Medicine Pearls

PRC sees more jobless nurses

2011-12-25T18:20:00.000-08:00

By Mayen Jaymalin, The Philippine Star
Posted at 12/26/2011 8:30 AM | Updated as of 12/26/2011 10:05 AM

MANILA, Philippines - More nurses will be unemployed next year, the Professional Regulation Commission (PRC) said yesterday.

Marco Sto. Tomas, of the PRC’s Board of Nursing (BON), said the current number of 230,000 jobless and underemployed nurses nationwide is rising.

“Although enrollment in nursing courses is going down, there are still many in the pipeline, considering that 68,000 graduates just took the licensure examination this month,” he said.

Many registered nurses are now willing to work for free or even pay hospitals so they could work and gain the necessary experience to qualify them for employment abroad, he added.

Labor Secretary Rosalinda Baldoz has ordered the PRC, an attached agency of the Department of Labor and Employment to coordinate with other concerned government agencies and look into the condition of unemployed Filipino nurses.

The DOLE is also looking into coming out with new rules to regulate the “hiring” of nurse volunteers in hospitals and other medical facilities nationwide, she added.

No regulation exists to stop or penalize government and private hospitals from using the services of licensed nurses for free, Baldoz said.

Sto. Tomas said the PRC is now pushing for the implementation of the so-called Hastening Options for Productivity and Employment (HOPE) for Filipino nurses, he added.

“The program aims to promote entrepreneurship putting up their own business for Filipinos nurses who are now having difficulty finding employment,” he said.

The PRC and other concerned government agencies are exerting efforts to improve the lives of nurses, including the unemployed, he added.

Future Shock: Color-coded surgery

2011-12-13T10:09:00.000-08:00

GMANews: More Pinoy nurses heading to Japan for licensure exam

2011-03-31T18:06:00.000-07:00

Despite a devastating earthquake and tsunami that hit Japan this month and the ensuing nuclear accident, a third batch of over 80 Filipino nurses are scheduled to go there on May 30 for a language training in preparation for that country’s tough licensure examinations.

In a press briefing, Japanese Ambassador Makoto Katsura said a total of 82 Filipinos will leave for Japan to undergo intensive Japanese language training there, after a two-month preparatory language course in Manila to be conducted by Japanese instructors.

“Although I have no doubts that you will be able to fulfill your duties and responsibilities as healthcare professionals in Japan, I am also aware that one of the most difficult obstacles for passing the Japanese nursing licensure examinations is the language barrier," Katsura said at the formal launch of the training course.

This is the first time that Japan is implementing a preparatory language course prior to the applicants’ departure for Japan. Only two of the 139 Filipino nurses in previous batches passed that country’s licensure exam.

Apart from the preparatory course, Japan has also revised its licensure exam for foreign nurses and caregivers to boost the passing rate of health workers.

The revisions include the use of English words for medical terms originally in Japanese, like diabetes, cataract and pulmonary tuberculosis.

Since 2009, the Philippines has sent a total of 139 nurses and 299 caregivers to train in Japan through the controversial Japan-Philippines Economic Partnership Agreement (JPEPA) signed in 2006.

Various groups had earlier questioned JPEPA’s constitutionality before the Supreme Court, saying the treaty violates constitutional provision on trade, natural resources, labor, education, mass media legislation, public utilities and foreign policy.

The Japanese Embassy said it has been taking steps to help Filipino nurses maximize employment opportunities for Filipino nurses under the treaty.

“This demonstrates the perseverance and dedication of both countries to take initiatives in improving the standing of Filipino candidate nurses in particular, especially in successfully integrating them, through language," Katsura explained.

Nurses who fail Japan’s licensure tests in Japan can only re-take the exam within the period they are allowed to stay in Japan.

If they still fail the examination, the nurses would have to return to the Philippines to apply again for training.

Apart from the six months of paid language training, Filipino nurses and caregivers are employed in Japanese hospitals and care-giving facilities for three years and four years, respectively, to familiarize themselves with the country’s healthcare system.

During that time, nurses undergoing work-training receive an average monthly salary of 130,000 yen to 220,000 yen (about P68,000 to P115,000) For caregivers, the monthly salary ranges from 125,000 yen to 185,000 yen (about P65,000 to P96,000).—With Jerrie M. Abella/JV, GMA News

Source: GMANews 3.31.2011

Melanoma Update: Yehey for Yervoy!

2011-03-26T00:48:00.000-07:00

The drug company Bristol- Myers Squibb has gained approval from the Food and Drug Administration (FDA) for Yervoy (ipilimumab) for the treatment of Melanoma, a very aggressive and often fatal form of cancer which is also the leading cause of death from skin cancer.

Although the complete course of treatment is quite expensive at the moment, we can only hope that in the near future it will become more affordable and be accessible to the majority of the population.

Here's the recent article from the New York Times: Yervoy, a Melanoma Drug, Wins F.D.A. Approval.

NLE: 37, 679 new nurses, Ateneo de Naga student tops exam

2010-08-27T22:25:00.000-07:00

ABS- CBNNews

MANILA, Philippines – The Professional Regulation Commission (PRC) on Friday said a total of 37,679 out of 91, 008 examinees passed the Nurse Licensure Examination that was given last July.

The exam was conducted in the cities of Manila, Baguio, Cagayan de Oro, Cebu, Dagupan, Davao, Iloilo, La Union, Legazpi, Lucena, Pagadian, Pampanga, Tacloban, Tuguegarao and Zamboanga last July 2010.

The members of the Board of Nursing are Carmencita M. Abaquin, Chairman; Leonila A. Faire, Betty F. Merritt, Perla G. Po, Marco Antonio C. Sto.Tomas (inhibited), Yolanda C. Arugay and Amelia B. Rosales (inhibited), Members.

The results of examination with respect to five (5) examinees were withheld pending final determination of their liabilities under the rules and regulations governing licensure examination.

Those who will register are required to bring the following

* Duly accomplished Oath Form or Panunumpa ng Propesyonal
* Current Community Tax Certificate (cedula)
* 2 pieces passport size picture (colored with white background and complete name tag)
* 1 piece 1” x 1” picture (colored with white background and complete name tag)
* 2 sets of metered documentary stamps, and
* 1 short brown envelope with name and profession;

and to pay the Initial Registration Fee of P600 and Annual Registration Fee of P450 for 2010-2013.

Successful examinees should personally register and sign in the Roster of Registered Professionals.

The oathtaking ceremony of the successful examinees in the said examination in Manila as well as the previous ones who have not taken their Oath of Professional will be held before the Board on Monday and Tuesday, September 20 and 21, 2010, with morning (8:00 A.M.) and afternoon (1:00 P.M.) sessions at the SMX Convention Center, SM Mall of Asia, Pasay City.

All must come in their white gala uniform, nurse’s cap, white duty shoes, without earrings, hair not touching the collar and without corsage.

Oathtaking tickets for the National Capital Region (NCR) and nearby regions will be available at the Philippine Nurses Association (PNA) at 1663 F.T. Benitez Street, Malate, Manila, from September 1 - 20, 2010 on a “first come first serve” basis.

All regional oathtaking schedules will be posted in the BON website: www.bonphilippines.org.

From AALA, Marianne Ruth Aquino to BAYER, Carmela Dawn Paloma

From BAYER, Chris Danne Bautista to CRISTAL, Mark Joseph Canawin

From CRISTE, Zyron Wendell dela Fuente to FLORES, Frederick JR Olavides

From FLORES, Gendy Melanrose dela Pena to LAZO, Joanne Beverly Rabaino

From LAZO, Jorena May Canonigo to NATIVIDAD, Sonia Mendaros

From NATNAT, Jovan Morales to REYES, Jennelyn Navarro

From REYES, Jennifer Bonnit to TOKUNAGA, Pristine Fernandez

From TOLDING, Kyrie Clarie Biang to ZUNO, Ralph Raymond Paras

CPR Simplified

2010-08-11T21:38:00.000-07:00

Physical therapy grads from RP barred from taking US exams

2010-07-19T20:59:00.000-07:00

JERRIE M. ABELLA, GMANews.TV
07/19/2010 | 11:17 PM

Filipinos have been temporarily disallowed from taking the licensure examination for physical therapist in the US following reports of cheating by a local review center.

In an exclusive report by GMA News’ Tina Panganiban-Perez on “24 Oras," the Professional Regulation Commission (PRC) and the Board of Physical and Occupational Therapy (BPOT) said the temporary suspension was imposed on physical therapy graduates from the Philippines, Egypt, India and Pakistan.

"We think it's not a ban, it's a temporary suspension. Second, we think it's not even [because of a] leakage, [but] because [there were] recalled [questions]," BPOT chair Dr. Rey Matias said in the report.

‘Pervasive security breaches’

In a statement on its web site, the Federation of State Boards of Physical Therapy (FSBPT) said it suspended the National Physical Therapy Examination (NPTE) testing for physical therapy graduates from the four countries due to “pervasive, ongoing security breaches."

The FSBPT said it is preparing a “separate, secure exam" for the graduates, expected to be completed in 2011.

“This necessary security measure is in response to compelling evidence gathered by the (FSBPT) reflecting systematic and methodical sharing and distribution of recalled questions by significant numbers of graduates of programs in the affected countries, as well as several exam preparation companies specifically targeted to these graduates," the statement read.

The FSBPT cited the case of the St. Louis Review Center in Manila, which it accused of sharing hundreds of live test items. It said this constitutes copyright infringement and cheating.

“The evidences taken from the hard copies of notes and flash drives showed exactly the same questions. Even the illustrations had the same figures as what were present in the board exam," explained BPOT member Bernadette Reyes.

According to the FSBPT, it is now pursuing criminal copyright charges against the owners of the review center.

The federation said it has invalidated the scores of examinees whom they believe to have benefited from the advance access to test questions. It also said the compromised items have already been removed from the exam.

The FSBPT earlier charged St. Louis for the same offenses, but the Philippine Department of Justice dismissed the case in 2009.

No regulator

The PRC admitted it cannot do anything about review centers even in light of accusations of cheating and copyright infringement.

“No particular agency or body is regulating the activities of review centers. Review centers are not under the jurisdiction of the PRC," said PRC chair Nicolas Lapeña.

A reviewer in St. Louis, identified only as Michelle, disputed in the “24 Oras" report the accusations against the center. “We have nothing to worry about. What they are saying about cheating is not true. If that were the case, don’t you think all examinees would have passed?" she said.

GMA News tried but failed to get in touch with the owners of St. Louis, whom the FSBPT identified as Gerard Martin, Roger Tong-An, and Carlito Balita.

A report in ABS-CBNNews.com said Balita, a radio announcer, has denied that he is one of the owners of the review center. He was quoted as saying that he was never engaged in review programs for physical therapists.

Labor Secretary Rosalinda Baldoz had earlier said she had already directed the Philippine labor attaché in Washington to prepare a letter to US authorities to appeal the suspension.

She added they will also investigate the veracity of the accusations of cheating against St. Louis. - KBK, GMANews.TV

Nursing grads must be flexible to find jobs in US

2010-07-15T06:40:00.000-07:00

DALY CITY, California – New nursing graduates are advised to be more patient and flexible in order to find jobs in the US.

Jaeann Milan graduated in 2008 with a nursing degree from the Philippines. She was expecting to find work right away when she went back to the US. Instead, she found herself applying and waiting for six months.

“I was discouraged, I almost moved to Los Angeles to try to find something there. But I just stayed here and waited it out. You just have to be patient,” said Milan.

A survey conducted in June 2009 by the National Association of Nursing Schools found that less than half of new graduates had no jobs by the time they finished school.

According to Priscilla Chua of Relief Nursing Services, hospitals are hesitant to hire new nurses because of the recession. She said hospitals spend an average of $50,000 to train each new hire.

With the high unemployment rate, many have lost their health care coverage. Also, budget cuts at state- and government-run hospitals have caused hiring freezes and hurt graduates’ chances for a job.

“I think there are still a lot of patients. It’s just that these nurses, they don’t want to change their jobs, they want to stay because of the recession,” Chua said.

But Chua said there are ways new nursing graduates can gain experience.

“You got to start somewhere. Start in long term care. Start through a nursing agency. Once you gain the experience, the hospitals will hire you. They’ll be more willing to hire you as a registered nurse,” added Chua.

Milan’s patience eventually paid off. She gained experience as a per-day nurse with a staffing agency and a job as a nursing school instructor. Milan has since become a full-time Registered Nurse at a hospital. --Balitang America

PRC Changes Nursing Exam Schedule

2010-01-12T23:51:00.000-08:00

By Katherine Evangelista
INQUIRER.net
First Posted 15:23:00 01/13/2010

MANILA, Philippines—The Professional Regulation Commission (PRC) on Wednesday announced that the 2010 licensure exam for nurses has been rescheduled.

In a statement, the PRC said that the nursing board examination for 2010 has been moved from June and November to July and December, following the Commission Resolution No. 2009-537 dated November 13, 2009.

Deadline for filing of applications for the July examination will be on April 14 for repeaters while first time examinees may file theirs until May 14.

For the December examination, repeaters may file their application until September 8 while deadline for first time examinees may file is on November 8, the PRC said.

G Spot: Hit or Miss?

2010-01-06T18:24:00.000-08:00

Love or Lust. Naked Truth or Bull Crap. Agree or Disagree.

Believe it or not, I'm putting the "G" on the spot.

Read on...

CNN) -- Ladies (and gentlemen): Can you find the G-spot?

Women everywhere have read or heard that they may possess a secret pleasure zone inside their bodies that, if stimulated correctly, yields intense pleasure and even orgasm.

But this so-called G-spot has never been precisely identified as a concrete biological entity. Scientists are still arguing over what it is and whether it exists at all.

Researchers at King's College London in the United Kingdom have brought the elusive G-spot to the forefront with a study of more than 1,800 female twins.

The study suggests that there is no genetic basis for the G-spot and that environmental or psychological factors may contribute to whether a woman believes that she has a G-spot.

No physical examination

The new study is published in the Journal of Sexual Medicine.

But the lead study author, clinical psychologist Andrea Burri, isn't sure that the question was asked in a way that accurately got the information the researchers were seeking, as reflected in the study's discussion section.

Her team did not physically examine the women for the presence of G-spots but instead gave participants a survey asking whether they believed that they had a "so called G-spot, a small area the size of a 20p coin on the front wall of your vagina that is sensitive to deep pressure?" (A 20p coin is about the size of an American nickel.)

They found that 56% of respondents answered "yes" and that there was no genetic correlation.

But only about 30% said they were able to achieve orgasm during intercourse, which may indicate that women were confused by the G-spot question because stimulation of the G-spot is supposed to induce orgasm, she said.

The definition of G-spot in the study is too specific and doesn't take into account that some women perceive their G-spots as bigger or smaller, or higher or lower, said Debby Herbenick, research scientist at Indiana University and author of the book "Because It Feels Good."

"It's not so much that it's a thing that we can see, but it has been pretty widely accepted that many women find it pleasurable, if not orgasmic, to be stimulated on the front wall of the vagina," said Herbenick, who was not involved in the study.

Arousable women

The study also found correlations with personality components in women who did report having G-spots: For instance, these women tended to be more extroverted, arousable and open to experience, which may indicate a psychological component to the G-spot, Burri said.

More research is necessary to make more conclusive statements about whether the G-spot has a physiological basis, experts say.

"I don't think that these are invented experiences at all," Herbenick said. "And if at the end of the day, someone's invented something and they feel pleasure from it, then I think that's great."

The G-spot has been so difficult to identify because it is more of a physiological change -- akin to swallowing or urinating -- than an anatomic structure such as a nipple, said Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego, California, who oversees the peer review process for the Journal of Sexual Medicine.

Evidence

But a recent study that adds credence to the G-spot concept.

French researchers Odile Buisson and Pierre Foldès did ultrasounds of a small number of women having intercourse with men.

By looking at the changes in the vagina, the researchers found physiological evidence of the G-spot. This study is under review at the Journal of Sexual Medicine, Goldstein said.

The G-spot is named after Dr. Ernst Grafenberg, a gynecologist known for his research on female genitalia. He described this pleasure zone of the vagina in a 1950 paper.

The 1982 book "The G Spot: And Other Discoveries About Human Sexuality" made the term "G-spot" popular.

A small study by Italian researchers in the Journal of Sexual Medicine in 2008 found that women who were able to achieve vaginal orgasms had thicker tissue between the vagina and the urethra, where the G-spot is said to reside.

A minority of women say they ejaculate when they have a G-spot orgasm. Some sex researchers say this fluid comes from a gland that's near the G-spot area.

Men have G-spots too

Men also have a G-spot of sorts, below the scrotum and above the anus, Goldstein said, although it has not gotten as much attention as the more mysterious female G-spot.

Experts agree that the idea of the G-spot has put pressure on both women and their male partners to find some kind of hidden treasure that leads to orgasm from the penis alone.

"Initially, it was a good concept, because who wouldn't like the idea of 'push a button and get the best orgasm ever?' " Burri said.

But those women who can't orgasm from vaginal intercourse may feel inadequate, and knowing that the G-spot may not exist can take some pressure off.

Women should explore their bodies, find out what they like, and communicate that information to their partners, Herbenick said.

"Whether you call it your G-spot or the front wall of your vagina, or if you make up a silly name for it ... at the end of the day, it's what you like and how your body works," she said. (Elizabeth landau/ CNN)

Japan hiring qualified Filipino nurses, caregivers

2009-12-10T12:59:00.001-08:00

Japan is currently hiring qualified Filipino nurses and caregivers, the Philippine Overseas Employment Administration (POEA) said, citing a report from a Japanese agency.

Filipino nurses interested in working in Japan must have Bachelor of Science in Nursing (BSN) degrees, board licenses, and at least three years experience, the Japan International Corporation of Welfare Services (Jicwels) said.

In the meantime, Jicwels is also facilitating the application of Filipino caregivers to Japan.

Applicants need to be a graduate of any four-year course, a certified caregiver by the Technical Education Skills Development Authority (TESDA) or a graduate of a nursing school with no board license.

Qualified applicants for both positions are also required to secure the following documents, which include a:

* Detailed resume
* Diploma
* Transcript of records
* PRC License
* Employment Certificates
* Valid TESDA Certificate
* Original and photocopy of first page of valid passport
* One 2x2 picture

Applicants from Cebu and Davao can submit the documents at their respective POEA regional offices. - GMANews.TV

Pinoy nurses fill vacancies in specialised areas in UK hospitals

2009-11-21T01:02:00.000-08:00

by Rose Eclarinal,
ABS-CBN Europe News Bureau, London | 11/21/2009 11:33 AM

SALISBURY, England - The United Kingdom nursing work force is ageing and British nurses are leaving the country to work in the United States and in recent years, in Australia.

These are some of the contributing factors for the shortage of qualified nurses in the UK both in the National Health Service or NHS and the private sector.

The UK faces the so-called graying of the population of the nursing work force and the younger ones are not interested in the nursing profession because they have more options for jobs that offer better pay and working condition. Those who leave the county to work elsewhere are driven by better pay and living conditions.

This is not the first time the UK has to deal with this problem. In the past, it has also turned to foreign nurses to do the job its peoples have pushed aside and snubbed.

Pinoy nurses for export

While the UK is in need of more nurses, the Philippines continues to produce nurses for export. Philippines is one of the biggest suppliers of overseas nurses to the UK, trailing behind is India, Britain’s former colony. UK’s overseas recruitment of nurses was criticized by the Brits because it is said to be designed as a short-term solution although it has helped the UK health sector manage the crisis.

The Salisbury District Hospital in Salisbury also turned to overseas recruitment to fill the vacancies in the hospital. Recently, it recruited some 17 OR (operating room) or theatre nurses from the Philippines.

“In the past two years our experience advertising for theatre nurses nationally and in Europe had very little success. Our reliance on agency nurses was high. We have now filled our vacancies in theatres, however we do have to look to the future and plan the workforce. There are a number of retirements in the next five years and recruitment will continue. Having established the current workforce we intend to recruit in this country and Europe,” said Colette Martindale, Surgical Directorate of Salisbury District Hospital.

She said there is no plan for another trip to the Philippines, however, that could also change. She also added that there is no preference over Filipino nurses but they chose to go to the Philippines this year because they knew ‘there was a reliable field of candidates.’

“There are still a high number of unemployed nurses in the Philippines. We have recruited from there in the past and we know the quality of work is good and the retention rate is good,” she added.

Nurses in specialized areas

Outside of any particular specialties, nursing has been removed from the ‘shortage occupation list’ by the UK Home Office. This means that employers with band 5 and 6 nursing posts have to prove that the vacancies could not be filled by nurses who are residents or nationals of the UK or of countries of the European Economic Area (EEA).

