Moszkito footbeds

Last semester, I purchased some shoes for clinicals that looked really cool but didn't hold up well. Every time I stepped down in them, I could feel the middle of my foot crushing down toward the floor. By the end of a 6-hour student shift, my feet were aching. So, over Christmas break, I tried to figure out what to do about it. I don't think I have a diagnosable problem like flat arches or pronation, but it did seem like the pain was coming from lack of support. So, I decided to try orthotic insoles.

I wasn't sure which company to try, so I ordered several pairs of insoles from Zappos.com. The ones I settled on were these Moszkito brand rigid (red logo) insoles. I decided on Moszkito for several reasons:

• They offer a much greater range of sizes than any other brand.
• They are made out of PVC with a lifetime warranty, so they won't "deform" as I walk on them. (The SuperFeet insoles I tried said you would have to replace them, like, every year or so.
• When I called the company to ask a question, I got to speak with a man named Lauren who answered all my questions very directly and spent a really long time on the phone with me.

Now for the review:

After wearing them in clinicals for a couple weeks, I find they are not quite what I was hoping, but I don't think it's the fault of the insoles. Moszkito has different sizing parameters--length of foot, width of foot, height of arch. Although I was thinking I had high arches based on the outline of my wet footprint and the measurement I took of my arch, I can feel the insole under my arch after I have been standing on it long enough. (This means that instead of getting rid of the pain, the insoles have just distributed the pain to a different location.) Salesman Lauren told me that this problem might be caused by the insoles being too wide. According to him, the heel is the most important part of the shoe, and if the heel doesn't fit, the foot won't fit correctly either. A heel descending on a wide shoebed will sort of spread out and allow the rest of the foot to spread/move as well. It certainly makes sense to me that, if a heel spreads out, the arch will get lower. Anyhow, the problem with his suggestion is that when I had a size narrower insole, I could feel the edge of the insole rubbing on the bottom of my heel. At first I thought that wouldn't bother me, but after you have been on your feet awhile, it doesn't take much to irritate them.

Final analysis: compared with other insoles, Moszkito was the best. However, they may not clear up your problem with sore feet. Get shoes with better support (i.e., more padding) first...
Moszkito homepage
Moszkito on Zappos.com

American Podiatric Medical Assoc

www.apma.org

I found this website over Christmas break, while I was trying to figure out how to keep my feet from getting very sore in clinicals. It has quite a lot of good information about general foot care. The rationale for shoe inserts is pretty straight forward, and this site won't help with trying to pick out the right one, unfortunately.

The FootBlog blog

http://thefootblog.org

Home of the Internet Foot & Ankle Journal, the footblog reviews podiatric information.

self-healing rubber

The BBC reports on a new self-healing rubber--when it is cut, the ends bond back together without being prompted by something like... glue. I don't know what it will be, but no doubt there will be a medical application from this.

via BoingBoing

Aetiology blog

http://scienceblogs.com/aetiology/

on disease...

MRSA : spreading among gay men

Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population. Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated multidrug-resistant MRSA.

via Aetiology

electronic medical records, 3D

Corpus Callosum notes this IEEE article on a new idea for 3D e-med recs. My first impression is that this is a waste of time. It is setting off my gimmick alarm, and I don't really see the advantage of showing a patient a 3D image from her own medical record that shows where her bone fracture is over showing her a picture of a bone fracture.

sim-SimMan® reconsidered

After my previous post in which I suggested that a virtual environment like Second Life might be a good place to do nursing simulations, I have had to reconsider, on two bases: (1) I actually tried Second Life; and (2) I have been working in Elsevier's Virtual Clinical Excursions.

Second Life is not nearly as user-friendly as I had been led to believe by its popularity. I was expecting something that ran about as smoothly as the 1990s-era Marathon, but with a more manipulable character. It is not nearly at that level.

Elsevier's VCE, which I have been assigned in Nur360 Care of the Childbearing Family, is cumbersome, bug-prone, boring, and inefficient as a learning tool. I spent four hours on it last night, and I all I took away is the ability to identify the phases of Stage I pregnancy by their cervical dilation. I could have learned that in five minutes without all the crap! The CD runs slow as it occasionally has to load files while you are doing the excursions, and I was timed out inappropriately four times in a row after viewing a particular video!! At one point, there is a long process of virtual Fentanyl administration that taught me nothing, and there is a point in the workbook where the instructions take up half a page--half a page of "click on__", "Now select___". I absolutely hate it. It is definitely not an educational tool so much as a business model. Publishers like workbooks because workbooks cannot be re-sold in the used book market. Also, by transitioning ("evolve"--get it, duh!) to the web slowly with propriety programs integrated with websites, the publishers can help contribute to the illusion that information needs to be costly and protected in order to be useful and/or accurate. It's the opposite of what the Internet should be doing for information. It's a little like associating information with the occult, a mystery religion of secularism. A term? "Academic gnosticism"--the belief that universities hold special and privileged information.

So, sim-SimMan® is out, but free and open access textbooks are still in.

I hate nursing school

Yes, here is the often-expressed sentiment I have heard from so many recent graduates. I can't speak for all students, but I hate nursing school because we're forced to do tons of work that doesn't teach us anything. Spending hours compiling paperwork that could have been spent actually learning about physiology and pathophysiology is a real, REAL drag. Since last Wednesday night, I have accomplished almost nothing other than researching a nursing care plan. What a fucking waste of time!!

