cxlxmxrx: 3/1/09

Verbal documentation system

Butler Memorial Hospital has won an award from CARING for a verbal documentation system it developed in-house for its IV therapists. I think it's awesome that this was developed in-house. I've had a couple ideas for IT improvements that I've floated in my work-place and gotten responses back that essentially boiled down either to "our abilities are dictated by the proprietary software we purchased" or to "we don't know what the security consequences of that would be." Oh, well then by all means, don't make any attempts to try improvement! It's nice to see an IT department with some guts.

Retarded

Not the best use of language.

DVT Awareness Month... is almost over!

Who knew? March was DVT Awareness Month, and now it's almost over. Well, go out today and tomorrow and tell people!

via Happy Hospitalist

Obama's bowling comments

Danny McCaslin would like people such as President Obama to stop using the word "retarded" and other turns of phrase that compare poor performance to intellectual disability. Actually, Obama didn't say that his score was low as Special Olympics participants' scores are low, he was suggesting that his bowling was an embarassing performance. While I agree that everyone slips up and makes offensive comments from time to time and shouldn't be beat up over every little thing, I also think this type of comment can't be said by someone who isn't embarassed of the Special Olympics' participants. This important to keep in mind when considering some of Obama's policy positions.

Così fan tutte: Atelier lyrique @ Monument-National

One of the few nice cultural events in my area is the Culture Coach program, which allows people to buy season tickets for the opera. The group gets bused in to Montreal. Occasionally, someone can't attend a certain performance, and the ticket goes up for sale. Such was my luck. Last night, I went to see Mozart's Così fan tutte, performed by L'Opera de Montreal's Atelier lyrique at the Monument-National.

I'm not really knowledgeable enough to comment on the performance, and you're probably not interested in reading about it. Let me just say that the performance was enjoyable for me, and it was a real pleasure to attend the Monument-National, which has a good-looking interior with spacious old-fashioned seating.

Monument-National, Montreal

Così is opera buffa, which is to say opera comedy. As it happens the most humorous moment in this opera is health care-related!

The plot involves a bet between two soldiers (FERRANDO AND GUGLIELMO) and a gentleman (DON ALFONSO) that their fiances (FIORDILIGI AND DORABELLA) will stay faithful while they are gone. The soldiers say they are going off to war, and then return disguised as foreigners to court their fiances. The gentleman recruits the ladies' maid (DESPINA) to help him win the bet.

In this scene, the soldiers in disguise pretend to poison themselves in order to win the affection of their fiances. The maid Despina arrives dressed as a doctor and "saves" them by using a magnet (!) to pull out the poison...

DORABELLA
His head is very cold.

FIORDILIGI
This one's cold as ice.

DORABELLA
And his pulse?

FIORDILIGI
I can't feel it.

DORABELLA
This one's beating very slowly.

FIORDILIGI AND DORABELLA
Oh, if help is long in coming,
There'll be no more hope of life!

FERRANDO AND GUGLIELMO
aside
Both have become
Calmer and more gentle;
We shall see if their pity
Will turn into love.

FIORDILIGI AND DORABELLA
Poor dears! Their death
Would fill me with grief.

DON ALFONSO
Here's the doctor,
Gentle ladies!

FERRANDO AND GUGLIELMO
aside
Despina dressed up!
How heavily she's disguised!

DESPINA
"Salvete, amabiles,
Bonae puellae!"

FIORDILIGI AND DORABELLA
He speaks a language
We do not understand.

DESPINA
Let's speak, then,
As you command me.
I know Greek and Arabic,
Turkish and the Vandal tongue;
And I can speak
Swabian and Tartar too.

DON ALFONSO
Keep all these languages
For yourself, sir;
For the moment,
Look at these poor fellows;
They've taken poison;
What can be done?

FIORDILIGI AND DORABELLA
Yes, doctor,
What can be done?

DESPINA
feeling the pulse and forehead of each
First I must know
The nature of this potion
And the reason it was taken;
Whether it was swallowed
Hot or cold,
A little or much,
In one draught
Or in several.

FIORDILIGI, DORABELLA AND DON ALFONSO
They took arsenic,
Good doctor,
And drank it here.
The cause was love
And they swallowed it
In a single gulp.