Salisbury District Hospital has advertised the vacancies for 2 years but there were no takers from the UK and from EEA.

The gold mine that the UK has found in the Philippines in early 2000 is still an attractive source to this date, providing work force for the UK health sector.

The 17 nurses that filled the vacancies at the Salisbury District Hospital have now started the Overseas Nursing Program. Nurses who were trained outside the EEA are required to pass the program and be registered at the Nursing and Midwifery Council or NMC.

“We have to undergo the classes and we have two days study at City College London. Nagpupunta sila dito. Para talagang school. Para ma-meet namin yun standards of nursing dito. At saka may different laws here as compared sa Pilipinas. Ang dami ditong laws na nagpo-protect sa patients so kailangan naming malaman yun,” said 24 -year- old Cathleen Lagtapon.

A pittance of a salary back home

Nursing work in the UK has always been attractive to Pinoy nurses because of the significant increase in their salary once they work in the UK.

“That’s one of the reasons I took up nursing because I wanted to work outside of the country. I really want to experience the hi-tech operations to further my career as an OR nurse,” said Lagtapon.

She was working as an OR nurse in Bacolod City earning a salary of P9,000 a month. As a nurse in training in the UK, she would receive a salary of 18,000 pounds annually or around P122,000 per month. Once registered with the NMC, there will be an increase of up to £5,000 in her annual salary.

Raising three children and working for a government hospital in the Philippines, Reynaldo Boy decided it was time to go where the grass was greener.

“Kasi nung una okay naman ang work ko sa Pilipinas. Since nasa government naman ako, ayos naman ang suweldo. Then later, nag high school na anak ko, I began to think na parang kulang ang kikitain ko dun,” he said.

With so many nurses in the Philippines seeking employment abroad, he considers himself lucky. He said however that as a father, there are trade-offs. He now has to get used to the long distance parenting set-up he has conceived for him and his children.

“Hindi ko na sila mababantayan dun. [Pero] yun naman talaga ang purpose nung pumunta ako dito to give them a better life. Pag nakapag-ipon ako, pwede kong makuha sila. Kung di ko man makuha, yung naipon ko, pwede kong ipadala sa kanila para sa studies nila-- to give them a better future, para makapag -aral sila, maging good citizen din some day,” he added.

Work ethics and family values are just some of the qualities that endear Pinoys to their British employers.

‘Compassionate, caring and hard working’

“I have found the Filipino nurses to be caring, compassionate, intelligent and hard working. They treat patients with respect and kindness. They have strong family values and they are driven to protect and provide for their families. Once adapted into the culture and way of life in a UK hospital they are encouraged to develop and become leaders in the future,” said Colette Martindale.

For Lagtapon and Boy, the opportunity to work abroad, to further their career as nursing professionals and provide a better future for their families are now happening. They are very grateful for this chance and the fact that unlike many others who came here, they didn’t even pay an exorbitant amount. They said their dream to work in the UK only cost them P15,000 for fees. But whatever social cost the nurses have to contend with in the future, for now they are happy.

“I want to keep pinching myself kung nandito talaga ako,” said Lagtapon.

How Sweet It Is?

2009-10-20T19:28:00.000-07:00

By Claire Suddath – Tue Oct 20, 2:20 pm ET
TIME

Too much sugar will make you fat, but too much artificial sweetener will ... do what exactly? Kill you? Make you thinner? Or have absolutely no effect at all? This week marks the 40th anniversary of the Food and Drug Administration's decision to ban cyclamate, the first artificial sweetener prohibited in the U.S., and yet scientists still haven't reached a consensus about how safe (or harmful) artificial sweeteners may be. Shouldn't we have figured this out by now? (See the top 10 bad beverage ideas.)

The first artificial sweetener, saccharin, was discovered in 1879 when Constantin Fahlberg, a Johns Hopkins University scientist working on coal-tar derivatives, noticed a substance on his hands and arms that tasted sweet. No one knows why Fahlberg decided to lick an unknown substance off his body, but it's a good thing he did. Despite an early attempt to ban the substance in 1911 - skeptical scientists said it was an "adulterant" that changed the makeup of food - saccharin grew in popularity, and was used to sweeten foods during sugar rationings in World Wars I and II. Though it is about 300 times sweeter than sugar and has zero calories, saccharin leaves an unpleasant metallic aftertaste. So when cyclamate came on the market in 1951, food and beverage companies jumped at the chance to sweeten their products with something that tasted more natural. By 1968, Americans were consuming more than 17 million pounds of the calorie-free substance a year in snack foods, canned fruit and soft drinks like Tab and Diet Pepsi. (See nine kid foods to avoid.)

But in the late 1960s, studies began linking cyclamate to cancer. One noted that chicken embryos injected with the chemical developed extreme deformities, leading scientists to wonder if unborn humans could be similarly damaged by their cola-drinking mothers. Another study linked the sweetener to malignant bladder tumors in rats. Because a 1958 congressional amendment required the FDA to ban any food additive shown to cause cancer in humans or animals, on Oct. 18, 1969, the government ordered cyclamate removed from all food products. (See the 10 worst fast-food meals.)

Saccharin became mired in controversy in 1977, when a study indicated that the substance might contribute to cancer in rats. An FDA move to ban the chemical failed, though products containing saccharin were required to carry warning labels. In 2000, the chemical was officially removed from the Federal Government's list of suspected carcinogens. (Read TIME's 1974 article on cyclamate and saccharin.)

In 1981, the synthetic compound aspartame was approved for use, and it capitalized on saccharin's bad publicity by becoming the leading additive in diet colas. In 1995 and 1996, misinformation about aspartame that linked the chemical to everything from multiple sclerosis to Gulf War syndrome was widely disseminated on the Internet. While aspartame does adversely effect some people - including those who are unable to metabolize the amino acid phenylalanine - it has been tested more than 200 times, and each test has confirmed that your Diet Coke is safe to drink. Nor have any health risks been detected in more than 100 clinical tests of sucralose, a chemically altered sugar molecule found in food, drinks, chewing gum and Splenda.

The fear-mongering and misinformation plaguing the faux-sweetener market seems to be rooted in a common misconception. No evidence indicates that sweeteners cause obesity; people with weight problems simply tend to eat more of it. While recent studies have suggested a possible link between artificial sweeteners and obesity, a direct link between additives and weight gain has yet to be found. The general consensus in the scientific community is that saccharin, aspartame and sucralose are harmless when consumed in moderation. And while cyclamate is still banned in the U.S., many other countries still allow it; it can even be found in the Canadian version of Sweet'n Low. Low-calorie additives won't make you thinner or curb your appetite. But they help unsweetened food taste better without harming you. And that's sweet enough.

The New Alphabet

2009-08-28T00:25:00.000-07:00

You know you're getting old when-

Before...

A is for apple, and B is for boat,
That used to be right, but now it won’t float!
Age before beauty is what we once said,
But let’s be a bit more realistic instead.

Now…

The Alphabet

A’s for arthritis;
B’s the bad back,
C’s the chest pains,

perhaps car-d-iac?

D is for dental decay and decline,
E is for eyesight, can’t read that top line!
F is for fissures and fluid retention,
G is for gas which I’d rather not mention.

H is high blood pressure–I’d rather it low;
I is for incisions with scars you can show.
J is for joints, out of socket, won’t mend,
K is for knees that crack when they bend.

L is for libido, what happened to sex?
M is for memory, I forget what comes next.
N is neuralgia, in nerves way down low;
O is for osteo, the bones that don’t grow!
P is for prescriptions, I have quite a few,
just give me a pill and I’ll be good as new!
Q is for queasy, is it fatal or flu?
R is for reflux, one meal turns to two.

S is for sleepless nights, counting my fears,
T is for Tinnitus; there’s bells in my ears!
U is for urinary; big troubles with flow;
V is for vertigo, that’s “dizzy,” you know.

W is for worry, NOW what’s going ’round?
X is for X ray, and what might be found.
Y is another year I’m left here behind,
Z is for zest that I still have– in my mind.

I’ve survived all the symptoms, my body’s deployed,
And I am keeping twenty-six doctors fully employed!!!

source: Lafalooza

'Nurse of the Year' charged with not being a nurse

2009-08-06T21:05:00.000-07:00

It ain't easy being a nurse. That is, if you're not one.

Here's the news from the Associated Press-

NORWALK, Conn. – A Connecticut woman who authorities say spent more than $2,000 to stage a dinner honoring her as "Nurse of the Year" has been charged with pretending to be a nurse at a doctor's office. Betty Lichtenstein, 56, of Norwalk was charged Thursday.

Prosecutors say Dr. Gerald Weiss believed Lichtenstein was a registered nurse, especially after she was named the Connecticut Nursing Association's "Nurse of the Year" in 2008.

According to the arrest warrant, that association does not exist.

The state's Medicaid Fraud Control Unit began investigating after a patient complained about Lichtenstein.

She faces up to five years in prison if convicted of reckless endangerment and criminal impersonation charges.

Lichtenstein did not return a telephone message for comment.

32,617 pass Philippine nursing licensure exams

2009-07-25T17:10:00.000-07:00

MANILA, Philippines—(UPDATE 2) A total of 32,617 out of 77,901 passed the Nurse Licensure Examination, the Professional Regulation announced Saturday.

Golda Manto Yap, a graduate of the Felipe R. Verallo Memorial Foundation, topped the exams, getting an average score of 86.80 percent.
The Board of Nursing conducted the test last June in the cities of Manila, Baguio, Cagayan de Oro, Cebu, Davao, Iloilo, Legazpi, Lucena, Tacloban, Tuguegarao, Sulu, Pagadian and Zamboanga.

Saint Paul University-Dumaguete had the best result when all 112 of its examinees hurdled the board for a 100-percent passing rate.

A total of 50 examinees made it to the Top 10 rankings.

The results for three successful examinees were withheld by the board.

The oath-taking ceremony for the successful examinees as well as those who passed previous exams but have not taken their oath will be held before the nursing board on August 18 and 19 at 8 a.m. and 1 p.m. at the SMX Convention Center, SM Mall of Asia, Pasay City.--Philippine Daily Inquirer

Click HERE to see the list of successful examinees.

Chart Toppers

2009-07-17T17:41:00.000-07:00

I got this email entitled Hospital Chart Bloopers the other day. Apparently these were actual writings on hospital charts. Well, this will at least lessen the toxicity of a chaotic day at the ER.

As they say, laughter is the best medicine.

Enjoy!

* She has no rigors or shaking chills, but her husband states she was very hot in bed last night.

* Patient has chest pain if she lies on her left side for over a year.

* On the second day the knee was better, and on the third day it disappeared.

* The patient is tearful and crying constantly. She also appears to be depressed.

* The patient has been depressed since she began seeing me in 1993.

* Discharge status: Alive but without my permission.

* Healthy appearing decrepit 69 year old male, mentally alert but forgetful.

* The patient refused autopsy.

* The patient has no previous history of suicides.

* Patient has left white blood cells at another hospital.

* Patient's medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.

* Patient had waffles for breakfast and anorexia for lunch.

* She is numb from her toes down.

* While in ER, she was examined, X-rated and sent home.

* The skin was moist and dry.

* Occasional, constant infrequent headaches.

* Patient was alert and unresponsive.

* Rectal examination revealed a normal size thyroid.

* She stated that she had been constipated for most of her life, until she got a divorce.

* I saw your patient today, who is still under our car for physical therapy.

* Both breasts are equal and reactive to light and accommodation.

* Examination of genitalia reveals that he is circus sized.

* The lab test indicated abnormal lover function.

* The patient was to have a bowel resection. However, he took a job as a stock broker instead.

* Skin: somewhat pale but present.

* The pelvic exam will be done later on the floor.

* Patient was seen in consultation by Dr. Blank, who felt we should sit on the abdomen and I agree.

* Large brown stool ambulating in the hall.

* Patient has two teenage children, but no other abnormalities.

Swine Flu Away?

2009-06-23T21:51:00.000-07:00

US firm makes 1st batch of A(H1N1) vaccine

Agence France-Presse
06/24/2009

WASHINGTON DC, United States—A US company that on Tuesday was awarded a $35-million contract to develop an influenza vaccine using insect cell technology has produced a first batch against (A)H1N1 flu, company boss Dan Adams said.

"We turned out our first batch of doses—about 100,000—against (A)H1N1 flu last week and we're continuing to manufacture it," Adams, chief executive officer of Connecticut-based Protein Sciences Corporation, told AFP.

The US Department of Health and Human Services on Tuesday announced that it has awarded a $35-million contract to Protein Sciences, which could be extended for another five years to reach $147 million.

The insect cell technology "has advanced in recent years to a point that we believe it could help meet a surge in demand for US-based vaccine for seasonal and pandemic flu," Health Secretary Kathleen Sebelius said in a statement.

A(H1N1), or swine flu, which emerged in Mexico in April, has been declared a pandemic by the World Health Organization, killing 231 people worldwide and infecting more than 52,000 people in 100 countries.

As the novel strain of swine flu spread, scientists around the world scrambled to develop a seed strain, a necessary first step in developing a vaccine using either chicken eggs or mammalian cells—the way most vaccines are produced.

They warned that the virus could mutate during the southern hemisphere's flu season before returning north in a more lethal form in autumn, in a pattern similar to that seen in the deadly 1918 flu pandemic, which claimed an estimated 20 to 50 million lives around the globe.

Protein Sciences makes flu vaccine by infecting caterpillar cells with a baculovirus carrying the gene for hemagluttinin, a molecule that sticks out of the surface of the influenza virus.

"Using this method, vaccine candidates, clinical investigational lots, and commercial-scale vaccine production may be available faster than by using traditional vaccine production methods," the health department said in a statement.

The method does not need a seed strain to develop a vaccine, Adams said.

"While everyone else was waiting to get a seed strain, we worked with the genetic code from the virus," said Adams.

"The CDC (Centers for Disease Control and Prevention) sent us a dead virus, which is perfectly safe, and then we extracted genetic information from that virus.

"We can be in manufacturing a lot, lot quicker than people who have to wait for a seed strain," he said.

Protein Sciences' technology is also safer "because these caterpillars don't have any association with man or other animals, so there's no chance for their cells to learn how to propagate human viruses," Adams told AFP.

Under the terms of the grant made to Protein Sciences, if the company's new insect-cell technology proves to be safe and effective, the pharmaceutical minnow, which has just 50 employees, must boost its US manufacturing capability "to provide a finished vaccine within 12 weeks of pandemic onset."

It would also have to produce at least 50 million doses of flu vaccine "within six months of pandemic onset."

That should not be a problem, said Adams, because manufacturing a vaccine using insect cells can be easily and rapidly scaled up because it does not require the same specialized factories required to produce vaccine using egg or mammalian cells.

"We can manufacture our product facilities that make monoclonal antibodies, which is a huge class of products with a huge manufacturing capacity around the world," said Adams.

Protein Sciences' new vaccine against swine flu "could be available right away" if the Food and Drug Administration (FDA) issues an emergency use authorization for it, as it did for the bird flu vaccine developed by Adams's company.

Swiss drugs giant Novartis, which the US government gave $289 million to help develop a vaccine against (A)H1N1 flu, said around two weeks ago that it was poised to begin pre-clinical trials—tests in vitro and on animals—on its first batch of novel swine flu vaccine.

Sanofi-Pasteur of France has said it hopes to have doses of swine flu vaccine ready for clinical trials within weeks, while Taiwan's Adimmune Corporation said it expects to complete clinical trials on its A(H1N1) influenza vaccine around September.

The Heart of the Matter

2009-06-08T16:49:00.000-07:00

NCLEX Review 3500

2009-05-30T19:38:00.000-07:00

Click on the link below to view

NCLEX Review 3500

NCLEX Notes part deux

2009-05-26T14:36:00.000-07:00

Just another study guide to help you in your NCLEX quest...

Note: Click on the "rectangle" located on the right upper part for full screen view.

2007 NCLEX RN Detailed Test Plan Educator

Publish at Scribd or explore others: Fiction Books nclex

NCLEX Notes

2009-05-25T15:53:00.000-07:00

Just some tips for those who are planning to take the NCLEX in the near future. The plan outlined below is still relevant today as it was two years ago.

The bottom line is, nothing beats hard work and preparation when it comes to passing an examination. So, check them out and be guided accordingly...

Note: Click on the rectangle on the right hand side to view in full screen.

2007 NCLEX RN Detailed Test Plan Candidate

Publish at Scribd or explore others: Fiction Books nclex

The Woman Behind the "New" Face

2009-05-05T19:47:00.000-07:00

This is where you can truly say, WOW!

Nation's first face transplant patient shows face
By MARILYNN MARCHIONE, AP Medical Write

Five years ago, a shotgun blast left a ghastly hole where the middle of her face had been. Five months ago, she received a new face from a dead woman.

Connie Culp stepped forward Tuesday to show off the results of the nation's first face transplant, and her new look was a far cry from the puckered, noseless sight that made children run away in horror.

Culp's expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish, and her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles.

But Culp had nothing but praise for those who made her new face possible. "I guess I'm the one you came to see today," the 46-year-old Ohio woman said at a news conference at the Cleveland Clinic, where the groundbreaking operation was performed.

But "I think it's more important that you focus on the donor family that made it so I could have this person's face." Up until Tuesday, Culp's identity and how she came to be disfigured were a secret.

Culp's husband, Thomas, shot her in 2004, then turned the gun on himself. He went to prison for seven years. His wife was left clinging to life. The blast shattered her nose, cheeks, the roof of her mouth and an eye. Hundreds of fragments of shotgun pellet and bone splinters were embedded in her face. She needed a tube into her windpipe to breathe. Only her upper eyelids, forehead, lower lip and chin were left.

A plastic surgeon at the Cleveland Clinic, Dr. Risal Djohan, got a look at her injuries two months later. "He told me he didn't think, he wasn't sure, if he could fix me, but he'd try," Culp recalled. She endured 30 operations to try to fix her face. Doctors took parts of her ribs to make cheekbones and fashioned an upper jaw from one of her leg bones. She had countless skin grafts from her thighs. Still, she was left unable to eat solid food, breathe on her own, or smell.

Then, on Dec. 10, in a 22-hour operation, Dr. Maria Siemionow led a team of doctors who replaced 80 percent of Culp's face with bone, muscles, nerves, skin and blood vessels from another woman who had just died.

It was the fourth face transplant in the world, though the others were not as extensive. "Here I am, five years later. He did what he said — I got me my nose," Culp said of Djohan, laughing.

In January, she was able to eat pizza, chicken and hamburgers for the first time in years. She loves to have cookies with a cup of coffee, Siemionow said.

No information has been released about the donor or how she died, but her family members were moved when they saw before-and-after pictures of Culp, Siemionow said.

Culp said she wants to help foster acceptance of those who have suffered burns and other disfiguring injuries.

"When somebody has a disfigurement and don't look as pretty as you do, don't judge them, because you never know what happened to them," she said.

"Don't judge people who don't look the same as you do. Because you never know. One day it might be all taken away." It's a role she has already practiced, said clinic psychiatrist Dr. Kathy Coffman.

Once while shopping, "she heard a little kid say, `You said there were no real monsters mommy, and there's one right there,'" Coffman said. Culp stopped and said, "I'm not a monster. I'm a person who was shot," and pulled out her driver's license to show the child what she used to look like, the psychiatrist said.

Culp, who is from the small town of Unionport, near the Pennsylvania line, told her doctors she just wants to blend back into society. She has a son and a daughter who live near her, and two preschooler grandsons.

Before she was shot, she and her husband ran a painting and contracting business, and she did everything from hanging drywall to a little plumbing, Coffman said. Culp left the hospital Feb. 5 and has returned for periodic follow-up care. She has suffered only one mild rejection episode that was controlled with a single dose of steroid medicines, her doctors said.

She must take immune-suppressing drugs for the rest of her life, but her dosage has been greatly reduced and she needs only a few pills a day.

Also at the Cleveland Clinic is Charla Nash of Stamford, Conn., who was attacked by a friend's chimpanzee in February. She lost her hands, nose, lips and eyelids, and will be blind, doctors said.

Clinic officials said it is premature to discuss the possibility of a face transplant for her. In April, doctors at Harvard-affiliated Brigham and Women's Hospital in Boston performed the nation's second face transplant, on a man disfigured in a freak accident. It was the world's seventh such operation.

The first, in 2005, was performed in France on Isabelle Dinoire, a woman who had been mauled by her dog.

