Sunday, August 30, 2009

What I've Learned So Far...

Anesthesiology = you get to do lots of crossword puzzles

Gastroenterology = Playing Nintendo all day long (yes, I'm dating myself)

ER = Treat 'em and Street 'em

Psychiatry = If your patient says he's suicidal he automatically get three hots and a cot. If you don't like him, you can PEC him.

Pediatrics = kids, good. parents, bad

Orthopedics = Can you say EGO? The Ortho guy that gave a talk last week called himself heroic at least 8 times.

IM = so busy they can't possibly tell the difference between an ass and an elbow (or their own ass from their own elbow for that matter)

Radiology = greek isles while reading CT scans on your laptop

ID = Basically you treat everything with one of four medications. You really can't screw up too much

Dermatology = Oh, that's a rash. Or, possibly.... a ... um... bad rash

Surgery = I can't stand on concrete that long. Maybe if I was suspended from the ceiling?

Geriatrics = well, you won't be curing anyone

More to come..................

Saturday, August 29, 2009

Nurse Practitioner Jobs ARNP Jobs 8/28

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8/27 Nurse Practitioner Jobs ARNP Jobs

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Nursing Care Plan for CHF | Nursing Lectures

This is a new post on a new nursing care plan for chf. Congestive Heart Failure is a serious medical condition. As a Nurse it is important to make sure that an appropriate Nursing Care plan for CHF has been implemented. Download this NCP for CHF for free.

Friday, August 28, 2009


Today I met my 2nd year buddy. Based on our background and academic interests, every first year gets paired up with a 2nd year "big brother/sister" to act as an advisor/confidant/support person for all the newbies. I met my buddy Karin today at a party set up by the school. All in all she and her boyfriend (also a 2nd year) were super cool.

Here's the weird part. Now I've heard this in passing... but today a group of 2nd years (including Karin and her boyfriend), were adamant that I stop wasting my time by going to class. Essentially (according to their theory), you can save time by staying at home and watching the streamed class lectures (all our class lectures are streamed for convenience to review at your leisure online). You can stay home and study, thus saving yourself the inconvenience of waking up early, getting ready, driving to school, parking, etc... all of which takes away precious study time. Huh?

I haven't missed much class thus far, save for the trial and one day this week when a neighbor cat attacked my baby bird... (she' ok now I think)... but I feel like going to class is so important. Maybe it's just psychological... because I NEVER went to class as an undergrad and I was a terrible student. I barely ever missed class during my Masters work and got all A's (ok, 1 B+). Plus, for christ's sake I'm paying like a billion dollars for med school... shouldn't I go? Or am I being too anal? I'm not going to say it's not a huge inconvenience to get to class... because it is. And I actually look forward to the weekends with relief because I can study uninterrupted. Of course, everyone says you have to go to anatomy lab... but the lectures are a waste of time. Damn, too bad. I wouldn't mind flaking out on anatomy. (SIDENOTE) Today I flicked a piece of fat from our cadavers hand onto my face.... and I freaked out and wiped my face on one of my lab partner's shoulders... Ha! I would have been SO PISSED if somebody did that to me. But hey, we're a team and it was a severe emergency!!!

Anyway, about skipping class... I'll have to think about that a little more.

Learning from research on the information behaviour of healthcare professionals: a review of the literature ...with a focus on emotion

Just came across this fascinating article ( at least to me): Learning from research on the information behaviour of healthcare professionals: a review of the literature 2004- 2008 with a focus on emotion. Fourie, Ina. Health Information & Libraries JournalVolume 2009 26(3):171 - 186. This study is a very detailed analysis of the scant literature on the role that "emotion" plays in health provider's information seeking behavior. Emotion goes way beyond what we might initially think and extends to include nine identified themes. Just a few of these 9 identified themes include: "difficulty in identifying and expressing information needs and information behavior", "uncertainty and anxiety", the role that personality and coping skills play and the role that self confidance and attitude play. The author even offers a detailed table with a large number of suggestions as to how Library and Information Science(LIS) professionals might impact or ameliorate the information seeking barriers of "emotional issues". One quote that really resonated with me from MacIntosh-Murrray and Choo in their article "Information behavior in the context of improving patient safety" Journal of the American Society for Information Science and technology 2005 56:1332-1345 "...front line staff are task driven, coping with heavy workloads that limit their attention to and recognition of potential information needs and knowledge gaps" However, a surrogate in an information-related role, an "information/change agent"-may intervene successfully with staff ..." What do you all think? any innovative ways in which librarians can better play this role as an information surrogate?

Thursday, August 27, 2009

A Few Updates

1. From my posting last Sunday... I am feeling a lot better. I am definitely on an emotional roller coaster... but feeling better about my ability to hang in there

2. My friend Leslie started 90 days of rehab this week. Hopefully all will go as planned and she can get back to residency as soon as possible

3. The trial I testified in resulted in a unanimous guilty verdict for 2nd degree murder. Louisiana carries a mandatory life in prison sentence with no possibility of parole. So that is a load off my shoulders.

First Day as a Real (Fake) Doctor

As my young classmates like to say "today I felt like a BAMF"... (apparently ?) a bad ass mother fucker. Yes, folks, I got to wear my white coat for the first time today for a PBL (problem based learning session) and for clinical practice in the standardized patient clinic. The clinic is set up as a floor in one of our buildings which looks like a real clinic (it does, really). There are real clinic rooms and "standardized" patients (meaning actors that present with a set of symptoms for us to practice on). Once we complete our history, exam, etc. the actors break role and give us feedback on our performance. It is also videotaped for evaluation. It was fun. I had a woman with a "cold" so they started me out easy... but I'm sure it will get more involved over time.

