News for today's 2018

Bayer aspirin: How a struggling painkiller was reborn as a heart medicine and earned billions for Bayer. - Slate Magazine

10:29 AM Tukiyooo 0

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Say you have a headache. Your fever's rising. Your back is aching. What do you take? Probably ibuprofen (<a href="http://www.amazon.com/gp/product/B000O7UBGC/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B000O7UBGC&linkCode=as2&tag=slatmaga-20" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Motrin</a>, <a href="http://www.amazon.com/gp/product/B00475J0YQ/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B00475J0YQ&linkCode=as2&tag=slatmaga-20" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Advil</a>), maybe acetaminophen (<a href="http://www.amazon.com/gp/product/B003D7KPJI/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B003D7KPJI&linkCode=as2&tag=slatmaga-20" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Tylenol</a>), possibly naproxen (<a href="http://www.amazon.com/gp/product/B00008PW1R/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B00008PW1R&linkCode=as2&tag=slatmaga-20" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Aleve</a>). Together, those drugs comprise nearly four-fifths of the $2 billion-plus over-the-counter pain relief market, prospering from aggressive ad campaigns and cheap manufacturing costs.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">But say you're having a heart attack. What do you take now?</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">If you've been listening to the advice of medical professionals for the past few decades, you'll pop an aspirin while you wait for the ambulance. And if you've been listening closely, you've already been taking it every day. Aspirin's benefit to heart-attack victims is common knowledge these days, while its effectiveness as a painkiller, or analgesic, is increasingly overlooked.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">That's no problem for <a href="http://www.amazon.com/gp/product/B001LFG0OI/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B001LFG0OI&linkCode=as2&tag=slatmaga-20" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Bayer</a>, aspirin's first modern manufacturer, which has rebranded its product as a "<a href="http://www.wonderdrug.com/" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Wonder Drug</a>" and made it a staple for aging baby boomers across the Western world. The rebranding triggered a remarkable resurgence for the company whose signature product once appeared doomed.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Aspirin as a painkiller is old news. The ancient Egyptians wrote of the medical benefits of willow in the <a href="http://en.wikipedia.org/wiki/Ebers_Papyrus" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Ebers Papyrus</a>, a text sold to an American antiques dealer by grave robbers in 1862. Willow contains salicylate, a key aspirin component, and the Egyptians had probably learned to use it as a salve and a tonic (although their preferred pain relief method was getting drunk). A few thousand years later in the mid-18th century, the English Rev. Edward Stone rediscovered willow's healing powers but failed to bring his finding to a wider audience. It wasn't until the late 1890s that a small German drug and dye factory called Bayer properly synthesized aspirin's various ingredients into a single drug. (Bayer faced stiff competition from another extremely popular new pain reliever called heroin.)</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Eventually Bayer secured international patents for aspirin, shipping the product across the globe and turning a massive profit. But their patents were dissolved in Britain and Australia during World War I, opening up the market to a glut of generic competitors. This wasn't the only challenge posed to aspirin by the war, as Diarmuid Jeffreys recounts in <em style="margin: 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; font-style: italic; "><a href="http://www.amazon.com/gp/product/1582346003/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=1582346003&linkCode=as2&tag=slatmaga-20" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Aspirin: The Remarkable Story of a Wonder Drug</a></em>. Facing a British embargo of phenol, a necessary ingredient of aspirin, Bayer nearly ceased production of aspirin in its German factories. Confronting pharmaceutical catastrophe, the German government covertly deployed a former Bayer employee to the United States to buy surplus phenol from the country's most prolific producer of the chemical, Thomas Edison. The <a href="http://en.wikipedia.org/wiki/Great_Phenol_Plot" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">Great Phenol Plot</a> was exposed and the brand's reputation was ruined in America. Soon after, the U.S. government snatched Bayer's American holdings, nullified its patents and trademarks, and sold everything to Sterling Products, who owned the company's American branch until 1994.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">The German branch of Bayer, Bayer AG, survived the war only to be bought up by the mega-corporation IG Farben in 1925. The corporation was dissolved in 1952 after many of its leaders were convicted of war crimes. Its factories—run by slave laborers—had produced the Zyklon B used to kill Jews in concentration camps. Bayer AG endured the dissolution of its parent company only to find itself steadily losing its market shares to new painkillers acetaminophen and ibuprofen. After surviving two world wars, the brand faced death at the hands of the free market.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Then a small miracle occurred: In the late 1960s, two British medical researchers, John O'Brien and Peter Elwood, uncovered studies by John Vane and Harvey Weiss suggesting that aspirin could improve heart health. Intrigued, O'Brien and Peter developed a theory that aspirin could prevent blood platelets from clumping up around the heart. These clumps are liable to burst, allowing blood clots to form and prevent blood flow to heart, causing a heart attack. By preventing these clots from forming, O'Brien and Elwood postulated, aspirin enables blood flow to the heart to remain steady, seriously reducing the risk of heart attack. In several medical trials, the researchers proved that a daily dose of aspirin taken by a heart attack survivor significantly decreases his risk of a second attack, confirming their hypothesis.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">The small sample size of their study cast doubt on its conclusions. In 1980, however, a British statistician named Richard Peto published a meta-analysis with apparently irrefutable evidence that aspirin had a positive effect on the heart, at least in male patients.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Bayer took note. By this point, Bayer Aspirin's pain relief market share was hovering at around 6 percent, a precipitous drop from its former dominance. Bayer's parent company in the United States, Sterling Products, jumped at the chance to rebrand its product as a vital tool in the fight against heart attacks. In 1983, Sterling lobbied the FDA for the ability to advertise aspirin's cardiovascular benefits on the product's labels. The company won the battle and soon began to rebrand its product as a life saver. Soon after, a slew of studies suggested that an aspirin a day could prevent the first occurrence of a heart attack—not only a second—and that an aspirin taken during a heart attack increases the victim's chance of survival. Other researchers demonstrated aspirin's effectiveness in preventing strokes, inhibiting blood clots from blocking blood to the brain. Aspirin was no longer limited to the pain relief market. It had become a market all its own.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">Bayer's profits have risen accordingly. In 1994, the German branch of Bayer bought back its American holdings from Sterling Products for $1 billion, uniting the company for the first time since World War I. In 2011, the company <a href="http://economictimes.indiatimes.com/news/international-business/bayer-confident-after-nearly-doubling-profits-in-2011/articleshow/12068402.cms" target="_blank" style="color: rgb(86, 129, 140); text-decoration: none; ">doubled its profits</a> from the previous year, to $3.3 billion.</div></div><div class="text parbase section" style="margin: 1.5em 0px; padding: 0px; border: 0px; font-size: 12px; font: inherit; vertical-align: baseline; color: rgb(0, 0, 0); font-family: verdana, sans-serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-size: 12px; font: inherit; vertical-align: baseline; ">For a company nearly left for dead three times in a century, that's an impressive comeback.</div></div></div><a href="http://www.slate.com/articles/business/the_pivot/2012/10/bayer_aspirin_how_a_struggling_painkiller_was_reborn_as_a_heart_medicine_and_earned_billions_for_bayer_.html?">http://www.slate.com/articles/business/the_pivot/2012/10/bayer_aspirin_how_a_struggling_painkiller_was_reborn_as_a_heart_medicine_and_earned_billions_for_bayer_.html?</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Bayer aspirin: How a struggling painkiller was reborn as a heart medicine and earned billions for Bayer. - Slate Magazine

Say you have a headache. Your fever's rising. Your back is aching. What do you take? Probably ibuprofen ( Motrin , Advil ), maybe aceta...

Institute for Healthcare Improvement

10:28 AM Tukiyooo 0

Institute for Healthcare Improvement

The Institute for Healthcare Improvement (IHI) believes that everyone deserves safe and effective health care, and we have been working with...

Institute of Medicine - National Academy of Sciences

9:51 AM Tukiyooo 0

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. <br /><br><br /><br>The IOM asks and answers the nation's most pressing questions about health and health care.<br /><br><br /><br>Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. Each year, more than 2,000 individuals, members, and nonmembers volunteer their time, knowledge, and expertise to advance the nation's health through the work of the IOM.<br /><br><br /><br>Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While our expert, consensus committees are vital to our advisory role, the IOM also convenes a series of forums, roundtables, and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking.<br /><br><br /><br><a href="http://www.iom.edu/">http://www.iom.edu/</a>

Institute of Medicine - National Academy of Sciences

The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authorita...