Swine Flu Q & A

2009-04-25T18:48:00.000-07:00

By The Associated Press
Fri Apr 24, 6:45 pm ET

Mexico is contending with an outbreak of swine flu, suspected in the deaths of dozens of people and sickening perhaps 1,000. In the United States, at least eight cases have been confirmed with the infection, all of them in California and Texas; only one person was hospitalized. Here are some questions and answers about the illness:

Q. What is swine flu?

A. Swine flu is a respiratory illness in pigs caused by a virus. The swine flu virus routinely causes outbreaks in pigs but doesn't usually kill many of them.

Q. Can people get swine flu?

A. Swine flu viruses don't usually infect humans. There have been occasional cases, usually among people who've had direct contact with infected pigs, such as farm workers. "We've seen swine influenza in humans over the past several years, and in most cases, it's come from direct pig contact. This seems to be different," said Dr. Arnold Monto, a flu expert with the University of Michigan.

Q. Can it spread among humans?

A. There have been cases of the virus spreading from human to human, probably in the same way as seasonal flu, through coughing and sneezing by infected people.

Q. What are the symptoms of swine flu?

A. The symptoms are similar to those of regular flu — fever, cough, fatigue, lack of appetite.

Q. Is the same swine flu virus making people sick in Mexico and the U.S.?

A. The Centers for Disease Control and Prevention said the Mexican virus samples match the U.S. virus. The virus is a mix of human virus, bird virus from North America and pig viruses from North America, Europe and Asia.

Q. Are there drugs to treat swine flu in humans?

A. There are four different drugs approved in the U.S. to treat the flu, but the new virus has shown resistance to the two oldest. The CDC recommends the use of the flu drugs Tamiflu and Relenza.

Q. Does a regular flu shot protect against swine flu?

A. The seasonal flu vaccine used in the U.S. this year won't likely provide protection against the latest swine flu virus. There is a swine flu vaccine for pigs but not for humans.

Q. Should residents of California or Texas do anything special?

A. The CDC recommends routine precautions to prevent the spread of infectious diseases: wash your hands often, cover your nose and mouth when you cough or sneeze, avoid close contact with sick people. If you are sick, stay at home and limit contact with others.

Q. What about traveling to Mexico?

A. The CDC has not warned Americans against traveling to Mexico but advises that they be aware of the illnesses there and take precautions to protect against infections, like washing their hands.

Source: Center for Defense Control and Prevention

Words of the Day

2009-04-22T21:18:00.000-07:00

Three words that caught my attention today while looking into some patients' charts courtesy of a wet-behind-the- ears Nurse Intern fresh out of school and eager to prove her mettle in the chaotic world of the Emergency Room Triage...

HEMMERHOID
MAGGETS
TETNAS

Spelling Bee, anyone?

C2007

The Tree of Life?

2009-04-19T22:40:00.000-07:00

I am no "Dr. No" and so this "From Russia with Love" thing is alien to me. We're here talking about whether or not "only God can make a tree"?

Nah, after watching the video, I am convinced of what Mr. Joyce Kilmer had known eons ago, that "Poems are made by fools like me, But only God can make a tree."

Nice try Doc but only a fool will fall into your claim of finding a growing tree inside a man's body. Ha-ha.

What's New in Stroke?

2009-04-15T16:44:00.000-07:00

By a stroke of luck, I passed this interesting video of Ed4Nurses while surfing on YouTube.

I am sharing it with you now just to brush up on what we have learned in school that for some could be from way, way back in the dark ages. :)

We tend to neglect stuff that we think we already know but since medicine continues to evolve and is not an exact science, we need to refresh our minds even with short videos such as this--

video credits: ed4nurses

I can Pill it, baby!

2009-03-30T19:00:00.000-07:00

There’s a new kid trying to make its presence felt on the Diabetic block with a promise that it is free from heart- related side effects (e.g. GlaxoSmithkline’s Avandia) often seen in other treatments.

Onglyza (generic name- Saxagliptin) is Bristol Myers’ answer to Merck’s Januvia, the leading drug in the market and the company is asking the FDA to approve the pill for patients with Type 2 Diabetes.

Let’s hope that Onglyza fulfill its promise and not turn into another bitter pill to swallow in the lucrative Diabetes market, that way we can really proclaim that Life is indeed Sweet!

Please pass the pill, Sugar…

PICC Line, Anyone?

2009-03-14T17:06:00.000-07:00

So, you passed the NCLEX without a sweat and you're good at IV insertions and what have you. Easy huh?

Well, sorry to burst your bubble but think again unless you know how to do this very common bedside procedure--

PICC Line Insertion!

Having cold fingers er feet now?

Well, you need not worry my friend. You will not do this procedure unless you're a certified PICC Line Nurse. Ha-ha. This is just FYI, since you will encounter this procedure a lot nowadays especially if you work on the Med-Surg Floor. :)

Here's more about Central Venous Line

Nursing Shortage in the US

2009-03-08T08:18:00.000-07:00

"An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said."

The excerpt above was taken from a "new" article from Yahoo!News. But the topic is certainly old news and conservative at the very least. Nursing shortage in the US is a harsh reality that the Obama administration should address the soonest possible time.

The truth is, the nurse-to-patient ratio is just horrible especially in the Nursing Homes where in most night shift cases, the ratio is up to 1 nurse for every 30 patients or more. The hospitals are not doing good either with a 1:12 nurse-to-patient ratio.

The Day shift ratio in most hospitals is a bit better at 8:1/ 7:1 but not the ideal numbers either. This is not only dangerous to the health and well-being of the patients but also to the health practitioners as well.

Since the US cannot provide the necessary manpower to address the said issue at the moment, the government should continue to look for measures that will help ease the burden on the overworked and heavily burdened US Nurses in order for them to continue to provide optimal health care to their patients.

One of the measures that they should do is to remove the quota for competent nurses coming to the United States especially from English-speaking countries (e.g. Philippines) wherein the nursing curriculum is very akin to that of the US system. This is necessary to answer the shortage for the time being.

And it has been proven time and again that Filipino nurses are not only competent and at par with their American counterparts with regards to their knowledge and skills but compassionate towards their patients as well. They treat every patient with dignity and respect.

Also these nurses are Bachelor's Degree holders and therefore are better equipped with the proper knowledge and expertise to handle the cases that they will encounter in the field.

Here's the article from Yahoo!News---

WASHINGTON (Reuters) – The U.S. healthcare system is pinched by a persistent nursing shortage that threatens the quality of patient care even as tens of thousands of people are turned away from nursing schools, according to experts.

The shortage has drawn the attention of President Barack Obama. During a White House meeting on Thursday to promote his promised healthcare system overhaul, Obama expressed alarm over the notion that the United States might have to import trained foreign nurses because so many U.S. nursing jobs are unfilled.

Democratic U.S. Representative Lois Capps, a former school nurse, said meaningful healthcare overhaul cannot occur without fixing the nursing shortage. "Nurses deliver healthcare," Capps said in a telephone interview.

An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said.

The shortage is expected to worsen in coming years as the 78 million people in the post-World War Two baby boom generation begin to hit retirement age. An aging population requires more care for chronic illnesses and at nursing homes.

"The nursing shortage is not driven by a lack of interest in nursing careers. The bottleneck is at the schools of nursing because there's not a large enough pool of faculty," Robert Rosseter of the American Association of Colleges of Nursing said in a telephone interview.

Nursing colleges have been unable to expand enrollment levels to meet the rising demand, and some U.S. lawmakers blame years of weak federal financial help for the schools.

Almost 50,000 qualified applicants to professional nursing programs were turned away in 2008, including nearly 6,000 people seeking to earn master's and doctoral degrees, the American Association of Colleges of Nursing said.

PAY DIFFERENCES

One reason for the faculty squeeze is that a nurse with a graduate degree needed to teach can earn more as a practicing nurse, about $82,000, than teaching, about $68,000.

Obama called nurses "the front lines of the healthcare system," adding: "They don't get paid very well. Their working conditions aren't as good as they should be."

The economic stimulus bill Obama signed last month included $500 million to address shortages of health workers. About $100 million of this could go to tackling the nursing shortage. There are about 2.5 million working U.S. registered nurses.

Separately, Senator Dick Durbin and Representative Nita Lowey, both Democrats, have introduced a measure to increase federal grants to help nursing colleges.

Peter Buerhaus, a nursing work force expert at Vanderbilt University in Tennessee, said the nursing shortage is a "quality and safety" issue. Hospital staffs may be stretched thin due to unfilled nursing jobs, raising the risk of medical errors, safety lapses and delays in care, he said.

A study by Buerhaus showed that 6,700 patient deaths and 4 million days of hospital care could be averted annually by increasing the number of nurses. "Nurses are the glue holding the system together," Buerhaus said.

Addressing the nursing shortage is important in the context of healthcare reform, Buerhaus added. Future shortages could drive up nurse wages, adding costs to the system, he said.

And if the health changes championed by Obama raise the number of Americans with access to medical care, more nurses will be needed to help accommodate them, Buerhaus said.

(Editing by Maggie Fox and Mohammad Zargham)

39,455 pass nursing board exam

2009-02-19T23:21:00.000-08:00

MANILA, Philippines - Some 39,455 nursing examinees passed the November 2008 Nursing Board Exam in 2008, with a nursing hopeful from Baguio City topping the highly anticipated list.

A radio report quoted the Professional Regulatory Commission (PRC) as saying the latest results showed that the passing rate was 44.51 percent of the 88,649 examinees.

The PRC said the exam’s topnotcher is Jovie Ann Alawas Decoyna of the Baguio Central University (BCU), who got a score of 89 percent.
She is joined by 72 other passers – most with tied scores – who were able to squeeze in to the Top 10.

While BCU produced this year’s topnotcher, Saint Paul University in Iloilo, the University of Saint Louis in Tuguegarao, Cagayan and the Foundation University were No. 1 in the passing rate, with all of their examinees passing.

Xavier University in Cagayan de Oro came next with a passing rate of 99 percent, with 336 of 341 students hurdling the test.

The November 29-30, 2008 examination was administered in 12 areas nationwide, including Manila, Baguio, Cagayan de Oro, Cebu City, Davao City, Iloilo City, Legazpi, Lucena, Tacloban, Tuguegarao, Sulu, and Zamboanga City.

The Board of Nursing is composed of its chairman Carmencita Abaquin, and members Leonila Faire, Betty Merritt, Perla Po, Marco Antonio Sto.Tomas, Yolanda Arugay, and Amelia B. Rosales.

Requirements

Board passers are required to bring the following: duly accomplished Oath Form, a cedula, two (2) pieces passport size picture, one (1) piece 1"x1" picture, two sets of metered documentary stamps, and one short brown envelope with name and profession.

Passers also need to pay a P600 initial registration fee and a P450 annual registration fee. They are also required to personally register and sign in the Roster of Registered Professionals.

Oath-taking ceremonies for Manila examinees and those who have not previously taken their oaths will be held at the SMX Convention Center in SM Mall of Asia in Pasay City on April 6 and 7 (Monday and Tuesday).

Passers must come in their proper oath-taking attire.

Oath-taking tickets for Metro Manila and neighboring provinces will be available at the Philippine Nurses Association office along 1663 F. T. Benitez Street in Manila’s Malate district, starting March 2.

Meanwhile, the schedule for oath-taking on other regions will be posted on the Board of Nursing website (www.bonphilippines.org).

Looking Back

In June 2008's nursing exam, 27,765 out of 64,459 passed, or 43.1 percent of the more than who took the test.

At that time, a University of Santo Tomas graduate topped the list of passers with an 86-percent score.

The Nursing Licensure Exam, like a few other licensure exams in the country, has had its own share of controversies, the most-talked about being the one conducted in 2006.

The alleged leakage incident that year prompted the PRC to form an independent fact-finding committee that recommended a retake of the exam.

Although Friday's results has just elevated almost 40,000 students into being a registered nurse, the government is still concerned they would be an addition to the current pool of nurses that might find difficulty securing jobs abroad.

The Philippine Overseas Employment Administration (POEA) last Wednesday urged nursing schools to device ways on how to produce an even more competent set of graduates.

The POEA said that more stringent screening and an intensified training could help Filipino nurses hurdle the now stricter standards being observed by nurse-importing countries like New Zealand. - GMANews.TV

Here's the link to the complete list of successful examinees.

PRC: 1,087 pass physician licensure examination

2009-02-18T16:17:00.000-08:00

The Professional Regulation Commission (PRC) announced Wednesday that 1,087 out of 1,685 passed the Physician (Complete, Prelims and Finals with Prelims) Licensure Examination given by the Board of Medicine in the cities of Manila and Cebu this February 2009.

The result of the examination with respect to one examinee was withheld pending final determination of his liabilities under the rules and regulations governing licensure examinations.

PRC said the results were released in two (2) working days from the last day of examinations.

Registration for the issuance of Professional Identification Card (ID) and Certificate of Registration will start on Monday, February 23, 2009 but not later than Friday, February 27, 2009.

Those who will register are required to bring the following:

Duly accomplished Oath Form or Panunumpa ng Propesyonal
Current Community Tax Certificate (cedula)
Two pieces passport size picture (colored with white background and complete name tag)
One piece 1” x 1” picture (colored with white background and complete name tag)
Two sets of metered documentary stamps, and
One short brown envelope with name and profession.

Those who will register will also have to pay the Initial Registration Fee of P600 and Annual Registration Fee of P450 for 2009-2012.

PRC said successful examinees should personally register and sign in the Roster of Registered Professionals.

The oathtaking ceremony of the successful examinees in the said examination as well as the previous ones who have not taken their Oath of Professional will be held before the Board on Tuesday, March 10, 2009 at 1:30 p.m. in the afternoon at the Tent City of the Manila Hotel, One Rizal Park, Manila.

Registration for membership with the Philippine Medical Association (PMA) will start on Monday, February 23, 2009.

The successful Physician examinees who garnered the ten highest places are the following:
RANK NAME SCHOOL RATING (%)

1 Marky Jod Abay Pandes - University of the East Ramon Magsaysay Mem. Medical Ctr. 87.25

2 Judy Emil Dela Cruz Dela Cruz - Far Eastern University-Nicanor Reyes Medical Foundation 86.83

3 Kenneth Karl Liu Dy - University of Santo Tomas 86.58

4 Julie Rae Evangelista Lacson - Our Lady of Fatima University-Valenzuela 86.33

5 Don Leo Sullano Pepito - University of the East Ramon Magsaysay Mem. Medical Ctr. 86.25

6 Victor Denoga Estacio - University of the Philippines-Manila 86.17

7 Aillen Eleizer Ng Mangulabnan - Our Lady of Fatima University-Valenzuela 86.08

8 Charlie Ercilla Labarda - Our Lady of Fatima University-Valenzuela 86.00

9 Clarito Diaz Demaala III - University of Santo Tomas 85.92

10 Jessica Alcala Amarante - Our Lady of Fatima University-Valenzuela 85.58

Click here for the complete result.

Pinoy nurses may apply for nursing jobs in Japan online - POEA

2009-01-26T13:51:00.000-08:00

The Philippine Star
January 18, 2009 12:00 AM

Filipino nurses and caregivers aspiring to work in Japan may now register online.

The Philippine Overseas Employment Administration said Friday “applicants need not go to the POEA office because they can already register at the POEA Website

POEA chief Jennifer Manalili said applicants should wait for POEA e-mail for further instructions and only those who meet the minimum qualification shall receive the notification through e-mail.

Those who qualify, Manalili said, will have to submit the POEA e-mail notification and other necessary documents at the POEA main office in Mandaluyong or its nearest office in their respective regions.

Applicants for nursing positions must prepare their resumé, valid passport, college diploma, transcript of records, employment certificate indicating at least three years’ hospital experience, board certificate, and Professional Regulation Commission identification card.

Manalili said Japanese employers would shoulder the placement fee and language training for those who qualify.

Earlier, the POEA announced that Japan is hiring at least 1,000 Filipino nurses and caregivers in the next two years. Deployment will start by the end of April or early May.

Manalili said those who qualify for the jobs would undergo six months of language and culture training in Japan during which they will receive an allowance of $400 or more than P21,000.

After the training, Filipino nurses and caregivers are allowed to stay in Japan for three years to work in hospitals and other medical facilities.

During the three-year period, Filipino nurses can take the Japanese licensure examination.

Filipino caregivers will receive a monthly salary of $1,600, while nurses will get higher pay.

Saudi needs 60,000 staff, nurses for its hospitals

2009-01-04T00:36:00.000-08:00

Although this piece is good news, I say if given a choice, Filipino health workers should try their luck first in countries like the US, UK and Ireland were their welfare as foreign health workers are properly addressed and insured.

This is not to say that going to the Middle East is bad but culturally and historically when a foreign worker found himself/herself in a difficult situation in a particular Arab country were trial is involved; their rights as well as receiving a fair one is often neglected and overlooked by both the host country and the Philippine government representatives alike.

But wherever one decides to go in pursuit of his/ her dreams, just bear in mind this old adage, "Do your best and God will take care of the rest."

A TOP Saudi Arabian hospital is interviewing Filipino nurses here to fill 60,000 hospital positions in the Kingdom in the next six months, an executive said yesterday.

“Even with the economic crisis, the demand for nurses and other medical staff in the Middle East is very high and very urgent,” said Lito Soriano, a senior officer of LBS E-Recruitment Solution.

“Unlike in the United States, the projected need for nurses in the Middle East is immediate.”

Soriano said the King Fahd Medical Center was only one of many Saudi hospitals looking for Filipino nurses, and that its officials were here to interview candidates.

He said King Fahd had only recently hired two Philippine recruitment agencies to fill up its vacancies.

“The top priorities in Saudi are security and health,” Soriano said.

“Its ministries of defense, aviation and health, which operate government hospitals, are doing the hiring not just for nurses but for technical medical workers like x-ray technicians, respiratory technicians and the like.”

Soriano said Saudi Arabia was paying $600 to $1,000 a month in basic salaries “on top of free housing, free transportation and yearly vacation.”

The Kingdom had only recently increased its inflation allowance to 10 percent from 5 to preserve its workers’ purchasing power, he said.

Soriano, also executive director of the Federated Association of Manpower Exporters, said his group was urging President Arroyo to grant indefinite visas to foreign principals employing Filipino workers.

Mrs. Arroyo recently signed Executive Order 758, which grants indefinite visas to foreign businessmen who hire 10 or more Filipinos for their businesses here.

Soriano said his group hoped the President would extend the same privilege to foreigners recruiting for their respective countries. Michael Caber with Arlie Calalo

It's still OK in the UK for Philippine Health Workers

2008-12-29T01:21:00.000-08:00

Here's the good news from the Philippine Daily Inquirer--

Jobs in UK still await RP health workers

By Jerome Aning
Philippine Daily Inquirer
First Posted 20:19:00 12/28/2008

MANILA, Philippines--Filipino nurses and other health care professionals seeking overseas employment need not worry about losing job opportunities in the United Kingdom, as there are many vacancies there that have to be filled up in the next few years.

A recruitment industry expert made this assessment on Sunday as he identified the British health care sector as one that has been in need of health care professionals, regardless of the financial slump affecting many European countries.

"The health care industry in UK is mainly funded by taxpayer's money and is managed by the National Health Service (NHS) which is the largest employer in the UK," Emmanuel Geslani, a consultant of several Manila-based recruitment agencies, told reporters.

Geslani, however, said the NHS system has been "failing" in matters of primary care and hospital services due the lack of nurses and senior carers resulting in lack of hospital beds and personnel to attend to the sick.

He cited a recent study of current vacancies in nursing and senior carers that showing nearly 10,000 vacancies, resulting in the poor delivery of services in hospitals and care homes.

With the aging population of the UK calculated to reach 30 percent for the entire country by 2010 some 10 million senior citizens would need better services from care homes, the study said.

"Thousands of Filipino nurses can fill up the gap in the nursing shortage in the UK by entering the country as student nurses and at the same time expand their knowledge and experience in British schools," Geslani suggested.

The projected vacancies are so worrisome that some placement agencies in Britain have been recruiting nursing students even before they graduate or take their licensure exams, according to Geslani.

He added that one British consultancy firm, realizing the need to "capture" much needed health care professionals, pioneered a "study-and-work" placement scheme for nursing students and the so-called "under-board graduates" to boost their academic qualifications and help them meet UK standards.

The International Student Advisors Inc. offers a plan whereby students and graduates of social, health care and international nursing degrees from the Philippines would be temporarily employed, with pay, in care homes and hospitals in the UK while completing their units or taking additional ones in accredited British universities.

"Through the scheme, the students can understand what actually happens in the place of work and undertake projects in preparation for their essays and exams. Under the vocational work placement of at least 30 hours a week, the students can cover their living costs and tuition fees," Geslani explained.

