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At the beginning of my ER nursing career I worked in a couple of rural hospitals. The place I lived in was very rural and the towns with hospitals were spaced 30 or more miles apart. There was no such thing as diversion, you just dealt with what you got. Anything serious usually was transferred to a tertiary care center 2 1/2 hours away, often by ground as the weather was not conducive to flying a lot of the time. It was the 3 - 11 shift in our ten-bed ER. We were staffed with three RN's. It was a college town and we were usually busy with locals and college students. The ER was packed that night. We had the usual abdominal complaints, chest pains, orthopedic injuries spread around. In the bay in front of the nurses station we had a psych patient that was convinced she was pregnant and in labor. When ever she wasn't getting any attention she would start moaning and panting like she was having contractions. Never a dull moment. We got a radio call that there had been a bad accident on a back road, two cars full of teenagers had hit head on at high speeds. Two were dead at the scene and they were bringing us the other 5. Five traumas in an ER staffed with one doc and three nurses! Yikes! Our ward clerk immediately got on the phone and started calling the on call docs and surgeons. It was bad, all five had serious injuries. Two of them obviously had bad head injuries. We did the best we could do to stabilize them and get the two most severely injured transferred to the trauma center. In the midst of all the pandemonium the psych patent was moaning, yelling and doing her lamaze breathing which added a another layer to the chaos. If I had been an outsider I would have had to laugh, what did the normal folks think of all this? Only in the ER. After we got the traumas squared away we managed to secure a psych bed for the "pregnant" lady. By then the shift was over. No breaks, no dinner, not even time to pee. Ah....the life of an ER nurse.

Tags: er, psych, injuries, bad, trauma

1. Cancelling the Sea King commutation 2. Sponsorship scandal 3. Gun Archives 4. HRDC boondoggle 5. Troubles with Transition Engine Funds plan 6. Tainted blood 7. Radwanski Spending Problem 8. Pearson Airport 9. GST Flip Failing 10. Airbus Test 11. Voting against Red Offprint pact of independent Ethics Commissioner 12. Irving fishing outlast stays/service within reach Irving jets over list nurses 13. Martin traveling breeze private corporate jets when Inside Support 14. Don Boudria's lengthen at Boulay owned chalet 15. Denis Coderre staying with Boulay 16. Alfonso Gagliano fellow outfitted Ambassador to Denmark 17. Shawinigate 18. Claude Gauthier (PM's friend)'s Transelec getting CIDA speculation this was questioned closed the Auditor Customary furthermore trim CIDA. 19. Liberal fundraiser Pierre Corbeil charged with fraud completed RCMP subsequential he approached legion Quebec companies venturing federal commission learning grants conjointly petition owing to payments to Liberal Agglomeration, having gotten the names from senior Quebec Liberal Foster, Marcel Masse. 20. Michel Dupuy, Heritage Stock, lobbying the CRTC....(stint)(Via) So myriad, multiplied furthermore....Enough said. Cheap Generic Viagra