The Things We Carried, Then and Now - NYTimes.com

5:48 AM Tukiyooo 0

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div id="well" style="color: rgb(0, 0, 0); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div align="left"><h3 class="entry-title" style="color: rgb(0, 0, 0); margin: 0px 0px 12px; padding: 0px; font-size: 16px; ">The Doctor's Bag for the New Millennium</h3><address class="byline author vcard" style="font-weight: bold; font-size: 0.829em; margin-bottom: 12px; display: block; font-family: arial, helvetica, sans-serif; ">By <a href="http://well.blogs.nytimes.com/author/abraham-verghese/" class="url fn" title="See all posts by ABRAHAM VERGHESE" style="color: rgb(0, 0, 102); text-decoration: none; text-transform: uppercase; ">ABRAHAM VERGHESE</a></address><div class="entry-content"><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">When I was a medical student in Madras, India, in the late 1970s, my uncle, a retired physician, still made occasional house calls. In his early years he delivered babies in dimly lighted huts, often resorting to high forceps on the head - something that is rarely done now. His compounder - the man who would compound his prescription of mistura carminativa and dispense it in corked glass bottles - carried my uncle's medical bag. It was almost like a trunk - a mobile office. The compounder became so experienced from watching my uncle that he secretly began a practice of his own, delivering babies and even applying forceps.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">My uncle's doctor's bag from his halcyon days was long gone by the time I was a medical student staying in his house; it had been replaced by a newish model, a small tan suitcase with square corners and latches on the top. When it was opened, two shelves magically unfolded. The medicinal odor that emanated was so powerful it could deliver a buzz.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">One shelf held the sterilized syringes, needles, cotton swabs and alcohol that were the bread and butter of a doctor's trade in India - every patient wanted an injection, and doctors were destined to disappoint if they didn't oblige. The other shelf held ampules of adrenaline, Coramine, theophylline and other emergency medications as well as rows of bright orange vitamin B12 ampules - a dramatic injectable placebo.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">The bottom of the bag was stuffed with bottled medications, a blood pressure cuff and instruments that my uncle rarely used: Foley catheters, hemostats and the like. I had carried that bag for him more than once and been there when he jabbed adrenaline into a desperately wheezing patient and produced immense relief.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">A few years later, when I was an intern in Tennessee, my attending physician and mentor, Steven Berk, carried a leather doctor's bag, one he had toted around since his medical school days. His bag, unlike my uncle's, was small - the size of a loaf of bread, or perhaps a bit bigger - just enough to carry his ophthalmoscope, blood pressure cuff, reflex hammer and a few other things. It was well worn.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">The bag became a fetish for me. It embodied all the qualities I admired about the man: He was a careful listener, and he examined patients thoroughly and well. In the Mountain Home Veterans Hospital in Tennessee, which had a large domiciliary and nursing home population, he made original observations about pneumonia in the elderly and became a pioneer in the field.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">When I became Dr. Berk's chief resident, three years later, I bought a similar bag even though it was prohibitively expensive on a resident's salary. Mine was stiff, and despite lots of rubbing with neatsfoot oil it remained hard and unyielding.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">A year later, in 1983, I was a fellow in infectious diseases at Dr. Berk's alma mater, Boston University and Boston City Hospital. I noticed that in Boston the doctors who carried bags were a shrinking minority - often older, and often the best physicians. Neurologists favored them - more tools to carry, I presumed. Medical students were no longer routinely buying doctor's bags. I stopped carrying mine; my white coat held most of what I needed, and now that ophthalmoscopes came in penlight size, or were mounted on walls, I had eliminated the bulkiest item I needed to carry.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">I never got rid of my doctor's bag. Inventorying its contents recently, it was as if I were gazing into a diorama from the early '80s: eye drops to dilate the pupil, prescription pads, a pocket EKG book and EKG calipers, pens, measuring tape, penlights, laminated cards with algorithms on them for various conditions - and everything, of course, with a pharmaceutical company logo on it; no one felt compromised by that sort of stuff.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">As the years have passed, I now find myself in a minority of physicians who wear white coats. For those who do, the coat is not a repository of instruments, but a ceremonial robe.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Not so for me; my coat bulges with what I carry: a Queen Square reflex hammer with a bamboo stem (given to me by the widow of my medical school professor who read something I wrote in Granta about her late husband and the way he brandished that hammer; she arranged to meet in a London train station to present it to me), a stethoscope (a bulky, three-headed monster made by Tycos that I love), a tuning fork (frequency of 128 to test vibration), a magnifying glass (to study nail fold capillaries), an Optyse pocket ophthalmoscope, a penlight, a pocket Snellen eye chart, tongue depressors, hand gel, triplicate prescriptions, laminated billing and coding guides, packets of chewing gum....</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">The coat must weigh at least five pounds. But as a believer, I must walk the talk, carry the tools. I believe that a good bedside examination of a hospitalized patient has a high diagnostic yield: It can reveal the more obvious diagnoses and can guide judicious use of subsequent blood and imaging tests. But the exam also is a ritual, an important one, which when done well validates the patient's complaints and places its locus on the body, and not on a computer screen.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Recently, two of my colleagues at Stanford, John Kugler and Errol Ozdalga, who work with me in what we call the "bedside medicine group," persuaded me to add three tools to my armamentarium.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Dr. Kugler taught me to use a Vscan: a pocket ultrasound machine, which allows a great view of the heart, and adds volumes to what the stethoscope can discern. Dr. Ozdalga taught me to use the PanOptic ophthalmoscope, an instrument that looks a bit like a large revolver; it allows a beautiful view of the retina, and especially its blood vessels, far better than my conventional ophthalmoscope. One look in an eye and I have a sense of the status of the arteries in the kidney, the heart. The PanOptic can also be hooked up to an iPhone to take great pictures.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">The third tool I carry around is an iPad: It is a great way to demonstrate anatomy to patients, to take pictures and to pull up videos on <a href="http://stanfordmedicine25.stanford.edu/" style="color: rgb(0, 0, 102); text-decoration: none; ">a Web site that Dr. Ozdalga has developed,</a> which teaches and reinforces for residents and students specific techniques for examining patients: <a href="http://stanfordmedicine25.stanford.edu/" style="color: rgb(0, 0, 102); text-decoration: none; ">http://stanfordmedicine25.stanford.edu</a>.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Carrying these three new additions can cramp my fingers, and it is not always easy to find a place to set these down when examining a patient.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">Dr. Kugler showed me his modified messenger bag in which he carries his instruments. I've seen similar models made by Chrome, Vega and Eagle Creek - and I've just placed my order. I will soon be able to unburden my coat pockets.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">As technology advances and gets more portable, I see us bringing more tools to the bedside, and therefore spending more time with patients, instead of sending them hither and thither to diagnostic suites. The more time with the patient, the better.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; ">This is how you will know us, the doctors of the next millennium: by the things we carry.</div></div></div></div></div><a href="http://well.blogs.nytimes.com/2012/10/08/the-doctors-bag-for-the-new-millennium/">http://well.blogs.nytimes.com/2012/10/08/the-doctors-bag-for-the-new-millennium/</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

The Things We Carried, Then and Now - NYTimes.com

The Doctor's Bag for the New Millennium By ABRAHAM VERGHESE When I was a medical student in Madras, India, in the late 1970s, my uncle,...

Mobile Devices 'On Call' in Hospitals - Video - NYT

5:42 AM Tukiyooo 0

Mobile Devices 'On Call' in Hospitals - Video - NYT

At hospitals around the country, mobile devices, including smartphones and tablet computers, are becoming critical to efficient and precise ...