DESPINA
Don't worry,
Don't be afraid;
Here is an earnest
Of my skill.

FIORDILIGI AND DORABELLA
He's taken a piece
Of iron in his hand.

DESPINA
This is
A piece of magnet,
The stone which the great
Doctor Mesmer discovered
In Germany
And then became
So famous in France.

She touches the heads of the feigned invalids with the magnet and gently draws it the length of their bodies.

FIORDILIGI, DORABELLA AND DON ALFONSO
Look, they're moving,
Twisting, shaking!
They'll hit their heads
On the ground in a moment.

DESPINA
Ah, hold their foreheads
Steady, will you?

FIORDILIGI AND DORABELLA
We're standing ready!

DESPINAHold tight.
Courage! Now they
Are safe from death.

FIORDILIGI, DORABELLA AND DON ALFONSO
They're looking round
And recovering their strength.
Ah, this doctor's
Worth all the gold in Peru!

FERRANDO AND GUGLIELMO
rising to their feet
Where am I? What place is this?
Who is he? Who are they?
Am I before Jove's throne?
Are you Pallas or Cytherea?
Ferrando to Fiordiligi and Guglielmo to Dorabella
No, you are my fair goddess!
I recognise you by
That sweet face,
And by that hand I now know so well;
It is my only treasure.

They embrace the girls tenderly and kiss their hands.

DESPINA AND DON ALFONSO
It's the effect of the poison still;
Don't be afraid.

Atelier lyrique's cast

NIH autism stimulus money

Furious Seasons' take on the stimulus package's funding for autism research:

I'm all in favor of researching the hell out of autism spectrum disorders, but does anyone seriously believe that this $60 million will create new jobs and stimulate the economy? I don't. If anything, it'll redeploy already-well-paid researchers and their staffs from other projects into autism research projects defined by NIMH. I fail to see how that creates new jobs. I'm not hearing about mass layoffs of researchers.

I guess it falls into line with my initial suspicions when I first saw details of the stimulus plan a ways back--and that is that a fair amount of the $500 billion or so in spending (and borrowing from China) would go to priorities that can't create new jobs. For example, paying a portion of laid-odd peoples' COBRA. That won't suddenly create new health care jobs and won't create a job for the laid-off person, so it kind of defeats the stated purpose of President Obama's stimulus package (or Congress' or whomever's it is), which is to create jobs, and that bugs me.

News experiment

Okay, here's an experiment in posting my GoogleReader shared news items. If you read and care, post a comment on "good vs. bad"...

removed 31 Mar 2009: this was a bad idea

Video of HIV cell to cell crossing

Okay, I tried to post the video here, but it's not working, so just view it on the original source page.

Neurosurgeon has heart attack, continues surgery

This is an awesome news report. While I understand the logic behind many of the self-protective measures required in health care, I also find them to be emasculating. Perhaps the only place where manliness (or, dare I speak its name... chivalry) and health care can meet is on the field of self-abnegation, putting oneself in harm's way in order to help another. So, it comes as something of a relief to read about this Italian (of course!) neurosurgeon Claudio Vitale...

Claudio Vitale, 59, insisted on finishing the surgery in Naples before undergoing his own operation to clear an artery, Ansa news agency said.

Mr Vitale refused to abandon the operation to remove a tumour, even though he needed emergency treatment.

Both surgeon and patient are reported to be on the mend.

According to reports, Mr Vitale started to feel chest pains part way through the operation at Naples' Cardarelli Hospital.

When the pains worsened, Mr Vitale's team urged him to stop the procedure and get treatment, but he refused.

He agreed to undergo a blood test, which confirmed a heart problem, but the neurosurgeon insisted on completing the operation before getting medical help, reports say.

Half an hour after finishing the surgery, Mr Vitale had an angioplasty operation to treat an angina attack.

"I couldn't leave [the patient] at such a delicate moment," Mr Vitale was quoted by La Repubblica newspaper as saying.

"I'm not a hero, I only did my duty," he said.

Mr Vitale said he hoped to return to work after a period of recuperation.

via Mindhacks

Funny anatomical model with patient gown

I got a kick out this anatomical model that you can get a patient gown for, from AnatomyTools...