For the PBL session, we get together in a small group with a professor who gives us a case. Then we review it, discuss it, and give a differential diagnosis.

Overall a pretty cool day... because getting back to the BAMF part... Now on my first day of school the faculty warned us that our community now (immediately, today) views us as doctors. The general community makes little distinction between short coats, long coats, students, residents, interns, attendings, whatever. For all intents and purposes YOU ARE A DOCTOR... SO ACT LIKE ONE. Yada yada we all laughed and nodded... but essentially blew it off.

But today. TODAY, I felt it. It's a weird thing. Something like a mix of respect, or power, or something rather indescribable. I got into an elevator with three gorgeous "put together" women in suits. I was wearing my white coat. And they were staring. And smiling. Normally a bunch of beautiful women wouldn't even look at me. Why would they? I'm just an "average" woman in an elevator. Odd. Then I drove downstairs and a female doctor in a white coat waved to me. Another anomaly that I'd never experienced before. Then (just for kicks and to continue my experiment) I wore my coat into a little store by my house. Ahead of me was an urban mom, who looked like one of those "power mom" kinda chicks. You know the well dressed flashy kind that always has somewhere to be, and speaks a little too loud when she talks to her children in public? So she was ahead of me in line with her three kids. And she was actually "flustered". At one point, she looked at me in the middle of her transaction and said "Do you want to just go ahead, I'm sure you are really busy and have to be somewhere". I almost fainted in front of the cupcake display, I swear. I politely told her to please take her time, I wasn't in a rush.

Now please don't misread why I am writing this. It isn't about power, or getting privileges, or being better. But these are three things that have NEVER happened to me before... and then all three occur on the first day I wore my coat.

This must be what the deans meant during the white coat ceremony, when they spent 2 hours discussing the great responsibility that occurs with wearing the white coat. Holy smokes, I'll take it.

Radiology Rocks

Well, I said I was going to keep my mind open... and I'm thinking radiology is totally awesome. I never thought that I'd be interested in something like that because I didn't feel it was clinical enough... but it is so cool. One of my hobbies is photography... so maybe that is one of the reasons why I like it... but overall it's like a little puzzle figuring out each image.

This week we actually had a "radiology session"... so we went into the darkroom and discussed images of the body. I'm getting the hang of it... and it's really fun.

How Pregnant Women and New Moms Should Prepare for H1N1 Flu

Midwives, pregnant women, and new moms, watch this webcast for the latest on what you should know about H1N1 flu. Features questions from the public and answers by experts from ACNM, CDC, and NIH.

Wednesday, August 26, 2009

Don't Miss our Annual EBP Conference, October 2

Please join us for the St. Joseph Hospital 5th Annual Evidence-Based Practice Conference, “Evidence Based Approaches to Infection Prevention and Management” on Friday, October 2 from 8-4:30pm at St. Joseph Center, Orange, Ca. This 8-hour course will include various speakers from St. Joseph Hospital as well as from local healthcare agencies.

Topics will include: Influenza, HealthCare Associated Infections, Current Legislation, Biofilm, Community Trends in TB and others.
This annual conference has been one of our best attended classes of the year and will prove to be another interesting and educational event. Learn the latest and improve your clinical practice!
Registration is NOW available for St. Joseph Hospital Employees through our new on-line registration through CareNet.

For those interested from outside St. Joseph Hospital, please call the Clinical Education Department for further information about registration at (714) 771-8000, extension 17345. Cost for the entire day is $75.00. Space is limited and early registration is recommended.

RIP Bear

My big black beast Bear is sick and had to be put down. I love him so much and can't believe I am losing another cat so soon. He found us and it took a good 18 months before he came to live in the house for good. I had him for just over 6 years, the vet says he was close to 14 years old. I am glad that I was able to give him a good 6 years of love and cuddles and happiness. He was my little shadow and would cry when I left the house. RIP Bear, I love you! xox

Tuesday, August 25, 2009

ACOG Encourages Laboring Women to Quench Their Thirst

Women who decide to give birth in a hospital may soon have access to more than ice chips during labor. The American College of Obstetricians and Gynecologists (ACOG) just released a committee opinion recommending that clear liquids (water, juice, sports drinks, etc.) be provided to women who have uncomplicated labor or are scheduled for a planned cesarean.ACNM has long supported a liberal

Monday, August 24, 2009

Aug 21st Nurse Practitioner Jobs ARNP Jobs

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H1N1 Virus (Swine Flu): What you need to know

Date: Thursday, September 10, 2009
Time: 4:00 PM
Location: Connelly Center Cinema

Dr. Hans Liu, MD, FACP
Bryn Mawr Medical Specialists Association, Bryn Mawr, PA, Professor of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia

Well-known speaker and consultant Hans Liu, MD, FACP, is an infectious disease specialist whose professional endeavors have included researching antibiotic resistance and treatment of infections, as well as investigating issues in global health. He is former Chief of Infectious Diseases at Penn Presbyterian Medical Center in Philadelphia and a longstanding medical educator. Dr. Liu lectures nationally and internationally.

