teen suicide stats

The blogger at Agoraphilia has posted an interesting graph showing that suicide is a must higher problem amongst older people than amongst teens, with the rate rising steadily through life. This doesn't really surprise me...

women over-report empathy

Frankly, I am not surprised to read at MindHacks that when gender differences in empathy are measured by self-report, women are more empathetic, whereas there is also most gender difference when empathy is measured more objectively... 'nough said.

brain lamp

via MindHacks

early Dx with PET-MRI scanner

Researchers this week announced a new, faster way of imaging inside the body that could detect tumors more quickly and lead to earlier treatment. Scientists from the University of Tübingen in Germany report in this week's Nature Medicine that they were able to locate and monitor tumor growth in mice with a scanner they developed that combines positron emission tomography (PET) and magnetic resonance imaging (MRI)—and said they were optimistic it could be ready to use in humans within three years.

papercraft anatomy head

Artist Bert Simmons creates papercraft anatomical structures...

via BoingBoing

nursing in the news roundup

A nursing in Canberra, Australia, will be designed specifically for dementia patients, although the article does not say how...

A Canadian LPN who protested Planned Parenthood is fighting the suspension of his license.

Shift work results in decreased health:

They ate fewer hot meals each day, but were more likely to snack, with a preference for fattier and sweeter foods, and drank more tea and coffee.

One study showed 69 per cent got no exercise at all, while another showed they were more likely to smoke, and smoke heavily, than other workers.

And more nurses are turning to travel nursing...

the signature incident

I had a small conflict with one of my nursing instructors a while back, and I've been obsessing over it ever since. I don't why I didn't think to just blog about it!

A Monday or two back, I went in to see my Nur356 Professional Concepts instructor about a test we had taken recently. My grade was, I thought, quite low considering that she had said she would give us bonus points for attending a certain out-of-class lecture. When she was looking at my grade, she said, "Oh, I know. You must be the signature I couldn't read [on the sign-in sheet for the lecture]." She proceeded to produce the sign-in sheet and said something along the lines of "really, that signature isn't legible," in the tone of "your signature isn't acceptable."

Now, you have to understand that we have a daily class sign-in sheet that has all of our names printed next to the place where we sign our signatures. So, all that was required was for her to look at a sign-in sheet and match my signature on it to the one on the sign-in. And that's assuming that my signature really is illegible, which is an exaggeration. So, in essence, she chose not to read my signature, even though she had promised points on a test.

Why? Although not illegible, it is not an exaggeration to say that my signature is large and distinctive. Essentially, she decided that my signature did not represent the type of cowed and broken student she prefers to have in her classes.

Aside from the bold-facedly unethical removal of points from my test, I am aghast at the attitude completely inappropriate for a university setting. The type of person she wants for her program is completely opposite the type of person that instructors should be trying to cultivate, and you don't critique someone's signature anyhow. Honestly! If she wants to teach elementary school, she should leave academia!

gallbladder for real?

I thought this photo from Wikipedia was of a sculpture that incorporated gallstones, until I looked at it closer. Is that a gallbladder in an emesis basin??!! I didn't realize so many gallstones could fit in the gallbladder...

protein map of spit may mean easier testing

By Julie Steenhuysen

CHICAGO (Reuters) - U.S. researchers have identified all 1,116 unique proteins found in human saliva glands, a discovery they said on Tuesday could usher in a wave of convenient, spit-based diagnostic tests that could be done without the need for a single drop of blood.

As many as 20 percent of the proteins that are found in saliva are also found in blood, said Fred Hagen, a researcher at the University of Rochester Medical Center in New York who worked on the study.

The researchers hope saliva-based tests could be used to diagnose cancer, heart disease, diabetes and a number of other conditions.

Already there are saliva-based antibody tests to detect human immunodeficiency virus, or HIV, and hepatitis infections, Hagen said. He said this protein map will provide new targets.