Ebola researcher receives experimental vaccine

The ebola researcher who received a needle-stick recently is being given a new vaccine. Photo above is of a quarantine unit at Hamburg University Hospital in Germany...

A scientist accidentally pricked her finger with a needle used to inject the deadly Ebola virus into lab mice. Within hours, members of a tightly bound, yet far-flung community of virologists, biologists and others were tensely gathered in a trans-Atlantic telephone conference trying to map out a way to save her life.

Less than 24 hours later, an experimental vaccine — never before tried on humans — was on its way to Germany from a lab in Canada.

And within 48 hours of the March 12 accident, the at-risk scientist, a 45-year-old woman whose identity has not been revealed, was injected with the vaccine.

So far, so good. If the woman is still healthy by Thursday, she can consider herself safe.

Dr. Stephan Guenther, head of the Bernhard Nocht Institute for Tropical Medicine in Hamburg, where the researcher was working, said tests so far show the scientist is healthy and free of the virus.

The peak period for an outbreak during the 21-day Ebola incubation period passed this week, he said.

"We are now on the downside," Guenther told The Associated Press, noting that with each passing day the chance of infection taking root diminishes.

It's not entirely clear the researcher was actually infected with the virus. At the time of the accident, she was wearing three layers of protective gloves, and though the needle stuck her, the plunger of the syringe was not pushed so it's not certain the virus entered her bloodstream.

That means scientists may never know if the vaccine worked or she was just lucky.

There are two other known accidents involving researchers who came into direct contact with a similar strain of Ebola. A Russian researcher died, and a British scientist became ill but survived.

After the needle stick, Guenther knew he had to act swiftly.

He rushed an e-mail to fellow scientists in the Ebola research community. One was Dr. Heinz Feldmann, chief of the virology laboratory at the Rocky Mountain Laboratories, a U.S. National Institutes of Health research facility in Hamilton, Mont.

"We considered this as serious as (the Russian) case, in terms of the exposure," Feldmann told the AP in a telephone interview last weekend.

Feldmann was part of an international group of experts from the U.S. Centers for Disease Control and Prevention, the U.S. Army Medical Research Institute of Infectious Diseases, the Canadian Public Health Agency, Boston University and the University of Texas Medical Branch.

Feldmann, Guenther and several other experts took part in the teleconference debating the options. These included a live vaccine never before tried on humans, another treatment designed to interfere with the virus' ability to multiply, or an anticoagulant that Army research found had saved the lives of monkeys exposed to Ebola.

The option that emerged as the strongest was the vaccine, which had been developed by Feldmann and collaborating researchers at several institutions. Much of the key work was done about nine years ago at a microbiology research lab run by the Canadian government in Winnipeg, Manitoba, where Feldmann worked at the time.

more story here

Nur464 clinical day 2

I had my first clinical coup today. Last night, I waited too long to study meds and ended up going to bed and crossing my fingers, but today I remembered everything I needed to when questioned. Woo-hoo!

So, yesterday, you will recall, I was left to figure out trach care on my own when I was supposed to be shadowing. Today, the patient was being discharged and the attending nurse had to go to radiology with another patient. So, when the EMTs arrived, there was no nurse to do discharge. I ask my clinical instructor, what should I do? Find the nurse covering for the nurse who left the floor, she says. I do that. The covering nurse says, there's nothing to doing a discharge, just hand them the paperwork. Okay, I say (never having been involved in a discharge before).

As it turned out, there were other complications with the discharge, but what's going on here?

Actually, my major impression from today was of lack of basic nursing skills. I can do the whole meds thing okay, but whenever it comes to turning, standing, bathing, etc, I default to letting whoever is with me take charge of the situation. Which is not good. But at least I know it's a problem.

Next week, hopefully I'll get some patients with tubes and whatnots.

Oh, and the main basic thing I can't figure out is I+Os. I know this sounds stupid, but I don't know how I'm supposed to know when I check and record I+Os and when the aide does this. Part of the problem is that previously the instructors have told us to "do the aide's work" for our patients, which is nice but doesn't let us get practice managing and interacting with aides. I'm going to have to ask someone about this and just accept seeing a dropped jaw and perhaps a red face.