Sunday, August 23, 2009

Needless to Say

I'm really having a tough weekend. Three nervous breakdowns later I am really questioning if this is right for me. I know this is part of the process... apparently everyone feels this way. Yada yada... they give the lectures about managing stress and getting help... but crap...I feel so out of sorts I don't even want to reach out. I see classmates on facebook (lots of them .... together) boozong it up... how do they have time? On my free time all I can think about is sleeping! And really folks, I'm studying. Here's my normal schedule:
6:00 am Wake up, wash my face, walk the dog
6:30 am pack a lunch, shower (optional), get dressed, pack my backpack
7:30 head out for class
8:00 - 9:00 class starts ANATOMY
9:00 - 12:00 ANATOMY LAB
12:00-1:00 Usually a mandatory meeting (Deans, health, projects, etc)
1:00-3:00 Biochem or 1:00 to 4:00 Foundations in Medicine
4:00 head home, walk the dog, sleep 30 minutes till 5:00
5:00 - 8:30 study, then dinner
9-11:00 - study some more and optional shower
11:30 Bed

20 Things Happening in My Brain... and None of them Good

1. Did I do this just to prove that I COULD make it?
2. Do I not deserve to be here?
3. Did I try to manipulate fate by trying so hard to get into med school?
4. Can I even do anything else with my life at this point?
5. Did I waste my 20's trying to prove that I was good enough to be a doctor?
6. I don't know how to memorize this many structures
7. Can I make it?
8. I can't make it
9. No one else seems to be freaking out
10. I'm too old for this
11. I should have had babies and started an organic farm, made jam and grown herbs
12. I am so tired
13. I am so tired
14. My brain is stuffed
15. I AM studying, dammit
16. When is the refund/withdrawal date?
17. Am I the dumbest one here?
18. I am so tired
19. Two more weeks before the first block exam
20. How many fucking things can possibly be in an arm?

Saturday, August 22, 2009

Thyroidectomy Nursing Lectures

This is a nursing lecture on Thyroidectomyfor nursing students and other health professionals. Enjoy!

Friday, August 21, 2009

Midwifery News Roundup

At ACNM, we’re busy celebrating the 1000th baby born at Special Beginnings Birth and Women's Center and preparing for the next issue of Quickening (our newsletter for midwives). Until next week, check out these news links that we think are worth sharing:Breastfeeding: Natural Protector Against Swine Flu (Women’s eNews)New Studies Compare Blood Clot Risks from Oral Contraceptives (Our Bodies Our

Thursday, August 20, 2009

Glad that's Over

Well today was the big day. I testified. Its over. I had to skip 3 med school classes... but truthfully I feel like it was worth it. I felt that I did a good deed, and now I can move on. Funny, I stared at him (HIM) the entire time I was in the courtroom on the stand and he never looked at me even once. I'll be very curious to see what the verdict is in a few days. Louisiana is a capital punishment state, so if he is guilty he may receive the death penalty. I'm not sure how I feel about that.

8/20 Nurse Practitioner Jobs

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Wednesday, August 19, 2009

Help! I Have to Write a Nursing Care Plan and I Have No Idea How!

By: Jonathan Ginsburg

Regardless of the particular college or university, all nursing students will need to write several nursing care plans during their time in school. Put simply, a nursing care plan is just that: a plan of action, tailored to a specific individual, that addresses specific needs. Such needs are usually medical in nature, such as how the patient can manage her diabetes on a fixed income, but they can also encompass other aspects of the patient's life, such as mental health and spirituality.

Different institutions have different formats for such plans, but they generally include the following sections: The problem to be addressed; the goals for the patient; a step-by-step approach to solving the problem and achieving the goals; and a space that allows for notes to be made as the patient progresses through the steps of the plan. Some plans also include a case history of the patient as it relates to the particular problem.

It's critical for students to learn how to write such plans in college, because they will have to create them when they become nurses in the so-called real world. Yet they can be incredibly intimidating. Often the student is simply presented with a fictional case history and a template and told to go from there. How can the student adequately create a step-by-step plan to assist this patient?

That is where academic writing companies can come in handy. Students can greatly benefit from a model paper which demonstrates what a typical nursing care plan should look like, custom-written to suit their school's needs. Using this model, they can create their own plans, both for that given assignment and also into the future.

If you are a nursing student, don't blow off this particular assignment. It's too important. Get help if you need it, but be sure you learn how to write a solid nursing care plan. You will appreciate it in the future.

About the Author

Jon Ginsburg is a partner with, an innovative academic writing company which specializes in providing custom-written, original model papers of all kinds. PowerPapers firmly believes that a quality model paper can be a key learning tool for almost any student. Check them out at

(ArticlesBase SC #1134823)

Article Source: - Help! I Have to Write a Nursing Care Plan and I Have No Idea How!

Tuesday, August 18, 2009

Thoughts on Things

Today we had a lecture on your relationship with your patient... how close to get, whether it is alright to be "affected", how to listen... etc. So I know too close is not good (like you're not allowed to have sex with your patients... can you believe they actually had to tell us this one?)... but let me tell you a little story and see what you think.

So I used to have this patient that I loved to death. His name was Mr. Lawrence. Mr. Lawrence was about 63 although he looked much older from years and years of alcohol and drug abuse. He came to see me for enrollment in a clinical trial. He was a little out there... tall and skinny and always wore butterfly collar 70's polyester shirts, had large wide frame black glasses which made his eyes look bigger than they were... and his hair was grey and wiry, sticking up Einstein style. All in all he was adorable. He always asked me to repeat myself and not talk too fast because his "noives" (nerves) weren't good.