Redefining Medicine With Apps and iPads - The Digital Doctor - NYTimes.com

5:40 AM Tukiyooo 0

<base href="data:"><nyt_text style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div id="articleBody"><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">As a third-year resident in internal medicine, Dr. Rajkomar was the senior member of the team, and the others looked to him for guidance. An infusion of saline was the answer, but the tricky part lay in the details. Concentration? Volume? Improper treatment could lead to brain <a href="http://health.nytimes.com/health/guides/symptoms/swelling/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Swelling." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">swelling</a>, <a href="http://health.nytimes.com/health/guides/symptoms/seizures/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Seizures." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">seizures</a> or even death.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Rajkomar had been on call for 24 hours and was exhausted, but the clinical uncertainty was "like a shot of adrenaline," he said. He reached into a deep pocket of his white coat and produced not a well-thumbed handbook but his <a href="http://topics.nytimes.com/top/reference/timestopics/subjects/i/iphone/index.html?inline=nyt-classifier" title="Recent and archival news about the iPhone." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">iPhone</a>.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">With a tap on an app called MedCalc, he had enough answers within a minute to start the saline at precisely the right rate.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The history of medicine is defined by advances born of bioscience. But never before has it been driven to this degree by digital technology.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The proliferation of gadgets, apps and Web-based information has given clinicians — especially young ones like Dr. Rajkomar, who is 28 — a black bag of new tools: new ways to diagnose symptoms and treat patients, to obtain and share information, to think about what it means to be both a doctor and a patient.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">And it has created something of a generational divide. Older doctors admire, even envy, their young colleagues' ease with new technology. But they worry that the human connections that lie at the core of medical practice are at risk of being lost.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"Just adding an app won't necessarily make people better doctors or more caring clinicians," said Dr. Paul C. Tang, chief innovation and technology officer at Palo Alto Medical Foundation in Palo Alto, Calif. "What we need to learn is how to use technology to be better, more humane professionals."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Paul A. Heineken, 66, a primary care physician, is a revered figure at the <a title="Web site" href="http://www.sanfrancisco.va.gov/" style="color: rgb(102, 102, 153); text-decoration: none; ">San Francisco V.A. Medical Center</a>. He is part of a generation that shared longstanding assumptions about the way medicine is practiced: Physicians are the unambiguous source of medical knowledge; notes and orders are written in paper records while standing at the nurses' station; and X-rays are film placed on light boxes and viewed over a radiologist's shoulder.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">One recent morning, while leading trainees through the hospital's wards, Dr. Heineken faced the delicate task of every teacher of medicine — using the gravely ill to impart knowledge.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The team arrived at the room of a 90-year-old World War II veteran who was dying — a ghost of a man, his face etched with pain, the veins in his neck protruding from the pressure of his failing heart.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Heineken apologized for the intrusion, and the patient forced a smile. The doctor knelt at the bedside to perform the time-honored tradition of percussing the heart. "Do it like this," he said, placing his left hand over the man's heart, and tapping its middle finger with the middle finger of his right.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">One by one, each trainee took a turn. An <a href="http://health.nytimes.com/health/guides/test/x-ray-skeleton/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about X-ray - skeleton." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">X-ray</a> or echocardiogram would do the job more accurately. But Dr. Heineken wanted the students to experience discovering an enlarged heart in a physical exam.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Heineken fills his teaching days with similar lessons, which can mean struggling upstream against a current of technology. Through his career, he has seen the advent of CT scans, ultrasounds,<a href="http://health.nytimes.com/health/guides/test/mri/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about MRI." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">M.R.I.</a>'s and countless new lab tests. He has watched peers turn their backs on patients while struggling with a new computer system, or rush patients through their appointments while forgetting the most fundamental tools — their eyes and ears.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">For these reasons, he makes a point of requiring something old-fashioned of his trainees.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"I tell them that their first reflex should be to look at the patient, not the computer," Dr. Heineken said. And he tells the team to return to each patient's bedside at day's end. "I say, 'Don't go to a computer; go back to the room, sit down and listen to them. And don't look like you're in a hurry.' "</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">One reason for this, Dr. Heineken said, is to adjust treatment recommendations based on the patient's own priorities. "Any difficult clinical decision is made easier after discussing it with the patient," he said.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">It is not that he opposes digital technology; Dr. Heineken has been using the Department of Veterans Affairs' computerized patient record system since it was introduced 15 years ago. Still, his cellphone is an old flip model, and his experience with text messaging is limited.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">His first appointment one recent day was with Eric Conrad, a 65-year-old Vietnam veteran with severe <a href="http://health.nytimes.com/health/guides/disease/emphysema/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Emphysema." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">emphysema</a>. First came a conversation. Dr. Heineken had his patient sit on a chair next to his desk. Despondent, the patient looked down at his battered Reeboks, his breaths shallow and labored.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Heineken has been seeing Mr. Conrad since 1993, and since then, he said, "we've been fighting a saw-tooth battle with his weight."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In an instant, the computer generated a chart showing the jagged history of weight successfully gained, then lost. Dr. Heineken pivoted the computer screen so the patient could see a steady gain in recent months. "It's looking a lot better than it has," he said. Mr. Conrad's face brightened slightly.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Then Dr. Heineken turned his back to the computer and sat so close to the patient that they were knee to knee. Mr. Conrad drilled his gaze into his physician's eyes, looking for answers.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">It was not until Dr. Heineken was ready to listen to Mr. Conrad's lungs that he asked him to move to the examining table.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"I love him to death," Mr. Conrad said about Dr. Heineken. "He's right to the point, good news or bad news."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Thirty-eight years and a technological revolution separate Dr. Heineken from Dr. Rajkomar.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The son of an electrical engineer from Mauritius, Alvin Rajkomar grew up in Silicon Valley and taught himself to program at age 12. As an undergraduate at Harvard, he started out in physics but became hooked on medicine in Mauritius, where he spent a few days one summer shadowing his uncle, a physician at a community clinic.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"There were no fancy medications or procedures," he said. "Just the art of doctoring."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In 2009, in his third year of medical school at Columbia, he was among the first in the hospital to use an iPhone as a clinical tool. "Every time you looked something up you'd get scolded," he said. "At that point, people believed that if you had your phone out you weren't working."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Among the new crop of device-happy physicians, Dr. Rajkomar is now an elder statesman of sorts, showing trainees his favorite apps, along with shortcuts through the electronic medical record and computerized prescribing system.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">He stores every clinical nugget he finds on an application called Evernote, an electronic filing cabinet. "I use Evernote as a second brain," he said. "I now have a small textbook of personalized, auto-indexed clinical pearls that I carry with me at all times on my iPhone."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Along with MedCalc, the clinical calculator, Dr. Rajkomar's phone has ePocrates, an app for looking up drug dosages and interactions; and Qx Calculate, which he uses to create risk profiles for his patients. His favorite technology is his electronic stethoscope, which amplifies heart sounds while canceling out ambient noise.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Not that he is indiscriminate in his use of technology. When he decided the electronic health record was taking too long to load on his <a href="http://topics.nytimes.com/top/reference/timestopics/subjects/i/ipad/index.html?inline=nyt-classifier" title="More articles about iPad." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">iPad</a>, he went back to taking notes by hand, on paper. But he is experimenting with writing by hand on a Samsung mini-tablet.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">He is aware of the pitfalls of computerized records, particularly the "if the problem is X, then do Y" templates, which encourage a cut-and-paste approach to daily progress notes. While efficient, they can give rise to robotic bookkeeping without regard to how the patient is faring.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Tablet computers that are linked to electronic health records are making their way into the hands of medical trainees around the country. All internal-medicine residents at the University of Chicago and Johns Hopkins are given iPads; entering medical students at Stanford are given vouchers they can use to buy one.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">A <a title="Abstract study" href="http://archinte.jamanetwork.com/article.aspx?articleid=1108771" style="color: rgb(102, 102, 153); text-decoration: none; ">University of Chicago study</a> this year in Archives of Internal Medicine found that residents with iPads were able to enter orders in a more timely manner, and a majority of residents perceived that the iPads improved their work efficiency. At the U.C.S.F. Medical Center, some physicians use iPads, and many use one of the hospital's computers on wheels.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Rajkomar's outpatient clinic is four miles west of the U.C.S.F. hospital, at the San Francisco V.A., where he works down the hall from Dr. Heineken.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Where Dr. Heineken is competent with the V.A.'s electronic health record system, Dr. Rajkomar is a virtuoso, a Vladimir Horowitz of the computer keyboard. He can keep his eyes fixed so steadily on the patient that the typing goes all but unnoticed.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">As the conversation with the patient goes, so goes Dr. Rajkomar's interaction with the computer. Lab results? On the screen in a flash. A list of past and current medications and dosages? Voilà!</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Yet he also knows when the computer needs to be set aside. During a visit, when a patient confided that his wife was taking his pain medication, Dr. Rajkomar excused himself and walked down the hall to consult with the pharmacist about a plan to keep that from happening.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Rajkomar knows he has a great deal to learn about being a physician, especially patients' social and psychological complexities.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"One patient fired me," he said, smiling as he added, "Dr. Heineken gets those patients."</p><nyt_correction_bottom><div class="articleCorrection" style="margin-bottom: 2.8em; "></div></nyt_correction_bottom><nyt_update_bottom></nyt_update_bottom></div></nyt_text><span style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; "></span><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><span class="Apple-style-span" style="font-size: medium; "><a href="http://www.nytimes.com/2012/10/09/science/redefining-medicine-with-apps-and-ipads-the-digital-doctor.html?">http://www.nytimes.com/2012/10/09/science/redefining-medicine-with-apps-and-ipads-the-digital-doctor.html?</a></span></div><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Redefining Medicine With Apps and iPads - The Digital Doctor - NYTimes.com

Dr. Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling...