But, protests the straw-man professor, that's what nursing is, and when you get into practice, you will be doing plenty of paperwork then, too. Bullshit! The paperwork in the hospital may be heavy, but it's all designed to be done within the length of a shift. In school, paperwork is assigned of indeterminate length. And in the hospital, all you have to do is chart to the satisfaction of liability and patient safety. In school, you have to out-perform the other students. It's all baloney.

I wouldn't mind just blowing off the stuff I don't care about, but what if I want to go to grad school? I can't just get by with a 74 average.

Research Blogging blog

www.researchblogging.org
Here is a resource for those interested in following peer-reviewed research.

• Bloggers -- often experts in their field -- find exciting new peer-reviewed research they'd like to share. They write thoughtful posts about the research for their blogs.
• Bloggers register with us and use a simple one-line form to create a snippet of code to place in their posts. This snippet not only notifies our site about their post, it also creates a properly formatted research citation for their blog.
• Our software automatically scans registered blogs for posts containing our code snippet. When it finds them, it indexes them and displays them on our front page -- thousands of posts from hundreds of blogs, in one convenient place, organized by topic.

childless women highly productive

Journal of Vocational Behavior reports that childless women are more productive than men or child-bearing women. This should come as no surprise to nurses, at least to the older ones. Maybe with the decrease/death of nurses as dorm-bound maidens, this is no longer so obvious. via BPS Research Digest

And in related postings, Frontier Psychologist tries to define nervous breakdown.

1. WALLACE, J., YOUNG, M. (2008). Parenthood and productivity: A study of demands, resources and family-friendly firms. Journal of Vocational Behavior, 72(1), 110-122. DOI: 10.1016/j.jvb.2007.11.002

Dean Vaughn sucks, part deux

Received the following e-mail regarding the hated Dean Vaughn system. Just before, I had determined not to attend this class anymore as I don't have the time to waste...

Date:	2/18/2008 8:25:24 PM
From:	xxxxxxxxx
To:	All course individuals (NUR363 - Care of Adults II, Spring 2008)
Subject:	Important reminder about med-term

Hi class,

I just wanted to remind those of you who will be in the classroom lab tomorrow... that you should review the med-terms from Lesson 1 & 2 so that you will be able to recall them on the two fill-in the blank lists tomorrow. They will look like your lists I handed out. You will not HAVE to remember the audionym, but please review them. Try to relate the prefixes and suffixes to medical terms that you have heard or know (or can now define!). Quiz each other if you get the chance. If I get a chance, I'll mix the terms up on the lists, so that you won't just be remembering them from the order they are in. They will be averaged into the homework quiz grade, and that's good news!! :) See you tomorrow!

I am bringing earplugs and a Taber's medical dictionary, though.

Speaking of that, I went to get the Taber's yesterday and found one at our local second-hand shop, The Cornerstone Bookstore (in the first-floor Health/Medical section). I thought it was a real deal since the new edition is like $30, and this one was in great condition for $8. But it turns out, the one I bought yesterday is from 1974! The amazing thing is that it basically hasn't changed in all that time--same cover, same design, same size, same fonts and layout... I enjoy that, actually. I guess that part of the conservativism of the medical profession that people speak of, since doctors certainly aren't politically conservative.

2-18-2008

0730 rise
0800 computer lab to study, finish clinical paperwork (nope!)
1000 Nur363
1200 work on clinical paperwork (nope!)
1300 Nur356
1500 to CVPH for PPD test (not open!)
1540 grocery shopping
1645 nap
1800 dinner
1915 computer lab to finish clinical paperwork (nope!)
2345 home, bed

girl with 4 kidneys

Laura Moon, 18, from Whinmoor, Leeds, is one of a tiny number of people to have four of the organs growing naturally. She only became aware of her unusual anatomy six months ago after undergoing an ultrasound scan to investigate stomach pains following a car crash...

She is now undergoing tests to see if all four kidneys are functioning and if she will be able to donate at least one, although she would not be able to choose the recipient.

via BoingBoing

skull - a - day blog

skulladay.blogspot.com

This person makes an image of a skull every day out of different media. Unfortunately, the year is drawing to a close, but it's not too late...

via BoingBoing

meat (artwork) is anatomy (artwork), too

Victoria Reynolds makes paintings of meat...

via BoingBoing

internal organs clothes/toys

iheartguts.com

bacteriophage stuffed toy

...and other plush microbes at
www.giantmicrobes.com

"emotional labor"

I hadn't heard of emotional labor before, but nursing is certainly one field that fits.

via MindHacks

world's smallest bodybuilder

Good for this guy. I certainly could not be this small and not let it bother me...

At 2'9" and a mere one and a half stone, Aditya "Romeo" Dev is the world's smallest bodybuilder.

He must have some sort of proportionate dwarfism.

2-16-2008

0830 woke up on couch from last night
0900 reading...
0930 blueberry pancakes
1000 reading...
1430 ward clerk at CVPH (saw Rebecca Moulton visiting)
2300 home
2345 bed

Conan the Nurse Educator

Gov. Arnold Schwarzenegger Friday announced $2.7 million in grants to 18 registered nurse education programs across the state, including more than half a million dollars to three Bay Area programs. The grants are part of the Song-Brown Program, established by the Legislature in 1973 to increase the number of family practice physicians, physician assistants and registered nurses providing care to state residents. "These programs help nursing students by providing them more opportunities to pursue careers in nursing and help communities by directing more services to medically underserved areas across the state," Schwarzenegger said in a statement. "This is also a part of my long term commitment to address California's nursing shortages by helping to expand nursing programs and improve the supply of qualified nurses in our state." In the Bay Area, California State University, East Bay received $240,000, Oakland's Merritt College received $200,000 and San Rafael's Dominican University of California received $84,000.