After months of his visits I truly loved him. He was a total doll. He lived in an assisted living low income project for the elderly, and I gathered he was pretty lonely. Plus his health was so bad he rarely left his room. He did manage to continue his favorite hobby, wood carving, and he presented me with one of my most treasured possessions. He gave me a wood plaque in which he had carved a young woman sitting in lotus position meditating on a cloud... with the sun, moon, and stars carved around her. My name was on the plaque. I love this plaque not only because it was from him... but because I felt that he knew me as the person that I truly wanted to be. I wanted to be a cool, calming, peaceful influence on people... even if in my own head I'm an ADD maniac. At any rate, he explained to me that he felt calm and happy when he visited me... and I felt wonderful beyond belief. Eventually Mr. Lawrence confessed to me his entire history of alcohol and drug abuse, along with the most heart wrenching story I'd heard from Hurricane Katrina. Essentially he'd been rushed by rising water. His sister and a friend were trying to escape with him through a hole cut in the roof, but were unable to escape and died in the waters. His eyes poured with tears as he talked about his subsequent suicide attempts. He cried. I cried. and I cried some more later. A lot more later.

When Hurricane Gustav came a few weeks later, I couldn't stop thinking about him. I couldn't get him out of my mind. I was so worried, knowing he was in a home.. without anyone to help him and knowing his past experience with hurricanes. I called him. When he told me the home was requiring everyone to evacuate on their own... and then whoever couldn't would be evacuated later by bus, I knew he was terrified. I knew I shouldn't, (patient/doctor...researcher...relationship violated?) but I did. I offered to pick him up and drive him out of town to his sisters home. The relief in his voice was immeasurable and he broke down in tears. I ended up not having to pick him up... another family member sent a friend to get him... but the question is did I do something wrong? Did I get too involved? Or is this simply common decency? Love for fellow humanity? Would it have been different if I was already a physician? I hope I never let those fears get in the way of compassion.

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Monday, August 17, 2009

Journal of Nursing Administration devotes current supplement to "Magnet"topics

The July/August 2009 supplementary issue of Journal of Nursing Administration is devoted entirely to "The Evidence for
Magnet® Status". Articles that look especially interesting include: "Workplace Empowerment and Magnet Hospital Characteristics as Predictors of Patient Safety Climate" and "Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes". Employees of St. Joseph Hospital, Orange and CHOC may access the full text of the articles via the library's website. Others should contact the medical library at your institution.

How Many Unbelievable Things Can You See During 1 Practice Exam?

Today was our first mid-block exam (each semester in med school is divided into "blocks"... for my school three per semester)... but it was just for practice to see how we're doing. Thankfully (if you don't count the structures I haven't studied yet) I did pretty ok. Like 75-85% right... and that's just under normal study habits... ie. without studying like a maniac before a test.

BUT. The point of this posting is to tell you that I CAN NOT believe the nasty things I saw my classmates doing during the exam (this is a practical mind you... looking at cadavers)

1. One girl dragged her hair across an arm full of yellow goopy fat. Yuck... but at least it was unintentional

2. A guy actually leaned his FACE on the prop... which you use to prop up the body... while he was looking closer at a structure.

3. A second girl leaned her lovely eyelet lace shirt TOTALLY against a body.

These are just a few examples. I can not believe how unaware everyone acts... as if there is not a rotting, stinking, chopped up cadaver leaking nasty fluids and covered in piles of yellow fat. They just casually lean over as if leaning over the sofa to get the remote. Now, not to say I haven't gotten a flick or two of cadaver juice on me since I've started this process... but almost every time it's been because someone flicked me... and I have a mental inventory of every part of my body, my hair, my clothes, my pen, and my book the ENTIRE time I'm in there. I'm sure as hell not going to LEAN against something simply because I forgot there was a pile of cadaver nastiness there. GROSS!

Saturday, August 15, 2009

Does it get cuter than this?

I thought I'd introduce you to my dog. Isn't he a doll?

The Unexpected Little Things Which Can Really Freak You Out

It's officially been 1 week (4 dissections) in the Anatomy lab now... and I'm starting to get a little more used to it. I still don't heavily participate in the dissections, but I've cut quite a bit, and am desperately trying to get used to the smell.

During the pre-lab lecture yesterday, something very disturbing happened. We are all standing around among the cadavers, and the guy next to me taps me on the shoulder and says "Hey look at that. That's really weird."

I look down at the cadaver in front of me (a woman), and I can see that she is laying on her stomach face down, and her fingers are curled up so that I can see her nails. And she´s wearing nail polish. A dark, rosy tangerine color. And I feel the tears coming. I don´t know why. It just became so real to me all of the sudden. Here is a cold, smashed grey body... but those nails are bright as can be... and I start thinking all sorts of things. Maybe she didn't know she was going to die. Now I know something personal about her. She likes that rosy tangerine color. Maybe her daughter painted her nails when she was in the hospital bed.

It took me the entire lecture to breathe and focus on the posterior cervical triangle... all the while standing composed and waiting patiently for my watery eyes to dry... and the redness of my face to return pink. I don't think anyone noticed. I wondered if anyone else feels this way?

Friday, August 14, 2009

Things that happened this week

1. I joined the Emergency Medicine student group. And can I just say I WANT TO DO EM SOOOOOO BAD! It does seem great for all the reasons I originally thought (see way below). They are having an intubation clinic session... but too many people wanted to sign up so they had to do a lottery... and I wasn't chosen. Boo :( Its ok, things happen for a reason... maybe I am supposed to be focusing just on studying right now... which I have been. And folks, let me just tell you...