He said the Makati City-based ISA, which recently expanded its recruitment activities in eight provinces, already sent over 600 Filipino health care professionals to enroll in renowned UK schools such the Anglia Ruskin and Hertforshire universities for additional nursing degrees and in preparing for taking up the British overseas nursing program assessment

US relaxes visa requirements for nurses

2008-12-10T19:47:00.000-08:00

Says shortage may become national security concern

By Veronica Uy
INQUIRER.net
First Posted 14:49:00 12/11/2008

MANILA, Philippines -- The US government has issued a directive to relax visa procedures for foreign nurses after the Department of Homeland Security (DHS) acknowledged the acute shortage of the health care professionals there.

The directive, Processing of "Schedule A" Nurse Visas, which can be accessed at http://www.hammondlawfirm.com/downloads/CIS_Ombudsman_Schedule_A.pdf, released on December 5, noted that "visa availability" remains the main obstacle for foreign nurses seeking work in the US, whether they intend to become immigrants or not.

The Office of the Citizenship and Immigration Services (CIS) Ombudsman of the DHS, which released the directive, said that while the Department of Labor (DoL) has already allowed employers to bypass the first step in the hiring process, it enjoins the USCIS to adjust its procedures as well.

"Specifically the USCIS should separate and prioritize, as well as centralize, its process for [Schedule A] applications in accordance with Congress' expressed concern over the national nursing shortage and to ensure consistent adjudication of applications," it said.

The DoL has designated registered nurses (RNs) as a Schedule A occupation, meaning there are insufficient US nurses able, willing, qualified, and available to fill the vacancies. The designation also means the wages and working conditions of US nurses will not be adversely affected by the employment of foreign nurses.

The CIS Ombudsman noted that all the criteria needed for automatically expediting such applications from employers apply to the US nursing shortage -- "extreme emergent situation," "humanitarian situation," and "compelling interest of the service."

It noted that the shortage will impact on the quality of patient health care in the US. "The shortage of RNs and an increased workload for current nurses is a threat to the quality of patient care," it said.

On the other hand, centralizing the applications would result in "more efficient processing times and improved consistency in the adjudications."

Lawyer Ibaro Relamida, counsel of Sentosa Recruitment Agency, said the directive will take effect right away. He said Sentosa's 600 Filipino nurses are expected to get their EB3 visas within the month.

"Last month, we were able to send only 20 nurses to the US," he told INQUIRER.net. "We still have the visas of 1,000 being processed."

A 2007 study of the US Department of Health and Human Services shows that the US would need 1.2 million nurses by 2014, about half a million to meet the demand, and 700,000 more to replace those leaving the profession.

In its report, the CIS Ombudsman cited a warning from the Americans for Nursing Shortage Relief to the House Subcommittee on the Nursing Crisis that the "shortage could result in serious national security and health concerns if there is a pandemic flu or other man-made or natural disaster, and the United States does not have adequate health care resources to respond."

The CIS Ombudsman acknowledged that the US cannot expect to meet the growing demand for nurses. It also recognized that the piecemeal approach to visa applications for foreign nurses would not work.

Currently, foreign nurses can work in the US if they have any of the following visas:

* H1C non-immigrant visas, three-year visas for nurses in specified areas with nurse shortage, were issued to 49 in 2007 and 110 in 2008;

* TN non-immigrant visas, also three-year visas with an option to extend in increments of three years open to Canadians and Mexicans, were issued to 194 in 2006 and 356 in 2007;

* H1-B non-immigrant visas, for nurses in specialized occupations, were issued only to 38 in 2006, 66 in 2007, and 136 in 2008;

* EB3 immigrant visas, which gives foreign nurses permanent legal residence (the so-called "green card"), are the ones on DoL's Schedule A. Although the most common visas issued for foreign nurses, they depend on visa availability as determined by the Department of State. In 2007, a total of 9,689 such visas were issued.

Pork & Brain

2008-12-05T20:13:00.000-08:00

This is one of the reasons why I want my meat, well done… ;)

Words of the Day: Neurocystercercosis and Taenia Solium

The Heart of the Matter

2008-11-19T10:30:00.000-08:00

Teen lives 4 months with no heart, leaves hospital

By RASHA MADKOUR, Associated Press Writer

MIAMI – D'Zhana Simmons says she felt like a "fake person" for 118 days when she had no heart beating in her chest. "But I know that I really was here," the 14-year-old said, "and I did live without a heart."

As she was being released Wednesday from a Miami hospital, the shy teen seemed in awe of what she's endured. Since July, she's had two heart transplants and survived with artificial heart pumps — but no heart — for four months between the transplants.

Last spring D'Zhana and her parents learned she had an enlarged heart that was too weak to sufficiently pump blood. They traveled from their home in Clinton, S.C. to Holtz Children's Hospital in Miami for a heart transplant.

But her new heart didn't work properly and could have ruptured so surgeons removed it two days later.

And they did something unusual, especially for a young patient: They replaced the heart with a pair of artificial pumping devices that kept blood flowing through her body until she could have a second transplant.

Dr. Peter Wearden, a cardiothoracic surgeon at Children's Hospital of Pittsburgh who works with the kind of pumps used in this case, said what the Miami medical team managed to do "is a big deal."

"For (more than) 100 days, there was no heart in this girl's body? That is pretty amazing," Wearden said.

The pumps, ventricular assist devices, are typically used with a heart still in place to help the chambers circulate blood. With D'Zhana's heart removed, doctors at Holtz Children's Hospital crafted substitute heart chambers using a fabric and connected these to the two pumps.

Although artificial hearts have been approved for adults, none has been federally approved for use in children. In general, there are fewer options for pediatric patients. That's because it's rarer for them to have these life-threatening conditions, so companies don't invest as much into technology that could help them, said Dr. Marco Ricci, director of pediatric cardiac surgery at the University of Miami.

He said this case demonstrates that doctors now have one more option.

"In the past, this situation could have been lethal," Ricci said.

And it nearly was. During the almost four months between her two transplants, D'Zhana wasn't able to breathe on her own half the time. She also had kidney and liver failure and gastrointestinal bleeding.

Taking a short stroll — when she felt up for it — required the help of four people, at least one of whom would steer the photocopier-sized machine that was the external part of the pumping devices.

When D'Zhana was stable enough for another operation, doctors did the second transplant on Oct. 29.

"I truly believe it's a miracle," said her mother, Twolla Anderson.

D'Zhana said now she's grateful for small things: She'll see her five siblings soon, and she can spend time outdoors.

"I'm glad I can walk without the machine," she said, her turquoise princess top covering most of the scars on her chest. After thanking the surgeons for helping her, D'Zhana began weeping.

Doctors say she'll be able to do most things that teens do, like attending school and going out with friends. She will be on lifelong medication to keep her body from rejecting the donated heart, and there's a 50-50 chance she'll need another transplant before she turns 30.

For now, though, D'Zhana is looking forward to celebrating another milestone. On Saturday, she turns 15 and plans to spend the day riding in a boat off Miami's coast.

Bone marrow transplant suppresses AIDS in patient

2008-11-12T14:01:00.000-08:00

BERLIN (Reuters) - A bone marrow transplant using stem cells from a donor with natural genetic resistance to the AIDS virus has left an HIV patient free of infection for nearly two years, German researchers.

The patient, an American living in Berlin, was infected with the human immunodeficiency virus that causes AIDS and also had leukemia. The best treatment for the leukemia was a bone marrow transplant, which takes the stem cells from a healthy donor's immune system to replace the patient's cancer-ridden cells.

Dr. Gero Hutter and Thomas Schneider of the Clinic for Gastroenterology, Infections and Rheumatology of the Berlin Charite hospital said on Wednesday the team sought a bone marrow donor who had a genetic mutation known to help the body resist AIDS infection.

The mutation affects a receptor, a cellular doorway, called CCR5 that the AIDS virus uses to get into the cells it infects.

When they found a donor with the mutation, they used that bone marrow to treat the patient. Not only did the leukemia disappear, but so did the HIV.

"As of today, more than 20 months after the successful transplant, no HIV can be detected in the patient," the clinic said in a statement.

"We performed all tests, not only with blood but also with other reservoirs," Schneider told a news conference.

"But we cannot exclude the possibility that it's still there."

The researchers stressed that this would never become a standard treatment for HIV. Bone marrow stem cell transplants are rigorous and dangerous and require the patient to first have his or her own bone marrow completely destroyed.

Patients risk death from even the most minor infections because they have no immune system until the stem cells can grow and replace their own.

HIV has no cure and is always fatal. Cocktails of drugs can keep the virus suppressed, sometimes to undetectable levels. But research shows the virus never disappears -- it lurks in so-called reservoirs throughout the body.

Hutter's team said they have been unable to find any trace of the virus in their 42-year-old patient, who remains unnamed, but that does not mean it is not there.

"The virus is tricky. It can always return," Hutter said.

The CCR5 mutation is found in about 3 percent of Europeans, the researchers said. They said the study suggests that gene therapy, a highly experimental technology, might someday be used to help treat patients with HIV.

(Reporting by Oliver Denzer; Writing by Maggie Fox in Washington; Editing by Vicki Allen)

Nursing board exam ‘leakage-free’--execs

2008-11-11T06:31:00.000-08:00

By Tetch Torres
INQUIRER.net
First Posted 14:01:00 11/11/2008

MANILA, Philippines -- The nursing board exam this November will be “leakage-free,” according to officials of the Board of Nursing, amid reports that one of the review centers have released some items in the tests scheduled for the 29th and 30th.

Carmencita Abaquin, BON chairperson, and member Marco Sto. Tomas, assured the public that they have taken the necessary steps to ensure the credibility of the forthcoming licensure exam.

They disclosed that text messages being circulated said that a review center has leaked parts of the test in Baguio, Cebu, and Surigao and that members of the Professional Regulatory Commission (PRC) -- one former, the other incumbent -- were behind this.

But Sto. Tomas said security measures have been adopted to prevent a repeat of the June 2006 scandal. These include the quarantine of the members of the PRC and BON from the time the questionnaires are “extracted, printed, and sealed.”

Sto. Tomas said 500 questions per test have been encoded into the computer. These will enter certain parameters/framework per competency (for the 5 tests) and the computer will extract these questions based on the framework by which they have been entered.

"All these are done under quarantine meaning we have no communication outside," Sto. Tomas said.

And then the questions will be extracted, printed, and sealed, he said.

Printing has been centralized unlike during the board exam controversy in 2006 when printing was done per region.

In transporting of questionnaires, there will be escorts from the Philippine National Police (PNP) and National Bureau of Investigation (NBI), Sto. Tomas said.

"These text messages from review centers are only using the leakage as a marketing ploy to entice examinees. They are capitalizing on what happened years ago and the PRC is suffering from this scheme," Abaquin said.

The BON is coordinating with the nursing schools, as well as the Commission on Higher Education (CHED), to implement strict measures to make sure that the country will have high quality nurses, Sto. Tomas said.

There are a total of 88,750 nursing graduates set to take the second licensure examination on November 29 and 30, with the figure considered to be the highest in PRC history.

The BON will go on quarantine starting November 19.

V for Venipuncture

2008-11-10T19:04:00.000-08:00

Such a simple procedure really but the most overlooked one. Remember to always follow the Universal precaution otherwise you will be in trouble with The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). :)

video credits: PocketSnips

NCLEX Tips

2008-11-09T02:45:00.000-08:00

NCLEX Sample Questions

1. A nurse is working in an outpatient orthopedic clinic. During the patient’s history the patient reports, “I tore 3 of my 4 Rotator cuff muscles in the past.” Which of the following muscles cannot be considered as possibly being torn?

A: Teres minor
B: Teres major
C: Supraspinatus
D: Infraspinatus

2. A nurse at outpatient clinic is returning phone calls that have been made to the clinic. Which of the following calls should have the highest priority for medical intervention?

A: A home health patient reports, “I am starting to have breakdown of my heels.”
B: A patient that received an upper extremity cast yesterday reports, “I can’t feel my fingers in my right hand today.”
C: A young female reports, ”I think I sprained my ankle about 2 weeks ago.”
D: A middle-aged patient reports, ”My knee is still hurting from the TKR.”

3. A nurse working a surgical unit, notices a patient is experiencing SOB, calf pain, and warmth over the posterior calf. All of these may indicate which of the following medical conditions?

A: Patient may have a DVT.
B: Patient may be exhibiting signs of dermatitis.
C: Patient may be in the late phases of CHF.
D: Patient may be experiencing anxiety after surgery.

4. A nurse is performing a screening on a patient that has been casted recently on the left lower extremity. Which of the following statements should the nurse be most concerned about?

A: The patient reports, “I didn’t keep my extremity elevated like the doctor asked me to.”
B: The patient reports, “I have been having pain in my left calf.”
C: The patient reports, “My left leg has really been itching.”
D: The patient reports, “The arthritis in my wrists is flaring up, when I put weight on my crutches.”

5. A 93 year-old female with a history of Alzheimer’s Disease gets admitted to an Alzheimer’s unit. The patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?

A: Recommend the patient remain in her room at all times.
B: Recommend family members bring pictures to the patient’s room.
C: Recommend a speech therapy consult to the doctor.
D: Recommend the patient attempt to walk pushing the w/c for safety.

6. A nurse is covering a pediatric unit and is responsible for a 15 year-old male patient on the floor. The mother of the child states, “I think my son is sexually interested in girls.” The most appropriate course of action of the nurse is to respond by stating:

A: “I will talk to the doctor about it.”
B: “Has this been going on for a while?”
C: “How do you know this?”
D: “Teenagers often exhibit signs of sexual interest in females.”

7. A high school nurse observes a 14 year-old female rubbing her scalp excessively in the gym. The most appropriate course of action for the nurse to do is:

A: Request a private evaluation of the female’s scalp from her parents.
B: Contact the female’s parents about your observations.
C: Observe the hairline and scalp for possible signs of lice.
D: Contact the student’s physician.

8. A nurse is caring for a patient who has recently been diagnosed with fibromyalgia and COPD. Which of the following tasks should the nurse delegate to a nursing assistant?

A: Transferring the patient to the shower.
B: Ambulating the patient for the first time.
C: Taking the patient’s breath sounds
D: Educating the patient on monitoring fatigue

9. A nurse has been instructed to place an IV line in a patient that has active TB & HIV. The nurse should where which of the following safety equipment?

A: Sterile gloves, mask, and goggles
B: Surgical cap, gloves, mask, and proper shoewear
C: Double gloves, gown, and mask
D: Goggles, mask, gloves, and gown

10. A nurse is instructing a person who had a left CVA and right lower extremity hemiparesis to use a quad cane. Which of the following is the most appropriate gait sequence?

A: Place the cane in the patient’s left upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
B: Place the cane in the patient’s left upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.
C: Place the cane in the patient’s right upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
D: Place the cane in the patient’s right upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.

11. A nurse has just started on the 7PM surgical unit shift. Which of the following patients should the nurse check on first?

A: A 75 year-old female who is scheduled for an EGD in 10 hours.
B: A 34 year-old male who is complaining of low back pain following back surgery and has an onset of urinary incontinence in the last hour.
C: A 21 year-old male who had a lower extremity BKA yesterday, following a MVA and has phantom pain.
D: A 27 year-old female who has received 1.5 units of RBC’s. via transfusion the previous day.

12. A 64 year-old Alzheimer’s patient has exhibited excessive cognitive decline resulting in harmful behaviors. The physician orders restraints to be placed on the patient. Which of the following is the appropriate procedure?

A: Secure the restraints to the bed rails on all extremities.
B: Notify the physician that restraints have been placed properly.
C: Communicate with the patient and family the need for restraints.
D: Position the head of the bed at a 45 degree angle.

13. A 22 year-old patient in a mental health lock-down unit under suicide watch appears happy about being discharged. Which of the following is probably happening?

A: The patient is excited about being around family again.
B: The patient’s suicide plan has probably progressed.
C: The patient’s plans for the future have been clarified.
D: The patient’s mood is improving.

14. A patient that has delivered a 8.2 lb. baby boy 3 days ago via c-section, reports white patches on her breast that aren’t going away. Which of the following medications may be necessary?

A: Nystatin
B: Atropine
C: Amoxil
D: Loritab

15. A 13 year old girl is admitted to the ER with lower right abdominal discomfort. The admitting nursing should take which the following measures first?

A: Administer Loritab to the patient for pain relief.
B: Place the patient in right sidelying position for pressure relief.
C: Start a Central Line.
D: Provide pain reduction techniques without administering medication.

16. A 64 year-old male who has been diagnosed with COPD, and CHF exhibits an increase in total body weight of 10 lbs. over the last few days. The nurse should:

A: Contact the patient’s physician immediately.
B: Check the intake and output on the patient’s flow sheet.
C: Encourage the patient to ambulate to reduce lower extremity edema.
D: Check the patient’s vitals every 2 hours.

17. A 32 year-old male with a complaint of dizziness has an order for Morphine via IV. The nurse should do which of the following first?

A: Check the patient’s chest x-ray results.
B: Retake vitals including blood pressure.
C: Perform a neurological screen on the patient.
D: Request the physician on-call assess the patient.

18. A patient that has TB can be taken off restrictions after which of the following parameters have been met?

A: Negative culture results.
B: After 30 days of isolation.
C: Normal body temperature for 48 hours.
D: Non-productive cough for 72 hours.

19. A nurse teaching a patient with COPD pulmonary exercises should do which of the following?

A: Teach purse-lip breathing techniques.
B: Encourage repetitive heavy lifting exercises that will increase strength.
C: Limit exercises based on respiratory acidosis.
D: Take breaks every 10-20 minutes with exercises.

20. A patient asks a nurse the following question. Exposure to TB can be identified best with which of the following procedures? Which of the following tests is the most definitive of TB?

A: Chest x-ray
B: Mantoux test
C: Breath sounds examination
D: Sputum culture for gram-negative bacteria

Answer Key

1. (B) Teres Minor, Infraspinatus, Supraspinatus, and Subscapularis make up the Rotator Cuff.

2. (B) The patient experiencing neurovascular changes should have the highest priority. Pain following a TKR is normal, and breakdown over the heels is a gradual process. Moreover, a subacute ankle sprain is almost never a medical emergency.

3. (A) All of these factors indicate a DVT.

4. (B) Pain may be indicating neurovascular complication.

5. (B) Stimulation in the form of pictures may decrease signs of confusion.

6. (D) Adolescents exhibiting signs of sexual development and interest are normal.

7. (C) Observation of the student’s hair is the next step.

8. (A) Nursing assistants should be competent on all transfers.

9. (D) All protective measures must be worn, it is not required to double glove.

10. (A) The cane should be placed in the patient’s strong upper extremity, and left arm/right foot go together, for normal gait.

11. (B) The new onset of urinary incontinence may require additional medical assessment, and the physician needs to be notified.

12. (C) Both the family and the patient should have the need for restraints explained to them.

13. (B) The suicide plan may have been decided.

14. (A) Thrush may be occurring and the patient may need Nystatin.

15. (D) Do not administer pain medication or start a central line without MD orders.

16. (B) Check the intake and output prior to making any decisions about patient care.

17. (B) Dizziness can be a sign of hypotension, that may a contraindication with Morphine.

18. (A) Negative culture results would indicate absence of infection.

19. (A) Purse lip breathing will help decrease the volume of air expelled by increased bronchial airways.

20. (B) The Mantoux is the most accurate test to determine the presence of TB

Source: Test Trade

The Placebo Effect

2008-10-23T22:04:00.000-07:00

Survey: Half of US doctors use placebo treatments
By MARIA CHENG, AP Medical Writer

LONDON – About half of American doctors in a new survey say they regularly give patients placebo treatments — usually drugs or vitamins that won't really help their condition. And many of these doctors are not honest with their patients about what they are doing, the survey found.

That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.

"It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "There is an element of deception here which is contrary to the principle of informed consent."

The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.

Placebos as defined in the survey went beyond the typical sugar pill commonly used in medical studies. A placebo was any treatment that wouldn't necessarily help the patient.

Scientists have long known of the "placebo effect," in which patients given a fake or ineffective treatment often improve anyway, simply because they expected to get better.

"Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a professor of psychology at the University of Hull in Britain who has studied the use of placebos.

Researchers at the NIH sent surveys to a random sample of 1,200 internists and rheumatologists — doctors who treat arthritis and other joint problems. They received 679 responses. Of those doctors, 62 percent believed that using a placebo treatment was ethically acceptable.

Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors explicitly called it a placebo treatment.

Most doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.

In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.

Smaller studies done elsewhere, including Britain, Denmark and Sweden, have found similar results.

