a new tele/clerk/aide for the PCU, and a new aide for another floor.

GO day 1 (p.s., I got a job)

Monday morning saw me in my first day of General Orientation (or, GO).

Oh, yeah, I got a job. I was worried about this for a while, but when I talked to my director she said there was an opening I could have. This was about two weeks ago. Actually, I believe I signed the H.R. job transfer form (P-5) on exactly the same date I signed my original employment papers some years ago.

I hadn't wanted to be in General Orientation today. My original plan had been to pass the NCLEX before starting any job so that I could forget pediatrics and maternity and just concentrate on wherever I was at the time. However, H.R. wouldn't let me sign the P-5 and not start orientation, so here I was today.

Since I went through GO once before, a lot was repetition today. Fire, hygiene, etc. It was all run by our educator, George (of ACLS fame).

4th annual R-3 barbeque

Although I've been working on the same hospital floor for four years, I've somehow only been to two of the four annual barbeques. This year I tried to provide something tasty by bringing Tanqueray No.10 gin and the fixings for martinis (Vermouth, olives, ice) and tonics (tonic, limes, ice). Unfortunately, nobody seemed to really like these. Who doesn't like a strong drink? Oh well. I left in the middle of the day to do some studying, then went back this evening and cleared up my stuff. At least I got a bottle of good gin out of it.

I enjoyed myself, although I don't enjoy being told that I'm stuck up because I wear a sweater vest sometimes. Give me a break.

Mice grown from skin cells

Luckily, they were grown from mice skin cells. Phew!

Seriously, as the WIRED article says:

The goal was to create an animal made entirely from reprogrammed cells, and to confirm that reprogrammed cells “are as good as embryonic stem cells,” said Beijing National Stem Cell Bank director Qi Zhou, co-author of the study published Thursday in Nature.

Much more research is needed to meet the second of Zhou’s criteria, but fulfilling the first is remarkable enough. Just three years ago, it would have been inconceivable.

This "inconceivable" is a bunch of crap. Political crap. When they say "inconceivable," they really just mean the technology wasn't there 3 years ago. Let us be frank. Matter has an essential mechanical character due to its Lego-like atomic structure that makes it manipulable. Eventually, we will be able to build cells and genetic systems from the atom up if not from the subatomic level up. This idea that we "must" have access to embryonic stem cells because we "can't" use anything else is not only crap, it's silly, and it's disingenuous for anyone to say otherwise.

Hopefully, Zhou's protocols will be easily adapted. It's sad that this technology is being brought out by communists rather than western democracies.

Please oppose House bill 1298

With all the hoopla over the current health care reform legislation (H.R. 3200), it's easy to miss other bills currently being considered. For example, the Pharmaceutical Market Access and Drug Safety Act of 2009 (H.R. 1298).

At first glance, H.R.1298 seems pretty straightforward stuff, saying that pharmaceutical companies can't sell different versions of drugs to other countries and securing the rights of people to purchase drugs sold in other countries.

But wait! Dig deeper. H.R.1298 also seeks to control the purchase of drugs through the Internet, not only purchase through American Internet pharmacies, but also purchase from foreign Internet pharmacies. This means your savvy grandma who used to order low-cost generic drugs from other countries could no longer do so.

The bill controls Internet drug purchases two ways. First, it makes it an offense for a pharmacist to sell you medications unless his website meets a bunch of design requirements and the MD, PA, or NP who gave you the prescription conducted a face-to-face medical evaluation. Second, it prohibits payments to "unregistered" foreign pharmacies.

That's right. This isn't regulation of businesses for the protection of consumers, it's the regulation of consumers. Think about it. You want to send someone money. Nope, that's against the law. Use PayPal on the wrong Internet site, and the Feds will be showing up at your door.

Proponents of the bill will say that outlawing purchases from overseas will protect consumers from themselves. But that is exactly the sort of protection we do not need. At the current time, protected substances are already illegal without a valid prescription. So what real benefit is there to adding laws against making payments?

Cui bono? Who benefits from banning payments to foreign pharmacies? Well, US pharmacies of course. Yes, this is a law passed for (1) the commercial benefit of pharmaceuticals and (2) the psychological benefit of those who see more control as a comfort.

Write your House Representative today and ask him to oppose H.R. 1298. You can also write your Senator, as the bill is in the Senate as well, as S.525 & S.1232.

NIH Wikipedia Academy

WIRED reports that representatives of Wikipedia went to the National Institutes of Health to train the health science types there in the in's and out's of wikis. This has the potential for both good and bad impacts on the health knowledge of Americans. Yes, it's true that, as Wikipedia is the first-stop for information for many amateur researchers, training the NIH could get accurate information to web users in a very timely manner. However, it also implies even more top-down control of information, now even in the primary exemplar of the web's possibilities for bottom-up knowledge building. Will those dissenting from the official government "consensus" on health and nutrition have their opinions deleted from Wikipedia articles? overwhelmed?

Well, anyhow, the government hasn't succeeded in regulating blogs, yet, so you can always follow dissent in the blogosphere...

PowerPoint: Armed Forces Journal almost gets it

An essay by Marine Col. Thomas Hammes, author of The Sling and the Stone, in the Armed Forces Journal takes users of PowerPoint to task for making dumb PowerPoint presentations. If you are an educator, administrator, or otherwise have a need to use PowerPoint, please read it.

Typical PowerPoint presentations suck, and if you think yours doesn't because you attended a "class" on how to use PowerPoint, you're probably one of the offenders. At my SUNY campus the PowerPoint "class" for professors and instructors is run by the IT folks. It teaches you how to navigate the buttons on the PowerPoint presentations, but (regardless of, or perhaps because of, the class) all teachers subsequently use the pre-packaged backgrounds, clip art, layout, and conceptual schemes with which we are all too familiar.

Lectures have become an absolutely horrible experience of visual and mental assault, and it appears that some instructors simply trade their .ppt files around if they exchange lecture topics. They then need only review the slides and make sure they understand the material with enough depth to get through the slide. Not acceptable. When you lecture, you need to be able to discuss the material at a level deeper than what the students get in the lecture. That way, questions can allow you to explain and clarify points of confusion rather than simply being speed bumps on the road to the end of the PowerPoint.

The only criticism I would make of Col. Hammes' article is his arbitrary division between "bad" uses of PowerPoint for discussion meetings and "good" uses for instruction meetings. He talks about those sitting in lectures being able to read through the slide before the lecturer does. Remember, lectures are verbal events revolving around interpersonal experiences. Having students focused on reading slides is a failure to use slides well. A lecturer should be the focus of attention during a lecture, and slides should serve to give graphic (not stenographic) support to the lecturer. The lecturer should need to reference and interact with slides, and, when finished with a slide, attention should revert back to the lecturer.

Nursing instructors, please check out a book like The Cognitive Style of PowerPoint...