Margaret Hamburg news

Today's Margaret Hamburg news...

While the FDA commissioner nominee requires senate confirmation, the deputy commissioner does not. Therefore, deputy Sharfstein will be the acting head of FDA.
The RPM Report makes some informed statements based on Elsevier's (not free) Pink Sheets, and suggests that the Hamburg-Sharfstein duality will be a confirmation issue and an agency challenge for Hamburg. Apparently, the Obama administration is denying an plans to split the agency.
Kiplinger says Hamburg "is expected" to be confirmed easily, and that there will be a lot of policy changes made quickly afterwards.

Nur464 clinical day 1

Well, today was the first day of what should be my last clinical rotation. Hard to believe. I haven't been in a hospital clinical (discounting psych, where we couldn't even pass meds) for a year.

So today I am supposed to be shadowing a nurse, and I volunteer to help a respiratory therapist with trach care, which I previously did on a mannequin 20+ months ago, and she gives me the supplies and leaves me. Nice.

Actually, performing trach care didn't bother me, but I did have a hard time with basic nursing practice like helping people move and change. I still haven't figured out things such as how much pressure to exert on elderly people to keep from hurting them. I gave a backrub today and discovered no muscle to rub.

Oh well. We'll how things go tomorrow when I actually have to manage the patient.

The Nursing Show & the face of nursing on the web

A few days ago, I found a podcast/blog called The Nursing Show. It's a model of professional nursing blogging in my opinion. Most blogs (including mine) don't always put nursing in a good light by presenting the authors in an immature/unprofessional way. The Nursing Show doesn't do that, although to be fair to all other nurse bloggers, the author is a professional educator, so you could think of the blog as advertising as well...

The stock photo used on the blog I have seen in a couple places now, and it also does a fairly good job of presenting nursing. The nurse is dressed believably but looks put together, and the laptop nicely gives the impression of technological education.

Tonight: reporting on the first day of Nur464 clinicals--hopefully not a disaster.

Tolkien Reading Day

I almost forgot that March 25 is Tolkien Reading Day, as marked on my geeky events calendar. I guess I have should have brought attention to this earlier.

To attempt some justification of blogging this on a nursing blog, today I re-read the parts of The Fellowship of the Ring in which Strider uses athelas to treat wounds. I was going to re-type them here, but I've run out time as I have to get some sleep before first day of hospital clinical rotation tomorrow.

Anyhow, I recommend you revisit Tolkien's work periodically. I found it relaxing and comforting today.

Below an image of the same edition I have. I've never known anyone else who has this edition, actually. It's an excellent size for reading with relatively large typeset.

How we got to where we are - health care concept map

This is a cool map. Click on picture for enlarged version.

via The Happy Hospitalist

World TB Day: March 23-25

One of these days, on which the Stop TB conference is occurring in Rio de Janeiro, is world TB day. Maybe today, maybe tomorrow...

Open EKG project

This is cool idea:

The openECGproject is an online community conceived around a simple, but challenging and worthy goal - to develop an open source hardware and software solution for electrocardiography.

I've never understood why there aren't more open source medical product projects. I suspect it has something to do with liability.

Hamburg on Schein board

Margaret Hamburg, the nominee for FDA commissioner, sits on the board of Henry Schein, a pharmaceuticals and medical device distribution company. As reported by Politics and Critical Thinking, Hamburg received about $200,000 of Schein stock on March 9, just before she was nominated by Obama. What does this mean? Is this a parting gift? Would an industry trying to buy government policy do something so transparent and try with only $200k when Hamburg is married to the director of Renaissance Technologies? The crazy view is presented by Health Care Renewal:

Given that Dr Hamburg has spent over five years living with the obligation for unyielding loyalty to the interests of Henry Schein...

...um, okay... A more restrained and thoughtful viewpoint is expressed by Adam Fein, who is excited about the possibility of having someone at FDA who understands business distribution models.

Almost hump-day round-up

One of my nursing instructors subscribes to SmartBrief and forwards the ANA brief to us. The most recent one had some pretty interesting links...

GoogleReader & cxlxmx's shared news

If you follow cxlxmxrx closely (and who doesn't?), you'll have noticed that there has been a new link at right for several days called "news". This link goes to a news feed aggregated from the RSS feeds in my GoogleReader.