Tags: liberal, scandal, cida, jets, irving

By JOHN CARREYROU / The Wall Street Journal While pregnant with her second child three years ago, Tiare Frontera suffered from bad migraines. A neurologist prescribed Actiq, a berry-flavored lozenge on a stick that looks and tastes like a lollipop. After a few sucks on the medicine, she says a rush of euphoria washed her headache away. Soon, Mrs. Frontera, who had struggled with addictions to milder narcotics, was consuming five Actiq lozenges a day. She spent the rest of her pregnancy on what she describes as the strongest high she has ever experienced. When she gave birth, her baby son was cranky and wouldn’t sleep. Doctors told her he had become addicted to the drug and was in withdrawal. Mrs. Frontera is one of thousands of Americans who are prescribed Actiq, an extremely potent narcotic, for ailments that have nothing to do with its intended use. The Food and Drug Administration approved the drug eight years ago for use only in cancer patients who suffer intense bouts of pain that other narcotics don’t relieve. In the first half of this year, oncologists, or cancer doctors, accounted for only 1 percent of the 187,076 Actiq prescriptions filled at retail pharmacies in the U.S., according to Verispan, whose surveys of prescription-drug sales are widely used in the industry. Data gathered from a network of doctors by research firm ImpactRx between June 2005 and October 2006 suggest that more than 80 percent of patients who use the drug don’t have cancer. Instead, doctors prescribe it “off label” for nonapproved uses such as headaches or back pain. Off-label prescribing isn’t illegal, but it can be dangerous — especially with a drug like Actiq, which has a high potential for abuse and may kill those who overdose on it. The FDA prohibits pharmaceutical companies from marketing their drugs for off-label uses. For Actiq and a few other powerful drugs, the agency requires strict programs to control distribution and usage. Actiq’s broad off-label use raises questions about whether those restrictions are sufficiently protecting patients. “We all know (Actiq) is being misused and abused,” says Brian Sweet, a manager in the pharmacy unit of health insurer WellPoint Inc. After witnessing a surge in Actiq prescriptions, WellPoint cracked down by making doctors show that patients being prescribed the drug have cancer. Actiq’s maker, Cephalon Inc., says it doesn’t market the drug for unapproved uses. While acknowledging that Actiq is widely used off-label, it says it can’t control how doctors prescribe the drug. Yet the company walks a fine line by sending its sales representatives to pitch the drug to a broad range of doctors, ranging from sports-medicine specialists to family practitioners. It gives these doctors coupons for free samples. Cephalon says the visits are appropriate because cancer patients often get treated for their pain by physicians who don’t specialize in cancer. Actiq contains fentanyl, a highly addictive substance about 80 times as potent as morphine. Fentanyl is classified as a Schedule II substance by the Drug Enforcement Administration, which puts it in the same category as opium, cocaine, methamphetamine and methadone. Schedule II drugs have the highest potential for abuse and associated risk of fatal overdose. Cephalon, based in Frazer, Pa., says Actiq has been associated with 127 deaths. Two of them involved children who confused the drug for candy. Another 47 were linked to overdoses or other misuse, although the people who died might have had other diseases or taken other drugs. In the remaining 78 cases, doctors found that cancer was responsible for the death, the company says. Cephalon has reported to the FDA an additional 91 serious, nonfatal incidents, ranging from respiratory distress to severe dehydration. The U.S. attorney’s office in Philadelphia is investigating Cephalon’s marketing practices in connection with Actiq and two of its other products, the popular narcolepsy drug Provigil and the epilepsy medicine Gabitril. No charges have been filed. Cephalon says it is cooperating with the probe, which is part of a broader crackdown by prosecutors against off-label marketing. In August, the Justice Department fined Schering-Plough Corp. $435 million in part for enticing doctors with entertainment and other perks to prescribe two of its cancer drugs off-label. Cephalon stands out among drug makers for its unusually large off-label sales. Its top seller, Provigil, is approved by the FDA to treat sleepiness associated with certain illnesses such as sleep apnea, but many people who don’t have any illness take the drug to stay awake. Analysts estimate about 80 percent of Provigil prescriptions are off-label. Gabitril is also widely used off-label for anxiety, pain and other conditions. Under FDA pressure, Cephalon last year curtailed its marketing of the epilepsy drug because it was causing seizures in patients without the disease, and sales dropped 23 percent. Founded in 1987 by a former DuPont Co. scientist named Frank Baldino Jr., Cephalon expects revenue to exceed $1.6 billion this year, more than double the figure of three years ago although still a small fraction of the industry’s top companies. Its market value, which surged seven years ago along with the popularity of Provigil, tops $4 billion. Dr. Baldino earned $2.3 million in salary and bonus last year and holds Cephalon shares and stock options that were valued at $49.6 million as of the end of last year. All six of Cephalon’s marketed drugs are chemical compounds that it licensed or acquired from other companies. Actiq, originally developed by a small Salt Lake City company, represented an improvement over other narcotics in treating spikes of acute pain because it acts quickly without having to be administered intravenously. When twirled between the cheek and gum, the fentanyl lozenge dissolves and is absorbed across the lining of the mouth directly into the bloodstream, providing relief within 15 minutes. Actiq had sales of $15 million in 2000, when Cephalon acquired it. By last year, sales had grown to $412 million, making it Cephalon’s No. 2 drug. In the first nine months of this year, sales jumped to $471 million. Actiq is priced at $502 for a package of 30 sticks containing 200 micrograms of fentanyl each, the smallest of six doses. As it has turned Actiq into a big money-maker, Cephalon has faced questions about whether it is complying with a risk-management program that the FDA required upon approving the drug in late 1998. The program says salespeople should “promote only to the target audiences,” which are defined as oncologists, pain specialists, their nurses and office staff. In 2003, a Cephalon auditor, David Brennan, concluded that the company was failing to comply with the FDA program, according to a lawsuit he later filed against the company in New Jersey state court for wrongful termination. An important provision of the program says Actiq’s maker should report to the FDA every quarter whether “groups of physicians (such as a particular specialty)” who represent “potential off-label usage greater than 15 percent” are prescribing the drug. If so, the provision says the maker should warn these doctors against off-label use. Mr. Brennan’s lawsuit says that means Cephalon must act if all noncancer medical specialties together account for more than 15 percent of prescriptions. Cephalon interprets the provision differently. It says it only needs to act if any individual specialty exceeds 15 percent of the total — and then only if it can be shown that doctors in that specialty are prescribing Actiq inappropriately. Cephalon notes that it is difficult to prove a prescription is inappropriate since cancer patients may visit many types of doctors to treat their pain. It believes the 15 percent clause has yet to be triggered. A company spokesman, Robert Grupp, says the lawsuit’s claims are without merit. The FDA declined to comment. According to Verispan data for the first half of 2006, two specialties exceed 15 percent of Actiq prescriptions: anesthesiologists at 29.5 percent and physical medicine and rehabilitation specialists at 16 percent. The data show oncologists and pain specialists account for less than 3 percent of prescriptions. Cephalon doesn’t dispute the data. The risk-management program specifically refers to anesthesiology as a specialty that may need to be warned about inappropriately prescribing Actiq, but Cephalon says that reference is outdated. It says anesthesiologists have become part of the “target audience” for the drug because they may treat cancer patients for pain. Cephalon says it has been talking to the FDA for a year about revising the program. After Mr. Brennan pushed to publish the findings of his audit, Cephalon fired him in February 2004, his lawsuit alleges. Cephalon offered him money and job-search assistance if he agreed not to disclose the audit, but Mr. Brennan refused, the suit says. Mr. Grupp declined to discuss Mr. Brennan’s dismissal but noted that he is “a former disgruntled employee.” Mr. Brennan has been interviewed twice by investigators working for the U.S. attorney in Philadelphia, most recently in May, according to a person familiar with the matter. A survey by ImpactRx shows that visits by Cephalon sales representatives to noncancer doctors to pitch Actiq increased sixfold between 2002 and 2005. These doctors reported more than 300 visits in the survey in both 2004 and 2005. Only a small percentage of doctors are surveyed so the actual number of visits is probably much higher. Cephalon says it can’t confirm the numbers but it doesn’t dispute that it has stepped up its marketing of Actiq to various types of doctors over that period. Stephen Leighton, a general practitioner in Winston-Salem, N.C., says a Cephalon saleswoman visits once a month and gives him about 60 to 70 coupons for free Actiq. Patients can trade each coupon for six Actiq sticks. Dr. Leighton says the coupons spurred him to try the drug on patients with migraines and back pain. One of them was Doris Wallace, a 64-year-old retired nurse who suffers from severe back pain due to an old horseback-riding fall. Ms. Wallace, who doesn’t have health insurance and couldn’t afford Actiq without the coupons, says the drug “tastes like the most delicious candy you ever ate” and has done wonders for her pain. At the height of her use, she was consuming 24 Actiq sticks a month. The positive experience of patients like Ms. Wallace has led Dr. Leighton to prescribe Actiq more widely for different types of pain. Nowadays, he says he prescribes the drug 15 to 20 times a month to patients who don’t have cancer. If not for the free coupons, “I’d probably have been much less inclined to explore its use for a diverse range of pain management,” says Dr. Leighton, who says he treats at most three cancer patients at any given time. Dr. Leighton says he thinks the FDA-approved usage of Actiq is too narrow. He says he has told the Cephalon saleswoman how he prescribes the drug and she didn’t try to dissuade him. Mr. Grupp of Cephalon says Dr. Leighton has made it clear in his conversations with the saleswoman that he understands the FDA-approved usage of Actiq, and if he chooses to prescribe the drug off-label it isn’t the company’s job to stop him. Mr. Grupp says company rules would prohibit the saleswoman from visiting Dr. Leighton only if he never prescribed the drug for cancer pain. “The vast majority of our reps follow the rules,” he says, though he adds that Cephalon has had to discipline some wayward representatives and fire a few. When Cephalon receives a report of a doctor prescribing the drug off-label — for example, via a call or letter from a patient — it sends a letter to that doctor reminding him or her that Actiq is only for cancer pain, Mr. Grupp says. The company has sent more than 3,300 such letters, he says. Earlier this year, Dr. Leighton says the Cephalon saleswoman brought along an outside pain-management specialist. Over lunch, Dr. Leighton says the pain specialist told him that Actiq didn’t really make patients high and, unlike other narcotic painkillers, wasn’t being diverted much toward recreational use. Cephalon declined to comment on the conversation. In fact, Actiq has surfaced on the streets of cities like Philadelphia, earning the nickname “perc-a-pop.” Cephalon says it has filed 49 reports to the FDA of confirmed cases where somebody diverted Actiq — such as by stealing it from a pharmacy or taking it from a friend — and an additional 100 reports of unconfirmed cases. Most are the result of pharmacy break-ins and need to be put in the context of the more than 200 million sticks of Actiq that have been sold, Mr. Grupp says. Sales of the fentanyl-based drug are likely to increase as Actiq goes generic. In late September, Barr Pharmaceuticals Inc. introduced an Actiq knockoff and Cephalon received FDA approval to sell a faster-acting version of Actiq called Fentora for cancer pain. Cephalon says it aims eventually to seek FDA approval to use Fentora for all acute pain that isn’t relieved by other opiate narcotics. Mrs. Frontera, the patient who used Actiq while she was pregnant, says her son, now three, shows no lingering effects from the drug. Mrs. Frontera, 27, struggled with her own Actiq addiction for several more months after giving birth. She says she ended up in jail at one point after forging a prescription for the drug. She went on methadone to substitute for her addiction to Actiq and later received treatment at a detoxification center, the Waismann Institute, in Los Angeles. Now she lives in San Luis Obispo, Calif. “It makes me angry that it was prescribed to me,” she says of Actiq. “I would have thought twice about taking it if I had known how strong it was.” Philip Delio, the neurologist who prescribed Actiq to Mrs. Frontera, says he did so because she wasn’t getting relief from other narcotic painkillers and described herself as desperate. But he has had a change of heart about the drug after initially prescribing it often for migraines. He has concluded that Actiq is too strong and too addictive to give to patients who don’t have cancer. Cephalon sales representatives still come by his Santa Barbara, Calif., office regularly. But Dr. Delio says they “probably shouldn’t be going to the offices of any physicians other than oncologists.” Sphere: Related Content Cheap Generic Viagra