2-15-2008

0555 rise, shower, eat...
0630 clinicals at CVPH
1445 ward clerk at CVPH
2315 glass of Benedictine and a book on the couch by the humidifier
2320 asleep

Nur363 clinicals day 4

Revised out of HIPAA considerations...
Second day with the ... wound, and first experience of patient vulnerability. Today went much better than yesterday. I even had quite a bit of down time, which was nice, because it means if I had been a "real nurse," I would have had time to take care of some other patients as well...

The one thing that bothered me was that I had come up with a schedule: Percocet prophylaxis, out of bed for lunch, ambulate, dressing change. But the patient was in sort of a bad mood and told me to just go away and not bring any pain meds unless called for. But the patient has to eat, ambulate, change dressing! So, when do I go back in? My instructor kept saying, not now, not now... well, I ended up getting out of clinicals about 1.5 hours late... And I was standing around getting anxious in the meantime...

Anyhow, after having that triple lumen drain come out yesterday, the wound was sopping with liquid today. The surgeon came in just as I was starting the dressing change, poked (poked!!) his finger all around the wound, and declared a dry packing rather than a wet-to-dry. After the surgeon, the patient was in quite a bit of pain, and today I experienced for the first time the feeling of having a patient be extremely vulnerable and the de facto trust in the nursing staff that must occur.

It was a strange, not pleasant, but not unpleasant experience. I myself am quite emotionally vulnerable but keep tight control over the information that people get about me in order to manage that. I don't have much experience of other peoples' vulnerability, either. Or maybe that's not true. Perhaps it is that normally when people seem vulnerable to me, it seems to be because of their own hang-ups and misperceptions, not because of a non-elective surgery or circumstances beyond their control. I found myself feeling quite bad for this person and rather distressed that I didn't have a better and faster technique for changing the wound.

2-14-2008

0555 rise, shower, breakfast, etc.
0615 clinicals
1430 home, shower
1530 Feinberg library for to study, procrastinate
2345 home

Street Anatomy blog

www.streetanatomy.com/blog
I found this blog once before, "lost" it, then found it again via ScienceRoll. Start reading. Very cool.

Free nursing textbook? Why not?

One of the things that rubs me the wrong way about nursing school is that we have to buy these gigantic overpriced textbooks when all the information in them is essentially free online. When using online sources for educating myself last semester, though, my instructor warned, "consider the source..." Yeah, all the people on the internet are dumbies and frauds, right? It's not as though most of the posters on wikipedia are professionals and highly knowledgeable amateurs, right?

Well, I just don't understand why there isn't a free, possibly open access, possibly open source textbook, at least for med-surg... or at least for fundamentals. I mean, nurses are more flexible and creative than medical personnel, right? Yet, Textbook Revolution has 15 free biology textbooks and 34 health sciences and medical textbooks. And I know that the US government has even more free medical textbooks. I'm just not sure where they are, but you can find 'em, I guarantee. Some might be listed at New York Emergency Room RN, but a lot the links there seem to be broken.

I found Textbook Revolution through the blog ScienceRoll, which takes the issue even further (the way it should be taken) with this post on Second Life. There should be:

• A wikipedia-style textbook that doesn't look like wikipedia. I know this sound stupid, but I really think that part of the legitimacy issue with wikipedia is its user interface. In the beginning it was cool. Now it looks amateur-ish. The "wiki" part of wiki-textbooks needs to be hidden behind a fascade.
• A sim-SimMan®. Second Life would be, like, the totally cheaper and idealer way to run bedside simulations. This is so obvious that it can't even stand elaboration!

More on these issues to come... I created a Second Life account tonight...

Lymphatic filariasis, testes, & Global Alliance

I covered this disease last spring in Bio406, but I don't remember ever seeing a video of it before. There's also an organization (if it's not a slush fund for a African dictator or something...) : The Global Alliance to Eliminate Lymphatic filariasis.

Wordpress nursing blogs

Well, as re the last post, I have checked out Wordpress as well (obviously, I have a lot of work for Nur360 that I don't really want to do...). Better than LiveJournal, but, eh, maybe not as good as Blogger? At least for me? Found another nursing student who just started blogging, though...

• my blog over there: cxlxmxrx.wordpress.com
• http://tomballryan.wordpress.com/

LiveJournal nursing blogs

After adding a few terms like "physician's assistant" to my profile interests and seeing that there was almost no one posting here on professional-oriented material, I decided to check out LiveJournal to see what it's like. I'll never know. I think you must have to have ADD to read those pages. Who designed them? They're a mess! Anyhow, here are some things I found over there...

• my LiveJournal account: cxlxmxrx.livejournal.com/profile
• http://community.livejournal.com/student_nurses/
• http://community.livejournal.com/nurse_students/
• http://community.livejournal.com/ukstudentnurses/
• http://community.livejournal.com/ausnurses/
• http://community.livejournal.com/ask_a_nurse/

Nur363 clinicals day 3

Revised out of HIPAA considerations...
Today I took care of a ... wound. This was my first real dressing change, as my previous wound care--last semester--was on a quite old incision requiring only a change of abd pad. Today's wound had had trouble in the past and the surgeon had taken the patient back to the OR to have a "triple lumen drain" placed.... I read about this in the chart the day before, and I was expecting some little thing like a JP tube. Woa, did I have a surprise.