2. Studying it has been! I feel ok, actually... I'm not really freaking out because I've been studying most every night. Except one night I got sick, and last night I met with the DA to go over my testimony. Yeah, I decided to testify. I guess. I kinda got guilted I guess. Anyway, back to studying. So the trick is to pre-read each lecture, then study each classes material when you get home. I have also been drawing millions of drawings for anatomy... that is fun and really helps me learn. I guess everyone will have to figure out their own learning style... bc the first week I was trying to memorize anatomy by jut reading and it WAS NOT working.

3. I'm taking my hound dog to a "pet therapy" service learning project. Basically we bring our pets to residential nursing homes and hospice, etc. and they visit the patients. Ok, whatever. Might be cool. I just figure its a good way to get my service hours and spend time with my dog at one whack.

Uninsured Women Lose Access to Midwives in South Carolina

On September 30, the five midwives providing services at the prenatal program at North Central Family Medical Center in Rock Hill, SC, will be out of work, and the uninsured women and families they serve will lose access to midwifery services. The clinic is planning to end the prenatal program because it has become too expensive.Specifically, North Central says it is too expensive to renew their

Wednesday, August 12, 2009

New review regarding the benefits of Fish Oil!

On August 3, 2009 the Journal of the American College of Cardiology published a paper reviewing the evidence of the benefits of fish oil or Omega-3 polyunsaturated fatty acids (PUFAs).

The findings support the use of fish oil for everyone- not just heart patients! The evidence supports that fish oil prevents as well as treats cardiovascular disease. Fish oil has been found to prevent heart failure as well as decrease hospitalization and death in both heart failure and post-MI patients. It has shown to reduce arrhythmias as primary and secondary prevention- particularly in atrial fibrillation (AF). Fish oil also helps to prevent atherosclerosis and there is data to suggest it helps in hyperlipidemia.

The optimal dose of fish oil- as measured by EPA/DHA is at least 500 mg per day for prevention and 800-1000mg per day for those with known heart disease. This can be accomplished with supplements or eating fatty fish such as salmon, tuna, mackerel, or sardines. Healthy persons would need 2 servings per week while heart patients would require 4 or 5 fish servings per week.

Further study is needed to determine optimal mix of EPA to DHA and mechanisms of action in arrhythmias, atherosclerosis and primary myocardial disease. The abstract of the paper is free at and a synopsis of the article is available at the then go to heartwire( you must sign in for a free membership) to access the article dated 8/10/09.

Save the date! Improving Quality of Life for Orphans and Vulnerable Children in Haiti

This lecture is part of the College of Nursing's 15th Annual Health & Human Values Lecture Series: Promoting Human Dignity Throughout the Lifespan

Date: Monday, September 21, 2009
Time: 7:30 PM
Location: Driscoll Hall Auditorium

Leonardo Shamamba, MD
HIV and AIDS Reach Out CoordinatorCatholic Relief Services, Port -Au-Prince, Haiti

Dr. Leonardo Shamamba, a gynecologist/obstetrician, has been working in the HIV/AIDS field throughout his career. Before becoming the HIV and AIDS Reach Out Coordinator in Haiti for Catholic Relief Services (CRS) he successfully developed similar programs in Uganda, Somalia and his native Democratic Republic of Congo. While progress has been made for clinical care and treatment of HIV in Haiti, disparities between institutional and community services limit the effectiveness of care. CRS addresses these challenges with a Community Support and Care Program by reinforcing community personnel capacity to address psychosocial, educational, economical, professional, and basic physical needs of people living with HIV/AIDS and orphans and vulnerable children.

In collaboration with Catholic Relief Services

For more information about the lectures, directions, or to be added to the mailing list, call the College of Nursing at (610) 519-4900.
All lectures are held at Villanova University and are free and open to the community.

More info at:

Contact Information: Louisa Zullo 610.519.4930

Research Abstract and Commentary: Topical Opioids

Effectiveness of Topical Administration of Opioids in Palliative Care: A Systematic Review [Authors' Abstract].
The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. This systematic review aimed to assess the quality of published literature and to examine whether topical opioids are effective in controlling pain in palliative care settings. After a systematic literature review, 19 studies (six randomized controlled trials [RCTs] and 13 case reports) met the inclusion criteria for the review. Eighteen studies favored topical opioids in pain relief, as evidenced by reductions in post-treatment pain scores, but time to onset and duration of analgesia varied widely. Because of the heterogeneity of the studies, meta-analysis was not possible. Despite clear clinical benefits described in small RCTs, there is a deficiency of higher-quality evidence on the role of topical opioids, and more robust primary studies are required to inform practice recommendations. N-of-1 trials should be encouraged for specific clinical circumstances.

LeBon, B., Zeppetella, G., & Higginson, I. J. (2009). Effectiveness of topical administration of opioids in palliative care: a systematic review. Journal of Pain & Symptom Management, 37, 913-7.