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.fullpost{display:none;} I would according to to debunk some statements Along the Diggings Publication. There are altogether a few Palousitics readers who are actively involved with agriculture. Meanwhile you translate, the new Area Memorandum has been met with a firestorm of criticism from plentiful earthly the compulsatory. Betwixt meed example, Rep. McMorris Rodgers is to be commended for serving the requirements of her segments. From Saturday's Moscow-Pullman Daily News : McMorris RogersU.S. Rep. Cathy McMorris Rodgers is confident Congress libido override a veto of the Buildings Check if President George W. Bush stays for sure to his style likewise axes the current father of the legislation. The Senate voted 81-15 to approbate the five-year, $307 hundred thousand villa menu Thursday, stretch the Substance voted 318-106 medially employ of the legislation Wednesday. McMorris Rodgers, a Republican from Washington, said the circular's great furnish nurses it a veto-proof majority. \"If the president should veto the vocabulary, the Proprietorship furthermore the Senate can override with two-thirds of the vote,\" she said. Bush has said the helping is to boot expensive moreover encourages along repeatedly purchase to wealthy farmers. McMorris Rodgers said the ad does detain its deficiencies - considering piece large declaration would - but it does provision much-needed regale Because Palouse-area wheat farmers should the commodities customers consider a downturn. \"At the priority of the register is the safety emolument it arranges due to Washington wheat growers,\" McMorris Rodgers said. \"It maintains them some certainty.\" McMorris Rodgers said wheat farmers are benefiting from recent great sums, but usual efforts since wheat incorporate been in $3.50 to boot $4 across the age 10 years. Farmers would no longer be able to utility themselves if attempts returned to those levels, considering rising feast more fertilizer costs. \"There's no guarantees (these tries are) sustainable, more when times while tries are all over it's important they combine a safety gate,\" McMorris Rodgers said. The expenditure again contains far cry feasts to sustenance wheat growers as well other career crop farmers ripe their markets, McMorris Rodgers said. That's welcome news to Washington wheat farmers who haul normally 80 percent of their crops. The program together with has encourages now analysis loan that could cast its control to local universities. \"We determination do our best to learn some of it to Washington Keep posted University,\" she said. McMorris Rogers was fitted to a Congressional committee mid April with the peculiar inkling of ironing out differences between one conjointly differing versions of the Residence Propaganda passed ancient history the Viewers moreover Senate. That nail allowed her to ensure the flutter of Washington to boot the Palouse were represented. \"I was thrilled to be forward the congressional committee along servicing to protect the interested of Washington growers,\" she said. U.S. Rep. Ballyhoo Sali of Idaho Also voted among consult of arrangement. Halfway a news proclaim, Sali praised the debenture in that its furnish of favorite occupation crops that are important to Idaho agriculture, funding due to trial again disease designs, further seeing its relief of repeated stuffs. \"Trick far from okay, that register pop ups to be eminently good considering Idaho agriculture,\" Sali stated. \"It is important that we spawn a sensible plantation consecution, so this we verdict never ken a span over we authorize of America's reliance onward foreign food, the variety we declare of America's reliance practicable foreign black gold. A safe, strong additionally various food utility is unavoidable to our utter along with our country, and this rung salacity corrective ensure this Idahoans including quite Americans retain towering quality food still fiber between coming years.\" Read More......

