Egg on My Face

Yesterday, Gizabeth, my husband, and I took a road trip to see the medical history exhibit at the Old Jail Museum in Greenwood, Arkansas. We had decided to make the museum for our daytrip after Google (yes, they share some of the egg – smile) maps put Greenwood just 8 miles from Altus and the Arkansas wineries.

We had a lovely day planned – leave Little Rock around 8:30 am, drive through McDonald’s for coffee (I love their coffee!), head to the museum which opened at 11 am (est time of first leg a little over 2 hr), have lunch at one of the winery restaurants, and then visit the flea market/farmer’s market in the Altus town square.

First error of the day: Greenwood, AR is NOT next to Altus, but there is a Greenwood Community located there. Notice the Greenwood, AR not marked by Google over to the west near Fort Smith and the Oklahoma- Arkansas border. That’s where we needed to be.

After stopping to ask directions in “Greenwood”, we got back on the road and headed west. We finally got to the museum which is located in an old jail, hence the name – Old Jailhouse Museum.

My second mistake – the medical history exhibit was in 2009, not this year. We enjoyed the visit anyway.

The museum grounds also has this wonderful dog-trot log cabin! At one time my grandmother on my father’s side lived in one of these. I loved the place. It is always cool in that center (dog-trot) area in the summer. Always has a nice breeze.

I did notice a couple of items with a medical bend. Here’s an old wooden wheelchair. Can you imagine having to use this?

This old wringer washing machine was the source of some horrible injuries to arms. I grew up using a wringer washing machine (a “newer” model than this). Mother got a non-wringer machine after I went to college.

This photo shows the damage tornados can do.

We ate a late lunch at a local diner, the Bulldog, then headed back to Little Rock. Glizabeth needed to be back by 5 pm (we were back by 5:20 pm) as she had a wedding to attend.

Even with the “egg on my face” stuff (or maybe because of it), we had a great day full of conversation, laughter, and music.

Efficiency

“I see you remembered to bring the office forms I mailed you.”

“Yes, but I need to fill them out,”  he replies.

I hand him a pen and clipboard, thinking “you had over a week to fill them out at home.”

Fifteen minutes later, I smile as he hands me the filled-in forms.

J's Snakes Quilt

My friend Gizabeth blogs at Methodical Madness. Her son just turned 5 years old. He has a pet snake.

Years ago (early to mid 1990’s I think) I printed out Cheri Strole’s Snake Paint quilt pattern (pdf). Fortunately, I didn’t lose it and actually was able to find it when I decided I needed to make J a quilt. I’m sorry that I couldn’t find a link for the pattern for anyone who might like this quilt.

I machine pieced an quilted this quilt. It is 43.5 in X 55 in. I used ultra-suede scrapes for the eyes and tongues, but quilting cottons for the rest of the quilt.

I am not a big fan of snakes, but I do love these.
The next several photos just show the snake faces. You can also see the quilting.



The back of the quilt was pieced to use some leftover fabrics.

I’ll be giving the quilt to Gizabeth tomorrow when she, my husband, and I take off for a road trip to visit a couple of the medical museums in Arkansas. I sure hope he likes it.

Melanoma of the Nail Matrix

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

Two recent articles in the Archives of Dermatology serve as a reminder that melanoma may occur under the finger nail in the nail matrix.

The first one (full references for both below) used slides and prepared information from 12 cases to “test” dermatologist. Here is one of the examples given in the paper:

Nevus. A, Clinical features; B, nail plate dermoscopy; C, intraoperative dermoscopy. ABCDEF rule information: A (age, 35 years), C (change in band at 2 years; it became enlarged or darker), D (digit, third finger, right hand), and F (no family or personal history of melanoma)

Only 46-55% made the correct diagnosis of nail matrix melanoma in situ in this study. The level of expertise did not statistically influence the correct diagnosis.

Early diagnosis of melanoma of the nail unit is challenging. The tumor most often presents with a longitudinal nail pigmentation (longitudinal melanonychia), but this is not a specific sign for melanoma.

Longitudinal melanonychia can also be caused by numerous nonmalignant conditions that include nevi of the nail matrix, benign melanocytic hyperplasia (nail matrix lentigo), and a number of inflammatory, traumatic, or iatrogenic nail disorders that induce the activation of the nail matrix melanocytes.

Features on clinical examination that are suggestive but not pathognomonic of melanoma include inhomogeneous pigmentation with bands or lines of different colors, presence of nail plate fissuring or splitting, rapid enlargement of the band, a proximal part of the band that is broader than the distal (triangular shape), blurred lateral borders, and pigmentation of the periungueal skin.