Jon Tilburt, the lead author of the U.S. study, who is with NIH's bioethics department, said he believes the doctors surveyed were representative of internists and rheumatologists across the U.S. No statistical work was done to establish whether the survey results would apply to other medical specialists, such as pediatricians or surgeons.

The research was paid for by NIH's bioethics department and the National Center for Complementary and Alternative Medicine.

The authors said most doctors probably reasoned that doing something was better than doing nothing.

In some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis, knowing full well that a virus is impervious to antibiotics, which fight bacteria. Experts believe overuse of antibiotics promotes the development of drug-resistant strains of bacteria.

Some doctors believe placebos are a good treatment in certain situations, as long as patients are told what they are being given. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said people with insomnia, depression or high blood pressure often respond well to placebo treatments.

"You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he suggested.

However, experts don't know if the placebo effect would be undermined if patients were explicitly told they were getting a dummy pill.

Brown said that while he hasn't prescribed sugar pills, he has given people with anxiety problems pills that had extremely low doses of medication. "The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.

Kirsch, the psychologist, said it might be possible to get the psychological impact without using a fake pill. "If doctors just spent more time with their patients so they felt more reassured, that might help," he said.

Some patients who had just seen their doctors at a clinic in London said the truth was paramount.

"I would feel very cheated if I was given a placebo," said Ruth Schachter, an 86-year-old Londoner with skin cancer. "I like to have my eyes wide open, even if it's bad news," she said. "If I'm given something without being warned what it is, I certainly would not trust the doctor again."

The Pros vis-à-vis Cons notwithstanding; Let us just remember that the Doctor- Patient relationship is sacred. Honesty is always the best policy in dealing with patients especially with regards to their treatments.

Clinical Eye

2008-10-21T20:15:00.000-07:00

Here are some of the latest news that caught my eyes...

General Anesthesia Tied to Developmental Woes in Kids

Youngsters under the age of 3 who had hernia surgery showed almost twice the risk of behavioral or developmental problems later compared to kids who hadn't had surgery, a new study finds.

Researchers suspect that exposure to general anesthesia during these operations might have played a role in the jump in risk, according to lead author Charles DiMaggio, an assistant professor of clinical epidemiology at Columbia University College of Physicians and Surgeons' Mailman School of Public Health in New York City. More...

Dr. Marc Bessler, right, and Dr. Daniel Davis performed a new kind of weight-loss surgery that passes a stapler down the throat to staple the stomach.

Toga (for transoral gastroplasty) is a new weight-loss surgery... click herefor more.

Magnet device aims to treat depression patients...

If it sounds like science-fiction, well, those woodpecker-like pulses trigger small electrical charges that spark brain cells to fire. Yet it doesn't cause the risks of surgically implanted electrodes or the treatment of last resort, shock therapy.

Called transcranial magnetic stimulation or TMS, this gentler approach isn't for everyone. The Food and Drug Administration approved Neuronetics Inc.'s NeuroStar therapy specifically for patients who had no relief from their first antidepressant, offering them a different option than trying pill after pill.

Read the entire article, here.

Pain in My Heart

2008-10-13T21:18:00.000-07:00

VIOXX- pain killer or heart killer?

The painful saga of the pain medicine continues...

Vioxx's Heart Risk Lingered Long After Use Ended

By Steven Reinberg
HealthDay Reporter

MONDAY, Oct. 13 (HealthDay News) -- When the pain killer Vioxx was pulled from the market in 2004 over concerns that it increased the risk of heart attack, stroke and death, many assumed that stopping the drug would end the risk.

But a new study finds that "the risk was increased close to twofold, and the risk persisted for approximately a year," said co-author Dr. Robert Bresalier, a professor of medicine at the M.D. Anderson Cancer Center in Houston.

"The good news is that, after a year, the risk seemed to go back down toward normal," he said.

However, the study's researchers and other experts also believe that long-term use of most non-aspirin painkilling drugs in this class -- called non-steroidal anti-inflammatory drugs (NSAIDs) -- also boost users' risks of heart attack, stroke and death to some degree.

NSAIDs include cox-2 inhibitor drugs such as the now-banned Vioxx and Bextra, as well as the remaining cox-2 on the market, Celebrex. Those drugs target the cyclooxygenase 2 (cox-2) enzyme involved in inflammation.

NSAIDs also include less targeted anti-inflammatory medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve).

The report was published online in the Oct. 14 issue of The Lancet.

For the study, Bresalier's group followed people who had participated in the international APPROVe trial, which compared Vioxx to placebo over 3 years in an attempt to see whether the drug could cut the recurrence of cancerous colon polyps. The trial was stopped early in 2004 because of the increased risk for heart attacks and stroke.

The researchers in the new study were able to contact 84 percent of the almost 2,600 people who had participated in the trial.

They found that a year after discontinuing Vioxx, ex-users still had a 79 percent increased risk of heart attack, stroke or death compared with those who had received placebo.

This finding was consistent with the increased risk observed during the trial, where the odds for cardiovascular trouble was more than double for those taking Vioxx. For individual patients, the risk of heart attack or stroke was doubled during the year after stopping the drug. The increased risk of dying was 31 percent compared with those who had taken placebo, the researchers noted.

Bresalier's group did find that Vioxx was able to reduce the recurrence of colon polyps, but this benefit has to be weighed against the increase in cardiovascular risk, they said.

Bresalier suspects that long-term use of all non-aspirin NSAIDs can raise the odds of cardiovascular trouble to some extent.

"Similar data has been evident for some of the other cox-2 inhibitors," he noted. "In fact, it seems to be a class effect for most if not all NSAIDs. There is a dose-dependent risk with Celebrex as well, whose magnitude was not that much different from Vioxx," he said.

Bresalier believes that certain patients should not take high doses of these drugs over a long period. "If you have a history of cardiovascular disease, speak to your doctor to understand the relative risks and benefits. If you're somebody who really needs to take these drugs because of chronic pain or severe arthritis, be aware of the issues. But you shouldn't be afraid to take these drugs if you need them," he said.

For people who take these drugs only intermittently -- for short-term pain relief, for example -- the risk is very small, Bresalier said. "It doesn't mean if you take one or two pills you're going to get a heart attack. For the vast majority of people taking these drugs, these are very good and safe drugs," he said.

Dr. Eric J. Topol, director of the Scripps Translational Science Institute and Chief Academic Officer of Scripps Health in La Jolla, Calif., was not surprised that the risk for heart attack and stroke continued even after Vioxx was stopped.

"What this does is help further demonstrate not only the risk of Vioxx, but the temporal duration," Topol said. "Now, we have compelling data that the risk extends a year after stopping the drug," he said.

Topol, who was one of the first to sound the alarm about Vioxx, is not sure that this is a class effect of all cox-2 inhibitors, however.

"There was always a signal that it [the risk] was worse for Vioxx that other cox-2 inhibitors. Whether or not other drugs like Celebrex shared that isn't known. That has not been demonstrated in studies of Celebrex. But you have to be suspicious, particularly since high doses of Celebrex have heart attack and stroke risk. But there's never been a study to show that it's a long-lasting liability," he said.

In response to the Lancet study, Vioxx manufacturer Merck issued the following statement: "Merck believes that this post-hoc analysis using limited data from a prematurely terminated study needs to be interpreted very cautiously and in the context of the rest of the data from the extensive clinical development program for Vioxx."

THINGS YOU DON’T WANT TO HEAR IN SURGERY

2008-10-05T02:03:00.000-07:00

- Better save that. We'll need it for the autopsy.

- "Accept this sacrifice, O Great Lord of Darkness!"

- Wait a minute, if this is his spleen, then what's that?

- Hand me that ... uh ... that uh..... thingie

- Oops! Hey, has anyone ever survived 500ml of this stuff before?

- There go the lights again...

- "Ya know, there's big money in kidneys… and this guy's got two of'em.

- Everybody stand back! I lost my contact lens!

- Could you stop that thing from beating? It's throwing my concentration off.

- What's this doing here?

- I hate it when they're missing stuff in here.

- That's cool! Now can you make his leg twitch?!

- Well folks, this will be an experiment for all of us.

- Sterile, shcmerile. The floor's clean, right?

- The “5-second rule” applies to organs, too – right?

- What do you mean he wasn't in for a sex change...

- “Oh, you mean HIS right…”

- OK, now take a picture from this angle. This is truly a freak of nature.

- This patient has already had some kids, am I correct?

- Nurse, did this patient sign the organ donation card?

- Don't worry. I think it is sharp enough.

- What do you mean "You want a divorce"!?!

- FIRE! FIRE! Everyone get out!

- Damn! Page 47 of the manual is missing!

Warts Up, Doc?

2008-10-01T23:11:00.000-07:00

Doctors were at a loss for explanations when an Indonesian fisherman grew warts out of his arms and feet that resembled tree branches. But according to Britain's The Sun newspaper, Dede's growths are going away, thanks to the help of an American dermatologist.

--SUPRI, Reuters / Corbis

NCLEX Tips

2008-09-29T16:53:00.000-07:00

NCLEX is quite easy if you know what to study and you prepare really well for it. NCLEX is designed to pass the student rather than to fail them.

Its purpose is to test your understanding of what you already learned, it all boils down on what you know, and that’s why preparation is the sole most important factor of passing the test.

That’s why my advice is for you to read and read and read…

Unfortunately, memorization doesn’t work out that well in this case since if you’re going to memorize everything you will end up as one dazed and confused examinee.

Rather it is the way you prepare and approach the issue. Instead of memorizing those kilometric explanations and descriptions in the book, it will do you more good to take notes of what you deem are important in every topic/ system that you encounter in your review. Familiarization and repetition of critical concepts in Nursing will surely help you pass the exam.

Thus, making some flash cards will be of much help in this particular case.

Here are some topics that I found on the net which will help you in passing the NCLEX. Learn about them and they will make your life come examination day really easy.

* Types of Nosocomial Infections
* Principles of Surgical Asepsis
* Medical Testing and Labs
* TURP Procedure
* Romberg’s Test
* Lithotripsy Procedure
* Levels of Consciousness
* Mental Exam Basics
* Grading of Deep Tendon Reflexes
* Glascow Coma Scale
* Normative Values
* Methods of Oxygen Delivery
* Dementia and Delirium
* Types of Injections
* Ethical Duties of Nurses
* Patient Rights
* Bioethical Principles
* Changes Associated with Aging
* Drip Rate Calculations
* Barriers to Communication
* Nutrition and TPN
* Attributes of Nutrients
* Methods of Absorption
* Metabolism and Nutrition
* Medical Nutrition Therapy
* Cultural Aspects of Diets
* Placenta Previa
* Stages of Labor
* Assessing Fetal Lung Maturity
* Pathology of Eclampsia
* PMS and Menopause
* Attributes of Battered Women
* Apgar Scores
* Types of Cardiomyopathies
* Opportunistic Infections
* Classifications of Cancer
* Medical Nutritional Therapy
* Staging of Pressure Ulcers
* Disease Pathology
* Types of Shock
* Lipid Profile Labs
* Coagulation Studies
* CBC Components
* Acne Treatment Medications
* Phases of Adolescence
* Three Types of Jaundice
* Pain Assessment
* Lymphoma Characteristics
* Sexually Transmitted Diseases
* Tanner Staging
* Vaccinations and Immunizations
* Symptoms of Child Abuse
* Performing Newborn Assessments
* Motor Development
* Development of Language
* Pharmacology
* Types of Adrenergic Receptors
* Properties of Decongestants
* Classifications of Drugs
* Antipsychotic Classifications
* Drug Interactions
* Major Injection Sites
* Calcium Channel Blockers
* Phases of Burn Management
* Types of Burns
* Wound Healing Phases

Here's an example of what a flash card should look like (Click on the photo for a closer look)--

To TPA or not to TPA?

2008-09-24T15:48:00.000-07:00

That is the question.

Tissue Plasminogen Activator or more commonly TPA is a genetically- engineered blood clot dissolver that was first used to prevent heart damage after a heart attack since the late 1980s and through the years have been one of the mainstays in the treatment of Stroke because of its ability to reduce the long- term disability that usually result from the disease.

TPA is usually given within three hours of a Stroke which is usually known in legal parlance as the “window- period” or “golden hour” to be effective and beyond that there‘s the clear and present danger of bleeding in the brain which is the TPA’s worst complication .

However recent findings by researchers and scientists in the medical field are now reconsidering that old belief and are now concluding that it is still safe to give TPA beyond the so- called “three- hour” window period.

Here's the news from the Associated Press- Study: Extending time of stroke drug treatment OK

And here's the article of the study from the New England Journal of Medicine - Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Easy ECG

2008-09-13T14:57:00.000-07:00

Even in the advent of modern diagnostic machines in the world of medicine, ECG or EKG remains the fastest and simplest way to look into the heart. It is still very useful especially in the Clinical or Emergency Room settings where a quick determination of the heart’s function is paramount especially in cases of Acute Myocardial Infarction or Heart Attack.

The Electrocardiogram can determine a heart block, enlarged heart muscles and rhythm disturbances. It also helps determine previous cases of heart attack. Thus, the ECG is a valuable tool because it helps diagnose irregularities and changes in the heart as well as to establish a baseline for subsequent ECGs.

Here are some videos that will help you further understand the concept and importance of the Electrocardiogram--

video credits:

Dr. Dean Keller and Dr. Melissa Stiles
University of Wisconsin School of Medicine and Public Health

Assessing Lung Sounds

2008-09-12T18:07:00.000-07:00

Normal Breath Sounds
The correct sequence of auscultation of the posterior chest is shown in the picture below. The sequence is from the apex to the base of the lungs from one side to the other including the lateral areas of the lungs.

Credits: Dr. Pat O'Leary
David W. Woodruff, MSN, RN- BC, CNS, CEN

Gastric bypass anatomy leads to diabetes control

2008-09-06T16:41:00.000-07:00

The Reuters article below which is about the relationship between gastric bypass and diabetes control further reinforce the phenomenon that many physicians are now encountering in their practice.

I have seen a lot of people who has diabetes and high levels of blood glucose but are now symptom- free after undergoing a gastric bypass. Now, this article will further explain the mechanism behind this new phenomenon.

So, read on…

NEW YORK (Reuters Health) - The rapid and substantial control of diabetes seen after gastric bypass surgery is due, at least in part, to the intestinal rearrangement involved in the procedure, the results of an animal study suggest.

Besides removing a substantial portion of the stomach, gastric bypass also attaches the output of the stomach to the lower intestines. The lower portion of the gut usually produces little glucose, but because of the direct input from the stomach it increases its production, French researchers report in the research journal Cell Metabolism.

The liver senses the higher level of glucose and reduces its own production of the sugar. Since the liver contributes much more to the body's overall glucose production than do the intestines, the net effect is enhanced glucose control, say Dr. Gilles Mithieux, from Universite de Lyon, and colleagues.

The increase in intestinal glucose formation was only noted with gastric bypass, not with gastric banding, which doesn't re-route the intestines. This may explain why only gastric bypass has been associated with enhanced diabetes control, the investigators conclude.

Furthermore, they note, sensors in the liver detect the elevated glucose and send an appetite-suppressing signal to the brain, which contributes to the satiety and weight loss seen with gastric bypass.

SOURCE: Cell Metabolism, September 3, 2008.

Urethral Catheterization

2008-09-01T17:21:00.000-07:00

Urethral catheterization is a frequently performed bed side procedure; if done haphazardly it may lead to infection, particularly if the catheter is left for long periods.

Urethral catheterization is done usually with a balloon tip Foley Catheter of varying sizes (8 Fr* to 26 Fr). The balloon size for most of the applications is designed to hold little over 5 ccs of fluid. Larger Foley catheters with balloon capacity in excess of 30 ccs are available for specific urology purposes. For an average adult sizes 14 to 18 Fr catheters are usually utilized.

Indications for urethral catheterization:
1. Urinary retention (palpable, prominent urinary bladder)
2. To keep the patient dry and manageable when he is obtended or comatose
3. Management of incontinence of urine
4. To watch hourly urine output in intensive care situation.
5. As a part of urologic studies and also managing post operative status.
6. To obtain a catheterized specimen of urine for culture and sensitivity when specially required. (Spontaneously voided midstream specimen is good enough under majority of circumstances and it is rarely necessary to catheterize for diagnosis of UTI).

NOTE: Where there is obvious injury to urethra following trauma Foley catheterization should not be attempted before cystourethrogram is performed.

Procedure:

Although the procedure may vary minimally between male and female patients, the basic principles of aseptic precautions and positioning are essentially the same.
Preliminary hand wash and wearing of cap and mask recommended.

Patient should be in the supine position with legs slightly apart for the male and with legs apart and knees flexed for the female patient.

A preliminary soap and water wash to the external genitalia is desirable.
From this point all procedures are done with sterile gloves.

External preparation of genitalia is performed using betadine pain and sterile drapes are laid to provide adequate exposure to the external genitalia.

Appropriate catheter is picked up and the integrity of the balloon is checked by introducing 5 cc of water into the balloon and deflated.

The sterile catheter is lubricated adequately with sterile jelly lubricant.

Catheterization of the male patient:

The penis is held with the left hand away from the scrotum and holding the catheter firmly with the right hand the well lubricated catheter is gently passed through the external urethral meatus. This is gently and gradually advanced and under most circumstances it is passed through the urinary sphincter without any problem.

Occasionally some resistance may be encountered at the level of the sphincter due to prostatic hypertrophy. By gently advancing further through the sphincter this can be overcome to some extent and catheter can be passed into the bladder.

Occasionally a larger catheter or a “coude” type of catheter may be required to overcome this obstruction. When the catheter passes into the bladder, urine will be seen coming through the catheter. At this point, it is advanced by another 1 to 2 cms and the balloon is inflated with 5 cc or sterile water.

The Foley catheter after collecting specimens for urinalysis and culture is then connected to the Foley bag. Some physicians prefer to apply betadine ointment at the external urethral orifice. The Foley catheter may be stabilized to the medial aspect of one of the thighs using adhesive tapes. This prevents the Foley catheter advancing more towards the bladder thereby carrying infection and also prevents it from unnecessary movements causing discomforts.

Catheterization of the female patient:

In the female, the vulval outlet and labia are carefully washed and painted with betadine and appropriate sterile drapes are laid. With the left hand exposing the urethral meatus by separating the labia with the thumb and index fingers the external urethral meatus is identified and previously lubricated catheter is carefully and gently advanced through it into the bladder.

Care should be taken not to contaminate the catheter by touching the unprepared parts of the genitalia and the vagina. Once the catheter is well placed inside the bladder and the urine is seen coming out of the tube the balloon is distended with 5 cc of sterile water and catheter connected and fixed as described earlier.

Post Catheterization management has to be carefully planned to avoid infections. Except in selected patients, routine antibiotic administration is not necessary. Catheter care and change of catheters when necessary should be remembered. In a hospital set up, catheter induced nosocomial infections of the urinary tract are fairly common. When prolonged catheterization is required appropriate urological and where necessary neurological consultations are obtained to plan long term management of the catheter dependent patient. Ambulatory patients who have Foley catheters left in situ are given appropriate instructions and training in the care of the catheters and also plan periodical visits to the doctors and health care staff.

Note: Consider – use of silicon coated catheter for long-term placements

Credits: NurseReview.Org/ Medindia.net

Face Value

2008-08-23T13:46:00.000-07:00

Face transplant patient can smile, blink again

By MARIA CHENG, AP Medical Writer
Fri Aug 22, 7:37 AM ET

LONDON - Transplanting faces may seem like science fiction, but doctors say the experimental surgeries could one day become routine. Two of the world's three teams that have done partial face transplants reported Friday that their techniques were surprisingly effective, though complications exist and more work is still needed.

"There is no reason to think these face transplants would not be as common as kidney or liver transplants one day," said Dr. Laurent Lantieri, one of the French doctors who operated on a man severely disfigured by a genetic disease.

In Friday's issue of the British medical journal Lancet, Lantieri and colleagues reported on their patient's status one year after the transplant. Chinese doctors also reported on their patient, two years after his surgery.

Last year, the French team operated on a 29-year-old man with tumors that blurred his features in a face that looked almost monstrous. They transplanted a new lower face from a donor, giving the patient new cheeks, a nose and mouth. Six months later, he could smile and blink.

The Chinese patient had part of his face ripped off by a bear. Surgeons in Xian gave him a new nose, upper lip and cheek from a donor. After a few months, he could eat, drink and talk normally, and returned home to Yunnan province in southwest China.

The patients were not identified although photos were included in the reports.

As is the case with all transplants, doctors use immune-suppressing drugs to prevent the recipient's body from attacking the donated tissue. In both face transplants, the patients started rejecting the transplanted tissue more than once. Their doctors solved the problem by juggling their medications.