Enough for everyone's need but not everyone's greed

4:06 AM Tukiyooo 0

<blockquote class="tr_bq">"There's enough for everyone's need, not everyone's greed."<br />James Lee Adams, Sr., my grandfather</blockquote><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgasG-jGfsLOBcq6Bg8j-RxtFrHv3DOiUGLLrdM8vqzG0tZ0yhPEvk5imxwgMZ8RwI6P_SbK0gIu36mH2_XdGmb0hfm6nX0ZWX-DyXykRjI6-J7SMNkmbOGboX-3VONj7BoUfoGfd0ALiU1/s1600/bigstock-Large-And-Small-Goldfishes-Un-4084635.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="262" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgasG-jGfsLOBcq6Bg8j-RxtFrHv3DOiUGLLrdM8vqzG0tZ0yhPEvk5imxwgMZ8RwI6P_SbK0gIu36mH2_XdGmb0hfm6nX0ZWX-DyXykRjI6-J7SMNkmbOGboX-3VONj7BoUfoGfd0ALiU1/s400/bigstock-Large-And-Small-Goldfishes-Un-4084635.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Sometimes little fish need a chance.</td></tr></tbody></table><br />Greed is wanting more than you need.<br /><blockquote class="tr_bq">Websters says "<table class="ts" style="background-color: white; border-collapse: collapse; color: #222222; font-family: arial, sans-serif; font-size: small; line-height: 12.499999046325684px; text-align: left;"><tbody><tr><td style="padding: 0px;">Intense and selfish desire for something, esp. wealth, power, or food." </td></tr></tbody></table></blockquote>It is an insatiable desire to accumulate. I don't look down upon those who accumulate wealth and are successful. Greed is not synonymous with wealth, however. We see it in school.<br /><br />We should all be able to strive and succeed and benefit. The wealthy aren't necessarily greedy. There are those who are poor that can be greedy too.<br /><br />Someone poor could want to have what others have without working for it. Someone poor could be greedy to have the things that another earned. We can all be greedy for food or power.<br /><br /><h2>How does this relate to school?</h2><h3>Greed in the classroom.</h3><h4>Praise.</h4>I've seen some kids who are successful who cannot stand the idea of another child being recognized for anything. In fact, as I work to give honest praise, I might praise a child who doesn't usually get it and the child who gets a lot of praise will come to my desk later to point out something the other child did wrong. It is almost like the child who gets a lot of praise thinks there is a finite amount of praise. Greed for all the attention can cause fault finding and a desire to monopolize praise. Don't let it happen. This is often a problem for the academically successful. Don't let them be academically arrogant but inclusive of others, even those not as naturally gifted as themselves.<br /><br /><h4>Attention.</h4>Greed often happens with children who are ignored at home but misbehave in the classroom because it gives them the attention they crave. By monopolizing attention in the classroom, the student feels important. Being noticed in a bad way is better than being ignored to some students.<br /><br />Recognize this for what it is and intentionally give positive attention and notice when this is happening. If all of your time is being monopolized by one child, the child may have a need - yes, that is possible - but it is also possible that the child has a greed. A huge, insatiable desire for attention - whatever it takes. And it is often easier to get attention for bad behavior than good behavior.<br /><br /><h4>Conversation.</h4>Some students want to always be heard. The unwise teacher can think that because one or two students speak out and really get it, that everyone understands. This is a lie. Good teachers are good at bringing all students into the conversation. I set boundaries and have often used the poker chip example that I shared in <a href="http://coolcatteacher.blogspot.com/2012/10/10-ways-to-listen-more-talk-less-teach.html" target="_blank">10 Ways to Talk Less, Listen More, Teach Well.</a><br /><br /><h4>Food.</h4>Of course it can happen with food. There are hungry kids but there are also kids that want more than their fair share and will do whatever it takes to get the food of others.<br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbD9_9Kr0RpRdmJyqzg1mcbqIJWrjNfmmLtY_rjMUi3X85-iQfMh96zq7j7t9XixCn_oWIYlsOxv3hWBqVAYmregDe2YwqEjvCQdh4R3xRZwykcdMYtHreE7PEuRf38zpx3LbKlVoDQyuv/s1600/bigstock-Cheering-Crowd-25662716.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbD9_9Kr0RpRdmJyqzg1mcbqIJWrjNfmmLtY_rjMUi3X85-iQfMh96zq7j7t9XixCn_oWIYlsOxv3hWBqVAYmregDe2YwqEjvCQdh4R3xRZwykcdMYtHreE7PEuRf38zpx3LbKlVoDQyuv/s320/bigstock-Cheering-Crowd-25662716.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Greed for all the attention and credit can kill a sense of team.</td></tr></tbody></table><br /><h3>Greed on the sports field.</h3>Greed can happen on the sports field too. It destroys teamwork when one athlete, gifted though he/ she be, tries to gain more glory without giving respect and honor to the teammates and coach. <br /><br />Greed can happen when those teammates are jealous of the superstar, even if that superstar is humble.<br /><br /><h3>Greedy teachers?</h3>Greed can happen when I want a moment of peace but a child has a problem and really needs me. There is, however, a need to have a break sometimes. There are teachers who will NEVER give time before school, after school, or during break. "I need my time," they'll say. Well, my job is to teach and help students and when they miss school, I do often have to tutor before and after school. That is the life of a teacher.<br /><br />Some teachers want all of the attention and it upsets these teachers when others get praise. We all crave attention and to know we matter but there is no excuse. Rejoice when others have good things happen.<br /><br />Some want to believe they have all the problems in the world. No one has a life as bad as they do. As soon as one person has a problem, they're unloading their Uzi-machine-gun clip of problems ready to fire to prove they have the worst life. No explanation for this, but I've seen it. I've probably done it a few times when I was having a pity party but it is a form of greed.<br /><br />Never saying no can be a form of greed. We want to do everything for everybody. WE all have one thing in common... 24 hours. That is all. No more, no less. Sometimes we must say no so we can be honest and balanced.<br /><h3>Greedy parents?</h3>There is a greed when wealthy parents of children, try to exert their monetary influence on the school to also get their children undeserved accolades, positions, or preference.<br /><br />This requires firm administrators with ethics to stand against this. Sometimes these parents may not know they are doing it, but are just more vocal than most.<br /><h2>Finding the balance.</h2>Teachers are constantly balancing between greed and need. We need to be wise and discerning as often, we are the ones who must find fairness amidst the complexity of human behavior. <br /><br />Administrators need this fairness and balance as well.<br /><br /><h3>There's enough for everyone's need but not everyone's greed. </h3>Greed is destructive if left unchecked. The greedy child may not realize it is happening or what he/she is doing. You can help these situations in positive, encouraging ways by pointing out the value of everyone.<br /><br />I like to teach about brainstorming and group dynamics and point out that often students who are quiet have great things to add. Great leaders bring out everyone and don't monopolize the conversation or the project. <br /><br />Greed takes many forms and it isn't just money. It can be attention, resources, praise. Scarcity can also cause greed - if people think that not much praise will be doled out -- they may fight for what little they think there will be.<br /><br />Why not create a situation where praise is lavish, but honest? A place where fairness resides. I know this sounds like heaven on earth, and that it may not be possible, however, as teachers and administrators, we must clearly be aware of the greed/need balance as we help meet the needs of everyone while combatting greed that breaks down teamwork and harms morale.<br /><br />Now, I need to get to school -- and that really is a need.<br /><br /><i><b>PS. This applies more than ever in the #edreform and #ebook movements as well as the desire to inundate students with advertising messages wherever they are.</b></i><br /><br /><br />- Written on my iPad using Blog Press by Vicki Davis, author, Flattening Classrooms, Engaging Minds<br /><br />Photo Credit: <a href="http://www.bigstock.com/" target="_blank">Big Stock</a>, you may not reuse photos unless you license them directly on their website or you are breaking copyright law.