Other groups are working on a saliva-based test for breast cancer that would detect a protein fragment from the HER2 protein. Hagen said such tests could eventually replace uncomfortable and costly mammograms.

"We envision in the future spitting in a tube and looking for a marker like this breast cancer marker. It would be much easier to do, potentially at home," he said.


Men in Nursing book

Men in Nursing: History, Challenges, and Opportunities (edited by Chad E. O'Lynn and Russell E. Tranbarger) is an academic book of some interest that contains a few interesting articles on the challenges of male students in nursing programs. I think I have definitely experienced some challenges, from the lack of actual teaching about "nursing fundamentals" such as touch and caring, which is mentioned in this book, to the almost total lack of visual aides in nursing lectures.

Medtronic: bad stents & hackable pacer device

The biomed company Medtronic seems to be taking a hit in the news recently, with a high death rate from a stent graft system and an automatic defibrillator monitor that sends un-encrypted medical data:
New data point to greater deaths in patients receiving Medtronic Inc's AneuRx stent graft system, which treats artery bulges in the abdomen, the U.S. Food and Drug Administration said on Tuesday.

AneuRx is used to treat abdominal aortic aneurysm or AAA, a life threatening condition in which the aortic artery bulges and can burst -- often without prior symptoms.

About 1.2 million Americans have such a bulge, according to Medtronic, but only 15 percent are diagnosed and half are never treated.

A common new technology for monitoring defibrillators is vulnerable to hacking and even to reprogramming that could stop the devices from delivering a lifesaving shock, according to research to be released Wednesday.

In the model researchers studied, transmissions from the defibrillator to the bedside monitor are not encrypted, which means that someone intercepting the transmissions could retrieve such data as the patient's birth date, medical ID number and, in some cases, Social Security number.

Alistair Cooke and penis enlargement

Following up on a recent post, I direct your attention to a Reason magazine article on crime and tissue harvesting:
Alistair Cooke's body lay cold in the embalming room of an East Harlem funeral home, suspended in the brief limbo between death and cremation. A "cutter" soon arrived to make a collection. He sliced open Cooke's legs, sawed the bones from the hip, and took them away. The quintessentially British presenter of Masterpiece Theatre and Alistair Cooke's America—the face of genteel, urbane Albion to millions of Americans—was being carved up for parts..
Alistair Cooke's remains were only the most famous of more than a thousand bodies plundered by Michael Mastromarino, owner of Biomedical Tissue Services (BTS). He had a simple business model: Pay funeral directors for access to bodies and resell bones, heart valves, spines, and other tissues to biotech firms in need of spare parts.
The history of transplantation has been one of overcoming visceral opposition-of rejecting what the prominent bioethicist Leon Kass calls "the wisdom of repugnance."

gastroparesis, Lipitor & Benicar

Last Wednesday, I went to my PA and discovered that my cholesterol, triglycerides, and blood pressure are all sky high. So, I got prescriptions for atorvastatin and olmesartan. Interesting changes occurred:

For some time, I have been having premature satiety, bloating, and also bowel movements of undesirable consistency (back and forth between constipation and diarrhea). Although I don't think the symptoms were quite strong enough to constitute gastroparesis, with my weight, age, and family history, I was wondering if I was experiencing some pre-diabetic problems.

Then, after taking the prescriptions for a few days, my bowel movements became well-formed and easily voided and I seem to be able to eat more now at one sitting and don't experience as much GI discomfort.

So, is gastroparesis treatable with statins and ARBs? I did a search on Google and in CINAHL Plus, and I couldn't find anything. In PubMed, I found two very sketchy sources:

Understanding the pharmacokinetic and pharmacodynamic characteristics of antihypertensive drugs will be of clinical importance in diabetic patients with advanced nephropathy (glomerular filtration rate of less than 30 ml/min) and/or other complications, such as impaired gastric motility or gastroparesis, and will thereby lead to a more rational management of hypertension in those patients. (1992)

Eight patients with postprandial hypotension and orthostatic hypotension were treated with the somatostatin analogue SMS-201-995. Low doses of this drug (0.2-0.4 microgram/kg) raised the blood pressure... Treatment was followed by abdominal cramps and nausea in two patients with gastroparesis diabeticorum...