These features have been summarized in the ABCDEF rule for diagnosis of nail melanoma and may help clinicians in distinguishing "nonalarming" from "alarming" bands. Each letter indicates features that are associated with an increased risk of melanoma:

• A (age as peak incidence of nail melanoma is between 50 and 70 years. A also reminds us of most commonly affected races: African Americans, Asians, and Native Americans).
• B (band: black to brown, breadth > than 3 mm, blurred borders)
• C (change: enlarging or darkening)
• D (digit: most fingernail melanomas affect the dominant hand)
• E (extension of the pigmentation to the surrounding tissues)
• F (family or personal history of melanoma)

The second one reminds us that melanoma in the nail matrix location (nail apparatus melanoma or NAM) is associated with a poor prognosis, mainly because of a delay in diagnosis. Too often diagnosed at an invasive stage. The authors note this is particularly true in cases involving amelanotic melanoma. They report 3 cases of in situ amelanotic melanoma with clinical lichenoid features, concluding that chronic unexplained monodactylic nail dystrophy should be investigated histologically.

All three of their patients (ages 39 to 60 yrs) presented with nail alterations characterized by lichenoid changes with longitudinal striation, distal splitting, and nail plate atrophy. Histologic examination revealed in situ amelanotic melanoma extending from the proximal matrix up to the distal part of the nail bed. (photo from article)

The authors give us the background on amelanotic NAM:

Amelanotic NAM represents 20% to 30% of ungual melanoma cases compared with less than 7% of the other cutaneous melanomas.

It usually presents as a chronic paronychia, a torpid granulomatous ulceration, a wartlike keratotic tumor, or a pyogenic granuloma.

It is usually located in the periungual folds or in the nail bed.

Clinical misdiagnosis, which is particularly frequent in amelanotic melanoma, is responsible for a delay in diagnosis as well as a poor prognosis.

REFERENCES
Dermatologists' Accuracy in Early Diagnosis of Melanoma of the Nail Matrix; Nilton Di Chiacchio; Sergio Henrique Hirata; Mauro Yoshiaki Enokihara; Nilceo S. Michalany; Gabriella Fabbrocini; Antonella Tosti; Arch Dermatol. 2010;146(4):382-387.
In Situ Amelanotic Melanoma of the Nail Unit Mimicking Lichen Planus: Report of 3 Cases; Josette André; Isabelle Moulonguet; Sophie Goettmann-Bonvallot; Arch Dermatol. 2010;146(4):418-421.

The Vanishing Oath

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

I received a copy of the documentary, The Vanishing Oath, from the the films producer Nancy Pando.   I’m not sure I can best Dr Wes’ review, but would like to add my impressions.  The documentary film  was directed by a young emergency room physician, Ryan Flesher, MD and produced by a former clinical social worker, Nancy Pando, LICSW.   Dr. Flesher’s own dissatisfaction/disillusionment with medicine led to the films production.

Physician burnout is an important topic and as with most job dissatisfaction is not due to just one thing.  The film addresses many with interviews of physicians, the public, and one lawyer – long hours, need to see more patients in less time, threat of malpractice lawsuits, increasing paperwork, increasing pressures from outside sources (government, insurance companies, etc).

Being a surgeon, I was particularly struck by the young aspiring hand surgeon who left (video clip) medicine after all of his years of training because of the toll it took on himself and his family.  I would love to know what he is doing now.  What job replaced medicine and surgery for him, because no job is without it’s own problems and exasperations.  Time management or life balance is always a “juggling” act which some are better at than others.

I will admit here and now that I have experienced some of this, so I was hoping (as I think Dr. Flesher was) that the film would show me better ways to guard against all those forces that take my joy of practicing medicine away.  Sadly, it didn’t, but there were two physicians interviewed who seem to always (or almost always) love their job.  I “soaked” these two up, especially the segment of Dr. Peter Rosen who advises “the most important thing is to revive your ideas, why did you want to be a doctor?”  I love his story of his first patient when he was 8 yrs old.  He has retained that enthusiasm. 

I am now working to get this shown in my community as Dr. Wes managed to in his.  No dates set as of today.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

MDiTV is the host for this week’s Grand Rounds.   It’s the “best edition ever, maybe” edition.  You can read this week’s edition here.