Enough for everyone's need but not everyone's greed

"There's enough for everyone's need, not everyone's greed." James Lee Adams, Sr., my grandfather Sometimes little fish...

gallery wall update courtesy of BirdAve

4:00 AM Anonymous 0

Hey all! The <a href="http://news-these-days.blogspot.com/2012/02/step-into-my-gallery.html" target="_blank">gallery wall</a> has gotten a spruce.<br /><br />I was lucky enough to win a print from <a href="http://www.birdave.com/" target="_blank">BirdAve Studio</a> via <a href="http://pawleysislandposh.blogspot.com/" target="_blank">Pawleys Island Posh</a> right before my vacation and I finally got around to hanging it up.<br /><br />It was hard to pick just one, and I'll definitely be getting more, but out of all the cities from all over the world I decided on Des Moines. Because of it's world class nightlife and excellent shopping of course. Actually it's where the hubs and I met (college) and it <i>is</i> a very happy place with very happy memories.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipMNIZgd1WvviTvfrTgCo-NYjcDHru7djndp_UhvFmlYiyoQpNddHN-nbRetNXveyao1oXA-tNtrC9oNeS4MfVayuqYzNO03lxYRHQeeUFc0JKbfDM2Mfhxl42yFiTUyl9iyfl0F95FEcF/s1600/BirdAvePic2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipMNIZgd1WvviTvfrTgCo-NYjcDHru7djndp_UhvFmlYiyoQpNddHN-nbRetNXveyao1oXA-tNtrC9oNeS4MfVayuqYzNO03lxYRHQeeUFc0JKbfDM2Mfhxl42yFiTUyl9iyfl0F95FEcF/s640/BirdAvePic2.jpg" width="528" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"></div>A great addition to the corner and one of the many perks of a gallery wall - the more the merrier. There is always room to add another special piece.<br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8UmSjMcrxOM-wb_zmhXVElAnmQ0ezwMwYEaFzZdWXItcVQxX-cK0fLJWDqG6N3M4sUBMDdmSsiqwSeTh7pmlWfV9aklSqgUZ49ssnXseTPlfjt10dE28rFikdohYI6gEn26Hzu-1l0ITW/s1600/GalleryWallUpdate.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8UmSjMcrxOM-wb_zmhXVElAnmQ0ezwMwYEaFzZdWXItcVQxX-cK0fLJWDqG6N3M4sUBMDdmSsiqwSeTh7pmlWfV9aklSqgUZ49ssnXseTPlfjt10dE28rFikdohYI6gEn26Hzu-1l0ITW/s640/GalleryWallUpdate.jpg" width="584" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhclx2dWdLwcwbZMH4UgTDCds-RXuiihcacIfbnHJpyxk7-L7sbuhzrmyQtwU39FAO9Jq_NJauGUY5ZivgHjB7HCZTLBQB0AqzVGHrLgmOYbMk8YzLg0QgiLE1euT9CLdzIcb-CzUjziQ4n/s1600/GalleryWallUpdate2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhclx2dWdLwcwbZMH4UgTDCds-RXuiihcacIfbnHJpyxk7-L7sbuhzrmyQtwU39FAO9Jq_NJauGUY5ZivgHjB7HCZTLBQB0AqzVGHrLgmOYbMk8YzLg0QgiLE1euT9CLdzIcb-CzUjziQ4n/s640/GalleryWallUpdate2.jpg" width="640" /></a></div>So how about you? Did you get to gettin' on any projects this weekend? Did you see the RHONJ reunion?  There aren't words for those ladies.<br /><br />More spruces to come!

gallery wall update courtesy of BirdAve

Hey all! The gallery wall has gotten a spruce. I was lucky enough to win a print from BirdAve Studio via Pawleys Island Posh right befo...

Daily Education and Technology News for Schools 10/09/2012

2:30 AM Tukiyooo 0

<ul class="diigo-linkroll">      <li>      <p class="diigo-link">                <a href="http://www.gpb.org/the-ignite-show/season-1/episode/the-ignite-show-with-georgia-governor-nathan-deal">The Ignite Show with Georgia Governor Nathan Deal</a>      </p>      <p class="diigo-description">We recorded a show in Atlanta with Governor Nathan Deal about helping high school students choose their career track. We also discussed what flattening the classroom means and how one can integrate the world into your classroom to create rich learning experiences. Thank you to my friend Anne, the show's host, for inviting me on.</p>              <p class="diigo-tags">          <span>tags:</span>                      <a href="http://www.diigo.com/user/coolcatteacher/education">education</a>            <a href="http://www.diigo.com/user/coolcatteacher/news">news</a>            <a href="http://www.diigo.com/user/coolcatteacher/flatclass">flatclass</a>            <a href="http://www.diigo.com/user/coolcatteacher/edreform">edreform</a>            <a href="http://www.diigo.com/user/coolcatteacher/careered">careered</a>            <a href="http://www.diigo.com/user/coolcatteacher/career">career</a>            <a href="http://www.diigo.com/user/coolcatteacher/tumblr">tumblr</a></p>                                        </li>      <li>      <p class="diigo-link">                <a href="http://www.bamradionetwork.com/index.php?option=com_content&view=article&id=901:how-we-teacher-girls-to-have-unhealthy-self-image&catid=35:jackstreet54&Itemid=89">Teaching in the Age of Entitlement: How to Avoid Contributing to the Problem</a>      </p>      <p class="diigo-description">Some students believe they are entitled to grades just for showing up, according to new research, especially if they are paying for their education (like college or private school). On this Radio show at the BAM Radio Network hosted by RAE Pica, she talked with researchers, an anonymous teacher, and I had a small reflection from my own experience about entitlement. It was a fun show to record and is pretty short.</p>              <p class="diigo-tags">          <span>tags:</span>                      <a href="http://www.diigo.com/user/coolcatteacher/education">education</a>            <a href="http://www.diigo.com/user/coolcatteacher/news">news</a>            <a href="http://www.diigo.com/user/coolcatteacher/edreform">edreform</a>            <a href="http://www.diigo.com/user/coolcatteacher/entitlement">entitlement</a>            <a href="http://www.diigo.com/user/coolcatteacher/tumblr">tumblr</a></p>                                        </li>      <li>      <p class="diigo-link">                <a href="http://blog.lproof.org/2012/10/the-beauty-in-the-threadbare.html">The Beauty in the Threadbare « Living Proof Ministries Blog</a>      </p>      <p class="diigo-description">Beth Moore has been one of my longstanding mentors through her many Bible studies she has written, but this blog post will appeal to any of you... especially those who work too hard and too long (like me) - these words caught my attention:  "Work martyrs are fake martyrs. They don’t count. They’re too self-important. It dawned on me about 2 years ago that no one was making me work nonstop but me so why, then, did I want to find somebody to blame for driving this skeleton like a shovel into quicksand? Anyway, I want to dance with my grandchildren at their weddings."   I want to dance with my grandchildren at their weddings too and my workload isn't doing that dream any favors. Rethinking many things in my life.</p>              <p class="diigo-tags">          <span>tags:</span>                      <a href="http://www.diigo.com/user/coolcatteacher/education">education</a>            <a href="http://www.diigo.com/user/coolcatteacher/news">news</a>            <a href="http://www.diigo.com/user/coolcatteacher/workaholic">workaholic</a>            <a href="http://www.diigo.com/user/coolcatteacher/work">work</a>            <a href="http://www.diigo.com/user/coolcatteacher/tumblr">tumblr</a></p>                                        </li>      <li>      <p class="diigo-link">                <a href="http://www.guardian.co.uk/education/2011/dec/23/primary-school-teachers-resign-facebook?CMP=twt_gu">Primary school teachers resign after Facebook insults about pupils | Education | The Guardian</a>      </p>      <p class="diigo-description">Facebook isn't private. Don't talk in bad ways about your children or students. You can't delete it. You can't erase it. If you're upset, pick up the phone, but even then, you could be recorded. Face to face, we'll you could be recorded too. I think you should be wary of venting but doing it in writing on a social network has to rank up there as the #1 dumb thing you can do. I see it on Tumblr all the time and it makes me cringe. Wake up. There is no private teacher's lounge online. Be wise and treat your students with respect. Sadly, the students can speak ill of their teachers all they want and no one deals with it, but we are adults and they are children. We are professionals and we should behave like it. Read this story and take heed.  "Printouts of the Facebook comments were posted on fencing near the school. One said: "No wonder everyone is thick … inbreeding must damage brain development." Another referred to seeing pupils queuing in a discount store.  The online exchange, allegedly between teachers at the school, prompted anger among parents."</p>              <p class="diigo-tags">          <span>tags:</span>                      <a href="http://www.diigo.com/user/coolcatteacher/education">education</a>            <a href="http://www.diigo.com/user/coolcatteacher/news">news</a>            <a href="http://www.diigo.com/user/coolcatteacher/facebook">facebook</a></p>                                        </li>  </ul><p class="diigo-ps">Posted from <a href='http://www.diigo.com'>Diigo</a>. The rest of my favorite links are <a href='http://www.diigo.com/user/coolcatteacher'>here</a>.</p>

Daily Education and Technology News for Schools 10/09/2012

The Ignite Show with Georgia Governor Nathan Deal We recorded a show in Atlanta with Governor Nathan...