Big Brother contaminates feeding tube

The TSA (Transportation Security Administration), which is the branch of government charged with taking away Americans' nail clippers, recently forced an adolescent with a feeding tube to open his sterile backup tube for inspection:

James Hoyne, 14, has a feeding tube in his stomach and carries a back-up in a sealed clear plastic bag. Hoyne said two weeks ago a TSA officer insisted on opening the sterile equipment, contaminating his back-up feeding up tube which he later needed."

I said 'Please don't open it' and she said 'I have to open it whether you like it or not. If I can't open it, I can't let you on the plane,'" Hoyne said of his conversation with the TSA screener.

Your tax dollars at work!!

via BoingBoing

oncology & blood xfusion... patient experience

The Cheerful Oncologist is a blog that has ended, and too bad. From the comments:
I hated the blood. Of everything, it is still the thing that I shudder most at when I remember. I hated that I felt bad and that I needed it. I hated to take it in the summer when the supply was low, and there might be someone who was otherwise healthy but needed it because of an accident. I hated that I could taste it for days and days afterward when it flowed through my port. I hated the feeling of having someone else's cells flowing through the center of me, as if it were some sort of violation of the core of my being. --emmy

Viagra: ten years & herbals bad

Apparently, Viagra is soon to be, or recently became, ten years old. PLoS publishes an essay on how Pfizer markets Viagra to healthy men:
Ultimately, there must be a debate about how limited resources for health care should be spent and who should make those decisions. Are men who seek to enhance their normal sexual function “worthy” enough to have their treatment paid for? If we pay for drugs and other procedures that enhance lifestyles, then other treatments either may not get funded at all or may become inadequately funded. Who will get the lifestyle drugs? Everybody who wants them? And do they get an unlimited supply? As the number of enhancement treatments grows, the scenario surrounding Viagra will become all too familiar with other drugs.

via Dr. Petra Boynton

Also, WIRED warns us against using herbal Viagra substitutes, which can have harmful effects:
In a report to Forensic Science International, which became available on Feb. 21, Dries de Kaste and his team explained that each of the shady products includes unnatural chemicals that are not listed on their labels. Since none of those molecules have been tested in rigorous safety studies, and each can affect the cardiovascular system or interact with other drugs, they are quite dangerous.

via BoingBoing

gastric bypass... on Konishiki

Famous Hawaiian-born sumo wrestler Konishiki has had gastric bypass surgery. The laparoscopic surgery I saw recently was on a fat man and some very deep wounds were created. I can't imagine operating on Konishiki.

via F-cked Gaijin

Nur363 endocrine, renal test sucked

We had an exam today on endocrine, urinary tract, and renal disorders. And I did very badly. It seems like no matter how much I study, there are details that I completely miss. And I don't just mean forget, I mean completely miss as in looked, didn't register, don't remember even seeing that before. We had a question on ABG's and DKA coma, which you were supposed to associate with metabolic acidosis, which seems like a no-brainer as long as you already know that's the answer. Here are the answers I was trying to choose between...

pH 7.1, pCO2 16, HCO3 [low]
pH 7.2, pCO2 46, HCO3 [high]

But what if diabetic ketoacidosis is a special case of pH imbalance--the pathophysiology is unique after all? (And why would you ask an ABG question if it's just supposed to get you to regurgitate a standard metabolic acidosis profile?) I was thinking... metabolic acidosis is related to failure of the kidneys to buffer adequately... so in a DKA patient the kidneys are working correctly... resulting in a higher circulating bicarb than in metabolic acidosis... possibly resulting in a different ABG profile... Plus... I don't really know how the diagnostic ABG test works and since acids and bases exist in dynamic equilibrium and not in a static state, it's possible that higher circulating bicarb is reflected in the ABG...