Thanks to everyone who submitted to this week’s edition of Grand Rounds.  After following the weekly blog carnival for  months, submitting a few times and now playing the role as host has been immensely gratifying. The submissions covered a wide-range of topics; from surgical procedures to how the progression of 80’s music mirrors the evolution of birth control (seriously). ….. Thanks again to everyone that participated and I hope you all enjoy this week’s picks of the best medical blog reads as much as I did!

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Medical schools across the country have been holding their graduation ceremonies and white coat burning ceremonies.  JAMA has include a wonderful essay by Sunita Puri, MD MS on her coat:  Worn

I never thought this day would come.

The meaning of the day struck me at the oddest of moments. I was rushing around my apartment, picking up bedsheets, pillowcases, towels, jeans, gym clothes, all badly in need of a whirl in the washing machine. Oddly, it was always an afterthought to add my short white coat to my pile of laundry. And today, as I placed it at the top of the pile, I suddenly remembered that I never needed to wash it again. I had just returned from my last day of my last clinical rotation as a medical student. The last day I ever had to wear this short, awkward coat.

I began my usual prelaundry ritual of examining my white coat. I emptied its pockets,…….. Yet in surveying the coat now, I was moved by the memories that each imperfection indexed. …..

Mrs J gave me the pen that later leaked, bruising my right lower pocket with a black splotch. …….

Ms A's mother gave me the turquoise necklace that I kept in my lower left coat pocket. …...

I had to retire the coat with the spray of coffee on its entire left side. Mr D was my patient only briefly, in his shuffle between the surgery, medicine, and ICU services, but I had been the one to call and tell his wife that she should drive to the hospital soon. …….

Over the course of this two-year introduction to clinical medicine, my white coats served as time capsules and canvases. Their physical appearance changed as an intoxicated patient's blood splattered during my first attempt at an arterial blood draw …….

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Dinah, Shrink Rap, asked readers for Shrinky Book recommendations and has compiled the full list of recommendations:  Our Readers' List of Best Shrinky Books.  Here are just a few of the suggested books.  Check out the post for the full list.

Existential Psychotherapy, by Irvin Yalom

Shoot the Damn Dog by Sally Brampton

Darkness Visible by William Styron

An Unquiet Mind by Kay Redfield Jamieson

Man's Search for Meaning by Viktor Frankl

In Session by Deborah A. Lott
The Dance of Anger by Harriet Lerner
In a House of Dreams and Glass By Robert Klitzman, MD
I had a black dog - Matthew Johnstone

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Another list of books.  This one is summer reading suggestions from the New Yorker: If You Liked My Book, You'll Love These.  The list includes suggestions from six writers, genre by genre.

In the science section:

The Immortal Life of Henrietta Lacks (Crown),  by Rebecca Skloot, has spent fifteen weeks (and counting) on the Times best-sellers list.
The Man Who Mistook His Wife for a Hat: And Other Clinical Tales (1985)  by Oliver Sacks
Confessions of a Knife (1979) by Richard Selzer
Love at Goon Park (2002) by Deborah Blum
A wonderful character study of Harry Harlow, the dark, eccentric scientist whose amazing, often disturbing research on primates led to much of our understanding of child-rearing.
His Brother’s Keeper: A Story From the Edge of Medicine (2004) by Jonathan Weiner
The tale of a mechanical engineer who turned himself into a geneticist with hopes of saving his brother’s life.

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LockupDoc has written a nice post:  How doctors can use their own feelings to provide better care

……..But, wait. There’s an invaluable clinical pearl that physicians can borrow from the world of psychotherapy to help them to better hone this “sixth sense.”

I’ll explain.

Have you ever been around a negative, depressed person for too long? Or too many negative, depressed people in a short period of time?……………..

And that’s the “secret”–it’s actually quite simple: The feelings that others elicit in you are often reflections of their own internal mood states. So, how you feel in the presence of someone very well might be similar to what they are feeling……

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 Threads has a nice tutorial by Kenneth King on Ribbon Braid. 

This little braid is one I learned a few years ago while flying to a teaching gig. It’s what is called a “two element” braid, which means there are two strands that go into the making of it. For the demonstration, I’m choosing to use white and black ribbon for clarity, but you can use either the same colors for both elements, or a different color……………

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Dr Anonymous’ BTR show guest this week will be Ray Saputelli, NJ Academy of Family Physician. The show begins at 9 pm ET.