We went to Tribeca.....again!!!

1:17 AM Tukiyooo 0

<span style="font-size: large;">If you are a regular reader of my blog you are probably getting a sense of what is my favourite restaurant in Ranelagh - it's Tribeca.  We are terrors for finding a restaurant we like and then continually going to it and never trying out any other place.</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">On Sunday we met friends for lunch and when they asked us to make a booking you can imagine what restaurant we chose!!!</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">The two friends were Frank & Eilish.  They brought their son with them and also Frank's sister and partner.  Frank loved the vibe of the restaurant, he was amazed by how busy it was and how there was such a good vibe in the place.  He had been speaking to the waiter about the steak special on the menu and he loved that when the waiter was delivering the steak to another table as he passed our table he nudged Frank and pointed out what the steak and eggs were like.  Frank turned to me and said "I got the nudge - I love that!!!"  </span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">Food came out and it was gorgeous as usual!  I also had a nice glass of house wine.  I ordered the merlot (as usual - as pointed out by Ciaran!).  After lunch we walked to our house and had coffee and cake for afters.  A lovely afternoon with friends!!</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">Here's some <a href="http://massafelliphotography.com/tribeca-restaurant-at-ranelagh/">photo's of Tribeca </a>that I found on the Internet as well as a <a href="http://ramp.ie/index.php/Go_Fork_Yourself-detail/fork-yourself-tribeca-ranelagh/">review</a> of the restaurant.</span>

We went to Tribeca.....again!!!

If you are a regular reader of my blog you are probably getting a sense of what is my favourite restaurant in Ranelagh - it's Tribeca. ...

An Open Letter to Alan Levy CEO of Blog Talk Radio

9:00 PM Tukiyooo 0

<div dir="ltr" style="text-align: left;" trbidi="on">Sometimes I find that being an internationally renown internet radio celebrity type can lead to frustration.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ7xqv1ux6FV3ZxYrb9LOxuxMRV0N2x0NWs1OzCbNdiYk58JLYBZOb6avMDChyphenhyphenxKjT6y5BICpNIJJEmDC3vDop9-6srCSZ1sFMsHzAqwP2VdjpurEhZduOrmB7C4qfBJwanH6BeZkKSKA/s1600/Alan+Levy+Blog+Talk+Radio.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ7xqv1ux6FV3ZxYrb9LOxuxMRV0N2x0NWs1OzCbNdiYk58JLYBZOb6avMDChyphenhyphenxKjT6y5BICpNIJJEmDC3vDop9-6srCSZ1sFMsHzAqwP2VdjpurEhZduOrmB7C4qfBJwanH6BeZkKSKA/s400/Alan+Levy+Blog+Talk+Radio.jpg" width="400" /></a></div>Oh sure…The notoriety is non-stop. Fame follows me. And the chicks?<br /><br />Holy Cow, if either Jayman or I fail to get hit on or propositioned by less than eight uber-hot babes in a single day, we consider that day to be sub par, and well, an aberration.<br /><br />Anyhoo…<br /><br />I have no problem helping to write and produce the show.  I have no problem being my witty self on air.  I have no problem with helping Jayman to provide laughter and entertainment to millions across this Big Blue Marble of ours.<br /><br />But ya know what I DO have a problem with?<br /><br />The forum which we utilize to entertain and inform both the washed and unwashed masses, Blog Talk Radio!!<br /><br />Damn right.<br /><br />I know, I know….It is a free service and Jay and I don’t pay the Premium Membership in order to get all the bells and whistles, but man…I just don’t understand some things about BTR, so I have a few questions for its Co-Founder and CEO, one Alan Levy.<br /><br />For instance…Our <i>“A Couple of Sickos”</i> show from September 30th…It had been Number One in the Comedy category for days and yesterday?  It was still getting hundreds of listens, and yet?<br /><br />Poof!!  It disappeared from the ratings altogether.  WTF?  How does that happen?<br /><br />Gee Mr. Levy, I’m sorry that all those crappy shows that pay you $399.00 or more a year can’t compete with <i>IWS Radio</i>, but that’s no reason to callously and arbitrarily erase our greatness from every book, ledger, and internet obelisk!!<br /><br />We go through this every week.  <i>IWS Radio</i> is on the top of the ratings and then BAM!!  You sprinkle your Emeril dust on us and we are served up to be the main course upon the dinner table of obscurity.<br /><br />You know the truth Mr. Alan Levy…With our numbers, <i>IWS Radio </i>would show up on the comedy category ratings as shows Number one through ten!!  Uh-huh…but noooo…<br /><br />You there at BTR have some Masonic type rating system that us non-Knight Templar radio types know nothing about.  I bet you and your staff laugh at Jay and I as you do your secret BTR handshake and pull us from our Number One spot every week.<br /><br />Hell, you won’t even let us be Number One in different categories at the same time.  What’s up with that?  I am so sorry that we are that awesome, but evidently you look down upon awesomeness and in turn choose to reward mediocrity.  Such a rare and odd trait in a successful CEO and business type guy.<br /><br />Another thing…I have a problem with your $399.00 Premium Member charge. Without it, BTR limits Jay and I to 45 minutes per show, offers us no promos, and yet, we still hit Number One every week, and you know what?<br /><br />As of late, our two shows per week are getting a total of 5,000-7,000 listens per week.  So let’s be temperate and call it 6,000 per week.<br /><br />People who listen to our show see one helluva lot of ads that you load onto our show page, and let’s say your ad revenue is equal to one cent per listen on our show.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNoilUFNHGv2CormP31A8rchQ_DnveDAezqeH2M3CTL9mmjkMhzSFtSJ34nIiUvxTwUw7a97fjIZJreTQ7qHVREgkbqYoVWoGh35Rby9wXvwLslBV8ODsnR2jMNAhIH4Wr3TotXauD6V0/s1600/Alan+Levy+CEO+Blog+Talk+Radio.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNoilUFNHGv2CormP31A8rchQ_DnveDAezqeH2M3CTL9mmjkMhzSFtSJ34nIiUvxTwUw7a97fjIZJreTQ7qHVREgkbqYoVWoGh35Rby9wXvwLslBV8ODsnR2jMNAhIH4Wr3TotXauD6V0/s400/Alan+Levy+CEO+Blog+Talk+Radio.jpg" width="400" /></a></div>You are making at least $60.00 per week off of our unbridled talent, and what do we get for our efforts? That’s right…Heartache!!<br /><br />You are easily and conservatively estimating, making over $3,000.00 a year on our show and you can’t say unto us…<i><br /></i><br /><i>“I’m sorry, that I can’t change the way we rate shows, because honestly, I don’t even know how that works, but since you are such a consistently great radio show and make money for us, I will pay your $399.00 in order to become a Premium Member, and therefore you can do longer shows and generate even more income for me.”</i><br /><br />See Mr. Alan Levy how easy that would be?  You owe us mister…You owe us big time, and you need to do the right thing and pay our Premium Membership.  You owe it to us, but more importantly…<br /><br />You owe it to the world and our adoring, ad-clicking fans.<br /><br /><i>Cheers!!</i><br />Matt-Man<br /><i><span style="color: blue;"><a href="mailto:mattmaniws@ymail.com">mattmaniws@ymail.com</a></span></i><br /><a href="https://twitter.com/MattMan_IWS"><i><span style="color: blue;">@MattMan_IWS</span></i></a></div>

An Open Letter to Alan Levy CEO of Blog Talk Radio

Sometimes I find that being an internationally renown internet radio celebrity type can lead to frustration. Oh sure…The notoriety is non-st...