The way it works is this: various news sources, blogs, and other websites (actually, almost everybody these days) publish RSS feeds. I go subscribe to these feeds through GoogleReader. GoogleReader allows me to tag certain items within each feed to be "shared". GoogleReader then aggregates these items and publishes them. You can read them on my GoogleReader page, or you can subscribe to an aggregated RSS feed (click on the orange square in the navigation, as shown below...). I think this is a pretty cool way to share information. You could potentially have layers upon layers of feeds, all mixing and matching news differently for different audiences.

I just started using GoogleReader last week, so I'm still working out the kinks--trying to figure out what is useful and efficient reading via GoogleReader. This is harder than it sounds. One thing that seems fairly fruitful, however, is to subscribe to RSS feeds of Del.icio.us bookmarks. This methods allows you to sidestep corporate filters to some extent. Also, if you find someone like-minded on Del.icio.us, you almost assured a steady supply of links you will find relevant and interesting. Just a suggestion.

Hospital explosion!

I woke this morning to an article in the local paper about an explosion in an area hospital:

BY DAN HEATH

SARANAC LAKE — Although no one was hurt in a
boiler-room blast at Adirondack Medical Center Sunday morning, damage from the
explosion made it necessary to move all patients from the Saranac Lake
hospital.

Hospital President and CEO Chandler Ralph, speaking at a
news conference Sunday afternoon, said all 35 patients were, or will be,
transferred to other area hospitals and health-care
facilities.

"Although this was a very dangerous situation, staff
reacted immediately to safeguard each and every patient. The incident command
system was extremely effective and, as usual, all staff was on board to assist
in these efforts, including area rescue squads and vendors assisting us in
repairing the damage," she said.

"Kudos also to our medical staff,
who immediately assessed their patients in order to most efficiently and safely
have their patients transferred to the most appropriate
facility."

Patients were transferred to CVPH Medical Center in
Plattsburgh, Alice Hyde Medical Center in Malone, AMC in Lake Placid and
AMC-Uihlein nursing home in Lake Placid due to a projected loss of heat and hot
water for at least two days.

AMC Communications Manager Joe Riccio
said about half of those transfers had occurred by about 4:30 p.m. and all were
expected to be completed Sunday evening.

One patient who is on a
respirator required transport by an Advanced Life Support ambulance and crew,
including hospital staff.

AMC staff will be sent to the area
medical facilities if needed to help care for patients.

Ralph said
the blast happened at about 10 a.m., but there was no subsequent fire. No one
was in that area of the building at the time.

The explosion, she
said, "shook the building."

A supervisor on duty quickly decided to
start the transfer operations when it was determined the boiler could no longer
be used, she said.

Ralph said the hospital is working with the New
York State Department of Health on alternatives such as portable
boilers.

Ambulances from many area hospitals and fire departments
were at the Medical Center Sunday, with five lined up out front at 3 p.m. and
others waiting in a queue out back.

Saranac Lake Fire Department
Second Assistant Chief Chuck Dobson said ambulances and crews from the Malone,
Moira, St. Regis Falls, Chateaugay, Tupper Lake and Lake Placid fire departments
and from EMT of CVPH in Plattsburgh, Northern Ambulance of Malone, Seaway Valley
Ambulance Service of Massena, Varins Ambulance Service of Plattsburgh and
Lamoille Ambulance Service based in Ticonderoga were involved in the patient
transfers.

Saranac Lake Fire Department firefighters are helping
hospital staff to determine the explosion's cause, which remained under
investigation Sunday evening.

First Assistant Chief Dave Bickford
said a 3-foot by 3-foot section of the chimney, 8 feet to 10 feet in height,
either exploded or collapsed.

He said debris from the 40-foot
chimney did fly around the boiler room, damaging some equipment, but it appears
the two boilers are operational. They can't be used, however, until the chimney
is taken down, Bickford said.

AMC Chief Financial Officer Patrick
Facteau said the bottom of the chimney in and atop the boiler room was nearly
disintegrated. He said engineers were on the way to the hospital to help assess
the damage.

The lack of structural integrity of the chimney makes
it a potential risk to other parts of the facility. The area around it has been
cordoned off to traffic and pedestrians.