Upcoming shows (9pm ET)

6/10: Ray Saputelli, NJ Academy of Family Physicians
6/17: Family Physician Dr. Kim Yu
6/24: Dr. Bryan Vartabedian, 33 Charts
Jul-Aug: Summer Break
8/26: Dr. A Show 3rd Anniversary

Patient Satisfaction Following Breast Reconstruction Using Implants

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. 

As more women turn to postmastectomy breast reconstruction, surgeons are beginning to look at outcomes.  Not simply safety and complications, but also patient satisfaction. 

A recent March 2010 article in the Journal of Plastic and Reconstructive Surgery (full reference below) looked patient satisfaction among women who had reconstruction using implants. 

The authors note that research in this field has been “hindered by the absence of an outcomes measure for use in evaluation of patient satisfaction and health-related quality of life (HRQoL).”

The BREAST-Q is a new questionnaire that specifically measures postsurgical body image and quality of life in the breast reconstruction patient.  The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (Br23) [EORTC QLQC30 (Br23)] is a cancer-specific questionnaire that incorporates a breast-specific module and measures overall functioning following breast cancer treatment. 

This study used these two questionnaires to evaluate patient satisfaction and health-related quality of life following alloplastic (implant) breast reconstruction and more specifically if the type of implant used (saline versus silicone) has an effect on health-related quality of life.

A chart review of University of British Columbia patients was performed, compiling data on the following demographic features: type of breast cancer, unilateral versus bilateral reconstruction, history of radiation or chemotherapy, complications, type of implant, follow-up time, age at second stage, timing of reconstruction, and comorbidities.

A total of 280 patients were identified. Sixteen patients were deceased and 17 patients had noncurrent addresses (neither responders nor nonresponders).  Out of the 247 “active” charts, there were 75 silicone implant recipients and 68 saline implant recipients who responded (an overall response rate of 58 %). Chart review was possible for 100 of the 104 nonresponders.

In this patient population, responses to the BREAST-Q indicated a statistically significant higher overall satisfaction with breast reconstruction, higher psychological well-being, higher sexual well-being, and higher satisfaction with surgeon for silicone implant recipients. This finding was maintained after adjusting for variables that differed between groups. In addition, radiation exposure and unilateral versus bilateral reconstruction were included in the regression analysis, as these variables were felt a priori to influence overall satisfaction with outcome.

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Results using the EORTC QLQC30 showed no statistically significant difference on any subscale, with the exception of higher overall physical function in silicone patients and higher systemic therapy side effects in saline patients. This is a cancer-specific questionnaire that examines function and symptom severity in cancer patients. In general, condition-specific measures allow greater responsiveness to intervention-related change compared with generic outcomes measures.

The BREAST-Q was developed at the Memorial Sloan Kettering Cancer Center and the University of British Columbia.  This instrument measures health-related quality of life following breast surgery. The module used in this study was specific to breast reconstruction. This instrument encompasses six scales: (1) psychosocial well-being, (2) physical well-being, (3) sexual well-being, (4) satisfaction with breasts, (5) satisfaction with outcome, and (6) satisfaction with care.

The EORTC QLQC30 (Br23) was developed by the European Organization for Research and Treatment of Cancer at the Netherlands Cancer Institute.   This instrument evaluates health-related quality of life in cancer patients. The QLQC30 module incorporates nine scales (five functional, three symptom, and one global health-related quality of life).

The authors drew these conclusions:

Responses on a surgery-specific instrument show silicone recipients to have overall higher satisfaction with the reconstructed breast(s). After adjusting for age, follow-up time, radiation therapy, and unilateral versus bilateral surgery, silicone recipients scored an average of 64 points for overall satisfaction with breast while saline patients scored 57 points. Similar results were seen for sexual well-being, psychological well-being, and overall satisfaction with surgeon.

Findings using the EORTC-QLQC30 revealed no statistically significant difference in overall global health status. Thus, it may be concluded that increased satisfaction in silicone implant recipients found using the BREAST-Q is not equivalent to increased overall global health as measured by the EORTC-QLQC30. The findings of this study provide reliable data that will allow surgeons to adequately inform their patients preoperatively regarding the expected outcomes of breast reconstruction using silicone and saline implants.

REFERENCE

Patient Satisfaction and health-Related Quality of Life following Breast Reconstruction:  Patient-Reported Outcomes among Saline and Silicone Implant Recipients; Macadam, Sheina A.; Ho, Adelyn L.; Cook, E. F. Jr; Lennox, Peter A.; Pusic, Andrea L.; Plastic and Reconstructive Surgery. 125(3):761-771, March 2010; doi: 10.1097/PRS.0b013e3181cb5cf8

SurgeXperiences -- Call for Submissions

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active. 