When I went in to see the patient, the catheter had come out and was on the floor. Rather than a small tubing, it was a long, flat silicon tube with holes all along both sides, like a soaker garden hose. I had never seen anything like it, and neither had my nursing instructors. I can't find any pictures of this type of wound drain on the internet, but it was marked "Axiom," so I assume it was one of these. There was a plastic flange sutured to the abdomen, and I'm not really sure where the drainage tubing went from there. The surgeon was not happy that the tubing came out, but he elected not to replace it.

The wound change went okay, but the day in general was pretty crappy. Nursing school is difficult for me partly because by nature and by previous training, my memory works in abstractions and generalities. So... at our hospital, Lovenox comes in special pre-drawn syringes, but I had to give heparin, which I found in a vial. Now, when I found it, I was thinking that I was going to find it in a special pre-drawn syringe, because in my memory I generalized Lovenox/heparin/special syringe. When I found the vial, I thought, "well, it must be that the syringe is not pre-drawn, but one of these syringes with a pre-applied needle [an insulin syringe, which we don't use in our hospital because we have the insulin SQ pens, but they're still stocked for some reason...]." So, I drew up 1ml of heparin in a 1ml insulin syringe that is marked in units (duh!). This made me feel like a real idiot. It didn't help that I double-checked the syringe with a nurse who gave me the wrong information before I went to the instructor. Oh well, at least I had the right dose of heparin.

2-12-2008 - 2-13-2008

Tuesday:
0730 rise
0800 Feinberg library for work (procrastination)
1330 lunch
1400 back to Feinberg
1900 dinner at cafeteria
1930 back to Feinberg
~2330 wrap up, missed gym
This day had a decently high level of productivity and included mapping out several chapters of pharmacology information.
---------------------------------------------------
Wednesday:
0030 try to start studying for exam, falling asleep, procrastinating, etc.
0900 get ready for "the day"
1000 MED-SURG EXAM #1 in Nur363
1200 lunch and nap
1300 Nur360 (zombie zone)
1500 to CVPH for clinical research
1645 home
1730 decide to take short nap
1900 wake for dinner
1940 fell asleep on couch
0030 woke up and went to bed
This day went not as well as hoped, but better than it could have. It's hard to say how the exam went because I was so tired. I think I either did very well (>93) or very badly (<80).>
Failures today includes bad use of time while staying up all night to study as well as total lack of research for clinicals.

Aubrey de Grey on TED Talks video

This was the first introduction I had to de Grey, I believe. I find his arguments convincing. You can make up your own mind...

Aubrey de Grey on Colbert video

via BoingBoing

SEED magazine cribsheets

www.seedmagazine.com
I can't give unqualified endorsement to any project that takes an aggressively atheist (i.e., anti-religion) viewpoint, but SEED magazine has some good articles.

For nursing students, some of their cribsheets might be useful, or maybe not...

Cribsheet #1 Stem Cells
Cribsheet #3 Avian Flu
Cribsheet #12 Genetics

Kohlberg stages of moral development

Yesterday in Nur356, we started to discuss ethics in nursing, including going over the six Kohlberg stages of moral development (good explanation here). These disturb me greatly. I'm not exactly sure why, but I think it's because they're so wishy-washy. The fact that Kohlberg (and others) can test people and fit them into these categories doesn't really tell you that much about them:

1. The theory does not take into consideration the interplay of different types of development in the life cycle. For example, we know from ADD that different parts of the brain can mature at different rates, resulting in different types of emotional responses. And we know that adolescents normally present with stage 3-like thinking--idealistic and so on. Do these emotional responses over-ride other cognitive styles of decision-making? Temporarily? This question leads to...
2. "Moral development" doesn't measure anything real. Is it a cognitive process, an emotional response? Does it have a place in the brain? Ideas about "goodness" involve all sorts of assumptions and beliefs about metaphysics, psychology, relationships. Kohlberg is making a way of measuring not a narrow development, but whole Weltanshauung. This leads to...
3. Kohlberg is arbitrary. Is it any surprise that the highest level of moral development corresponds to the type of political and philosophical outlook of people in Kohlberg's socio-economic circle in his time? This leads to...
4. Are there higher levels that Kohlberg couldn't measure because he couldn't understand them? If Level 6 isn't just a pretentious subset of one of the other levels, it is based on the idea of uniform dispersal of utility, which is based on an assumption of uniform value. Julius Evola might critique this by questioning, from a metaphysical perspective, uniform value. Charles Murray might critique this by questioning, from a biological perspective, uniform value. Some economists might critique this by questioning whether the self-effacing attitude implied at Level 6 actually leads to increased utility for all parties. They might also wonder about the free-rider problem...
5. How does an "immoral" person fit in? The Kohlberg stages are predicated on the notion that test subjects' reasoning will lead to a justification of "good" action. What about someone who says Heinz should follow the will-to-power? This person may be cognitively out of Levels I+II, but their reasoning seems to be like stage 2. How does Kohlberg deal with them?
6. How does game theory fit in? What if there's only a few doses of drug left and many Heinzs and wives?

Well, I would like to follow up on these questions more, but no time for that in nursing school. Actually, I think that, considering the shallowness with which these topics are covered in nursing school, they shouldn't be covered at all.

patient almost bleeds out after angiogram

From South Africa:

Anna Sophia (Ona) Vasconcelles, 63, from Primrose underwent an angiogram in Glynwood Hospital in Benoni on January 14...