Well, obviously one problem is that I didn't really understand the underlying concept of metabolic acidosis, thinking it was related to an inadequacy of kidney function rather than an inadequacy of the kidney's function, you see. That's not entirely my fault as this was the message I took away from Nur362, in which I got the ABG questions right on the exams. But it does point to the problem that I'm not really learning physiology in nursing school. In order to keep myself from getting mixed up, I have to dig deeper than we are going.

Anyhow, the problem that really grates on me is that I reviewed the notes after the test and, sure enough, right there under the diabetic ketoacidosis heading it says metabolic acidosis. I had gone over these notes maybe five times last night, and I don't even remember seeing these words on the paper. They're so meaningless in that context that my eye glossed right over them. This happens to me all the time, and I don't know how to prevent it without, as I said above, taking every word in the notes and systematically reviewing it more thoroughly. I just don't have time for that.

And then there's The Big Number Issue. At work, I can't remember doctors' pager numbers even though I've been working as a ward clerk for 3 years--they just don't have meaning to me, and they don't stick. If I could have remembered the reference values for the ABGs, I probably could have figured out the correct answer. But I didn't remember the pCO2 value, and I assumed, of the two answers I was trying to choose between, that one represented a high value and one a low value. If you know your ABGs, you know that they actually represent a low-high value and high-high value. But what if the low-high value really was low? That would represent decreased ventilation, and wouldn't a patient in a coma have reduced respiratory status?

Well, it sounded good at the time. Wikipedia says that Kussmaul first defined Kussmaul breathing as a "sign of coma and imminent death," but the article on diabetic coma says "In the early to middle stages of ketoacidosis, patients are typically flushed and breathing rapidly and deeply, but visible dehydration, pallor from diminished perfusion, shallower breathing, and rapid heart rate are often present when coma is reached." So, depending on which article is right I was either wrong and wrong or wrong and right...

This whole nursing school situation is very frustrating. Since returning to school to do nursing, I had maintained a 4.0 average, including a 4.0 in the A&P crash summer course, which I took while working full time (40 hours per week). And it looks right now like I will be repeating at least Nur360 maternity and maybe this whole semester if I'm not kicked out of the program. This is really crappy.

Knome's commercial gene sequencing

I was alerted to the following because I am on Knome's e-mail list. Not that I will ever be able to afford to use their service...

The New York Times
reports on Dan Stoicescu, a millionaire who paid to have his genes sequenced by Knome, Inc:

Mr. Stoicescu is the first customer of Knome, a Cambridge-based company that has promised to parse his genetic blueprint by spring. A Chinese executive has signed on for the same service with Knome’s partner, the Beijing Genomics Institute, the company said.

Scientists have so far unraveled only a handful of complete human genomes, all financed by governments, foundations and corporations in the name of medical research. But as the cost of genome sequencing goes from stratospheric to merely very expensive, it is piquing the interest of a new clientele.

“I’d rather spend my money on my genome than a Bentley or an airplane,” said Mr. Stoicescu, 56, a biotechnology entrepreneur who retired two years ago after selling his company. He says he will check discoveries about genetic disease risk against his genome sequence daily, “like a stock portfolio.”

Knome is not the only firm in the private genome business. Illumina, a sequencing firm in San Diego, plans to sell whole genome sequencing to the “rich and famous market” this year, said its chief executive, Jay Flatley. If competition drives prices down, the personal genome may quickly lose its exclusivity. The nonprofit
X Prize Foundation is offering $10 million to the first group to sequence 100 human genomes in 10 days, for $10,000 or less per genome. The federal government is supporting technology development with an eye to a $1,000 genome in the next decade.

But for now, Knome’s prospective customers are decidedly high-end. The company has been approached by hedge fund managers, Hollywood executives and an individual from the Middle East who could be contacted only through a third party, said Jorge Conde, Knome’s chief executive.

Verein zur Förderung Freier Informationen für die Pflege e.V.