The French patient now takes three pills a day to prevent rejection.

"That's less than most people with diabetes," said Lantieri, a plastic surgeon at the Henri Mondor-Albert Chenevier Hospital in suburban Paris.

Other doctors were reassured by the results.

"To be able to wean down the dosage of the medication in small amounts and relatively quickly, that is encouraging," said Dr. Bohdan Pomahac, a plastic surgeon at the Brigham and Women's Hospital in Boston.

Pomahac has permission to do a face transplant in the U.S., as do doctors at the Cleveland Clinic.

Experts have worried that if patients take lifelong anti-rejection drugs after a transplant, their cancer risk will jump. Some also predicted that rejection would destroy the face within a few years. Those fears seem to have been allayed, Pomahac said.

With three successful partial face transplants so far — including the world's first on a woman whose face was bitten off by a dog in France — doctors say that some of the surgery's initial uncertainties, like how functional the new face would be, are being answered.

For example, Lantieri's patient's face was paralyzed by tumors for more than a decade. The French team wasn't sure if nerves could grow after the transplant. But they discovered later their patient could blink, proving the brain was able to restore long-forgotten facial nerve connections.

Not everyone is convinced that face transplants are so revolutionary.

Dr. Patrick Warnke, a plastic surgeon at the University of Kiel in Germany, calls them a "dead-end road," because he doesn't think the rejection problem can be solved. Instead, he hopes to re-grow tissue from patients' own stem cells.

Still, the biggest obstacle to more face transplants may not be scientific, but social.

"When kidney transplants first began, people were reluctant to donate because there were a lot of cultural, social and religious issues," Pomahac said. "This is exactly the same scenario now."

Doctors plan to do more face transplants, but are having a hard time finding donors.

"Everyone says they would accept a face transplant if they were disfigured," Lantieri said. "The real question is, would you be a donor, or would you allow your family member to donate their face? That is the answer we need to change."

___

On the Net:

http://www.lancet.com

Philippine Physician Examination Results

2008-08-21T11:51:00.000-07:00

TOP TEN PHYSICIANS Board Examinees

1. Marlon Diaz Garcia, Far Eastern University-Nicanor Reyes Medical Foundation -- 88.75%

2. Dave Anthony Pasetes Diomampo, Saint Louis University -- 88.17%

3. Gentry George Teng King, University of Santo Tomas -- 87.42%
Janice Jill Keng Lao, University of the Philippines-Manila -- 87.42%

4. Nemencio Jr Reyes Ronquillo, University of the Philippines-Manila -- 87.17%
Paolo Potato Villanueva, University of Santo Tomas -- 87.17%

5. Allan Louie Espino Cruz, University of Santo Tomas -- 86.92%

6. Philip Blanco Antiporta, University of Santo Tomas -- 86.58%

7. Ma Cristina Dela Cruz Briones, University of Santo Tomas -- 86.42%

8. Lemuel Benedict Robleza Non, University of the Philippines- Manila -- 86.17%
Sheila Jane Tan Zanoria, Cebu Institute of Medicine -- 86.17%

9. Angela Sacayan Apostol, University of the East Ramon Magsaysay Mem. Medical Ctr.-- 86.08%
Karel Ann Alipasa Espejo, University of the Philippines- Manila -- 86.08%

10. Grace Ann Mariano Nicolas, University of Santo Tomas -- 86.00%

Lists of New Physicians--

Dr. A

Dr. B

Dr. C

Dr. D

Dr. E

Dr. F

Dr. G

Dr. H

Dr. I

Dr. J

Dr. K

Dr. L

Dr. M

Dr. N

Dr. O

Dr. P

Dr. Q

Dr. R

Dr. S

Dr. T

Dr. U

Dr. V

Dr. W

Dr. Y

Dr. Z

The Nurse Notes: Old & New

2008-08-19T02:00:00.001-07:00

A new nurse throws up when the patient does. An experienced nurse calls housekeeping when the patient throws up.

A new nurse wears so many pins on their name badge you can't read it. An experienced doesn't wear a name badge for liability reasons.

A new nurse charts too much. An experienced nurse doesn't chart enough.

A new nurse loves to run codes. An experienced nurse makes graduate nurses run to codes.

A new nurse wants everyone to know they are a nurse. An experienced nurse doesn't want anyone to know they are a nurse.

A new nurse keeps details and notes on a notepad. An experienced nurse writes on the back of their hands, paper scraps, napkins, etc.

A new nurse will spend all day trying to re-orient a paient. An experienced nurse will chart the patient is dis-orientated and restrain them.

A new nurse can hear any alarm at 50 yards. An experienced nurse can't hear any alarms at any distance.

A new nurse loves to hear abnormal heart and breath sounds. An experienced nurse doesn't even want to hear about them unless the pt is symptomatic.

A new nurse spends 2 hours giving a patient a bath. An experienced nurse lets the nurse's aide give the patient a bath.

A new nurse thinks people respect nurses. An experienced nurse knows everybody blames everything on the nurse.

A new nurse looks for blood on a bandage hoping they will get to change it. An experienced nurse knows a little blood never hurt anybody.

A new nurse looks for a chance "to work with the family". An experienced nurse AVOIDS the family.

A new nurse expects medications and supplies to be delivered on time. An experienced nurse expects them to be never delivered at all.

A new nurse will spend days bladder training an incontinent patient. An experienced nurse will insert a Foley catheter.

A new nurse always answer their phone. An experienced nurse checks their caller ID before answering their phone.

A new nurse thinks psychiatric patients are interesting. An experienced nurse thinks psychiatric patients are crazy.

A new nurse carries reference books in their bag. An experienced nurse carries magazines, lunch and something else in their bag.

A new nurse doesn't find this funny. An experienced nurse does.......

So, what are you?

On Organ Transplants and Medical Ethics

2008-08-14T18:30:00.000-07:00

The issue of when to declare a person dead in order to harvest his/ her vital organs so that another person may live is a very delicate one no matter from which angle you look at it. An issue that's hard to ignore and poses a lot of questions and quite a dilemma to all the parties involved.

There’s an on- going debate as to when to declare potential organ donors dead. The old criterion of brain death as the sole determining factor is now being challenged by a lot of people in the medical field. Many of them are now advocating on a new protocol called Cardiocirculatory death as the new basis to declare a person dead.

The New England Journal of Medicine tackle this issue in its August edition and the Associated Press pick up the story. I copied the said article as the link to the NEJM website and posted them here.

So, read on…

Doctors debate when to declare organ donors dead

By STEPHANIE NANO, Associated Press Writer Thu Aug 14, 3:56 PM ET

NEW YORK - A report on three heart transplants involving babies is focusing attention on a touchy issue in the organ donation field: When and how can someone be declared dead?

For decades, organs have typically been removed only after doctors determine that a donor's brain has completely stopped working. In the case of the infants, all three were on life support and showed little brain function, but they didn't meet the criteria for brain death.

With their families' consent, the newborns were taken off ventilators and surgeons in Denver removed their hearts minutes after they stopped beating. The hearts were successfully transplanted, and the babies who got the hearts survived.

"It seemed like there was an unmet need in two situations," said Dr. Mark Boucek, who led the study at Children's Hospital in Denver. "Recipients were dying while awaiting donor organs. And we had children dying whose family wanted to donate, and we weren't able to do it."

The procedure — called donation after cardiac death — is being encouraged by the federal government, organ banks and others as a way to make more organs available and give more families the option to donate.

But the approach raises legal and ethical issues because it involves children and because, according to critics, it violates laws governing when organs may be removed.

As the method has gained acceptance, the number of cardiac-death donations has steadily increased. Last year, there were 793 cardiac-death donors, about 10 percent of all deceased donors, according to United Network for Organ Sharing. Most of those were adults donating kidneys or livers.

"It is a much more common scenario today that it would have been even five years ago," said Joel Newman, a spokesman for the network.

The heart is rarely removed after cardiac death because of worries it could be damaged from lack of oxygen. In brain-death donations, the donor is kept on a ventilator to keep oxygen-rich blood flowing to the organs until they are removed.

The Denver cases are detailed in Thursday's New England Journal of Medicine. The editors, noting the report is likely to be controversial, said they published it to promote discussion of cardiac-death donation, especially for infant heart transplants.

They also included three commentaries and assembled a panel discussion with doctors and ethicists. Many of the remarks related to the widely accepted "dead donor rule" and the waiting time between when the heart stops and when it is removed to make sure that it doesn't start again on its own.

In two of the Denver cases, doctors waited only 75 seconds; the Institute of Medicine has suggested five minutes, and other surgeons use two minutes.

State laws stipulate that donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible. Some commentators contended that the Denver cases didn't meet the rule since it was possible to restart the transplanted hearts in the recipients.

"In my opinion, it's an open-and-shut case. They don't have irreversibility, and they don't have death," said Robert Veatch, a professor of medical ethics at Georgetown University.

But others argue the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.

The Denver transplants were done over three years; one in 2004 and two last year. The three donor infants had all suffered brain damage from lack of oxygen when they were born. On average, they were about four days old when life support was ended.

In the first case, doctors waited for three minutes after the heart stopped before death was declared. Then the waiting time was reduced to 75 seconds on the recommendation of the ethics committee to reduce the chances of damage to the heart.

The authors said 75 seconds was chosen because there had been no known cases of hearts restarting after 60 seconds.

The hearts were given to three babies born with heart defects or heart disease. All three survived, and their outcomes were compared to 17 heart transplants done at the hospital during the same time but from pediatric donors declared brain dead.

"We couldn't tell the difference," said Boucek, who's now at Joe DiMaggio Children's Hospital in Hollywood, Fla.

There were nine other potential cardiac-death donors at the hospital during the same period, but there wasn't a suitable recipient in the area for their hearts, the report said.

The parents of one of the infants in the study, David Grooms and Jill Airington-Grooms, faced the devastating news on New Year's Day 2007 that their first child, Addison, had been born with little brain function and wouldn't survive.

After they decided to remove life support, they were asked about organ donation, and quickly agreed.

"The reality was Addison was not going to live," said Jill Airington-Grooms. "As difficult as that was to hear, this opportunity provided us with a ray of hope."

Three days later, Addison was taken off a ventilator and died. Her heart was given to another Denver-area baby, 2-month-old Zachary Apmann, who was born five weeks premature with an underdeveloped heart.

His parents, Rob and Mary Ann Apmann, said they were given several options and decided to wait for a transplant. They agreed they would accept a cardiac-death donation to increase Zachary's chances.

Mary Ann Apmann said she wasn't worried that the first available heart came from a cardiac-death donor.

"At that point, Zachary was so sick. We did have him at home. But we knew it wasn't much longer," she said.

After the transplant on Jan. 4, his condition quickly improved, and his blue lips disappeared.

Now, at 21 months: "He's just a crazy little kid who loves to play and swim and throw rocks," his mother said.

The two families haven't met yet but have been in touch through letters and calls. Coincidentally, David Grooms said he had an older brother who died three days after he was born in the 1970s with the same heart condition as Zachary's. The Grooms now have an 8-month-old daughter, Harper.

"Addison did only live three days in this world, but because of this, she lives on," her mother said.

Here's the link to--
The New England Journal of Medicine

2008 Philippine Nursing Board Examination Results

2008-07-24T14:57:00.000-07:00

When Are You Most Likely to Have a Heart Attack?

2008-07-23T15:03:00.000-07:00

Heart disease, including heart attack, is the world's No. 1 killer. A person's risk of heart attack depends mostly on a familiar repertoire of factors: exercise, smoking, diet, weight, genes. But our bodies' circadian rhythms also play a role, leaving us more prone to injury during certain hours than others. If you're guessing that the danger zone comes at the end of a stressful workday, guess again. Here to explain is Roberto Manfredini, professor of internal medicine at the University of Ferrara in Italy.

Q: What time of day am I most likely to have a heart attack?

A: The most dangerous times for heart attack and for all kinds of cardiovascular emergency - including sudden cardiac death, rupture or aneurysm of the aorta, pulmonary embolism and stroke - are the morning and during the last phase of sleep. A group from Harvard estimated this risk and evaluated that on average, the extra risk of having a myocardial infarction, or heart attack, between 6 a.m. and noon is about 40%. But if you calculate only the first three hours after waking, this relative risk is threefold.

The cardiovascular system follows a daily pattern that is oscillatory in nature: most cardiovascular functions exhibit circadian changes (circadian is from the Latin circa and diem, meaning "about one day"). Now, a heart attack depends on the imbalance between increased myocardial oxygen demand (i.e., a greater need for oxygen in your heart) and decreased myocardial oxygen supply - or both. And unfortunately, some functions in the first hours of the day require more myocardial oxygen support: waking and commencing physical activities, the peak of the adrenal hormone cortisol [which boosts blood-pressure and blood-sugar levels] and a further increase in blood pressure and heart rate due to catecholamines (adrenaline and noradrenaline), which show a peak when you wake up. All those factors lead to an increase of oxygen consumption but at the same time contribute to the constriction of vessels. So you have reduced vessel size and reduced blood flow to the coronary vessels.

You have to remember that blood coagulation is important in the genesis of what we call thrombi, the blood clots that can block the blood vessels and cut off supply to the heart. When we wake up, platelets, the particles in the blood that make thrombi, are particularly adhesive to the vessels. Usually we have an endogenous system - it's called fibrinolysis - to dissolve the thrombi. But in the morning, the activity of our fibrinolytic system is reduced. So we have a greater tendency to make thrombi that can occlude the coronary vessels. This contributes to further reduction of coronary blood flow. Thus, at the same time that you need more blood flow, you have less.

All these changes, however, probably are not so harmful in healthy people. But for a person with a plaque in the coronary vessel, if these changes occur at the same time and peak at the same time, the final result is a higher risk of heart attack during that specific window of morning hours.

Why is the risk also higher during the last part of sleep? Usually, during the night, the cardiovascular system is "sleeping," which is characterized by low blood pressure and heart rate. But the last stage of sleep - REM, or rapid eye movement, sleep [when we believe most dreaming occurs] - is a risk period for cardiovascular emergencies because when you dream, you have a dramatic increase of activity of the autonomic nervous system - even more than when you are awake. Probably each of us can remember waking up in the morning sometimes feeling very tired. That's because during that stage of dreams, we were running or facing some danger. Your heart was running, so it was consuming oxygen. And for similar reasons to those when you're awake, that activity is risky if you don't have a good vessel system.

It's probably difficult for people to minimize the effects of their own biological rhythms. For example, you cannot avoid your morning risk by simply waking up later. Some researchers have tried an experimental model, in which people were instructed to stay in bed for four hours after they woke up before rising. But the same pattern simply occurred four hours after waking, because the risk is linked to our activities. We can't be afraid of the catecholamines and the peak in blood pressure in the morning. It's part of our physiology. And for healthy people, it's not a problem.

It's important for doctors, however, to remember this risk when we give therapy. Usually people take hypertensive drugs in the morning, when they wake up. But this is already the higher-risk period - so is the last hour of activity of the pill they have taken the day before [and not all pills give 24-hour coverage]. We have to be sure that the pill we're prescribing is still active when patients need it most. It's not as easy as simply asking patients to take pills before bed instead of first thing in the morning, because during sleep we have a low heart rate and blood pressure. If you lower your blood pressure too much during the night, you risk reducing blood supply to the brain, and that can be harmful too

--Laura Blue
TIME.com

Life & Death

2008-05-06T21:16:00.000-07:00

The new United States guidelines on who should and should not get care in catastrophic events and disasters that was released yesterday by a multi- disciplinary task force whose members includes people from various medical groups, military, academe and government agencies such as the Centers for Disease Control and Prevention, the Department of Health and Human Services and the Department of Homeland Security will surely elicit a lot of criticisms from various sectors by citing that Doctors and Health Practitioners should not be given the God-like task to determine who should receive treatment or not or to put it more bluntly, who should live or die.

The said guidelines is an ethical nightmare anyway you look at it since it will affect a lot of people and it is quite understandable for some people to oppose the said recommendations.

And it is never easy for any person, more so to people who have sworn to save lives to the best of their abilities to be confronted with this kind of dilemma but we need to bite the bullet when the worst- case scenario occur to preserve vast needed resources both in manpower and supply.

Aside from the obvious that cover people with the highest risk of death or very slim chance of survival owing to the degree or severity of an injury or illness, the guidelines also include-

• People older than 85.
• Those with severe trauma, which could include critical injuries from car crashes and shootings.
• Severely burned patients older than 60.
• Those with severe mental impairment, which could include advanced Alzheimer's disease.
• Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

In this age of terrorism and super- bugs, I deemed it as a wise move (although with reservations) from the authorities to come up with the guidelines to follow in the event of a massive catastrophe so as to avoid the same confusion that occurred in various hospitals following the 9-11 Terrorist attacks where medical personnel were overwhelmed by the sheer volume of casualties.

Let’s just hope that the medical personnel that will be manning the triage if ever the circumstance calls for it will be knowledgeable and competent enough to handle this life and death questions in their midst.

You can read the controversial guidelines from the May 2008 issue of Chest, the American College of Chest Physicians Journal entitled DEFINITIVE CARE FOR THE CRITICALLY ILL DURING A DISASTER

The Vicente Sotto Memorial Medical Center Scandal

2008-04-17T22:05:00.000-07:00

Primum non nocere

This morning, I saw the so- called Vicente Sotto Memorial Medical Center Scandal on YouTube and I was appalled by the way those medical professionals handled the situation wherein some doctors and nurses of the said hospital were seen laughing, videotaping and boisterous while performing an operation on an unidentified patient to remove a canister of body spray stuck inside his rectal vault.

Copies of the said video is now roaming the world wide web as well as in the form of multimedia messages being passed around on cell phones of every Juan and Juana de la Cruzes both in the Philippines and abroad which will further damage the already soiled reputation of the medical profession that is under fire and scrutiny after the exposé regarding the cheating perpetrated by some unscrupulous individuals in collusion with some Review Centers during the Nursing Board Examinations two years ago.

Based on my experience a case like this in the Philippines is quite unusual and you can expect that word will certainly travel fast in the four walls of the hospital, a patient’s privacy and confidentiality be damned (which is never practiced or observed anyway).

Also given the penchant of Filipinos for gossips and making other people’s business theirs, it’s not surprising that what could have been a hush- hush affair has turned into a circus that one could only imagine in a carnival freak show.

I have encountered several cases in similar situation in the United States wherein a patient will come in with abdominal pain or rectal pain and after a thorough physical and medical examination, we discovered to our horrors, foreign objects (e.g. toothbrush cases, soda cans and bottles, umbrella handles, etc.) stuck in places wherein they should not even be present.

In an ideal world, this could have been dealt with without any incident but in the real world even among doctors and nurses and other members of the medical profession who are supposedly and should be well- versed on patient‘s right to privacy and confidentiality, cases like the one that was seen in that Cebu hospital will always elicit curiosity, laughter and even ridicule for after all, humans are not perfect and we are prone to succumb to its frailties.

And yes, even in a country like the United States of America where you are expected to be always politically correct in everything, people in the medical field would react the same way like their brothers and sisters in the profession in any part of the world when confronted with the same scenario. The difference though is people here usually talk and make light of the situation privately and amongst themselves without resorting to histrionics and more importantly no jerk will take a video or a picture and worst, post it in YouTube for the entire world to see.

I’ve been in a similar situation in the past but I can say that all the people who were involved in the procedure as well as the staff who were curious enough to drop by and see for themselves the “unusual case” conducted themselves in a more appropriate and professional manner.

Obviously there was a failure in discipline and ethics here since the head of the team that operated on the patient allowed the unthinkable to happen under his watch. Add to the fact that this incident occurred in the presence of both medical and nursing students make it even worse!

And then we ask ourselves--

Did the members of the Medical- Surgical Team of the Vicente Sotto Memorial Medical Center violate the rights of the said patient?

Definitely.

Did the members of the Medical- Surgical Team renege on their duties and responsibilities as medical professionals?

Certainly.

Did the members of the medical- surgical team break their oath as medical practitioners?

Without a doubt.

Those involve should be held accountable for their actions and be meted the necessary sanction that merit the gravity of their indiscretion.

Lest we forget, aside from the Hippocratic Oath, members of the Medical profession should always bear in mind this fundamental tenet of Medicine---

First, Do No Harm (Primum non nocere).

Here's the video of the said scandal and watch it at your own risk. Let me just reiterate that the posting of this video here is not meant to cast aspersion on the character of the patient who will remain unidentified but done so for educational purposes only so that people in the medical profession will not commit the same mistake again.