The hospital has 97
certified beds. Ralph said it was fortunate more beds weren't full Sunday
morning.

The AMC Saranac Lake Emergency Department will remain open
to evaluate and treat patients. Those who need admission will be transferred to
other hospitals.

The hospital's medical offices and out-patient
non-surgical services — such as x-ray, laboratory and physical therapy — will
also remain open. The power did not go out due to the blast, Ralph
said.

"I have more than 30 years in health
care. I have never heard of this happening. We will get to the bottom of it, and
it will never happen again."

2009 International Nursing Research Conference

The 2009 International Nursing Research Conference starts today and runs the week. Hosted by UK's Royal College of Nursing at Cardiff in Wales. To bring attention to the event, BBC journalist Jane Elliott has written up Doreen Norton's research on pressure ulcers, which I guess could be called the quintessential example of nursing research.

Unfortunately, we are not able to make our profiles work for you...

I was going through some old documents on my computer and found my screen captures from when I tried to use eHarmony a while back. I guess with some of the advertisements that have come out since then, more people know that you can get rejected from eHarmony, but I didn't know that then!!

I uploaded the results of my profile to Scribd...
http://www.scribd.com/share/upload/10211808/1f2a1nbyr77nmfip0l9l

Fluid volume monitored with finger probe

This is pretty amazing:

A study just presented at the International Anesthesia Research Society (IARS) 83rd Scientific Congress on March 14th in San Diego, California has shown that Masimo's Radical-7 Pulse CO-Oximeters can be used as a viable option for intravascular fluid volume monitoring during surgery, thanks to a proprietary Pleth Variability Index (PVI) function, which is a measure of the dynamic changes in perfusion index (PI) that occur during the respiratory cycle.

Sunday comic: nurse song

BigPimpin is a webcomic by a med student. He's set some lyrics about nursing to the tune of "When you're a Jet" from Leonard Bernstein's West Side Story. It's too small to read here, so go to his site...

Gorillas and heart disease

These photos are of a gorilla undergoing echocardiogram and cardiac auscultation exams. Apparently, gorillas in captivity are prone to heart failure. Who would've thunk it?

A1CNow+, home test kits, and nursing clinics

In med-surg class this semester, we discussed the hemoglobin A1C test and the instructor mentioned that he thought it was now available as a home test kit. I decided to try to get one over spring break and check it out. But no pharmacy in my area had one, and they all told me I needed to go to the hospital, which says that they're not even aware that the A1C can be done another way.

Well, as it turns out, the HbA1C is not quite available as a home test... yet. A Google search turns up several types of "home test" kits, but all except one involves mailing a sample into a lab. The one exception is the A1CNow+, which is made by a company called Metrika, which was purchased by Bayer. It involves a disposable monitor good for 10 tests.

The technology for A1CNow+ has actually been around for a while. In the MedGadget review from 2006, the Bayer Press Release suggests the device will be sold for at home use. As of now, it is actually only available for use in clinics and hospitals. However, I called the customer service reps at Bayer, and they told me it is going to be released for home use in the near future.

The A1CNow+ looks to be a little over $10 a pop. That compares with the mail-in version at around $19-$25 a pop, although it isn't clear from the mail-in kits whether there might be an additional lab charge to get your results back.

If you really want to do an at-home test, you can get a mail-in kit from Amazon. (Also--hush, hush--you can buy the A1CNow+ direct through Amazon, although you shouldn't be able to. The main disadvantage to this is that there is a 1-year expiration, so you would need to go halfsies with somebody else to get your money's worth).

The interesting thing I discovered while looking into this matter, is that there is a whole slew of "home test" or "office test" kits available. For example, check out the second Google hit on A1CNow+. Health Management Systems has two pages of test kits, covering everything from PSA to HDL.

On Amazon, you can buy a monitor that does multiple heart health tests. Why stop there? The sensible thing is to make a monitor that can be used for a variety of tests. And then make a laptop-based system that comes with software that allows you to track and organize multiple patients.

Where is all this heading?