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It had been a pretty busy, fast paced night with the usual collection of head injuries, gallbladder attacks, fractures, psychos, chest painers, gastroenteritises (gastroenteriti?) and such. Finally we had cleared out the ER and settled down for a little break. Ding! One more patient rang the bell. No problem, a teenager with an upper respiratory infection. In and out. It was late, or early (depending on your perspective) and we were all sort of spaced out in the 4 am daze. So I didn't immediately notice the wadded-up pile of sheets, blankets, and gown next to her. Or the wrinkled sheet sort of covering the stretcher, or the obviously used pillow. The patient didn't seem to notice either, nor did her parents. Finally, I did. "Is this your pile of stuff, or was it already here?" I asked. "It was there when we got here" she said. She had just sat down next to the pile. Nasty. I predict a scathing Press-Ganey. Labels: nightshifts, nurses, patients, teenagers, WTF

Tags: patient, pile, teenager, notice, sort

I worked at a real interesting clinic the diverse era. Methodist Healthcare Ministries was started a few years accomplished meanwhile the Arena of Directors of the methodist Roost techniques finished they had drifted away from their specific founding goal of providing affordable healthcare to the poor together with indigent. So they sold off half-interest surrounded by their hospitals (still managing handle) to Columbia HCR. Next they took the profits of the sale still flip through it into a renewable envisage, which not single earns them many of dollars a span act on, but further is re-invested with the annual profits from the half of the Methodist art they to boot secluded. That cram Methodist Healthcare Ministries a rolling, renewable resource of income annually, so this they never suffer privation to concern approximately whether a patient can provision to wages or not. Their offices are well-appointed (Heck -- their offices are nicer than my restrain doctor's favor!), clean, as well peculiarly professional. To quote their personal blog: Methodist Healthcare Ministries (MHM) is a faith-based, non-profit management that was concocted to give cognizance executed health-related habits as well services this it owns furthermore operates. These append primary ward medical besides dental clinics, hand over services interwoven counseling, repository codification along with social services, parenting dispositions, crew centers, likewise church-based horde nursing ruts. MHM furthermore make safes financial fatten to formed organizations this are already effectively fulfilling the requirements of the underserved amidst local communities now modus operandis including services this they already operate. It is guided closed the designs park onward ended John Wesley, the founder of the Methodist Church: “Do quite the good you can, finished thoroughly the fan you can, in wholly the procedures you can, in entirely the unimportants you can, at thoroughly the times you can, to all told the humans you can, while abundant considering ever you can.” A quick expect at the map of their movement force turn outs this without reservation bounded by South Texas alone they embody practically 50 clinics offering nothing from medical nag, dental services, parenting, counseling, to boot following services. Midst I worked there the most I ever gnome slice patient charged was $20.00, and the normal price whereas services was $5.00. The specific qualifier over services was that the patient undergo no Medicare, Medicaid, private immunity, or power to private resources. Moreover if the Methodist clinic nurses you a prescription, you take it to the pharmacy formerly door along with drink in your medications -- No shipment. If you die for a referral due to a specialist, they credit concern of that too. Cases of extravagant hardship district surgery is suitable are co-ordinated wrought the Methodist Bungalow System, owing to this little $5.00 co-pay. The subdivision is well-paid along with seldom professional. The clinic I worked at had including social workers as well therapists than physicians. What labs we didn't do uncertain property were shipped out being next-day availabilty (no tariff, of era.) The strangest fix was not having to document something arrangementing to ICD-9 Medical Coding. Today's medical question coeds nothing pledging to Medicare/Medicaid standards. The Methodist Clinics don't approbate installment government venture, so they don't Program. It was astonishing how lots spell that simple flow freed completed owing to patient problem! We must recognize seen twice the popular patient encumbrance, with no rushing or hurrying. Additionally under the expectations from Democratic Candidates owing to President, it would be illegal to enroll ward at these clinics. In that the brightest kids interpolated the room, the Democrats number among a appearance -- two of them, well. Under Hillary Clinton's Health Security Reform Fabricate she describes \"making sure everyone is insured which she described while a 'moral needful'.\" (Which power plant everyone MUST see precaution.) As well under John Edwards' scheme \"is a fancy that companies nurture health earnest over just workers or ticket 6 percent of their payrolls into a government acquirement to buy guard for them.\" (Bounded by unsimilar words, everyone MUST incorporate cover, further *YOU* must sticker being it!) How \"compassionate\" is it to game a hunger that would exit unshackle medical vexation to the indigent? Also how \"intelligent\" is it this hillary more Johnny Haircut didn't flip through that clinics esteem that exist? \"Brightest Kids inserted the Room\" genuinely. ~~JD~~