Here's the latest news from ABS- CBN--
3 doctors, nurse face raps over YouTube 'rectum scandal'

Result of the Philippine Physician Licensure Examination

2008-02-21T09:57:00.000-08:00

List of Successful Examinees as released by the Professional Regulation Commission.

A total of 1,054 out of 1,985 passed the Physician Licensure Examination given by the Board of Medicine in the cities of Manila and Cebu this month.

Please click on the links below:

Doctors A

Doctors B

Doctors C

Doctors D

Doctors E

Doctors F

Doctors G

Doctors H

Doctors I

Doctors J

Doctors K

Doctors L

Doctors M

Doctors N

Doctors O

Doctors P

Doctors Q

Doctors R

Doctors S

Doctors T

Doctors U

Doctors V

Doctors W

Doctors Y

Doctors Z

Philippine Nursing Board Examination Result

2008-02-21T00:43:00.000-08:00

CONGRATULATIONS TO THE NEW REGISTERED NURSES AND WELCOME TO THE PROFESSION!

LICENSURE EXAMINATION HELD ON DECEMBER 1 & 2 2007
RELEASED BY THE PROFESSIONAL REGULATION COMMISSION FEBRUARY 20, 2008

List of New Registered Nurses A-G

List of New Registered Nurses H-M

List of New Registered Nurses N-S

List of New Registered Nurses T-Z

List of New Registered Nurses Retakers

Feetish

2008-01-14T04:32:00.000-08:00

Many men don't bother to see a doctor when they have foot troubles, but there are five foot problems they should never ignore, says the American College of Foot and Ankle Surgeons:

* Heel pain. This is often caused by tissue inflammation but can also result from a broken bone, a tight Achilles tendon, a pinched nerve, or other problem.

* Ankle sprains. They always require prompt medical attention. Skipping medical care increases the likelihood of repeated ankle sprains and the development of chronic ankle instability.

* Big toe stiffness and pain. This usually develops over time, as cartilage in the big toe joint wears down and eventually leads to arthritis. The sooner it's diagnosed, the easier it is to treat.

* Achilles tendonitis. This causes pain and tenderness at the back of the foot or heel. This is usually the result of a sudden increase in physical activity. The risk of an Achilles tendon rupture can be reduced by treating the symptoms of Achilles tendonitis.

* Ingrown toenails. These can pierce the skin, allowing bacteria to enter the body. Men shouldn't try to perform dangerous "bathroom surgery" in such cases. A doctor can perform a quick procedure that will stop the pain and permanently cure an ingrown toenail.

Source: HealthDay News

Time Bomb

2008-01-09T23:47:00.000-08:00

Here's an article from TIME Magazine written by Laura Blue that according to a new study, researchers have found a link between Anxiety and Heart Attack.

This is study is not really new but just a re- affirmation of that age- old belief with regards to the relationship between a person's frame of mind and disease.

So, to all of you out there, Relax and Enjoy Life. . :)

Read on...

It's no secret that men with angry, explosive personalities are at a higher risk of a heart attack. But they're not alone: Nervous, withdrawn and chronically worried people are courting coronary problems, too, according to a new long-term study in the Journal of the American College of Cardiology. Of 735 American middle-aged or elderly men who had good cardiovascular health in 1986, those who scored highest on four different scales of anxiety were far more likely to suffer heart attacks later in life. Men in the top 15% on any of the four scales, or on a combined scale of all four, had a 30% to 40% greater chance of heart attack than their less anxious peers.

Researchers have long known that problems of the mind can affect health. Other studies have looked at the relationships between heart-attack risk and factors like "Type A" personality, anger or depression. But "very few studies look at many psychological factors at one time," says Biing-Jiun Shen, lead author on the anxiety paper and an assistant professor of psychology at the University of Southern California. "I think that's a unique part of this study."

Using data from the U.S. Normative Aging Study, Shen reviewed the men's responses to a series of questions on the Minnesota Multiphasic Personality Inventory (a commonly administered personality test), and pulled out their scores on four separate anxiety scales that measured obsessive or compulsive thoughts; introversion and social exclusion; phobias; and a predisposition to become tense or have a physical reaction, like nausea or hyperventilation, to stressful situations. Even after accounting for other mood problems, like depression or anger, and for a whole host of physiological and demographic indicators — including age, body mass index, education, blood pressure, cholesterol levels and smoking and drinking habits — the effect of chronic anxiety was clear. It was also a stronger risk factor for heart attack than any of the other psychological problems in the study.

What's not so clear is why that might be. The relationship between stress, psychological problems and coronary disease or other physical woes is still not well understood. But it is the subject of intense scientific scrutiny. Many other researchers are trying to understand the interaction between mood disturbances like anxiety or depression and other health problems.

Shen notes the results of his study may not be universally applicable across populations. "We only looked at men who are older, around 60," he says. While men may suffer more heart attacks than women, women are far more likely to suffer from anxiety, just as they're more likely to suffer from depression. Gender aside, there's no reason to believe that the link between anxiety and heart attacks is straightforward. "We're not saying depression's not important. We're not saying anger's not important," Shen says. "Different factors can be essentially different for different groups." Still, psychological problems are often related, which means that different problems can affect the body in the same ways. The bottom line is that more study will be needed before we know how much sway our brains have over our heart function — and how much we can control what happens in the mind to prevent a heart attack.

ER Toxicity

2007-12-23T22:50:00.000-08:00

HAPPY HOLIDAYS EVERYONE!

Physical Examination &History Taking in the ER

2007-12-22T22:14:00.000-08:00

Study: Timing of BP Pills Might Matter

2007-12-17T11:44:00.000-08:00

Taking a blood pressure pill at bedtime instead of in the morning might be healthier for some high-risk people.

New research suggests that simple switch may normalize patterns of blood pressure in patients at extra risk from the twin epidemics of heart and kidney disease.

Why? When it comes to blood pressure, you want to be a dipper. In healthy people, blood pressure dips at night, by 10 to 20 percent. Scientists don't know why, but suspect the drop gives arteries a little rest.

People with high blood pressure that doesn't dip at night — the non-dippers — fare worse than other hypertension sufferers, developing more serious heart disease. Moreover, heart and kidney disease fuel each other — and the 26 million Americans with chronic kidney disease seem most prone to non-dipping. In addition to heart problems, they're at extra risk of their kidney damage worsening to the point of dialysis.

Most blood pressure patients need two or three medications. So Italian researchers performed an easy test: They told 32 non-dippers with kidney disease to switch one of those drugs from a morning to a bedtime dose. In two months, nearly 90 percent of these high-risk patients had turned into dippers. Their nighttime blood pressure dropped an average of 7 points, without side effects or increase in daytime blood pressure.

Better, a key sign of kidney function improved significantly, too, Dr. Roberto Minutolo of the Second University of Naples reports this month in the American Journal of Kidney Diseases.

It's the latest research in the field of chronotherapy: How our bodies' internal rhythms make certain diseases worse at certain times of the day, and in turn affect how to time treatments.

While the Italian study is too small for proof, similar studies from Europe also back a bedtime switch for non-dippers. The work is catching the attention of U.S. hypertension specialists, and now doctors at Baltimore's Johns Hopkins University are planning a larger study to see if a bedtime switch really could give certain people healthier hearts and kidneys.

How big a problem is non-dipping?

"I think it's huge," says Hopkins' Dr. Lawrence Appel. "This is our best lead" into why black Americans with kidney disease, in particular, tend to worsen despite treatment.

Appel found 80 percent of black kidney patients in a recent study were non-dippers. Most startling, 40 percent had nighttime blood pressure that was even higher than daytime levels.

Two-thirds of chronic kidney disease patients, and at least 10 percent of the general population, are estimated to be non-dippers, says Dr. Joseph Vassalotti of the National Kidney Foundation. One theory is that their bodies have trouble excreting salt.

Yet few patients have ever heard of the problem — and few doctors know who is affected. Most people get their blood pressure checked only during the day. A 24-hour blood pressure monitor can tell but is rarely used, partly because insurance seldom pays for the extra visit to download and diagnose the readings.

And most patients who take several once-a-day pills swallow them all in the morning, meaning they all start wearing off around the same time, says Dr. Gina Lundberg of St. Joseph's Hospital in Atlanta.

"It does make good sense to take some in the morning and some in the evening," says Lundberg, a spokeswoman for the American Heart Association.

Everyone has an internal clock, determined by genes, that affects health. Many of these biological rhythms are circadian, meaning they fluctuate on a 24-hour cycle.

Consider how that can affect the timing of treatments. Some older "statin" pills fight cholesterol best if taken at bedtime; they target a liver enzyme that's most active at night. Asthma attacks are more frequent at night, and the stomach secretes more heartburn-causing acid at night, affecting some patients' dosing requirements. Researchers even are studying how to better time certain cancer chemotherapies and allergy treatments.

The best-known example: Blood pressure jumps in the early morning hours, as the awakening body produces more stress hormones. That's also why heart attacks and strokes are most common in the morning.

The nighttime dipping problem has gotten far less attention. The new Italian study marks an important advance, says Dr. Mahboob Rahman of the University Hospitals of Cleveland.

"We know now that you can change medication timing and lower blood pressure at night," he explains.

That doesn't mean everyone should switch willy-nilly to bedtime dosing. Morning may be best for people on just one drug, and no one yet knows if the switch truly gives non-dippers better overall health. "That's the million-dollar question," Rahman cautions.

Still, Lundberg says it's worth asking your doctor how to time doses, saying one at night for someone taking multiple medicines couldn't hurt.

--LAURAN NEERGAARD, AP Medical Writer

Pediatric CPR Demonstration

2007-12-14T09:47:00.000-08:00

Adult CPR Video Demonstration

2007-12-13T19:01:00.000-08:00

The Role of Antibiotics and Nasal Steroids on Acute Sinusitis

2007-12-06T13:28:00.000-08:00

This article I came across only shows that not all sinus infections are created uhm infected equal. he-he

Seriously, this British study is a known fact since a long, long time ago to most people in the medical profession.

In fact, this was harped on us over and over again by our professors in the Best Medical School along Aurora Boulevard in the Philippines years back when I was a young med student.

Since most acute sinus infections are caused by viruses which are self- limiting ergo no amount of antibiotics and nasal steroids can help cure them of the infection but still a lot of medical practitioners give them for reasons that they only know--

--is it because of trying to please their patients; that they will be satisfied that their doctor have given them something for their troubles rather than the “normal” advice in this particular case of just drinking plenty of fluids, rest and steam inhalations?

Or are they just beholden to the drug companies that give them some percentage of their sales, finance their travels for medical seminars or what have you?

Anyway this study published by HealthDay News is nothing but a re-affirmation of that belief that in most cases of sinus infections, antibiotics and nasal steroids actually doesn’t work.

Here’s the rest of the news…

TUESDAY, Dec. 4 (HealthDay News) -- Antibiotics and nasal steroids work no better than a placebo in combating sinus infections, a new British study shows

"Antibiotics are probably not as effective as have been previously believed, particularly for the majority of cases of acute sinusitis," said study author Dr. Ian Williamson, a senior lecturer in primary medical care at the University of Southampton. "Patients should turn more to symptomatic remedies like analgesics while the body heals itself, usually over a period of three days to three weeks. Topical steroids have little overall effect, but may be beneficial, particularly in milder cases of acute sinusitis."

"For sinusitis, however it is being diagnosed in the primary-care setting, many of these cases do not require treatment, and a more cautious and conservative approach would seem to be warranted," added Dr. Reginald F. Baugh, vice chairman of Texas A&M Health Science Center College of Medicine and director of the division of otolaryngology at Scott & White, in Temple, Texas.

But other experts say the study, published in the Dec. 5 issue of the Journal of the American Medical Association, is no reason to scrap antibiotics altogether in this scenario.
"This is a helpful and useful study, and we shouldn't condemn antibiotics in those people who need them," said Dr. Michael Stewart, chairman of the department of otolaryngology at New York Presbyterian-Weill Cornell Medical Center, in New York City.

But, he added, only a minority of sinus infections are bacterial and will respond to antibiotics. The majority are viral infections, which won't respond to antibiotics.

According to an accompanying editorial, sinus problems account for 25 million doctor's office visits in the United States each year. Antibiotics are used to treat sinus infections 85 percent to 98 percent of the time in the United States.

Overuse of antibiotics not only won't help a patient with a viral infection get better, it will contribute to the growing problem of antibiotic resistance, experts have noted.

"Antibiotic resistance is rising dramatically, and there is no question about that," Baugh said.
For this study, 240 adults with sinus infections were randomized to one of four treatment groups: 500 milligrams of the antibiotic amoxicillin three times a day for seven days plus 200 micrograms of the nasal steroid budesonide once a day for 10 days; a placebo in place of the antibiotic plus budesonide; amoxicillin plus a placebo in place of budesonide; or two placebos.

In the amoxicillin group, 29 percent of patients had symptoms lasting at least 10 days, and 33.6 percent of those not receiving amoxicillin had the same symptom length of time.

In both the budesonide and no-budesonide groups, exactly 31.4 percent of patients had symptoms lasting at least 10 days.

The nasal steroids seemed to be more effective in individuals who had less severe symptoms.

As the editorial pointed out, most patients with acute sinusitis will get better on their own. Unfortunately, there's no good way to determine who has viral sinusitis and who has bacterial sinusitis.

"It's difficult to make a distinction in a primary-care setting," Baugh said.

If the symptoms are worse, treatment might be warranted, he added. "But for the bulk, I would assume it would be more of a wait-and-see approach. The bugs are winning," he said.

While researchers investigate possible new treatments, sinus infections sufferers might look to analgesics or brief use of steam inhalations, Williamson said.

Dr. William Morris, chairman and director of the department of osteopathic manipulative medicine at Touro College of Osteopathic Medicine in New York City, recommends an alternative approach: manual pressure to the bottom of the head and beginning of the neck, to allow better drainage from the head.

"One of the problems with sinusitis is that the sinuses tend to get closed up," he said. "If you don't drain properly, bacteria is just happy as a clam. If you can increase drainage and improve flow through the sinuses, you're going to be facilitating the process."

Worm study shows antidepressant may lengthen life

2007-11-25T20:17:00.000-08:00

This article from Reuters looks promising for the millions who are suffering from cases of Depression worldwide.

But it is still a big but like the other experimental drugs. This is certainly worth the wait if ever it will be successful in the future.

Anyway, read on...

WASHINGTON (Reuters) - An antidepressant may help worms live longer by tricking the brain into thinking the body is starving, U.S. researchers reported on Wednesday.

The drug, called mianserin, extended the life span of the nematode Caenorhabditis elegans by about 30 percent, the researchers reported in the journal Nature. They hope to find out if the same mechanism can help people live longer.

Three other compounds, including another antidepressant, have similar effects, said Michael Petrascheck of the Fred Hutchinson Cancer Research Center in Seattle. But the life-extending benefits come at a cost.

"Weight gain and increased appetite seems to be one of the side effects. It is one of the reasons these are not such popular antidepressants," Petrascheck said in a telephone interview.

Many studies have shown that slightly starving certain animals -- reducing how much they eat by about 30 percent -- can cause them to live longer.

It is not entirely clear if this occurs in humans, but researchers are keen to duplicate the beneficial effects of calorie restriction without the misery of going hungry.

Howard Hughes Medical Institute researcher Linda Buck and colleagues were looking for drugs that might do this.

C. elegans is a roundworm, or nematode, much studied because despite its tiny size, its biology is similar to that of humans and other animals.

Buck's team did a random search through 88,000 different drug compounds to see if any of them happened to make C. elegans live longer.

They found four drugs that extended life span by 20 percent to 30 percent. The drug with the strongest effect was mianserin, in a class of drugs known as tetracyclic antidepressants.

It blocks brain cell signaling by the neurotransmitter or message-carrying chemical serotonin, which is linked with mood and appetite.

The drug is used in Europe under several brand names, including Bolvidon, Norval and Tolvon but not usually in the United States. It can cause aplastic anemia and other effects on immune system cells.

Buck's team found that in addition to interfering with serotonin in the worm, it also blocked receptors for another neurotransmitter, octopamine.

They said some other research suggests that serotonin and octopamine may complement one another -- with serotonin signaling the presence of food and octopamine signaling starvation.

Buck said it is possible that mianserin drug tips the balance in the direction of octopamine, tricking the brain into thinking it has been starved.

Petrascheck said another antidepressant, mirtazapine, had similar effects. An antihistamine and migraine drug called cyproheptadine, as well as a compound not used in people called methiothepin also affected serotonin and extended worm life span.
They tested other popular antidepressants that affect serotonin and found they did not make the worms live longer.

He is worried that people will rush to take the drugs in the hope of living longer.
"It is a stretch from a worm to a human being," Petrascheck said.

(Reporting by Maggie Fox, editing by Will Dunham and David Wiessler)

New Guideline to Treat Unprovoked Seizure

2007-11-20T15:17:00.000-08:00

A guideline developed by the American Academy of Neurology recommends a routine electroencephalogram (EEG) and brain scans be considered when diagnosing and treating adults who experience their first unprovoked seizure. Evidence shows such tools often detect brain abnormalities that caused the seizure and predict seizure recurrence. The guideline is published in the November 20, 2007, issue of Neurology, the medical journal of the American Academy of Neurology.

The guideline recommends a routine EEG be considered as part of the diagnosis of a person with a first unprovoked seizure. “Evidence shows an EEG revealed abnormalities indicating epilepsy in about one in four patients and was predictive of seizure recurrence,” said Krumholz, who is also a professor of neurology at the University of Maryland School of Medicine.

The guideline also recommends CT or MRI brain scans be routinely considered since the scans are significantly abnormal in one of 10 patients, helping to indicate the cause of their seizure. “A CT scan or MRI may lead to the diagnosis of disorders such as a brain tumor, stroke, an infection, or other structural lesions and may help determine a person’s risk for a second seizure,” said Krumholz.

For adults who experience their first unprovoked seizure, Krumholz says the results of an EEG, CT or MRI will influence aspects of patient care and management, including drug treatment, patient and family counseling, and the need for immediate hospitalization and subsequent follow-up.

Seizures are among the most common serious neurological disorders cared for by neurologists. Annually approximately 150,000 adults will have a first seizure in the United States. It is estimated that in 40 to 50 percent of these people, seizures recur and are classified as epilepsy.

Source: American Academy of Neurology

Listening for the Sounds of Heart Failure Part II

2007-11-14T23:10:00.000-08:00

ON Auscultation:

Recognizing the Extra Heart Sounds

Body Oddities

2007-10-29T19:38:00.000-07:00

Ever wonder why your eye suddenly starts twitching or why you start hiccupping uncontrollably in public and simply can't stop? Or how about pondering the medical reason behind yawning or getting a brain freeze immediately after eating ice cream? Well, according to experts there are medical reasons for such oddities and what you're about to read may surprise you.

Sneezing
Achewww! Known as sternutation, the act of sneezing removes an irritant from the nose. When a particle or cluster of particles pass through nasal hairs and reach the nasal mucosa, they trigger histamine production. This reaches nerve cells in the nose which signals to the brain to initiate a sneeze. Particles such as dust may irritate the nose and result in a sneeze. Sneezing is more common for people with allergies when they're exposed to various allergens like animal dander and pollen.

Hiccups
Hiccups are the result of a spasm in the diaphragm, which contracts to pull air into the lungs causing a sudden rush of inhaled air. According to Dr. Michael Farber, Director, Executive Health Program, Hackensack University Medical Center, "This sets off a chain reaction causing the airway opening to close quickly which in turn halts the flow of air thus causing the vocal cords to react by closing quickly, creating the characteristic hic." Hiccups may be the result of eating a big meal, swallowing air, drinking carbonated beverages, tobacco use or sudden emotional excitement. He explains, "Hiccups may improve through basic maneuvers such as relaxation or distraction, eating and drinking, or techniques of altered breathing."

Blushing
Awwww, you're blushing. Turning red in the face is caused by the dilation of blood vessels in the face. In fact, this normal physiologic response allows the transfer of heat from our bodies to the skin's surface. Dr. Yael Halaas, board-certified facial plastic surgeon in New York explains, "Several factors cause blushing such as a change of temperature, spicy foods, emotional responses and alcohol. Some medical conditions can also cause blushing such as Acne Rosacea." In this condition, there is an increase of vasculature and enlargement of blood vessels in the face. This condition can be treated by a dermatologist or qualified physician.

Brain Freeze
This almost instantaneous headache is a reaction to a cold substance coming into the roof of the mouth. Better known as brain freeze, Dr. Michael Farber says, "Typical onset is within seconds of exposure to a cold precipitant, as the body reacts by initially reducing blood flow to the region to conserve heat followed by enhanced blood flow return to the region." Nerves within the area sense this and transmit the sensation back to the nerve base as pain. His advice -- relieve pain by pressing the tongue against the roof of the mouth to warm the area.