Commentary by Dana Rutledge

The clinical problem of painful skin and mucosal lesions is a challenge in all settings, but particularly in palliative care where systemic opioids may not be sufficient for pain relief or where patients may resist systemic opioids due to unfavorable side effects. This systematic review used the Centre for Evidence-Based Medicine methods, and was done appropriately, although the last search for primary studies was done in August 2006 and the publication date is May 2009 (a long window of time for newer studies to have been published).
Findings showed that topical opioids were used for both malignant and nonmalignant wounds as well as oropharyngeal mucositis. Applications for skin wounds were 1-6 times daily and every 2-3 hours for mouthwashes. Opioids were administered in a variety of carriers (e.g.., hydrogel). The primary finding was pain relief following use of topical opioids. Secondary findings indicated that 0.1% diamorphine (heroin) led to pain relief in one hour with duration between 24 and 48 hours, while topical morphine relieved pain immediately to 60 minutes after administration and lasted 2 to 45 hours in ulcers and one to four hours in mucositis.
Scarce reports were found related to adverse effects. Primarily reported were local effects such as itching, burning, and discomfort. Possible administration problems existed with exudates and possible tolerance with prolonged usage.
Due to the intrinsic difficulties with studies in palliative care patients (heterogeneity, low recruitment, high drop out rates), the authors recommended N of 1 trials. In N of 1 trials, a single subject receives a treatment or placebo in a randomly assigned order; data are collected on outcomes to determine effect in this one patient. For example, a palliative care patient with a wound might be set up to receive 6 days of treatment (3 days of a topical opioid/3 days of placebo; order determined in a random manner) with pain monitored carefully for severity, onset of pain relief, adverse effects etc.

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Tuesday, August 11, 2009

Fellow Fossils

Oh, I almost forgot... this week I've met several people who are 29 and 30 who seem awesome. Yay!

And frankly, while everyone does seem very young... I haven't met anyone who I felt was immature or didn't deserve to be here. In fact, there are some pretty interesting people in class.

A Big Decision

So I haven't mentioned this before because I don't want to be a drama junkie... but it's finally come to the point where I can't keep it a secret anymore. I might have to involve the school... I'm not sure.

I had a little "situation" in my life about a year ago. Essentially (without giving away all the details), a contractor that I hired to work on my home went nuts and murdered another man that was working on my home (not AT my home, thankfully). Depending on the circumstances, this might not be a big deal... but it is in this situation for three reasons.

1. My house was demolished, and the person who was supposed to rebuild it was put into jail. Hence why I am now rebuilding my house with my boyfriend.

2. The nut job contractor actually used ME (and boyfriend) as an alibi for his "self defense" defense

3. I am now being asked to testify in the murder trial because clearly I have an important piece of information that disproves the defense.

So the big problem is that this trial is coming up SOON.. and I just started med school, dammit. This guy has already messed up SO much of my life that I don't want to get behind because of his stupid trial. At the same time, I feel socially responsible for testifying to keep this maniac in prison.... I'm really at a loss. This really affected my life for a long time, and I feel like I'm just now starting to put things back in order... and here comes the DA, now calling me every night. What to do, what to do?

Hmmm... maybe I'm not the idiot

So today I found out that our lab groups were specifically designed. Essentially one "more experienced" person (whatever that means) was assigned to be in the group with the younger folk. So I guess that's me. Hey, at least I'm the oldest for a reason... other than just being old.

Washington State Stacks Financial Incentives in Favor of Vaginal Birth

The state of Washington is taking an innovative step toward tackling rising cesarean section rates by eliminating the profit motive. Beginning this month, the state’s Medicaid reimbursement for uncomplicated cesarean sections dropped from approximately $3,600 to about $1,000—the same reimbursement provided for complicated vaginal birth.Because the cost of vaginal birth is lower than the cost of

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Monday, August 10, 2009

Age of Tankmates 21, 21, 22, 23, 23, and me

My lab group works well together and everyone seems competent, prepared and pretty cool overall... so needless to say I'm MUCH happier today with Anatomy lab #2, knowing that I have a strong group. Not to mention, everybody seems surprisingly tolerant of the fact that I am really not particularly stoked about sawing up human bodies. Additionally, the body dried out a little bit so it was a bit less juicy... and "flinging" was kept to a minimum. Perhaps these don't seem like very significant events, but my lab experience was immeasurably better this go around. Minus the smell of dead rotten cadaver, of course.

I wish I could say the same for the rest. I met with E last night and she helped me out with a few tips. Up until now I'd been listening to my nuts Colombian physician boyfriend who had to take anatomy for two years and was required to know every placement of every amino acid in the human body. Needless to say, he stressed me out little bit unnecessarily (I still love you baby, and thanks for all your help).... E got me on the right page... and essentially said we were just responsible for knowing what we'd been over in class. It's still a lot, folks, so that's not much of a reconciliation... But at least I haven't considered dropping out of med school... today anyway.

Saturday, August 8, 2009

Anatomy. They don't call it gross for nothin'

I knew it was going to be bad. But I'd been trying to Buddha Zen Meditate Woosah myself into believing it wouldn't be so bad for weeks. I expected to feel kinda grossed out... but assumed I'd get over it quickly.

So we get the tank and everybody places bets on whether we have a male or female. Losers buy the winners drinks. I call female and we win. Yay! Best part of the experience is over.

So we have an old lady. Nice little old lady I'm sure. But upon the first few cuts we realize she has a lot of fat. Everywhere. She doesn't seem too fat, but there is fat piling up everywhere. We're starting with the back muscles, and one girl is dissecting the left side. And folks, she is REALLY into this. She is literally flinging cadaver slop everywhere... and I have to ask her several times not to fling on me. She actually has a piece on her face!!! And its all over her scrubs, and she is pushing her hair out of her face with her gloves. I was traumatized.