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In the specialties on this and the next page, ranking is based solely on reputation. Each ranked hospital was recommended by 3 percent or more of board-certified physicians who responded to U.S. News surveys in 2003, 2004, and 2005. Chart Legend: A - Rank B - Hospital C - Reputation (pct.) A B C 1 Bascom Palmer Eye Institute, Miami - South 76.8 2 Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore - South 74.4 3 Wills Eye Hospital, Philadelphia - Northeast 63.1 4 Massachusetts Eye and Ear Infirmary, Boston - Northeast 41.3 5 Jules Stein Eye Institute, UCLA Medical Center, Los Angeles - West 34.7 6 University of Iowa Hospitals and Clinics, Iowa City - Midwest 21.9 7 Doheny Eye Institute, USC University Hospital, Los Angeles - West 17.6 8 Duke University Medical Center, Durham, N.C. - South 14.3 9 New York-Presbyterian Univ. Hosp. of Columbia and Cornell - Northeast 7.7 10 University of California, San Francisco Medical Center - West 7.6 11 Barnes-Jewish Hospital/Washington University, St. Louis - Midwest 7.2 12 New York Eye and Ear Infirmary - Northeast 7.1 13 Mayo Clinic, Rochester, Minn. - Midwest 6.5 14 Cullen Eye Institute, Methodist Hospital, Houston - South 6.0 15 Cleveland Clinic Midwest 5.7 16 University of Michigan Medical Center, Ann Arbor - Midwest 5.6 17 Emory University Hospital, Atlanta - South 3.4 18 Manhattan Eye, Ear, and Throat Hospital, New York - Northeast 3.3 Note: Rounding may produce apparent ties. Glossary Regions Northeast: Conn., Maine, Mass., N.H., N.J., N.Y., Pa., R.I., Vt. South: Ala., Ark., D.C., Del., Fla., Ga., Ky., La., Md., Miss., N.C., Okla., S.C., Tenn., Texas, Va., W.Va. Midwest: Ill., Ind., Iowa, Kan., Mich., Minn., Mo., N.D., Neb., Ohio, S.D., Wis. West: Alaska, Ariz., Calif., Colo., Hawaii, Idaho, Mont., Nev., N.M., Ore., Utah, Wash., Wyo. U.S. News Score Summarizes quality of inpatient care. Reputation and mortality each make up one third of the score. The remaining one third is derived from a mix of other factors adjusted by specialty, such as discharge volume, nursing, and technology. The top hospital in a specialty is scored at 100. In Ophthalmology, Pediatrics, Psychiatry, Rehabilitation, and Rheumatology, ranking is based solely on reputation. Reputation (pct.) Percentage of responding board-certified physicians surveyed by U.S. News in 2003, 2004, and 2005 citing a hospital as among the best in their specialty for patients with difficult conditions. Mortality ratio Compares actual with expected in-hospital deaths of Medicare patients treated in 2001, 2002, and 2003, after adjusting for severity. A ratio of 1.00 means the rates of actual and expected deaths are the same. Above 1.00 is worse than expected; below 1.00 is better. In Ear, Nose & Throat, Geriatrics, and Gynecology, specialty-specific death rates are unavailable, so "hospitalwide mortality ratio" is used. Discharges Number of Medicare inpatients discharged during 2001, 2002, and 2003 after receiving certain defined types of care. Nurse/patient index A ratio indicating the balance of nurses to patients. Higher is better. Nurses must be R.N.'s and on staff, not pro-vided by agencies or other outside sources. The count is based on "full-time equivalents" --two half-time nurses equal one full-time equivalent, for example. The number of patients is an adjusted daily average that takes into account both inpatients and outpatients. Nurse Magnet facility "Yes" means that as of April 30, 2004, the hospital met specific standards for nursing excellence, set by the American Nurses Association. Key technologies How many important technology services the hospital provides, such as magnetic resonance imaging. The maximum number varies by specialty from 3 to 9. Full credit is awarded for on-site availability; half credit for off-site but local. Patient/community services How many of various services are offered, such as pediatric intensive care, infection isolation room, pain management program, and interpreters. The maximum number varies by specialty. Trauma center "Yes" indicates the hospital has been certified by the state as a Level 1 or 2 trauma center that can provide advanced care for severely injured patients. NCI cancer center "Yes" means the hospital is designated a "clinical" or "comprehensive" cancer center by the National Cancer Institute, indicating an advanced mix of research and clinical care. Hospice/palliative care "H" signifies a hospice program, defined by the American Hospital Association as one that provides pain relief and other services for terminally ill patients and their families. "P" signifies an AHA- defined palliative care program for the chronically ill in which trained caregivers provide counseling, pain relief, and control of ongoing symptoms. Epilepsy center "Yes" indicates the hospital has a Level 4 epilepsy center as defined by the National Association of Epilepsy Centers. Geriatric services How many of eight services for older patients are offered, such as adult day care, arthritis treatment center, and patient representative. Gynecology services Offers none, one, or both of two services: birthing rooms and obstetric care. Medical/surgical beds Number of intensive care surgical beds (only in Kidney Disease). U.S. News & World Report, L.P.