After the procedure, she suddenly started bleeding profusely from the wound to her thigh.

The bleeding was stopped and she was admitted to the intensive care unit.

"A nurse was supposed to monitor my mom's condition, be he mostly sat talking to a patient in the bed next to hers.

"Shortly after 11:00 her stomach was distended like a stone. I called the nurse, but he just told me to go home.

"I insisted that something was wrong, but he said it was his job and not mine to monitor her...

Her mother's blood pressure suddenly dropped and James called the cardiologist.

The cardiologist asked a female nurse to check if Vasconcelles was bleeding, and the nurse denied it.

The staff apparently shortly afterwards again called the doctor because they could hardly detect Vasconcelles's blood pressure.

The doctor rushed to the hospital and battled to save her mother's life. She had to receive three units of blood and one unit of plasma.

Not the best advertising for male nurses, but this one wasn't registered properly.

scholarpedia website

www.scholarpedia.org
While remaining aware of the limitations of wikipedia and liking the idea of a free, open-access encyclopedia by scholars, I don't think scholarpedia is going to make it. The whole point of the wiki encyclopedia project is to harness the distributed knowledge and productivity of millions of web users around the world. There aren't enough scholars, even if they could agree.

As an experiment, I looked up INR, PT, and prothrombin on scholarpedia and found zero entries. The ones at wikipedia are quite nice...

2-10-2008 - 2-11-2008

0800 rise, laundry, cleaning, stuff
1230 gym (upper body resistance)
1330 family dinner
1445 work (again, no Vickie; also, Bob came in to see Jason, seemed to give me a snub on the phone, did I do something on Tuesday? I'm no good at this friends business...)
2230 clinical paperwork; falling asleep at computer; hating life...
0845 clinical paperwork "finished", shower, etc.
0915 try to study for class quiz
1000 Nur363 (quiz was not on the reading I did...)
1200 reading for Nur356
1300 Nur356
1500 walk across campus to Feinberg lab, print clinical paperwork, walk back across campus to Hawkins and turn in paperwork
1530 home
1615 napping...
1900 dinner
2000 watch some bonus material from Jon's THX1138 DVD
2115 try to get some work done at Feinberg lab
2340 gym closed, so no cardio workout, then to bed...

Yes, no sleep Sunday night. These two days sucked.

what do old people look like?

"Very old. Their stomach is very big. They have a wheelchair. They look like they can't walk." [Link]

Not in the near future, I hope.

2-9-2008

1000 internets
1430 work
2330 bed

2-8-2008

0600 rise
0650 clinicals
1445 work
2330 gym
0030 bed

Nur363 clinicals day 2

Revised out of HIPAA considerations...
By the end of the day yesterday, my ... patient had been discharged, so I picked up a ... patient. This patient seems to be pretty much being dismissed by the staff, especially as is apparently waiting for nursing home placement. The patient was reported to be "totally out of it."
After working with the patient, I found the situation better than reported to me. The patient had trouble ..., but instead of the problem being from inability, it seemed to be more about distraction and communication. Actually, the nurses said I had gotten the patient to eat more than anyone else. Patience? I don't know.

The instructor wanted me to try balancing two patients as well, so I picked up a patient with ... problems who just wants pain relief with the occasional attack. Of course, you don't get admitted for pain relief. ... was also elevated in the ER workup and ... and furosemide were administered overnight. Discharged before I went home....

Highlights of the day included working with a really good-looking RN. (This type of thing is a perk of being a man in nursing.) What I took out of clinicals this week was the need for more complete learning outside of clinicals. When more patients start getting added, it is way too much work to do research on each of them.

2-7-2008

0600 get up, shovel driveway, shower
0650 clinicals at CVPH
1300 fetal monitoring "lab" at Hawkins Hall
1500 home, shower...
1600 library for study
1900 dinner
2100 library for study
2330 gym
0030 sleep

Sith by Sithwest blog

My list of topics doesn't include maternity, but if it did, this would be on it...

Nur363 clinicals day 1

Revised out of HIPAA considerations...
Junior-level clinicals happen on Thursdays and Fridays. We have to go into the hospital on Wednesday night to get our assignments and then do research on conditions, medications, etc. Our clinical paperwork includes a short history of the current admission. Here was my patient history for today:

...

Love those question marks? In the H&P, the surgeon wrote he was going to do an open surgery, but then wrote "lapxxxxxxxx" in his procedure note. Also, no reason for admission given or rationale for tele/ox.

The patient was supposed to have an NG and Jackson-Pratt, but when I got there this morning, the NG and JP were out, patient was up and passing gas, and the surgeon discharged.

What's a student to do? I got a ... patient awaiting nursing home placement for tomorrow...

Old Pre-Meds organization

www.oldpremeds.org
In the e-mail today, I received the latest newsletter [pdf] from the National Society for Nontraditional Premedical and Medical Students. I had forgotten that I was even a member (which really just means signing up for the website, I think).