And did I mention the smell? I guess I don't have to. I'm sure you can imagine. Well, to say the least I didn't cut very much... I tried to... but I think it's going to take me a little while to get used to all of this. At one point I must have looked like I was going to pass out, because everybody looked really nervous and kept asking me if I wanted to sit down. I must have been green because I wasn't actually saying anything.

Well, I guess I'll have 3 labs per week until Thanksgiving to get over it. One down, like 65 to go. Crap.

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Friday, August 7, 2009

Wilmington (NC)Women Ask, “Where’s My Midwife?”

Women receiving prenatal, postnatal, and routine gynecologic care at Carolina OB/GYN in Wilmington, NC, were surprised last week to find that midwifery services were eliminated from the practice. Patients were told to reschedule their visits with an obstetrician instead. Due in part to restrictive state laws governing midwife-physician collaboration, this change leaves local women seeking

Thursday, August 6, 2009

Panic, Anxiety, Stress, Nausea, Holy crap... what did I get myself into??

Ok, it's the end of day 2 of classes and I cannot believe what I have got myself into. Studying hard. Will write more later as soon as I have time... but I wanted you all to know that I haven't forgotten about you. This week has been nuts to say the least.... for the following reasons:

1. I feel really old, and my class is young. Previous years the average age at my school was 25, this year it is 23. Even the anatomy professor stood up and said the class looked like high school students. Guess that's a compliment for me? Anyway, I think normally I am a very social person... but I really haven't felt like getting to know anyone yet. I'm feeling massive uneasiness, and a general all around sense of anxiety... not to mention lonely and a bit of an outsider (which I'm not used to!)

2. NOBODY explains anything in med school. They give a partial lecture for a class, with no accompanying reading or anything. You don't have a set booklist... just a bookstore that carries 20 embryology books, 30 anatomy books, 15 biochem books, etc. You are supposed to go through the books and see which ones YOU like... then buy a selection of books so you can learn the topics the class requires... which is very ambiguous and very nerve-wracking. There is no clear plan to prepare for anything. Overall I'm very confused.

To say the least I am panicking. What the hell have I done? Am I crazy? Did I make a HUGE mistake? All these years??? The material seems cool, the professors are good, I like the clinical correlations.... but I am so confused and over my head. Ok, will post again soon!

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Tuesday, August 4, 2009

The Real Risk of Late Prematurity

A study in the August 2009 issue of Obstetrics and Gynecology shows that late prematurity is an independent risk factor for neonatal morbidity. For those of us who aren’t women’s health experts, that means babies born between 34 and 37 weeks of pregnancy are at greater risk for health problems than babies born on or after week 37. Midwives already know that late prematurity puts babies at risk

Monday, August 3, 2009

A Wonderful, Wonderful Day!

So today was the day! My White Coat Ceremony. My family came into town and we made a weekend out of it. Yesterday I took a bus tour around the city to see six different community health clinics and centers that we will be working at... then I met my family (and everyone else's family) at the city park for a beautiful summer BBQ. The food was great, and I got to introduce my family to the Deans as well as to southern pulled pork sandwiches.

Then today we met up extra early for breakfast (I actually succeeded in not spilling coffee all over my outfit)... then headed over to the Hilton for the ceremony.

It was nice overall, but the Dean unexpectedly asked us to say one word that describes what brought us to this university to study medicine. Everybody was kinda freaked out, because the people ahead kept taking all the words. There are a lot of words in the english dictionary, but today I swear there were only about 80. Everyone ahead of me took my ideas... Adventure, Humanity, Exploration, so when it got to my turn I settled on Discovery. What other words did I hear? Caffeine, Luck, Stick-to-it-ive-ness, Bribes (?), and of course, Mom. I also got my white coat, which despite actually going in to try the sizes I somehow got stuck with a Medium (which I ordered) which I KNOW was actually an XXL (which I DID NOT order), and I was swimming in it. However, along with my white coat, I got an unexpected fabulous present. A Littman Stethescope... everyone got one as a surprise from the alumni association. Can you say A-W-E-S-O-M-E????? I was so excited during the ceremony that I could barely keep from bursting into tears of excitement.

Then after we went to lunch, and had so much fun. They still have 25 cent martinis... and needless to say we got a little silly with my parents and ate massive amounts of bread pudding.

White coat ceremony.... can't be beat!

ECG Nursing Lecture

This Nursing Lecture is about ECG or ElectroCardioGraph used in the study and diagnosis of diseases related to the Cardiovascular system.

It depicts and details the different ECG patterns.

Enjoy this nursing lecture.

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What does TM feel like?

I don't have MS but have TM (transverse myelitis), something related with many similar symptoms. Most people do not have a clue what it feels like or what I go through to get through a day. I walk with a cane and a full-length leg brace which while it allows me to walk also adds more weight and uses more energy.
I got this off another blog, it is not my own writing but I felt that it is accurate and worth sharing.

Another favorite of mine is the Spoon Theory, it can be found on this website:
Please read it too!

MS Symptoms - What It Feels Like

When we say we can't do something because we don't feel well, put yourself in our shoes by using the examples of our symptoms below---

What You Can do To Understand Painful Heavy Legs... Apply tightly 20 lb ankle weights and 15 lb thigh weights then take a 1 mile walk, clean the house, go shopping and then sit down - how ya' feeling now?