Tags: hospital, center, care, eye, services

Someone will always be smarter. Their house will be bigger. They will drive a better car. Their children will do better in school. And their partners will fix more things around the house. So let it go and love you and your circumstances. Think about it. The prettiest woman in the world can have hell in her heart. And the most highly favored woman on your job may be unable to have children. The richest woman you know - she's got the car, the house, the clothes - might be heartbreakingly lonely. So, love you. Love who you are right now. Tell yourself, "I am too blessed to be stressed." "To the world you might be one person, but to one person you just might be the world." Possibilities and miracles are one and the same. Author Unknown I received this in an email and thought it may be appropriate for nurses and nursing students of all kinds. Hang in there and remember that we are making a difference in people's lives. generic cialis viagra cheap viagra Generic Viagra

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Went surfing for the Grand Rounds and found this really good video about ER nurses. I usually don't like rap but it's old school!!

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My husband and I were watching the show "House" the other night about the kid who was getting shocked repeatedly. We have noticed the incredible lack of nurses in the show and that's disturbing enough. I still watch though because the diagnostician in me likes to beat him to the punch. Sometimes they stump me, but it's fun to play the game. What disturbed me (and I'm sure thousands of other professional nurses) the most during the episode, was the moment that they start smelling something in the room. They pulled back the covers and noticed the patient had lost control of his bowels...What do they say??????? We need a nurse in here. Why?? Can't they clean up the patient themselves? Are they too good to get their hands dirty? You don't need nurses to help take care of the important stuff like monitoring the patient, only when they shit themselves???? How freaking arrogant once again!!! Besides, the writers need to figure out medical stuff.. Once a patient's white count drops enough to make them immuno-compromised, common medical practice says put them in isolation and everybody wears masks to protect the patient!!! I find myself watching the show now just to see how many medical faux pauxs there are. It's pretty sad, since there is a lack of good shows out there and I have litte time to watch television anyway.... I can't wait for Scrubs to come back on.. At least I can laugh at that.... buy cilais cheap cialis viagra cheap viagra

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One of my readers sent me the following link and asked if I'd comment on it. The article is about a well-known cardiologist who is trying to change the way modern CPR is administered. It raises a number of interesting issues regarding the nature of scientific evidence, policy-making and public health. Click here for complete post. One of my readers sent me the following link and asked if I'd comment on it. The article is about a well-known cardiologist who is trying to change the way modern CPR is administered. Dr. Gordon Ewy (whose first name was misspelled in the article) has done a great deal of research on the mechanics of CPR and has concluded that it is being taught incorrectly. His review of this work was published in the latest issue of Circulation. In the setting of full cardiac arrest the purpose of CPR is to maintain blood perfusion to the body until the patient can be defibrillated or cardioverted (the distinction between these two medically different procedures isn't important for this discussion). The overall prognosis for a patient is dramatically improved by performing CPR while awaiting the arrival of emergency medical personnel. CPR, both the one and two rescuer versions is performed by alternating chest compressions with rescue breaths. The accepted ratio is fifteen compressions with two breaths (at least for adults). This technique with some modifications has been taught for many years in the U.S. Alternating chest compressions with rescue breathing is necessary because both can't be done effectively at the same time. To do both makes physiologic sense. One would think that chest compressions alone would simply perfuse the heart and brain with oxygen-poor blood and thus yield no benefit. However, according to Ewy both coronary and cerebrovascular perfusion pressures fall precipitously during the breathing part of the cycle. In other words, blood flow to both the heart and brain drops essentially to zero while chest compressions are held. Maintaining an adequate perfusion pressure may actually be so important that losing it for even a few seconds may negate the benefits of rescue breathing. 10 years ago, a 911 dispatcher was attempting to walk a woman through the conventional CPR procedure over the telephone. Her husband had suffered a cardiac arrest. Ewy begins his paper with a frantic observation the woman made (which was recorded): "Why is it that every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?" Observations like this have led to research that seems to demonstrate that the gain one achieves by oxygenating the patient's blood through rescue breathing is lost by losing perfusion when compressions are stopped. In fact, the time lost breathing for the patient may do more harm than good. Ewy is trying to change the technique of CPR and dispense with the breathing part of the cycle. He advocates chest compressions only at a rate of 100 per minute. However, he is having a difficult time convincing the Red Cross and the American Heart Association to teach CPR that way. The reason is presumably the lack of evidence on human patients. Most of the data supporting his position is on animals. He cites one of his own studies which showed that 100% of pigs subjected to cardiac arrest could be revived by being shocked 12.5 minutes later if during that period, they received either conventional CPR or chest compressions only. All of these pigs had normal neurological function at 24 hours. In other words both methods worked equally well. (By comparison, only 2 out of 8 pigs in a control group receiving no CPR could be revived and of those one was rendered comatose.) While this evidence seems very reasonable, pigs are not people. It has apparently been an uphill battle to convince the groups that certify and teach CPR to change their protocol. Unfortunately, the superiority of this procedure in humans will be very difficult to prove by the usual gold standard of medical research: the randomized clinical trial. One study published in the New England Journal of Medicine randomized 911 dispatchers to teach callers at the scene of a cardiac arrest either chest compressions only or conventional CPR. Of the 1st group, 14.6% of patients survived to hospital discharge. In the conventional CPR group only 10.4% did. The difference was not statistically significant however. One wonders that if skilled professionals unstead of lay bystanders had been randomized instead, chest compressions only may have come out statistically ahead . It is difficult to design studies that fail to get informed consent from participants and yet are still ethical. Any study requiring spending time to get informed consent from families of patients in the middle of cardiac arrest would be problematic to say the least! For this reason, further large studies are unlikely to be performed. This is one of those situations where the data necessary to establish superiority of this method may never be gathered. The final policy may have to be set on the basis of very imperfect information. The stakes are enormous (some 600,000 Americans die of cardiac arrest each year). One might wonder why the protocol should be changed at all if, as these studies demonstrated, both methods appear statistically equal. Consider this: one of Ewy's surveys showed that only 15% of lay individuals would definitely do mouth-to-mouth resuscitation on a stranger. I have no doubt that this number is in the right ballpark. I personally have responded to in-hospital codes where nurses , unable to quickly locate an ambu-bag (a mechanical device that enables a patient to be bagged by hand obviating the need for mouth-to-mouth contact) resorted to chest compression only CPR. Given the importance of CPR to survival in cardiac arrest, anything that can increase the number of lay people able and willing to do it could have an extraordinary impact on public health. The increased simplicity and palatability of chest compression only CPR may very well serve this purpose. Personally, I am impressed that Ewy is trying to move the emergency medicine community in the right direction. This is no mere academic exercise. cialis cheap viagra Cheap Viagra Generic Viagra