I just don't have enough dedication to all the memorization necessary for med school, so I guess I've given up on that idea, but some of the forums are really quite interesting, and there is one woman who posts there who went from RN to BSN to NP to MD. Quite a path taken. That seems like way to much time in school to me. I believe she did her nursing at Georgetown if I'm not mistaken.

maternity book from Amazon

I haven't gotten the Lowdermilk textbook yet for Nur360 Care of the Childbearing Family, so I ordered the previous edition (hope they haven't changed much) from Amazon with expedited shipping for $4.50. The seller must also be a nursing student. She writes:

Sent: Thu 2/07/08 9:41 AM
Hi Chris,
I know what that's like--I was in the same situation with a textbook earlier in the semester. I have just shipped the book via Priority Mail.

It should be there in a day or two. Good luck with your studies!
Kelly

That's the way buying nursing books should be. I can't wait to pass on my textbooks as well. Thanks, Kelly, and good luck to you, too! (Now, we'll have to wait and see if the textbook is any good...)

2-5-2008 - 2-6-2008

The last two days were pretty crappy. I was supposed to get a lot of work done on Tuesday, but then at 0532 on Wednesday morning, still up and still not getting much done, I decided to skip classes on Wednesday and get some sleep. I recorded my intended and actual schedules up until about 1400 on Wednesday. I am not helping myself with this behavior!

Wednesday: 1600 clinical research; 2145 gym; 2230 supper; 2300 bed

Dyspnea & cadence

I recently purchased a CD of Navy SEAL cadences to try listening to while running. For the past year or so, I've been trying to listen to mp3's of internet talk radio shows, but it doesn't do much to help. I also tried listening to Bach (I was intending to go through his whole repertoire on the treadmill), but I discovered that Bach actually inhibits athletic performance.

So, yesterday, I put on my radio shows and interspersed them with the SEAL cadences, and I had a very interesting experience... At one point, I was nearing the end of one of the radio shows and nearing a point of breathing exertion that usually makes me slow down--it's the point where your breathing starts getting irregular and shallow and your footfalls lose their pacing. Then the show ended and a cadence started and all of sudden my breathing became deeper, more regular, more productive, and my running regained its pace.

I know that there have been quite a few nursing studies done on the effects of music on patients, but I wonder if there are any studies on cadences. Does this only work when you're running (i.e., the autonomic breathing is effected through the motor cortex but not the auditory cortex) or could it work when you're just listening?

I searched the CINAHL and Medline databases. CINAHL doesn't return anything related to "cadence" and "breathing" or "dyspnea." Medline returns an article that confirms my anecdote:

We describe a breath-by-breath method to test for entrainment of breathing and walking cycles... The majority of subjects showed some evidence of entrainment (29 +/- 23% of breaths on average), which occurred intermittently, usually lasting less than 10 breaths at a time. The precision of phase locking during spontaneous entrainment was similar to that in 10 subjects who attempted to maintain deliberate entrainment. The results suggest that the walking cadence provides a persuasive, but not dominant, input to the central breathing pattern generator.

Medline also returns an article on cadence at the cellular level:

Observing the macroscopic complexities of evolved species, the exceptional continuity that occurs among different cells, tissues and organs to respond coherently to the proper set of stimuli as a function of self/species survival is appreciable. Accordingly, it alludes to a central rhythm that resonates throughout the cell; nominated here as primary respiration (PR), which is capable of binding and synchronizing a diversity of physiological processes into a functional biological unity... In all probability, PR emerges within the crucial organelles, with special emphasis on the DNA (5), and propagated and transduced within the infrastructure of the cytoskeleton as wave harmonics (49). Collectively, this equivalent vibration for the subphylum Vertebrata emanates as craniosacral respiration (CSR), though its expression is more elaborate depending on the development of the CNS...

These don't address my question, though. Could cadence be used to help control breathing in dyspneic patients? Can the appropriate brain centers be stimulated with electromagnets without physical activity? Food for thought... or research.

Revised 10/13/08 - I don't know if this is really kosher, but I've gone back and added a Researchblogging tag to this post. None of the content is changed...

1. Hill et al. (1998). Short-term entrainment of ventilation to the walking cycle in humans Journal Of Applied Physiology, 65 (2), 570-578


2. P Crisera (2001). The cytological implications of primary respiration Medical Hypotheses, 56 (1), 40-51 DOI: 10.1054/mehy.2000.1106

Dean Vaughn System sucks

Well, I just finished the first every-other-Tuesday-medical-terminology-lab that accompanies Nur363 Care of the Adult II. (Yes, that right. Never mind that 70% of this terminology was covered in A&P.) My instructor, who taught this course at an LPN technical school, is using the Dean Vaughn Total Retention System. If you have not been subjected to this system before, do not do it voluntarily. It involves using bad puns to associate words with ridiculously unfunny cartoon images. It is infantilizing. It is inefficient. It is inappropriate material for a 4-year university. Worst of all, in some cases, they teach incorrect meanings in order to gloss over confusion that might occur from historico-linguist changes. For example, the system's definition of "-ologist" is "expert." That is not only incorrect, it reinforces some of the intellectual errors of modernity.

Anyhow, I "forgot" to hand in the pre-test, so I can make a copy of it and learn the terms on my own. I SWEAR IF I REMEMBER THESE CARTOONS FOR THE REST OF MY LIFE, IT WILL RUIN MY APPRECIATION FOR MEDICAL TERMINOLOGY AND MAKE ME HATE THIS INSTRUCTOR AND SCHOOL FOREVER. There, I said it to you, the internets, instead of her...

Fat people are cheap(er)

PLoS Medicine reports Dutch study reporting that it costs less over a lifetime to treat smokers and fatties.