Painful Feet... Put equal or unequal amounts of small pebbles in each shoe then take a walk.

Loss of Feeling in Hands and/or Arms... Put on extra thick gloves and a heavy coat then try and pick up a pencil, if successful, stab yourself in the arm.

Loss of Feeling in Feet and/or Legs... Ask a doc for a shot of novocaine in both of your legs and then try and stand up and walk.

TN (Trigeminal Neuralgia). ..Take an ice pick and jam it into your ear or cheek whenever the wind blows on it, or a stray hair touches it. If you want something easier to do, get someone to punch you in the jaw, preferably daily.

Uncontrollable Itching... Glue or sew small steel wool pads to the inside of your shirt, pants and undergarments wear them for an entire day.

Tingling... Stick your finger in an electrical socket - preferably wet.

Tight Banded Feeling... Put 12 inch wide belt around you and make is as tight as you can and leave it there for the entire day.

Shots... Fill one of our spare needles with saline solution and give yourself a shot every time we do our shot.

Side Effects From the Shot... Bang your head against a wall, wrap yourself in a heating pad, wrap your entire body with an ace bandage tightly then finally treat yourself to some spoiled food or drink.

Trouble Lifting Arms... Apply 20 LB wrist weights and try and reach for something on the highest shelf in your house.

Spasticity... Hook bungee cords to your rear belt loops and rear pant leg cuffs then for your arms hook bungee cords to your shirt collar and cuffs on shirt sleeves then go dancing.

Poor Hearing/Buzzing in Ears...Put a bee in each ear and then put a plug in each one...bzzzzzzzzzzzzzzzzzz

Balance and Walking Problems... Drink 100 proof grain alcohol and then sit and spin in an office chair for 30 minutes, now try and walk.

Urgently Needing to Pee... We put a .5 liter remote controlled water bag and drip tube in your pants, we point out 2 restrooms in a crowded mall, then we tell you that you have 30 seconds before we activate the water bag (by remote control) to get to a restroom. Just for spite we may make that 20 seconds without telling you.

Bizarre and Inexplicable Sensations... Place tiny spiders on your legs or arms and allow them to periodically crawl around throughout the day.

Pins and Needles... Stab yourself repeatedly with needles all over your body or better yet....Get a large tattoo.

Dizziness (Vertigo)... Get on a gently rocking boat all day and all night and take several walks around the deck.

Fatigue... Stay awake for two full days to induce incredible fatigue and then cook dinner, clean the house, walk the dog and see how you feel.

Bowel Problems... Take a 4 day dose of an anti-diarrhea medicine followed directly by a 3 day dose of stool softeners for a minimum of 3 weeks, at the end of 3 weeks sit down on a hard uncushioned chair and stay there till tears appeared.

Burning Feeling... Make a full pot of boiling water and then have someone fill a squirt gun with the boiling water and shoot it at yourself all day long. However, you can give us the pleasure of shooting you instead...optional of course.

Intention Tremor... Hook your body to some type of vibrating machine try and move your legs and arms.....hmmm are you feeling a little shaky?

Buzzing Feeling When Bending Our Heads to Our Chest (L'Hermitte's)... Place an electrical wire on your back and run it all the way down to your feet, then pour water on it and plug it in.

Vision Problems (Optic Neuritis)... Smear vaseline on glasses and then wear them to read the newspaper.

Memory Issues... Have someone make a list of items to shop for and when you come back that person adds two things to the list and then they ask why you didn't get them. When you come back from shopping again they take the list and erase three things and ask why you bought those things.

Foot Drop... Wear one swim fin and take about a 1/2 mile walk.

Depression... Take a trip to the animal shelter everyday and see all the lonely animals with no home. You get attached to one of the animals and when you come back the next day you come in while they are putting her/him asleep.

Fear... Dream that you have lost complete feeling in your feet and when you wake up wiggle your feet, just so happens they don't move. Think about this every night wondering whether something on your body won't work the next day.

Swallowing... Try swallowing the hottest chili pepper you can find.

Heat Intolerance or Feeling Hot When it's Really Not... You are on a nice vacation to Alaska. It's 35° outside and 65° inside. Light a fire for the fireplace and then get into it. Once you have reached about 110° tell me how you feel, even a person without MS would feel bad, now add all of the above symptoms - welcome to our world.

And Finally... After subjecting yourself to the items above, let everyone tell you that you are just under a lot of stress, it's all in your head and that some exercise and counseling is the answer.

New Cochrane study: Reducing blood pressure below 140/90 brings no clinical benefit

Cochrane reviews are considered by most to be the Gold standard in evidence based medicine. This resource is updated every three months and now has nearly 20,000 voluntary reviewers. As such, the Cochrane systematic reviews have a well deserved global reputation. One of the newest reviews that is getting a lot of press is Treatment blood pressure targets for hypertension. This study is particularly important as so many guidelines are recommending even lower blood pressure targets. The summary in this review states: "Main results No trials comparing different systolic BP targets were found. Seven trials (22,089 subjects) comparing different diastolic BP targets were included. Despite a -4/-3 mmHg greater achieved reduction in systolic/diastolic BP, p<>Authors' conclusions .Treating patients to lower than standard BP targets, ≤140-160/90-100 mmHg, does not reduce mortality or morbidity. Because guidelines are recommending even lower targets for diabetes mellitus and chronic renal disease, we are currently conducting systematic reviews in those groups of patients. "
SJO/CHOC library users can access the full Cochrane report through the library's web site: