Monday, April 18, 2011

Not Running a Hospital: Painfully slow

You can already imagine the responses. "That's just in North Carolina." "Our patients are sicker." "There are problems with the data."

What would prompt that? This New York Times article, citing a forthcoming NEJM study about medical errors in North Carolina. Here's the lede:

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

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Facebook advertising: Facebook prepares to cash in on users' data - chicagotribune.com

Los Angeles Times Staff Writer

April 17, 2011

la-fi-facebook-ads-20110417

Julee Morrison has been obsessed with Bon Jovi since she was a teenager.

So when paid ads for fan sites started popping up on the 41-year-old Salt Lake City blogger's Facebook page, she was thrilled. She described herself as a "clicking fool," perusing videos and photos of the New Jersey rockers.

Then it dawned on Morrison why all those Bon Jovi ads appeared every time she logged on to the social networking site.

"Facebook is reading my profile, my interests, the people and pages I am 'friends' with, and targeting me," Morrison said. "It's brilliant social media but it's absolutely creepy."

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Top Ten Things You Should (and Shouldn't) Say to The Parent of an Autistic Child

If you're the parent or caregiver of a child on the autism spectrum, Autism Awareness Month is not for you.  You are already aware of autism.  Like, really, really aware.  Aware that you need another cup of coffee, a Xanax, and possibly an advanced degee in Education Law.

Autism Awareness Month is for everyone else.  To help out, here's my Top Ten Things You Should (and Shouldn't) Say to The Parent of an Autistic Child.

10. DON'T SAY: "Wow, your son is great at math.  He's just like Rain Man."

      DO SAY:  "Wow, your son is great at math."


9. DON'T SAY: "He should probably be in a special class, so other kids won't make fun of him."

   DO SAY:  "We should probably be teaching our children more empathy."


8. DON'T SAY:  "You should try giving your kid more discipline."

    DO SAY: "You should try these brownies I made for you."


7. DON'T SAY: "Wow, your kids all seem to have a lot of problems.  Have you ever heard of Munchausen by Proxy Syndrome?"

    DO SAY: "Wow, you're really on top of things for your kids.  It must be hard, but it seems like you're doing a great job."

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Sunday, April 17, 2011

A Good Death | What is a Good Death? | Getting Affairs in Order

Practical ways to help to ensure a "good death"

Poets, professors, priests, and plain folks all opine about what makes a "good death." In truth, deaths are nearly as unique as the lives that came before them -- shaped by the attitudes, physical conditions, medical treatments, and mix of people involved.

Still, many have pointed to a few common factors that can help a death seem good -- and even inspiring -- as opposed to frightening, sad, or tortuous. By most standards, a good death is one in which a person dies on his own terms, relatively free from pain, in a supported and dignified setting. Other things to consider:

Having affairs in order

Not everyone has the luxury of planning for death. But those who take the time and make the effort to think about their deaths during life and plan for some of the details of their final care and comfort are more apt to retain some control and say-so in their final months and days of life.

Legal specifics of such planning can include taking steps to get affairs in order by:

Controlling pain and discomfort

Most Americans say they would prefer to die at home, according to recent polls. Yet the reality is that three-quarters of the population dies in some sort of medical institution, many of them after spending time in an intensive care unit.

As life expectancies increase, more people are becoming proactive. A growing number of aging patients are choosing not to have life-prolonging treatments that might ultimately increase pain and suffering -- such as invasive surgery or dialysis -- and deciding instead to have comfort or palliative care through hospice in their final days.

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Unnamed 04/18/2011

Posted from Diigo. The rest of my favorite links are here.

Saturday, April 16, 2011

Illinois Coalition Against Sexual Assault: English: Home

"Every day, women, men, and children across America suffer the pain and trauma of sexual assault. From verbal harassment and intimidation to molestation and rape, this crime occurs far too frequently, goes unreported far too often, and leaves long-lasting physical and emotional scars. During National Sexual Assault Awareness Month, we recommit ourselves not only to lifting the veil of secrecy and shame surrounding sexual violence, but also to raising awareness, expanding support for victims, and strengthening our response." President Obama's Proclamation on Sexual Assault Awareness Month

The Illinois Coalition Against Sexual Assault (ICASA) is a not-for-profit corporation of 33 community-based sexual assault crisis centers working together to end sexual violence. Each center provides 24-hour crisis intervention services, counseling and advocacy for victims of sexual assault and their significant others. Each center presents prevention education