Monday, Monday

4:30 PM Tukiyooo 0

<span style="font-weight: bold;"><a href="http://www.archidose.org/wp/">A Weekly Dose of Architecture</a> Updates:</span><br /><br />This week's dose features <a href="http://archidose.org/wp/2012/10/08/brooklyn-army-terminal/">Brooklyn Army Terminal</a> in Brooklyn, New York by Cass Gilbert:<br /><a href="http://archidose.org/wp/2012/10/08/brooklyn-army-terminal/"><img alt="this       week's  dose" src="http://archidose.org/wp/wp-content/uploads/2012/10/Oct12-08.jpg" style="cursor: move;" title="This week's dose" width="640" /></a><br /><br />The featured past dose is the <a href="http://archidose.org/wp/2004/11/15/cognito-films/">Cognito Films</a> in Culver City, California by Randall Stout Architects:<br /><a href="http://archidose.org/wp/2004/11/15/cognito-films/"><img alt="this       week's  dose" src="http://www.archidose.org/Nov04/cognito1.jpg" style="cursor: move;" title="featured past dose" width="640" /></a><br /><br />This week's book review is <a href="http://archidose.org/wp/2012/10/08/toyo-ito-forces-of-nature/"><i>Toyo Ito: Forces of Nature</i></a> edited by Jessie Turnbull (L):<br /><a href="http://archidose.org/wp/2012/10/08/toyo-ito-forces-of-nature/"><img alt="this week's book review" height="300" src="http://archidose.org/wp/wp-content/uploads/2012/10/ito.jpg" style="cursor: move;" title="This week's book review" /></a>   <a href="http://www.archidose.org/books/ando.html"><img alt="this week's book review" height="300" src="http://www.archidose.org/books/ando.jpg" style="cursor: move;" title="This week's book review" /></a><br />(R): The featured past book review is <a href="http://www.archidose.org/books/ando.html"><i> Seven Interviews with Tadao Ando</i></a> by Michael Auping.

Monday, Monday

A Weekly Dose of Architecture Updates: This week's dose features Brooklyn Army Terminal in Brooklyn, New York by Cass Gilbert: The fea...

Some 13,000 May Have Gotten Meningitis-Linked Drug - WSJ.com

3:33 PM Tukiyooo 0

An estimated 13,000 patients may have been exposed to the tainted spinal steroid injections which have sickened more than 100 people with fungal meningitis and killed eight, federal officials said Monday, as clinics and surgery centers continued to reach out to those who could be affected.<br /><br><br /><br>It was the first estimate of the potential scope of the meningitis outbreak, which has been traced by federal and state investigators to three lots of methylprednisolone acetate injections produced by New England Compounding Center. Some 105 people in nine states have been sickened by fungal meningitis, said Curtis Allen, a spokesman for the Centers for Disease Control and Prevention.<br /><br><br /><br>Tennessee, Virginia, Indiana, Maryland and Michigan reported new cases. Tennessee—with 35 cases, the most of any state—also reported an additional death, its fourth, according to the CDC.<br /><br><br /><br>Investigators from the U.S. Food and Drug Administration and state officials are probing the Framingham, Mass., facility where NECC made the 17,676 potentially tainted steroid injections, which were then shipped to 75 clinics in 23 states, according to federal and state officials.<br /><br><br /><br>A CDC spokesman said it isn't possible to know how many cases there will be. The CDC and state health officials scrambled last week and over the weekend to track down patients who received the shots to see if they had been sick and to warn them to watch for possible symptoms.<br /><br><br /><br>The numbers of cases are rising sharply now not necessarily because people are continuing to get sick, but because investigators are pinpointing more illnesses among those who already received the injections of methylprednisolone acetate for relief of back and neck pain.<br /><br><br /><br>The injections were given between July and September. So far, those who have been infected developed symptoms between one and four weeks after receiving their injections.<br /><br><br /><br>"There's no evidence that new infections are occurring at a more rapid rate," said John Jernigan, medical epidemiologist at the CDC who is involved in the investigation.<br /><br><br /><br>It is too early to know how many people ultimately will be affected. Federal and state investigators must determine how many people received potentially contaminated injections, then track down each one. They must then confirm that those who have subsequently become ill actually had fungal meningitis and not another disease. There are "too many variables to speculate on the number of possible cases," said a CDC spokesman.<br /><br><br /><br>The FDA had already advised medical professionals last week not to use NECC-made products.The compounding pharmacy that produced the injections in question issued a recall Saturday of all products made at its compounding center. "This action is being taken out of an abundance of caution due to the potential risk of contamination," NECC said in a statement. The company has said it is cooperating with investigators.<br /><br><br /><br>Meningitis is a potentially deadly inflammation of the brain or central nervous system. It is usually caused by viruses or bacteria, but can also be brought on by fungi. The two fungi found thus far in some patients—known as aspergillus and exserohilum—are commonly found in the air and soil.<br /><br><br /><br>The fungal form of meningitis is particularly difficult to diagnose because the symptoms can be vague and mild initially, including fever, headache, nausea and stiffness of the neck, according to the CDC. People with fungal meningitis can also experience dizziness and confusion. Several of the patients in the current outbreak have had strokes.<br /><br><br /><br>Most of the people who have been sickened had normal immune systems, Dr. Jernigan said, meaning they weren't at particular risk of infections. While the investigation into how patients became infected is ongoing, there is some evidence to suggest that the fungi in the medication penetrated the lining protecting the central nervous system after being injected epidurally, Dr. Jernigan said.<br /><br><br /><br>While the fungi aren't harmful in the environment, they can become deadly when they flourish in a medication and are then injected directly into a part of the body that should not have germs, Dr. Jernigan said.<br /><br><br /><br>Ms. Reed underwent an autopsy; the lawyer said he didn't yet know the results.One possible victim, 56-year-old Tennessee resident Diana Reed, died Wednesday; she got meningitis after receiving steroid injections, says a lawyer for her family. She had received the injections at a facility that has since been closed because of a meningitis outbreak, according to its Web site.<br /><br><br /><br>The outbreak has drawn renewed attention to the little-regulated world of compounding pharmacies. The FDA is hampered by federal law and conflicting federal court decisions over its authority to regulate compounding pharmacies. Current and former senior FDA officials said the agency has sought greater authority over the past decade, but so far has been stymied.<br /><br><br /><br>Government officials say the FDA is especially concerned about large compounding pharmacies that send out large amounts of drugs across the country—as opposed to a small pharmacy that may compound a medication three or four times a year.<br /><br><br /><br>In particular, the agency hasn't been able to take the normal steps it would take to ensure the safety of a drug produced at a compounding pharmacy. That includes requiring and evaluating clinical trials, and inspection of manufacturing facilities.<br /><br><br /><br>Attempts in the past by the agency to regulate more strenuously have been challenged in court.<br /><br><br /><br><a href="http://online.wsj.com/article/SB10000872396390443982904578044682649925200.html">http://online.wsj.com/article/SB10000872396390443982904578044682649925200.html</a>?

Some 13,000 May Have Gotten Meningitis-Linked Drug - WSJ.com

An estimated 13,000 patients may have been exposed to the tainted spinal steroid injections which have sickened more than 100 people with fu...

Tackling the Underlying Problems of Failure to Rescue :: Article - The Hospitalist