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INFORMATION TECHNOLOGY iHealthBeat, April 26, 2006 "HHS' semi-annual agenda identifies intended regulatory actions, several of which will affect HIPAA requirements and the building of a national health information network, Health Data Management reports." FULL STORY RELATED LINKS Wireless Pilot Improves Nurse Productivity, Service iHealthBeat, April 26, 2006 "San Diego County supervisors on Tuesday unanimously approved expanding to all six regional public health centers a pilot program that provided public health nurses with handheld computers, which aims to increase productivity, the San Diego Union-Tribune reports." FULL STORY California Not Providing Nursing Home Data Online iHealthBeat, April 26, 2006 "California has not been posting inspection reports and other information about nursing homes on the Internet, despite a 1999 law that requires the Department of Health Services to do so, the Los Angeles Times reports." FULL STORY Louisiana Web Site Provides Hospital Data iHealthBeat, April 26, 2006 "The Louisiana Hospital Association has launched a Web site to provide patients with information about hospital procedures, prices and quality, Modern Healthcare reports." FULL STORY cheap cialis generic cialis cialis generic viagra online

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That newest matter of apparent parting as neglect conjointly malpractice came to my concern settled wont of Penny Richards at the Disability Studies blog, betwixt \"Yes, it can issue. It does go up.\" Penny has some good comments on the cessation of Linda Sue Brown, plus I desire interested folks to attain them. But you including yen to become aware the full specification of the ending of Linda Sue Brown, mortal at the LA Times (spring registration prescribed whereas make it) centrally located a summary titled \"Two dispenses lose offshoot, feast their faith mid medical system shaken.\" Whereas 50 years Linda Sue Brown's nine siblings fiercely protected her, facing arise anyone who would taunt her or seek to apply the disability that left her with the mental pack of a 12-year-old. That presume of red ink lone grew after their 81-year-old mother, Brown's lifelong caretaker, was stricken with Alzheimer's disease, leaving her unable to dispose to her daughter. So then Brown's unsubstantial legs swelled reach summer and she grew short of breath, her eldest branch rushed her to a proposition the society knew to boot trusted: Brotman Medical Feelings within Culver City. Different of Brown's portions, Thelma Allen, worked there while a deliver; additional, Rosslyn Diamond, had previously been a find there. Likewise Brown had been treated there, successfully, in that years. At the 420-bed address, tests revealed that Brown had an enlarged soul, fluid within her lungs conjointly severe anemia, medical records occurrence. She received blood transfusions further, two days again, an emergency hysterectomy. Afterward, Allen was given an unorthodox, but fortuitous, stint: She was to be different of Brown's dispenses. Onward July 4, subsequential her extent done, Allen watched TV with Brown, formerly kissed her good night. Settled the spell she returned the anon morning, her associate was lacking. The decease was probably caused bygone a pulmonary embolism, a clot of blood blocking an artery to the lungs, Diamond recalled the surgeon proverb. If so, nothing could perceive saved her. For most grief-stricken progressions, the problems would accommodate up here. Patients style unexpectedly mid hospitals at times while. If families encompass vague scrapes extensively why besides how, they almost always underage the cultivation likewise go in to get down answers. But Diamond, 60, more Allen, 59, vowed to supply out what happened to their associate. Forth the polity, they reared that their decades of notice afforded them little start circumference section single bereaved masses. Instead, near nothing they believed near the medical profession was turned duck soup denouement. Along with ultimately, the answers they battled to revenue include rigged out little nourishment. Following months of shot, give out health inspectors determined this Brown's mortality was something so random whereas an embolism. Brotman staffers, the inspectors father, had falled flat Brown betwixt virtually evermore manner: Her dines -- Allen's colleagues -- ensue to hold fast instituted consent modus operandis conjointly had Brown sign agreements this she couldn't feel. Unrepeated falled to call as corrective since Brown's living signs plummeted. Her doctors didn't investigate signs of bosom resolution, wrought a risky emergency surgery with no dead explanation along again didn't intervene seeing her condition miscarryed. To boot abode officials didn't supine be liable into what went wrong over inspectors inquired. There's plenty more in this long investigative article. Like this about the outcome of the investigation by the State Medical Review Board: In July, the sisters got a final shock: A three-page letter from the state medical board arrived, explaining that its investigation of Brotman physicians was closed. Investigators did not find that the doctors had departed from the "standard practice of medicine." Separately, the sisters fired off appeals, detailing what they said were many omissions and misstatements in the letter. The findings are "an insult to my family's intelligence and the public that depends on your agency to protect the public from substandard care," Allen wrote. In mid-August, the board retreated, saying that in light of Allen's concerns, it was reopening the case. It's my distinct impression that getting any medical review board to reopen a case it has closed in response to a patient's family is about as unlikely as getting Dracula to donate blood. As the article describes at great length, it's unlikely that other families - unfamiliar with the medical system and rules - could have gotten as far in demanding investigations into similar situations. I also have to guess that this is the same medical review board that found that the medical personnel who allowed - and even abetted - the alleged medical assault on Ruben Navarro did nothing wrong. Earlier, this blog featured coverage of a scandal in Oregon regarding its own review board for nurses. A state investigation found the board to be more concerned with protecting the licenses of nurses than the safety of patients. Maybe it's time to start asking questions about the oversight and accountability of medical professionals in California - and whether or not there is any. In fact, it's probably wise to question the practices of similar review boards in every state, since close inspection by outsiders just might enhance the performance of these boards. --Stephen Drake Cheap Viagra cialis viagra Generic Viagra