I just discovered that NursingWiki, which I just blogged earlier today, is run by a German organization called Association for the Promotion of Unrestricted Information on Nursing. I think that in fact this organization only runs NursingWiki. However, it is nice to know it exists, which it does at:
Verein zur Förderung Freier Informationen für die Pflege e.V.
Bismarckstrasse 78
D-45888 Gelsenkirchen

Benner vs. Ericsson on experience

Mindhacks reports on a recent Time magazine article that highlights work by Dr. K. Anders Ericsson, who has shown that experience is not a good measure of expertise. Rather, it is challenge and exertion that produces expert performance. This seems to be at odds with the Patricia Benner idea of novice to expert nursing, in which inexperienced nurses just follow rules, while experienced ones perform intuitively.

Actually, I don't have any idea if Benner and Ericsson are at odds, because I don't know enough about either theory. However, Ericsson-as-presented-in-blog-post is at odds with Benner-as-presented-in-nursing-concepts-course. I have the feeling that part of the point of promoting Benner to nursing students is social control--that is, get students to internalize the idea they are novices so you can tell them "hey, just the follow the rules."

Nursing programs as I have witness them are two-faced in promoting "critical thinking" and "evidence-based practice" on the one hand and hierarchy and the authority of elders on the other. It would be nice to say that this is the difference between newer and older nurses, trained under different systems, but it doesn't seem to be.

In fact, just today, just an hour ago, I had one of the Dean Vaughn system medical terminology labs in which the instructor told us before class that, in her PhD program, they had been learning about the importance of learning styles and that we each had to develop our own ways to study and learn, and told me during class that I should stop studying the terminology by myself (quietly) and follow the video with the rest of class.

NursingWiki & Wikipedia nursing portal



Here are two wiki resources for nurses. The NursingWiki is a nice idea, but there aren't many articles, the articles aren't very in depth, and it seems sort of redundant when you have Wikipedia, which covers pretty much everything in the world. Additionally, the NursingWiki suffers from a certain lack of vision for the site. For example, under the article "nurse," there is a portrait of a smiling woman woman in white scrubs. Why? Is that what a nurse is--a "smiling woman in white scrubs"? Likewise, the article "nursing language" contains no discussion of medical terminology or the incorporation of extra-medical terminology into nursing but does have a list of random medical terms and their German translations--huh?

Nurses interested in contributing to open access, open source knowledge databases about nursing should stick with contributing to Wikipedia, since there is no need to duplicate that service. However, NursingWiki could fill a niche by providing articles for nurses. For example, a Wikipedia article on colecystectomy should not include information about nursing interventions as that is too narrow a focus (i.e., not of interest to the general reader) for an encyclopedia. However, a NursingWiki article on colecystectomy that describes nursing interventions with research citations would be a great resource.

(But shhhhh: it would also be step on the path to open access and open source textbooks!!)

HIV not a modern virus

PLoS Pathogens publishes a case of convergent evolution that suggests that ancient primates may have dealt with viruses similar to HIV (or SIV, I guess...).

via Monkey Day News

  1. Newman RM, Hall L, Kirmaier A, Pozzi L-A, Pery E, et al. (2008) Evolution of a TRIM5-CypA Splice Isoform in Old World Monkeys. PLoS Pathog 4(2): e1000003. doi:10.1371/journal.ppat.1000003

skin graft vs. penis enlargement

Moulitsas, founder of DailyKos, claims that some congressional candidate is funneling skin graft material away from burn victims toward penis enlargement patients. This is a little hard for me to swallow since the amount of skin needed for penis enlargement must be infinitesimal (since penis enlargement surgery doesn't really do much).

via BoingBoing

Let Britannia Rise blog


Following on previous posts about my extra-nursing-self, I share with you a blog I like to visit that is today promoting a bit of Handel. Now if, as some theorists like Virginia Henderson suggest, becoming a good nurse means becoming a well-rounded and well-educated person, this clip should improve your nursing ability as well...