In a paper published online Monday in the Public Library of Science Medicine journal, Dutch researchers found that the health costs of thin and healthy people in adulthood are more expensive than those of either fat people or smokers.

On average, healthy people lived 84 years. Smokers lived about 77 years, and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.

Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.

The cost of care for obese people was $371,000, and for smokers, about $326,000

1. Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. PLoS Medicine Vol. 5, No. 2, e29 doi:10.1371/journal.pmed.0050029

Knitting in the dark blog

rosebuttons.blogspot.com
One of my nursing instructors also likes to knit. For some reason, this seems like a very strange combination of interests to me, but what do I know?

BMC Nursing journal

www.biomedcentral.com/bmcnurs/
I assume everyone knows about BioMed Central, location of free, open access biomedical journals. Well, I haven't looked through their list of journals in quite some time, I guess, as I just noticed BMC Nursing.

Blue Sky cola & OpenCola

I try to cut out as much soda-pop as possible, as the stuff is just poison. However, I enjoy the flavor of cola, and there are some things that a cola soda accompanies very well. I looked into making my own cola based on Open Source cola, but it seemed like a pretty low work/payoff ratio.

However, at the local North Country Food Co-op, I discovered Real Sugar Blue Sky Cola, which is made with sucrose instead of HFCS and (just as importantly to me) without the strong acids that go into Coke, Pepsi, RC, etc. If you think it can't taste good, just try it. I actually like it better. The flavor of HFCS just doesn't compare with sugar, and Blue Sky doesn't have that "I'm drinking flavored battery acid" quality that you get with a Coke.

Blue Sky Real Sugar has been developed for consumers who have allergies to High Fructose Corn Syrup or wish to eliminate HFCS from their diets. 100% Natural, No Artificial Flavors or Colors, No Preservatives, No Caffeine, No Sodium, Kosher Certified, GMO free, and No High Fructose Corn Syrup.

2-4-2008

3 hours sleep; 0730 wake/breakfast; 0900 review readings for today's class; 1000 Nur363; 1200 attempted lunch with my father; 1300 Nur356; 1515 shopping for bread/wine for fondue tonight; 1600 internet; 1640 cardio workout at CV Fitness; 1800 dinner (fondue); 1930 watched McLaughlin group with family; 2000 went to Feinberg computing center to produce calendar for this semester; 0100 fell asleep on couch in front of TV

I have a lot of trouble keeping straight what's going on in my life, when schoolwork is due, and how much time I have left. So, I tried to put together a semester minder. It ended running to 40 5.5" x 8.5" pages. The cover I chose was this image called "... curing a woman's diseased eye with a beryl gemstone" from Ortus Sanitatis, 1491

Asian agricultural/food imports

Building on the last post, the really gross stories are the ones from BoingBoing about human hair soy sauce and chemical eggs, but these might be made up. Here're some more reliable stories:

http://news.bbc.co.uk/2/hi/asia-pacific/592010.stm
http://www.usatoday.com/news/health/2007-06-16-asia-foods_N.htm
www.aseanfood.info/scripts/count_article.asp%?Article_code=13006087
http://en.wikipedia.org/wiki/Cellophane_noodles#Health_concerns
http://www.shhk.gov.cn/Webfront_EN/Sub_news.aspx?cid=451&id=66
http://news.asiaone.com/News/AsiaOne%2BNews/Asia/Story/A1Story20071205-39717.html
http://en.epochtimes.com/news/6-12-14/49354.html

Keep these in mind as you're watching the Beijing Olympics this summer...

Prince of Peace green tea

There was an article in today's local paper about the fact that our local food cooperative has finished making mortgage payments. I was just there a few days ago looking for turmeric extract and green tea, and I was sorry to see that they no longer had a place on their shelves for Prince of Peace brand green tea.

Of course, the best thing both from the perspective of health benefits and quality control is to buy the whole leaves, but that is a lot more expensive and when you're at work or something it's so much easier to use tea bags. I'm very skeptical about the safety of Asian import products, but where else is green tea going to come from? Anyhow, I crossed my fingers and hoped that "Prince of Peace" might mean ethical business practices as well.

I can't vouch for the safety of the products, but Prince of Peace does do good work so I was happy to buy their product, especially when it turned out to be decently good. All summer and into the fall, I brewed up big batches of combination green and jasmine teas. I sweetened it with a little stevia, and it put it in unlabeled old Arizona green tea bottles. (Arizona green tea has very little actual green tea, but it is healthier to use their glass bottles to store heated liquids than to use plastic bottles.) It was great. Sorry to see Prince of Peace brand leave the North Country Food Co-op. If you find it near you, give it a try.

2-3-2008

1000 rise, breakfast, read paper; 1100-1400 internets; 1430-2300 work; 2300-2400 e-mails

Today was not very productive.

Xavier Thoughts & Loving and Serving blogs

Okay, I think these pretty much cover the spectrum in men in nursing. I'm not poking fun. Unlike medicine, which can withstand only a narrow variation in personality type, nursing can accept quite a range of people...

"Xavier is a Registered Nurse who specializes in complex wound care. He has been practicing for over ten years in his community. He often treats patients in areas where law enforcement refuses to enter without back-up. Xavier has been an avid shooter for over 25 years. He strongly supports the 2nd Ammendment, opposes gun control of any sort, and carries a weapon 24 hours a day."

"You can expect to read about our Catholic faith, our hopes for our family, living in Charlotte, frugality, nursing school (David), going green (Frances), technology, music, good reads, prayer, and more."