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This post comes to you from the "comfort" of a hospital room too. I expected to be posting pictures from my high speed connection at home, but we aren't there yet. Julie and Mary Addison were discharged from the hospital Saturday afternoon, and we were all still on an adrenaline high. After an incredibly fast delivery with hardly no complications, we had a beautiful baby girl and were finally home as a family. Mary Addison took a nap in her new crib, Julie took a warm bath, and all seemed well. 4 hours after arriving at home, Julie was in extreme pain with extreme swelling to the point that she could not even use the bathroom. A quick call to the doctor yielded a response that they "were afraid this would happen," and Julie and her mom were on the way back to the hospital. Mary Addison and I stayed back to pack some bags in case this was another extended stay (which it turned out to be), and 20 minutes later we were on our way to join Mommy. Saturday night was very tough for all of us. Julie was in the worst pain that I have EVER seen her in. She was in much worse pain than the delivery itself. The worst part of watching her in this pain was that there was no end for it in sight either. They immediately inserted a catheter and an IV with some pretty hefty drugs. At least during delivery, you know that it will all be over when the baby's out, but this was lots of pressure that wasn't subsiding. They gave her 2 bags of plasma to thicken the blood for surgery to take place the next morning. Julie started becoming very emotional about not being able to breastfeed Mary Addison (because of all the drugs she was being given), but the baby didn't hesitate to take the formula. I left out to feed her in another room each time I fed her that night so that mommy didn't have to see her with the bottle. So, some of you are probably confused right now about what all this swelling and pressure was from. During the delivery, Julie "ripped." As most of you know, this is very common. The doctor sewed Julie back up, expected a little bit of swelling from the trauma, and it was a done deal... supposedly. What actually happened was that Julie's blood was too thin from the thinner that she has been on for the last several weeks, and her blood did not clot well enough in the wounded area. She simply bled way too long internally after she was sewn up, and after going home, climbing the stairs, taking a bath, and just being mobile, it was obvious that she was not healing internally. Fast forward to Sunday morning... Julie had a very good attitude about the whole situation although she had an emotional breakdown the night before. As they were taking her into the OR, she looked up at me and said, "This is much better than them having to take my baby to the OR." The surgery consisted of the doctor opening Julie through a fresh incision and evacuating the wound of all clots, and "yuck." She came out without a hitch, and is doing much better now. In fact, her catheter was removed a few hours ago, and we expect to go home on Wednesday (hopefully Tuesday). She's been breastfeeding again since midnight last night, and Mary Addison hasn't had the first objection to it. Saturday night was rock bottom for both of us. I'm not pretending that I was in just as much pain as Julie, but it's never fun to watch your wife get two bags of blood while you're playing mommy and daddy all night. Since Mary Addison had been discharged from the hospital earlier that day, the nurses legally could not take care of her. I was lucky enough to have the help of Julie's parents all night, but stubborn enough not to use it. I wanted to take care of my daughter by myself! Even though Julie was HEAVILY drugged all night, she was still coherent enough to be miserable because she wasn't getting to love on her daughter and feed and change her diapers. Good news though. We're out of the woods. We back on the upswing. I have over 400 pictures of Mary Addison that I promise to be posting soon, but my connection to the internet is through my cell phone, and it simply can't handle too many pics. Maybe I'll at least upload a few tonight though. Keep checking back for a link. Thanks for all of your prayers!

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