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Is Nursing Making You Sick, Fat and Old? Annette Tersigni “The Yoga Nurse”, RN

As nurses, you are certainly aware that stress is one of the major medical problems of our times.  Studies show that nurses are the single sickest group of workers in the workforce.  Ouch!  This is appalling. When I worked nights in the PCU, I noticed that there were many more obese nurses working nights than days.  What have you observed?   In my experience, I have noticed that without exception, obese nurses apply to work nights. They want to work nights. These dedicated, long term night shift nurses also are on multiple meds and often discuss how many meds they are on, compare them, etc.  What strikes me is that they speak about it in such a way as if it’s the most natural thing in the world.  Please understand, I am writing this out of compassion for my fellow nurses, not as a critique.  I am telling the truth, and yes, sometimes the truth hurts.  We all know by now that working nights increases your risk for disease.

A nurse is the classic poster child for, “Is this job making me sick?”

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Impaired Nurses, Chemical Dependence, Substance Abuse

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Support needed to help nurses tackle substance abuse, Vanderbilt University:"An estimated 10 percent to 20 percent of nurses and nursing students in the United States may have substance abuse, misuse, dependency or addiction problems. The key to tackling this difficult issue — and protecting public safety — is support and treatment rather than punishment, according to a recent paper in the Journal of Clinical Nursing by Todd Monroe, a post-doctoral fellow at Vanderbilt University School of Nursing, and colleagues at the University of Tennessee. "Doctors and nurses are only human and face the same problems as everyone else, which can include chemical dependency," said Monroe."
Vanderbilt University
Nashville, Tennessee 37240 · (615) 322-7311
http://news.vanderbilt.edu/2011/02/help-nurses-tackle-substance-abuse

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Forum Discussions:

Drug Use As A Nursing Student:"Hi all. I am a male nursing student in my 2nd semester of school. I have 3 more after this and will take the boards next fall. I'm really excited about all of the possibilities and most of all (not to sound too cliche)about the opportunities to change lives that I'll have. I do have a question for current RN's. I occasionally smoke small amounts of marijuana. I don't have remorse or shame because I know it's a personal choice that I let affect noone around me. I only do it alone or with very close friends. I don't sell it or try to get anyone else to try it." http://www.nursingdiscussions.com/drug

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Impaired Nurses Bibliography, Alcohol And Drug Abuse Institute (ADAI):
http://lib.adai.washington.edu/biblist.htm#SP#occ

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Narcotic Use and Diversion in Nursing, Mandy L. Hrobak, University of North Carolina Charlotte:"Narcotic use and diversion in nursing is a growing problem that may be difficult to identify. Clinical indicators can help managers and staff become knowledgeable about signs and symptoms. Areas related to job performance, personality/mental status, and diversion are looked at as indicators. Workplace access and deviant work group norms can contribute to the picture. Certain methods of diversion may be hard to detect. Institutions need to be prepared to handle incidences of narcotic use and diversion before they occur. Policies can help provide for positive outcomes for the institution and the nurse, should she/he decide to receive treatment. Patient safety is of the utmost concern. A supportive environment is important for reentry of the rehabilitated nurse at work. Alcohol and drug dependency are covered under the American Disability Act of 1990. Assistance programs, education, and further research are needed in this area."
http://juns.nursing.arizona.edu/articles/Fall%202002/hrobak.htm

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National Resources:

American Society of Addiction Medicine:""The nation's medical specialty society dedicated to educating physicians and improving the treatment of individuals suffering from alcoholism and other addictions."
American Society of Addiction Medicine
4601 North Park Ave, Arcade Suite 101 Chevy Chase, M.D. 20815
Telephone 301/656-3920 Fax: 301/656-3815
http://www.asam.org

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National Association of Drug Diversion Investigators, Inc. (NADDI):"Established in 1987, the National Association of Drug Diversion Investigators, Inc. (NADDI) is a unique membership organization whose members are responsible for investigating and prosecuting pharmaceutical drug diversion. The organization has proven to be a valuable asset to law enforcement, the pharmaceutical industry and health regulatory personnel. NADDI's objective is simple: to improve the members' ability to investigate, and prosecute, pharmaceutical drug diversion."
http://www.naddi.org