2-2-2008

This day went pretty much the same as the day before except that I stayed at work from 23:00-03:00 to do one-on-one sitting with a patient. Normally, ward clerks aren't allowed, but since I've had nursing clinicals, am CPR certified, and the floor was understaffed, I was. It was the first time I've done anything of that sort. One-on-one with a problematic patient is quite a bit different from patient care in clinicals. This patient kept having to get on the bedpan and then get off again right away without being productive. The patient was also not sleeping and kept asking me to pull him up, by which he meant not being boosted toward the head of the bed but being physically pulled up into a sitting position. In order to do this, I had to lean over him and put my arms behind his back. Whenever I let go, he went back to a lying position. I was wondering what was going on until at one point, he said, "okay, just one more hug and I'll be ready to sleep." Eureka! Anyhow, that's pretty much how the whole half-night went: on and bedpan and off, change the HOB, sips of water, move the hands so the telemetry won't get pulled off... Not exactly fun. I'm glad they'll be aides to do one-on-ones after I graduate.

man gives birth to jaw bone

In Finland, stem cells were used to grow a man a new jawbone. The jaw developed in the man's abdomen.
via BoingBoing.net

2-1-2008

10:00, Wake up, laundry, magazine, internet, 14:30 work (sort of crappy day), 23:30 home.

I don't like to think of myself as a hypochondriac, but I do have this notion that everything is going to fall apart for me. Maybe I'll crash and fail out of nursing school, or maybe... a couple months ago, I had two instances of the same axillary lymph node being swollen and tender after consuming alcohol, which is a symptom of Hodgkin's Lymphoma. I wouldn't have thought anything of it, except that I have never had a tender lymph node before. Now, last night and today, I have had a little trouble swallowing. Everything goes down easy, but it feels like there is a series of speed bumps my Adam's apple is riding over when I swallow. Never had anything like this before...

Cenegenics

With regard to the changes I referred to in the last post, they are currently typified by the Cenegenics Medical Institute. You may have seen some of their advertising. The man in the following (supposedly) unaltered photos is (supposedly) 67. 67. That's almost 70 years old!!


You can read an article about him at The Telegraph. There's also a new advert that I saw in the back of National Review showing a 47yo tri-athlete who looks like a 20yo, and I just found this photo as well, of a 52yo:


Right now, there is a lot of controversy about Cenegenics, but my take on all this is that people assume there must be something wrong because it is "unnatural" to look this way at this age.

As a side note, I believe I read that the first man did Bill Phillips' Body for Life program before Cenegenics. So, if you're interested in going down this road, that would be a great place to start. Check out Phillips' film Body of Work.

longevity & nursing

In our unit on geriatrics last semester, we were told that aging resembles disease processes in many ways. While I understand the rationale behind that statement, I think it may present a skewed picture of nursing. It is a heterodox position, but I don't think care of the elderly is fundamental nursing practice. I use the distinction between necessary and sufficient conditions to make the point: learning how to navigate changes in mobility and mental status of the elderly is necessary nursing knowledge, but it is not sufficient nursing knowledge. That is, the skills unique to elder care can and are learned by a wide variety people including allied health workers and non-professionals. This point is highlighted by the fact that, while nursing students learn basic physiology and pathophysiology related to disease processes, geronotology is not covered in our studies as a branch of pathophysiology (which is what you would expect if aging resembles disease processes).

So, what does this tell us about the wide-spread use of nursing staff to manage elder care? Geriatrics is fundamentally a branch of public health, of government. Although nurses may work for the state or for private entities, in caring for the elderly, they are performing duties for the corporate social body. They are not providing care for the sick but performing an economic function in managing the aggregation of labor that is on the other side of the hump on the lifetime productivity bell curve. I think (I hope) this explains my visceral dislike of geriatrics--from the predominant social perspective, the elderly are like the walking dead.

Anyhow, what does this have to do with longevity, and what is longevity? On this blog, by "longevity," I mean an (as yet) imprecise term that is differentiated from geriatrics. Rather than the management of decline, it is the promotion of thriving. One could say I am just playing with semantics and that because of the inevitability of death, longevity is just a less morbid conception of dealing with geriatric patients. I would agree if medicine and technology were static, but in fact I believe there are great changes that are going to occur in the next decade or two that will make qualitative changes in the lives of chronologically advanced people.

My perspective is not new, but the people who are currently addressing these changes are research scientists and philosophers. In medicine, you occasionally hear news stories about new treatments, and about the health care system, if you hear anything, it is about the economic problems posed by increased life-span. But what about nursing, in terms of patient care, the labor market, and the professional concept? Will nurses have a new role de facto? Should they push for new roles in managing health? Should nursing shrink and allow the establishment of a new health profession in between nursing and medicine that would manage older people with fragile robustness? Is this the natural role of advanced practice nursing? Will there be a de-institutionalization of nursing homes, and the transformation of nursing home care into a distributed model like home health?

I don't have the answers to these questions, but they should be addressed.

"History of Midwifery"

Purely by chance, I just came across the website of German antiquarian bookseller Franz Siegle. He has a lot old science books, including some on the history of midwifery with interesting pictures. You can see the midwifery books and more images by going to www.antiquariat-siegle.de/catalogue.htm and clicking on Catalogue No.45. In this woodcut of midwives assisting in birth, I love the two guys in the background looking at the stars. What are they doing? Are they divining astrological signs about the birth, or is it just representing the men paying attention to their own interests while the women are birthing?