My public health textbook recommends nursing clinics as cost-effective alternative care centers. I think there's something to that, and home/office test kits would be an excellent way to facilitate a one-stop clinic solution. Why pay $100 for a sinlge lab test when you could pay that much for 4-5 office tests? Of course, there's always the reimbursement issue...

Margaret Hamburg on Ebola virus

FDA nominee Margaret Hamburg appeared on Charlie Rose twice in the mid-90s. The photo above is from a discussion of the Ebola virus. It's hard to understand why she hasn't been back. I wonder if it had to do with serving under Mayor Giuliani?

Things fall apart

Yesterday, I linked to a photo set of a falling down hospital. Today, I link to a photo set from TIME-CNN on places in Detroit that are falling apart. Have you ever been to a place like this? I have, in the mountains not far away. It's a strange feeling.

I always wonder, when contemplating this degradation, at the fact that we somehow keep this from happening to the places we live. We must all engage in "housekeeping" activities every day that we aren't even aware of in order to keep our buildings from falling down. Stop regulating the temperature in house, and how long would it be before the pipes froze or cracks started to appear? Just a little neglect, and everything falls apart.

Of course, this does have relevance for nursing and health care. These photos are the expression of what is happening to our bodies as well when we eat poorly and fail to exercise. Of course, you can't live forever, but just a little daily housekeeping can keep things looking good far longer...

via BoingBoing

Happy Certified Nurses Day

March 19, Certified Nurses Day: Never heard of it before, but hurrah nonetheless!

Falling apart mental hospital

Here's a Flickr set from some teens who toured an abandoned mental hospital. It sounds like the plot to a horror movie, and truly these photos make me uneasy...
http://www.flickr.com/photos/isaaceastgate/sets/72157607730502358/

Simian malaria case report

From the March 13 MMWR:

In the recent U.S. case, a woman aged 50 years with no previous history of malaria who was born in the Philippines but had lived in the United States for 25 years, returned to her home country to visit friends and relatives on October 17, 2008. While there, she stayed on the island of Palawan in a cabin located at the edge of a forested area known to be a habitat for long-tailed macaques. She had not taken malaria chemoprophylaxis and had not used any mosquito-avoidance measures, both of which are recommended preventive measures for travelers to this area.

The woman returned to the United States on October 30, 2008, and noted the onset of a headache. Fever and chills ensued, and symptoms persisted for several days, after which she sought medical attention. In the emergency department, she was noted to be hypotensive and to have thrombocytopenia. Examination of thick and thin malaria smears (Figure 1) was ordered, and an initial, erroneous diagnosis of babesiosis was made by a laboratory technician. Upon review by the laboratory supervisor the following morning, the diagnosis was reassessed as malaria with 2.9% of red cells parasitized. However, the atypical appearance of the Plasmodium sp. seen in the smears prevented a species-specific diagnosis. The woman was treated successfully with atovaquone-proguanil and primaquine for Plasmodium of undetermined species.

An ethylenediaminetetraacetic acid (EDTA) blood tube and two stained smears were sent to New York state's Wadsworth Center Parasitology Reference Laboratory for confirmation of malaria and molecular determination of species by PCR. The Wadsworth Center confirmed the presence of atypical rings and schizonts of a Plasmodium species (Figure 1), but conventional PCR targeting the small subunit (SSU) of rRNA did not yield a product consistent with any of the four species of Plasmodium known to infect humans. The specimen also was negative for the variants of P. ovale, which are commonly seen in Southeast Asia. However, primers specific for the SSU rDNA of the genus Plasmodium yielded a 1,055-bp PCR product that was sequenced and noted to be a 99% match over its full length to the SSU rRNA gene from P. knowlesi (H strain) (9). These data confirmed that the infection was caused by P. knowlesi.

National Museum's online photo gallery

via WIRED and BoingBoing comes the news that the National Museum of Health and Medicine is uploading their photos to Flickr. Shown above are photos from the WWII set: medical evac by plane; and a blood transfusion kit captured from the Japanese.

History of nursing is a difficult topic for me. Most of my youth was spent obsessed with WWII, and even today history and fiction of WWII makes me happier and more excited than almost anything. However, nursing in WWII was definitely a woman's job, as per the society of that time. I can't really identify with historical nursing and the attempt to do so makes me feel bad about myself. This is not how I would have chosen to experience professionalism, and I suspect other male nurses have similar issues.