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National Association of State Alcohol and Drug Abuse Directors, Inc.:"NASADAD's basic purpose is to foster and support the development of effective alcohol and other drug abuse prevention and treatment programs throughout every State. The Board of Directors is composed of a President, First Vice President, Vice President for Treatment, Vice President for Internal Affairs, Vice President for Prevention, Past President, Secretary, and Treasurer, as well as 10 regional representatives elected by the Association members in the region. The Washington, DC, office is headed by an Executive Director and includes divisions concerned with Research and Program Applications, Prevention Services, and Public Policy."
808 17th Street, NW, Suite 410, Washington, DC 20006
(202) 293-0090.
http://www.nasadad.org/

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September 12, 2000, Illinois, Chicago: Problem nurses escape punishment:"Lax government oversight and a shoddy system of reporting medical errors allow negligent, incompetent and impaired registered nurses to return to work in Illinois even after committing deadly errors. In Chicago, registered nurses have injected themselves with heroin and cocaine, then committed dozens of errors. They have stolen prescribed medications, then left patients to suffer in pain for hours."
http://chicagotribune.com/news/specials/chi-000912nursing3.story

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State Specific Resources:

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Illinois:

Illinois Nurses Association Statement on Chicago Tribune series on "Nursing Errors":"Like the general public, the Illinois Nurses Association was alarmed to see the disturbing headlines in the Chicago Tribune's series on nurses' involvement in medical errors. A close reading of the articles, however, reveals the findings that “nursing errors” are overwhelmingly attributable to inadequate staffing and systems, issues that nurses and the Illinois Nurses Association have long warned would result in the deterioration of quality care."
http://www.illinoisnurses.org/erorsTribStmt.html

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Peer Assistance Network for Nurses, Nurses Helping Nurses:"The Illinois Nurses Association developed a support network for nurses whose professional performance is hampered by abuse of chemicals or any resulting mental or physical illness. This support network is the Peer Assistance Network of Nurses, or PANN.
Peer Assistance Network for Nurses (PANN)
Illinois Nurses Association
105 W. Adams, Suite 2101
Chicago, IL 60603
p: 312-419-2900
Toll-free, confidential hotline: 1-800-262-2500
http://www.illinoisnurses.org/benefits.htm

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Kansas Nurses Assistance Program:"KNAP is a professional assistance program designed to assist all nurses and mental health technicians who have a problem or illness that has or could impair their ability to practice safely. KNAP is overseen by a voluntary Board of Directors comprised of nurses who are knowledgeable in these issues and who are willing to donate their time and expertise to assist other nurses."
Kansas Nurses Assistance Program
6005 Martway Suite 100 Mission, KS 66202
(913)236-7575, webmaster@ksbn.state.ks.us
http://www.ksbn.org/knap.htm

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New Jersey:

Nurses with Impaired Practice Problems:"The Institute for Nursing provides information and support to nurses with problems of impaired practice. These practice issues have primarily referred to substance abuse, a problem to which the nursing population is increasingly vulnerable. Services provided."
The Institute for Nursing 1479 Pennington Road Trenton, New Jersey 08618-2661
24 Hour Hotline 1-800-662-0108
http://www.njsna.org/practice/peer.htm

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Texas:

Impaired Nursing Students, Required Policy on Suspected:"Pursuant to the Nurse Practice Act (Texas Revised Civil Statutes Annotated, Article 4525a), any registered nurse associated with a University of Texas institution, as an employee or as a student, with reasonable cause to suspect the ability of any professional nursing student to perform the services of the nursing profession would be, or would reasonably be expected to be, impaired by chemical dependency must take one of the following actions."
http://www3.utsystem.edu/systempolicies/impnurs.htm

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International Resources:

Impaired Nurses, Who is the impaired nurse? Nurses Registration Board of New South Wales, Australia:"Nurses, like the rest of the community can suffer from physical or mental illness, whether it be a temporary condition or a gradual deterioration into a chronic illness. If a nurse is impaired, this is likely to affect his or her ability to care for patients. The impairment might be a physical handicap, a psychiatric condition, alcohol or drug dependence, a temporary stress reaction or declining competence due to age or illness."
http://www.nursesreg.nsw.gov.au/impaired.htm