Eye Twitch
According to experts, eye twitching is essentially a spontaneous spasm of muscles surrounding the eye. The involuntary twitching of an eyelid muscle may last less than a minute, although twitching may occur in one eye or the other, in both or underneath the eye. Some experts attribute it to fatigue, stress or caffeine. If spasms persist a doctor should be consulted.

Yawning
Known as the act of opening the mouth by taking a deep breath, yawning is a reflex often associated with fatigue, stress or boredom. Some experts say the real reason why we yawn is a result of low oxygen levels in our lungs. As such, when we're resting we don't use our entire lung capacity and just use air sacs at the bottom of our lungs. If the air sacs don't get fresh air, they partially collapse and as a result our brain prompts the body to yawn or possibly sigh to get more air into the lungs.

Leg Cramps
Although painful sensations caused by contracting or over shortening of muscles, better known as leg cramps, may occur infrequently they may also be a sign of medical disorders. For instance, in a young athlete leg cramping may be associated with dehydration, especially after intense exercise. According to Dr. Sean McCance, Orthopedic and Spine Surgeon, Mount Sinai Hospital and Lenox Hill Hospital, in the elderly population leg cramps is a common symptom of a condition called spinal stenosis. "Spinal stenosis is a narrowing of the spinal canal, which leads to compression of the nerves in the lower back. When people stand up and walk, the compression gets worse and that causes vague aching, cramping and sometimes pain and numbness in the legs." Plus, he says in general leg cramping can be a sign of poor blood supply to the legs. Typically when a patient complains of leg cramping; both a spinal exam and a vascular exam are performed.

Double Jointedness
Double-jointedness, or the ability to have flexible joints that bend in unusual ways, is also known as hypermobility. Basically, joints and surrounding structures such as ligaments and tendons are abnormally flexible which enables people to bend or rotate them in various ways. For instance, if people can bend their thumbs backwards to their wrists, this is the result of misaligned joints, abnormally shaped ends of one or more bones at a joint. Essentially, joints that stretch more than what is considered normal. The extreme flexibility signifies a wide range of movement between the bones as the result of a shallow socket, extra stretchy ligaments or bone ends that are smoother than normal.

Pins & Needles
Oooh, ahhhh, owww....when it comes to the pins and needles sensation in your legs, there could be a variety of reasons why it's occurring. Dr. Sean McCance explains, "When pins and needles is in one leg only, it is more likely related to a mechanical problem, whereas if it is in both legs, it is more likely related to a metabolic problem such as a vitamin deficiency, excessive alcohol use, or diabetes." In the setting of lower back pain he says it could be a sign of a herniated disc. This could cause symptoms including pins and needles and numbness in the leg, as well as pain and weakness. He adds, "That is best assessed by physical examination by a spinal specialist followed by an MRI."
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--Vicki Salami/ AOL Body

Signs & Symptoms & Syndromes

2007-10-28T20:10:00.000-07:00

1. Amenorrhea- Primary: absence of menses by age 16.
Secondary: absence of menses for 6 months in a female with previously normal menstruation, or absence of menses for 3 normal intervals with a history of oligomenorrhea.
2. Anuria- <100 ml urine/day Foley catheter.
3. Asterixis- Flapping with wrists hyperextended.
4. Babinski's sign- stroke sole of foot, & toes dorsiflex if pyramidal track lesion.
5. Battle's sign- Ecchymoses of mastoid process; basilar skull fracture.
6. Brudzinki's Sign- Neck flexion causes hip & knee flexion.
7. Carnett's Sign- Disappearance of tenderness when abdominal muscles are contracted, indicates intra-abdominal pain.
8. Chadwick's sign- cervix & vaginal cyanosis.
9. Chandelier Sign- Cervical motion tenderness.
10. Charcot's Sign/Triad-upper quadrant pain, jaundice, fever; gallstones.
11. Cheilosis- cracked lips; Riboflavin deficiency.
12. Cheyne Stokes respiration- Periodic breathing with periods of apnea (Elevated Intracranial Pressure)
13. Chvostek's sign- Tapping cheek results in facial spasm; hypocalcemia.
14. Colon cutoff sign- Spasm of splenic flexure with no distal colonic gas. (Abdominal X-ray).
15. Courvoiser's Sign- Palpable non-tender gallbladder with jaundice; pancreatic or biliary malignancy.
16. Cullen's Sign- Bluish periumbilical discoloration; peritoneal hemorrhage.
17. Cushing's Triad- Bradycardia, hypertension, abnormal respirations, ascending weakness.
18. Decerebration- Extension of legs & arms; wrists & fingers flex with midbrain & pons functioning.
19. Decortication- Noxious stimuli causes flexion of arms, wrists & fingers with leg extension, indicates damage to contralateral hemisphere above midbrain.
20. Dupuytren's contracture- Fibrotic palmar ridge to ring finger/ Palmar contracture; cirrhosis.
21. Egophony- E to A changes.
22. Fetor Hepaticas- Odor of breath & urine caused by Mercaptans.
23. Fever of Unknown Origin (FUO)- >/= 38.3*C,(>/=101*F), undiagnosed after 1 week of evaluation & extensive studies.
24. Free Air Under Diaphragm- Ruptured Viscus (CXR).
25. Glossitis- B12, folate deficiency.
26. Grey Turner's Sign- Flank ecchymoses; retroperitoneal hemorrhage.
27. Hegar's sign- Softening of uterine isthmus.
28. Hepatic angle sign- Loss of lower margin of right, lateral, liver angle (X-ray).
29. Homan's Sign- Dorsiflexion of foot elicits calf tenderness.
30. Horner's syndrome- eyelid ptosis, miosis, & anhydrosis.
31. Iliopsoas Sign- Elevation of legs against examiners hand causes pain; retrocecal appendicitis.
32. Jugular venous distention- (at 45* measure perpendicular distance from the sternal angle to top of column of blood= jugular venous pressure in cm H2O.
33. Kayser-Fleischer rings- Bronze Corneal pigmentation; Wilsons disease.
34. Kernig's Sign- Flexing hip & extending knee elicits resistance.
35. Kussmaul respirations- Deep sighing breathing
36. Levine's Sign - Patient describes pain with clenched fist over the sternum.
37. L4- S1 range or in the C5 to C7 disks- Most herniation occurs.
38. Meniere's disease: inner ear disorder involving a triad of symptoms of vertigo, tinnitus, and hearing loss.
39. Mercedes Benz Sign- Gallstones appearing as radiolucent clefts (Abdominal X-ray).
40. Moliminial symptoms- Mid-cycle ovulatory pain; premenstrual, increased discharge; breast tenderness, water retention, dysmenorrhea.
41. Muerkhe Lines- Narrow, arc-shaped bands of pallor in nail beds; hypoalbuminemia.
42. Murphy's Sign- Right Upper Quadrant Tenderness & Arrest of respiration secondary to pain/ Inspiratory arrest upon RUQ palpation; cholecystitis.
43. Myxedema- condition resulting from advanced hypothyroidism or thyroxine deficiency.
44. Normal CVP: approximately 4 to 10 cm.
45. Normal Intra Ocular Pressure: 13 to 22 mmHg
46. Normal PCWP: 4 to 13 mmHg.
47. Obtundation- Awake but not alert.
48. Obturator Sign- Flexion of right thigh & external rotation of leg causes pain in pelvic appendicitis.
49. Oculocephalic reflex- Dolls eyes maneuver, observation of eye movements in response to lateral rotation of head, no eye movements or loose movements occurs in bihemispheric (diencephalons) lesion.
50. Oculovestibular reflex- Cold caloric maneuver, raise head 60 degrees & irrigate ear with cold water, causes tonic deviation of eyes to irrigated ear if intact brain stem (midbrain); If conscious, causes nystagmus, vertigo, emesis.
51. Oliguria - <20 ml/h, 400-500 ml urine/day
52. Osler's Maneuver- Inflate cuff above systolic. If the radial artery pulse remains palpable, the true blood pressure may be 53. pH of expectorated blood- alkaline= pulmonary; acidic= GI.
54. Plummers nails- Distal onycholysis, separation of fingernail from nail bed.
55. Puddle Sign- Examiner flicks over lower abdomen while auscultating for dullness with patient on all fours; detects greater than or equal to 120 ml.
56. Pulsus paradoxus- Inspiratory drop in systolic blood pressure; >18= severe attack.
57. Racoon's eyes- Periorbital ecchymoses; skull fracture.
58. Raynaud's Syndrome- Red, blue or numb hands when exposed to cold.
59. Renal Bruits- high- pitched systolic & diastolic bruit just below costal margin lateral to midline; renal artery stenosis.
60. Rhonchi- fine, high-pitched, end-inspiratory crackles.
61. Rinne test- Air conduction last longer than bone conduction when tuning fork is placed on mastoid process.
62. Rovsing's Sign- Pressure to left colon causes referred pain at McBurneys point (RLQ); appendicitis.
63. Sentinel loop- Spasm of transverse colon (Abdominal X-ray).
64. SGOT/AST: Serum glutamic-oxaloacetic transaminase; peaks in 24 to 36 hours in MI.
65. SGPT/ ALT: Serum glutamic pyruvic transaminase.
66. Sister Joseph's Nodule- Umbilical nodule; carcinoma metastasis.
67. Spider angiomas- Arterioles with stellate red capillaries.
68. Stigmata of Liver Disease- Umbilical venous collaterals (Caput Medusae), jaundice, spider angiomas, palmar erythema.
69. Stupor- Unconscious but awakeable with vigorous stimulation.
70. Tactile fremitus- Increase vocal conduction when patient says 99.
71. Terry's nails- White proximal nail beds; cirrhosis.
72. Thumb Printing- Edema & gas of intestinal wall. (Abdominal X-ray).
73. Trousseau's sign- sign for hypercalcemia in which carpal spasm can be elicited by compressing the upper arm and causing ischemia to the nerves distally.
74. TSH- T3, T3RU, T4.
75. Virchow's Triad- Immobilization, trauma, malignancy
76. Weber test- lateralization of sound when tuning fork is placed on top of head.
77. Whispered pectoriloquy- Decreased loudness of whisper during auscultation

Listening for the Sounds of Heart Failure

2007-10-25T21:04:00.000-07:00

Recognizing Heart Murmurs on Auscultation:

Here's the last part of the Lesson--
Lesson XXI

Health Bits

2007-10-18T11:58:00.000-07:00

Pediatricians to FDA: No cold meds to children under 6 (CNN)---Cold and cough medicines given to infants and toddlers work no better than dummy pills and can be dangerous, pediatricians seeking to curb their use told government health advisers Thursday.

The doctors told the Food and Drug Administration advisers that the over-the-counter medicines shouldn't be given to children younger than 6 because they don't help them and aren't safe. Such a prohibition would go beyond last week's drug industry move to eliminate sales of the nonprescription drugs targeted at children under 2.

The group petitioned the FDA...

Wyeth Philippines, Inc.(ABS- CBNNews) on Thursday filed a formal notice and voluntary product withdrawal plan with the Bureau of Food and Drugs (BFAD) and Department of Health (DOH), saying it will voluntarily withdraw Dimetapp Oral Drops, the company's medicine for treatment of colds in infants. Click here for
more

Experts: Drug-resistant staph deaths may surpass AIDS toll(AP)

More than 90,000 Americans get potentially deadly infections each year from a drug-resistant staph "superbug," the government reported Tuesday in its first overall estimate of invasive disease caused by the germ.

Deaths tied to these infections may exceed those caused by AIDS, said one public health expert commenting on the new study. The report shows just how far one form of the staph germ has spread beyond its traditional hospital setting.

The overall incidence rate was about 32 invasive infections per 100,000 people. That's an "astounding" figure, said an editorial in Wednesday's Journal of the American Medical Association, which published the study.

Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections --click here

Study shows no language effects from vaccines (Reuters)--
A mercury-based vaccine preservative did not appear to affect language or other similar brain functions in children, U.S. researchers said on Wednesday in the first of a series of studies meant to lay to rest the controversy over thimerosal. More on this story

Landmark malaria vaccine clears another hurdle in tests on infants (AFP)--The most ambitious attempt to engineer a vaccine against malaria has cleared another key hurdle, with tests among African babies showing the prototype to be safe and highly protective, a study released on Wednesday said.

Known by its lab name of RTS,S the prototype is raising high hopes of the first vaccine shield against a disease that claims more than a million lives a year -- 800,000 of them African children aged under five -- and sickens hundreds of millions more.More..

Guide to Complete History Taking & Physical Examination

2007-10-17T23:17:00.000-07:00

HISTORY IDENTIFYING DATA:
Patients name, age, race, sex; referring physician or clinic.

SOURCE AND RELIABILITY:
Name and reliability of informant (patient, old chart, relative).

HISTORY OF PRESENT ILLNESS (HPI):
Describe the course of the patients illness, including when it began, character of the symptoms; location where the symptoms began; aggravating or alleviating factors; pertinent positives and negatives, other related diseases; past illnesses or surgeries, past diagnostic testing.

PAST MEDICAL HISTORY (PMH): Past diseases, surgeries, hospitalizations; significant medical problems; history of diabetes, hypertension, peptic ulcer disease, asthma, COPD, MI, Cancer, TB. In children include birth history, prenatal history, immunizations, type of feedings.

MEDICATIONS:

ALLERGIES:
Penicillin?

FAMILY HISTORY:
Medical problems in relatives; specifically ask about problems similar to patients illness. Asthma, MI, heart failure, hypertension, CA, TB, diabetes, kidney diseases, hemophilia.

SOCIAL HISTORY:
Alcohol, smoking, drug usage. Marital status and children; employment and home situations; exposure to carcinogens or environmental agents. In children include: Sleep, play habits, grade in school.

REVIEW OF SYSTEMS (ROS):
General:
Weight gain or loss, appetite loss, fever, chills, fatigue, night sweats.

Skin:
Rashes, bruising, skin discolorations.

Head:
Headaches, dizziness, tenderness, lumps or masses; history of seizures, head trauma.

Eyes:
Visual changes, visual acuity, visual field deficits, diplopia, inflammation.

Ears:
Tinnitus, vertigo, pain, discharge.

Nose:
Nose bleeds, discharge, sinus diseases.

Mouth & Throat:
Dental diseases, hoarseness, sore throat, pain.

Respiratory:
Cough, shortness of breath, sputum (color, amount), chest pain; history of PTB; vaccination for influenza or pneumococcus. Positive Purified Protein Derivative (PPD Testing).

Cardiovascular:
Chest pain, orthopnea, paroxysmal nocturnal dysonea; dyspnea on exertion, claudication, extremity edema.

Gastrointestinal:
Odynophagia, dysphagia, abdominal pain, nausea, vomiting, hematemesis, diarrhea, melena, hematochezia, constipation, bloody stool, change in bowel habits, jaundice.

Genitourinary:
Dysuria, frequency, hesitancy, hematuria, polyuria, discharge, impotence, testicular masses, penile discharge.

Gynecological:
Gravida/para, abortions, LMP (frequency, duration), age of menarche, menopause; dysmenorrhea, contraception, vaginal bleeding; last pelvic exam and pap smear, breast masses, self-examination, mammography.

Endocrine:
Polyuria, polydipsia, polyphagia, skin or hair changes, cold or heat intolerance, hormonal therapy.

Musculoskeletal:
Joint pain or swelling, arthritis, myalgias.

Skin:
Easy bruising, bleeding tendencies.

Lymphatics:
Lymphadenopathy.

Neuropsychiatric:
Weakness, seizures, paresthesias, memory changes, emotional depression disturbances.

PHYSICAL EXAMINATION

Vital Signs:
Temperature, heart rate, respiratory rate, blood pressure (right and left arm, sitting and standing height), weight.

Skin:
Rashes, scars, moles; capillary refill (in seconds).

Lymph Nodes:
Cervical, supraclavicular, auxiliary, inguinal nodes; size, mobility, tenderness, consistency.

Head:
Bruising, tenderness. In pediatric patients check fontanelles.

Eyes:
Pupils equal round and react to light and accommodation (PERRLA); extra ocular movement intact (EOMI); visual fields and acuity. Fundoscopy (fundi, papilledema, arteriovenous nicking, hemorrhages, or exudates), conjunctiva; scleral icterus, ptosis.

Ear:
Discharge, acuity, tympanic membranes (dull, shiny, intact, injected, bulging).

Nose:
Discharge, exudates, polyps. Pediatrics: Nasal flaring.

Mouth & Throat:
Mucus membrane color and moisture level; oral lesions, dentitions, tonsils, erythema.

Neck:
Jugular venous distention (JVD), thyromegaly, lymphadenopathy; range of motions, masses, bruits, hepatojugular reflex (HJR).

Chest:
Equal expansion, tactile fremitus, percussion, auscultation, rhonchi, crackles, rubs, breath sounds, egophony, whispered pectoriloquy.

Heart:
Point of maximal impulse (PMI), thrills (palpable tubulance); regular rate & rhythm (RRR), first & second heart sounds (S1 & S2); gallops, murmurs (grade 1-6), pulses (grade 0-2+).

Breast:
Retractions, tenderness, lumps, nipple discharge, dimpling, gynecomastia.

Abdomen:
Contour (flat, scaphoid, obese, distended); scars, bowel sound, tenderness, organomegaly, masses, liver span; splenomegaly, guarding, rebound, bruits; percussion note (tympanic), costovertebral angle tenderness (CVAT), inguinal masses.

Genitourinary:
External lesions, hernias, scrotum, testicles, varicoceles.

Pelvic Exam:
Vaginal mucosa, cervical discharge; uterus size & masses, adnexa, ovaries, suprapubic tenderness.

Extremities:
Joint swelling, range of motions, edema (grade 1-4+); cyanosis, clubbing, edema (CCE);pulses (radial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis; simultaneous palpation of radial and femoral pulses), Homans sign,; cyanosis, varicosities.

Rectal Exam:
Sphincter tone, masses, hemorrhoids, fissures; guaiac test for occult blood; presence or absence of stool in rectal vault, prostate (nodules, tenderness, size).

Neurological:

Mental status & affect; cranial nerves 1-12; gait, strength (graded 0-5); touch sensation, pressure, pain, position & vertigo; deep tendon reflexes (graded 0-4+) (biceps, triceps, patellar, ankle); Romberg’s test (ability of patient to stand erect with arms outstretched and eyes closed).

Cranial Nerve Exam:

I: Smell
II: Visions & Visual fields;
III, IV, VI: Pupil responses to light; positional & pursuit eye movements, ptosis.
V: Facial sensation, ability to open jaw against resistance, corneal reflex.
VII: Close eyes tightly, smile, shows teeth.
VIII: Watch tick, Weber test; Rinne’s Test.
IX, X: Palette moves in midline when patient says ah, speech.
XI: Shoulder shrug & turns head against resistance.
XII: Stick out tongue in midline. Heel to skin test.

Labs:
Electrolytes (sodium, potassium, bicarbonate, chloride, BUN, creatinine), CBC (hemoglobin, hematocrit, WBC count, platelets, differential); X-rays, ECG, Urine Analysis (UA), liver function tests (LFTs).

MINI-MENTAL STATUS EXAM

Orientation:
What is the year, day of the week, date, month? = 5 points What is barrio, town, city, country, hospital, floor? = 5 points

Registration: Repeat: 3 objects: apple, book, coat = 3 points

Attention/Calculation: Spell WORLD backwards = 5 points

Memory: Recall 3 objects = 3 points

Language: Name a pencil & a watch = 2 points Repeat, No ifs, ands or buts = 1 point

Three stage command:
Take this paper in your right hand, fold it in half, and put it on the floor= 3 points

Written Command:
Close your eyes. = 1 point Write a sentence = 1 point

Visual Spatial:
Copy two overlapping pentagons = 1 point

TOTAL SCORE 30 POINTS

Normal: 25-30
Mild Intellectual Impairment: 20-25
Moderate Intellectual Impairment: 10-20
Severe Intellectual Impairment: 0-10

MD's Notes

2007-10-17T15:07:00.000-07:00

Welcome to Medicine Pearls!

Below is what this blog is all about. Feel free to voice your opinions, suggestions, questions, violent reactions, etc.

Subjective:

-- Medical Education and Career Dilemmas

Objective:

--Welfare of the people in the health profession;
--career guides
-- study guides
-- white and green humor
-- true stories
--useful website links

Assessment:

-- Peer and Professional Help in day-to- day activities and practice

Prognosis:

-- Better Medical Professionals