Happy St. Patrick's Day...

...he said ruefully. It is now about mid-point in spring break of what will hopefully be my last semester of nursing school. Most colleges have spring break a little later, I think, but mine used to be on Playboy's Top Ten Party Schools list in the '70s just for the huge St. Patrick's Day bashes that were thrown here. It used to destroy the community downtown, so the college made a policy of always having spring break over the week of St. Patrick's Day so that the jungen would be home.

For me, things could definitely be going better. I was hoping that spring break would afford an opportunity for me to catch up on sleep and have a week or two of regular exercise before starting the second half of the semester, but instead I haven't been to the gym yet and my sleep schedule has been erratic. Last night I was up until after 0500 and then got up at 0800, ate breakfast and fell asleep on the couch until about 1130.

The unhappiness I had coming into spring break didn't vanish this week like the mists in the sunlight. I am feeling bitter and detached. Perhaps this is what happens to all university seniors when spring arrives, but I think this is something different. I'm not looking forward to graduation, I am absolutely dreading it and reviewing the last 3 years with a sense of regret.

Looking out a year to a year-and-a-half from this point, I would count things a success if (1) I'm working in a place with a schedule that meets my needs, (2) I've provided safe care to my patients for my first year out from school, and (3) I've completed or am near completing my CCRN certification. Getting to this point will involve three aspects of my life coming together, but instead these are spinning out of control and breaking up.

School. From my perspective, the whole point of schooling is to provide excellent bedside care. That's all I care about getting from school, but it's not what I'm getting at all. I've been on the Dean's List for several semesters, I've passed all my nursing courses, and I've gotten some A's along the way, too. Recently, we took Elsevier's HESI exam, and I scored in the top 15% of my class, met the recommended 900 HESI score, and am predicted to pass the NCLEX as a result. But I don't know anything! I haven't had a hospital clinical (I don't count Psych) in almost a year, and I couldn't tell you normal lab values, much of anything about meds, correct protocols for bedside procedures, etc. It's horrible. I wouldn't let myself take care of myself at this point, and I'm supposed to be graduating soon. I'm not safe. And what are we spending our time doing this semester? Building "critical thinking skills" by having to guess at what our syllabi mean (yes, we were told that straight-forwardly) and going over ethics and goal/objective setting. What a load of crap!
Work. As I've written about on this blog previously, work is not going as swimmingly as when I started nursing school several years ago. My hospital has started recruiting, but as of now, no management has spoken to me about applying although they all know I'm supposed to be graduating this spring. In fact, of the management who have ever taken an interest in my school work, all three have been removed in the last year or so. I joined the local chapter of AACN as a student member, and I've been totally cut out of the loop. Moreover, I'm supposed to start clinical next week on the hospital floor where I work. And, as per my discussion of school progress above, I am predicting it will be something of a disaster. Some nurses are going to expect me to know everything already since I work on the floor, and honestly, having not had a clinical for almost a year, I'm back at the stage of feeling intimidated by bed baths. It doesn't help that my clinical instructor is one of these nurses.
Personal. If the floor where I am now doesn't hire me, my only three other options are to try to get a position on a straight med-surg floor here, to look for jobs over an hour's drive away, or to move away from my town. Any is a losing proposition for me. My original plan was to start out on the telemetry unit and then progress to the step-down unit, where I would have at most only 4 patients. Right now, I'm not safe with any number of patients, but constitutionally, I am suited more to fewer complex patients than to more patients of low acuity, I think. I could learn and become safe in a step-down or ICU, but for me to have 7-8 patients at a time is just asking for a mistake to happen. The other option of trying to get a position on a cardiac floor a drive away is going to send me into a depression I think. Losing two or more hours a day commuting is a partial definition of hell for me, and I've never owned a car before and don't want one. To move away means leaving my family and also giving up on returning to the karate club I was attending before nursing school, where I met a lot of people I like. The two other times I have moved away from my hometown, I've ended up in deep depression, and I don't want to try it again right away.

Anyhow, tonight is corned beef, then a cigar, and hopefully to bed early so I can get a full night's sleep and be productive tomorrow. Happy St. Pattie's Day.