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Drug diversion, qsl.net:"Drug diversion can be best defined as the diversion of licit drugs for illicit purposes. Prescription drug abuse accounts for almost 30% of the overall drug problem in the United States, representing a close challenge to cocaine addiction. Pharmaceutical diversion reaps large profits for the traffickers, and devastation for the abusers. This eventually affects their friends, families, and their workplace. The diversion of pharmaceutical drugs means that prescription drugs were illegally obtained by a variety of methods and a variety of offenders. This may have been accomplished by deception, or an outright theft of the drugs. Health care professionals face the prescription drug abuser on a daily basis. These drug seekers prey on physicians, pharmacists, dentists, and their staff, in a relentless attempt to obtain pharmaceuticals."
http://www.qsl.net/w5www/diversion.html

Emergency room nurses' attitudes, nurses' attitudes toward impaired nurses, and studies of attitudinal change:"Surveys of nurses' and nurse managers' attitudes toward impaired nurses, all published in recent years, suggest that they are generally supportive of impaired nurses and sanguine about their prospects for recovery."
http://www.health.org/research/res-brf/research2.asp?ID=35

Cincinnati (Ohio) Police Pharmaceutical Diversion Squad:"The Cincinnati Police Pharmaceutical Diversion Squad was formed through a Byrnes Memorial Grant in October 1990. Initially, the squad consisted of one supervisor, four investigators, and a secretary. The grant term ended in 1994, but because of the successes, the City of Cincinnati decided to continue to finance the operation."
Pharmaceutical Diversion Squad, Sergeant Kerry Rowland, Commander
Cincinnati Police Department
310 Ezzard Charles Drive Cincinnati, Ohio 45214 USA
513-352-1610
http://www.cincinnatipolice.org/pdu.htm

Pharmaceutical Diversion Education:"Pharmaceutical Diversion Education is designed to assist a wide range of the population in understanding the potential abuse and addiction that can be associated with prescription medication. Year after year, Drug Enforcement Administration statistics indicate that pharmaceuticals are almost 30% of the overall drug problem in the United States, running a close second only to cocaine abuse. However, until recently, law enforcement, health care professionals, and the general public have placed little emphasis on this huge problem."
Pharmaceutical Diversion Education, Inc.
P.O. Box 146 Bethel, Ohio 45106
Phone 1-800-566-2049 Fax (513) 734-1647
http://www.rxdiversion.com/

Prescriptiondrugabuse.org:"Prescription drug abuse is a modern-day plague. According to one government estimate, over six million Americans have abused prescription medication. As a result of this abuse, families are torn apart and lives are destroyed. This site focuses on education, hope, and recovery for prescription drug abusers and their families."
http://prescriptionabuse.org/

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Crohn's Disease Basics & Overview | Healthline

What Is Crohn's Disease?

Crohn’s disease is a chronic condition that causes inflammation, swelling, and deep sores called ulcers in the body’s gastrointestinal (GI) tract (commonly called the digestive tract). Although it can involve any part of the GI tract from the mouth to the anus, Crohn’s disease most often affects the lower portion of the small intestine (the ileum) and the upper portion of the large intestine (the colon).

Crohn’s disease is similar to another chronic inflammatory condition that affects only the colon—ulcerative colitis. These diseases are part of a larger group of illnesses called inflammatory bowel disease (IBD).

Both Crohn’s disease and ulcerative colitis fluctuate between periods of remission (inactivity) and relapse (increased activity). Neither have a medical cure, but medical and alternative therapies can reduce the symptoms that people with Crohn’s disease and ulcerative colitis experience during times of relapse. In many cases, these therapies help people maintain a normal lifestyle with few interruptions from the diseases.

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Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry

Abstract

We characterized the prevalence, antibiotic susceptibility profiles, and genotypes of Staphylococcus aureus among US meat and poultry samples (n = 136). S. aureus contaminated 47% of samples, and multidrug resistance was common among isolates (52%). S. aureus genotypes and resistance profiles differed significantly among sample types, suggesting food animal–specific contamination.

Antimicrobials are used extensively in food animal production, where they are often applied subtherapeutically for growth promotion and routine disease prevention [1]. Surveys conducted by the National Antimicrobial Resistance Monitoring System (NARMS) indicate that retail meat and poultry products are frequently contaminated with multidrug-resistant Campylobacter species, Salmonella species, Enterococcus species, and Escherichia coli [2]; but little is known about the prevalence of other antibiotic-resistant pathogens in the US food supply.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
856-415-9617, (fax) 415-9618

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