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