7:02 AM Tukiyooo 0

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">A recent HealthGrades Quality Study titled <em style="margin: 0px; padding: 0px; ">Patient Safety in American Hospitals</em> (July 2004) highlighted the frequency of patients dying from complications that develop while in hospitals. Failure to rescue, according to the 3-year study, accounts for 60,000 deaths each year in Medicare patients under the age of 75.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Based on my experience as a pulmonary and critical care physician, this statistic quantifies an important problem. Deaths from complications of illness, or care, during a hospital stay happen more than we'd like to admit. However, the good news is that by identifying the underlying problem and deploying some targeted, systemic changes, hospitalists can begin to handle decompensation quickly, proactively, and before it's too late.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Moving forward, hospitals need to build an effective patient safety net, which requires three important elements: point-of care tools for caregivers, proactive clinical surveillance, and real-time process monitoring.</p><div class="imageContainer" style="margin: 10px 0px 10px 10px; padding: 0px; width: 295px; float: right; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-size: 10px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUjhmmQ1UV0h-VQrvWuDweiqmlekDkIe7DAifMgMKuzZmFsyJRuMKP945lC5T4HdjfXJyWl2uHUaXoqd7XxnKXn5VkPPf9VeTBcmXKdcoFVC9H11mhnYmVr5sxqOv7KIWZhMZaSMLSED8/s1600/2005_02_pp34_01-700543.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5796938836374589618" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUjhmmQ1UV0h-VQrvWuDweiqmlekDkIe7DAifMgMKuzZmFsyJRuMKP945lC5T4HdjfXJyWl2uHUaXoqd7XxnKXn5VkPPf9VeTBcmXKdcoFVC9H11mhnYmVr5sxqOv7KIWZhMZaSMLSED8/s320/2005_02_pp34_01-700543.jpg" /></a><div class="imageCaption" style="margin: 0px; padding: 10px 0px 0px; font-family: Trebuchet, 'Trebuchet MS', Helvetica, sans-serif; font-size: 14px; border-top-width: thin; border-top-style: solid; border-top-color: rgb(204, 204, 204); color: rgb(51, 51, 51); ">FIGURE 1. Catastrophe Timeline — Review of the patient's chart revealed instability had been developing for hours before a "code" was called</div></div><h3 style="margin: 0px 0px 0.3em; padding: 0px; font-size: 1.25em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Reasons for Failure to Rescue</h3><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">A huge effort, and amount of money, has been focused on finding errors that lead to harm. Unfortunately, we're tackling the wrong errors. New tools like barcode medication administration or CPOE tackle errors of commission. These errors might occur when a doctor or nurse administers a wrong dose or wrong medication. Errors of commission are much easier to identify and solve, but clinically significant errors of commission that cause harm are relatively rare events and don't affect overall hospital mortality.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Errors of <em style="margin: 0px; padding: 0px; ">omission</em>, however, are much more insidious. An error of omission is an error that occurs when an action is not taken or an important step in the process is left out. Examples of an error of omission include sub-optimal patient care resulting from the inadequate availability of patient information for decision-making, or a more blatant example, when a patient's vital signs indicate decompensation but the clinical response is inadequate or delayed.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Errors of omission continue in today's hospitals for two very important reasons: First, we lack a systematic way to handle clinical decompensation. While we have "code" teams, their efforts often come into play too late. Second, lacking a way to recognize and respond to the issue, we have accepted that failure to rescue is in some ways inevitable and excusable.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">The basic, first step is to replace the inherently unreliable paper patient chart. Paper patient charts get misplaced, information is sometimes missing and/or illegible, and they make it impossible for a team effort to optimize care.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Hospitals need to get patient data such as vital signs and medication usage in electronic form. That way, it is effortless and time-efficient to determine a patient's status and check up on patients even when not physically near them. Making this change alone, even in only one hospital unit, hospitalists can begin to effect significant positive changes in patient safety outcomes.</p><h3 style="margin: 0px 0px 0.3em; padding: 0px; font-size: 1.25em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Catastrophes Aren't Inevitable</h3><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Often, the first time physicians become aware of a problem is when they receive a frantic call to come to the bedside. The patient is decompensating and needs immediate, dramatic intervention to save their life. However, when we take the time to look back at the patient chart and "connect the dots," we see that instability had been developing for hours before an urgent summons for assistance.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Even with the best care, patients' clinical needs often change after admission. Patient status can change rapidly, so a perfect assessment earlier in the day can quickly become dated. Further, bedside staff have many other patients, and staffing assignments don't build in "slack time" to permit paying extra attention when problems develop. Consequently, signs of clinical deterioration are often missed or not acted upon until there's a code on the unit and dramatic measures are needed to save a life.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Proactive clinical surveillance tools are the second big step in creating a safety net for patients. With patient data in electronic form, hands-on caregivers, nurses, and supervisors can use specially designed "dashboard views" to quickly identify which patients are exhibiting warning signs of clinical decline and exactly where they are located.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">To be most effective, staff should view clinical surveillance information in a variety of useful ways:</p><ul style="margin: 1em 0px 1em 2em; padding: 0px; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-size: 10px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><li style="margin: 0px; padding: 0px; font-size: 1.2em; line-height: 1.5em; ">Hospital–wide for a big picture of where the trouble spots are</li><li style="margin: 0px; padding: 0px; font-size: 1.2em; line-height: 1.5em; ">By unit, to scan through patients and see the values that are triggering an alert</li><li style="margin: 0px; padding: 0px; font-size: 1.2em; line-height: 1.5em; ">By provider, so doctors and nurses can scan their list of patients and see which have triggered alerts</li><li style="margin: 0px; padding: 0px; font-size: 1.2em; line-height: 1.5em; ">By patient, drilling into all the details of that patient's current status and previous care</li><li style="margin: 0px; padding: 0px; font-size: 1.2em; line-height: 1.5em; ">By patient, drilling into all the details of that patient's current status and previous care</li></ul><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">tion, which are out of range or trending in the wrong direction, should automatically highlight patients. With the complete clinical record on-line, staff can prioritize which patients to visit next and what type of supplemental resources might be needed to enhance care.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">For hospitalists, clinical surveillance tools save an immense amount of time and help prioritize patient care. Typically hospitalists manage a large number of patients who are scattered around the hospital. Determining where to start rounds and which patients should be seen first is often difficult. Even worse, patients' conditions suddenly change for the worse soon after you've checked on them. There are just too many patients to continually be looking at patient charts and relying on verbal information: that's why there are computers!</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Supervisory staff can provide an additional safety net, if they have the tools to do so effectively. Typically, they rely on "report" and walking around, visiting staff, looking for an opportunity where their intervention could be helpful. By referring to "hot spots" indicated on a clinical surveillance dashboard view, they would know where they're needed and spend their time helping, rather than prospecting.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Some hospitals have formalized their response to the failure to rescue problem by creating "rapid response teams." Such teams can also rely on clinical surveillance tools to identify patients in need, rather than waiting for a phone call from an overwhelmed primary caregiver.</p><div class="imageContainer" style="margin: 10px 0px 10px 10px; padding: 0px; width: 295px; float: right; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-size: 10px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2x-k8t0VbVzJuQhOiapQdkh9-nnbXRN3T-Amca9yTLbUBD39L34XbgGE-mj_JwpXPEZGCaBTd8CgGdnha1MX5KV0i2hcb-rHd2cAX0Vs3xK-HA5MDbqjWvty9KVykiFx0G441KUJdiXM/s1600/2005_02_pp35_01-703468.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5796938847364258946" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2x-k8t0VbVzJuQhOiapQdkh9-nnbXRN3T-Amca9yTLbUBD39L34XbgGE-mj_JwpXPEZGCaBTd8CgGdnha1MX5KV0i2hcb-rHd2cAX0Vs3xK-HA5MDbqjWvty9KVykiFx0G441KUJdiXM/s320/2005_02_pp35_01-703468.jpg" /></a><div class="imageCaption" style="margin: 0px; padding: 10px 0px 0px; font-family: Trebuchet, 'Trebuchet MS', Helvetica, sans-serif; font-size: 14px; border-top-width: thin; border-top-style: solid; border-top-color: rgb(204, 204, 204); color: rgb(51, 51, 51); ">FIGURE 2. Clinical surveillance information may be seen in "dashboard views" by unit or provider, to scan through patients and see values that triggered an alert.</div></div><h3 style="margin: 0px 0px 0.3em; padding: 0px; font-size: 1.25em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Making Best Practices Work</h3><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Organizational performance can be dramatically improved when patient outcomes and staff activity can be measured and analyzed. Traditionally, this has been done retrospectively.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">By evaluating outcomes of patients and compliance with processes, many sites have been able to improve processes for future patients. However, because reporting has been periodic, results become available only months later, and implementation of care enhancements are delayed.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">With comprehensive patient data in electronic form, real-time monitoring of compliance with intended processes and best practices becomes possible. For example, if there is a consensus that the head of the bed of ventilated patients should be elevated to reduce the incidence of ventilator-associated pneumonia, then the monitoring system can show, by ICU, the percentage compliance with that protocol at any given moment.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Since the report is available real-time, non-compliance can be addressed immediately, benefiting the patient and directing education about the protocol precisely when and where it is needed for maximum impact.</p><h3 style="margin: 0px 0px 0.3em; padding: 0px; font-size: 1.25em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; letter-spacing: normal; line-height: 15px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Creating a Reliable Patient Safety System</h3><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">An electronic medical record forms the very foundation of a patient safety system. This electronic data provides the capability for proactive clinical monitoring and much more sophisticated process analysis that happens in days or weeks, not over a course of months or years.</p><p style="margin: 0px 0px 1em; padding: 0px; font-size: 1.2em; line-height: 1.5em; color: rgb(0, 0, 0); font-family: Georgia, 'Times New Roman', Times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; ">Capture patient data electronically, set up a set of effective alerts based on hospital-defined triggers, and enact process monitoring to improve outcomes and fix problems as they occur. With these three elements, hospitals have the best antidote for failure to rescue and are able to create a safety net for patients.</p></div><a href="http://www.the-hospitalist.org/details/article/257883/Tackling_the_Underlying_Problems_of_Failure_to_Rescue.html">http://www.the-hospitalist.org/details/article/257883/Tackling_the_Underlying_Problems_of_Failure_to_Rescue.html</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Tackling the Underlying Problems of Failure to Rescue :: Article - The Hospitalist

A recent HealthGrades Quality Study titled Patient Safety in American Hospitals (July 2004) highlighted the frequency of patients dying fr...