SurgeXperiences is a blog carnival about surgical blogs that occurs every two weeks. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.  

There is no host listed for  SurgeXperiences 324 which is due to run June 13th, but please don’t let that keep you from making your surgically related posts via this form.  Submissions should be made by midnight Friday, June  11th.

If you wish to host SurgeXperiences 324 or any future edition, please contact Jeffrey who runs the show here.

Here is the catalog of past SurgeXperiences editions for your reading pleasure.

Susan's Quilt

Several years back, my mother gave me a stack of old scarves she had embroidered through the years.  She thought I might be able to make a quilt of them.  I actually made several – one for her and one for each sister.  Here is the one I gave to my sister Susan.

I tried to look at the embroidered areas of each scarf, considering the size and shape of the area, as well as the condition after years of use.

As with many of my quilts, I failed to take photos along the way.  This blog (and digital cameras) are helping me change that.   I remind you (and myself) of that, as the photos here were sent by my sister.  I would have loved to have some that show the details better, but beggars can’t be choosey.

This one is 58 in X 78 in.  It is machine pieced (not sure about the quilting).  It uses four “hole in the barn door” blocks, two basket blocks, two hexagon blocks, and two six-pointed star “flowers.”

*** Update June 8, 2010—email from my sister states “I finally found where you signed your quilt. The ink is so faint I did not see it. The quilt was pieced by you and quilted by mom and given to me Sept 7, 2000.”

Here you can see some detail, though not as clear as I would like.  Note the duck and marshes in the hexagon.
Here is another detail shot.

Dog Bite Prevention

Updated 3/2017 --  all links (except to my own posts) removed as many no longer active. 

It seems that each year, I just miss National Dog Bite Prevention Week which is the third full week of May. As you know, it’s June already. Can it ever hurt to review such important information?

More than 4.7 million people a year receive bites from man/woman’s best friend. If you have read this blog for very long, you know I dearly love my dogs -- deceased ones (Columbo, Ladybug (photo), and Girlfriend) and the living one, Rusty. I have no illusions that dogs bite and given the right provocation, I think mine would though most of the time they are totally harmless and would just invite you in to rob me.

Most dog bite-related injuries occur in children 5-9 years of age. Almost two thirds of injuries among children 4 yrs or younger are to the head or neck region. Dog bites are a largely preventable public health problem, and adults and children can learn to reduce their chances of being bitten.

Basic safety around dogs:
• Do not approach an unfamiliar dog.
• Do not run from a dog and scream.
• Remain motionless (“be still like a tree”) when approached by an unfamiliar dog.
• If knocked over by a dog, roll into a ball and lie still (“be still like a log”).
• A child should not play with a dog unless supervised by an adult.
• A child should immediately report stray dogs or dogs displaying unusual behavior to an adult.
• Avoid direct eye contact with a dog.
• Do not disturb a dog who is sleeping, eating, or caring for puppies.
• Do not a pet a dog without asking permission from its owner first.
• Do not pet a dog without allowing it to see and sniff you first.
Things to consider before adding a dog to your household:
• Learn about suitable breeds of dogs for your household.
• Dogs with histories of aggression are inappropriate in households with children.
• If your child is fearful or apprehensive around dogs, then don’t get one. it will not make the child less fearful.
• Spend time with a dog before buying or adopting it. Use caution when bringing a dog into the home of an infant or toddler.
• Spay/neuter virtually all dogs (this frequently reduces aggressive tendencies).
• Never leave infants or young children alone with any dog.
• Do not play aggressive games with your dog (e.g. wrestling).
• Properly socialize and train any dog entering the household. Teach the dog submissive behaviors (e.g. rolling over to expose abdomen and relinquishing food without growling.
• Immediately seek professional advice (e.g. from veterinarians or animal trainers) if the dog develops aggressive or undesirable behaviors.

Physician Burnout

Updated 3/2017 --  all links (except to my own posts) removed as many no longer active. 

Dr. Wes and Kevin,MD have both written reviews of the documentary film “The Vanishing Oath.”   I started the process rolling of trying to get the film shown locally.  No date yet, but looks like it will happen before the year is out. 

This is not a new phenomenon in medicine (or any profession).  Dr. Robert Goldwyn wrote a nice essay on the some of the issues that can lead to burnout though not once did he mention burnout specifically.  The title says much:

“I Bargained on Working Hard as a Surgeon,  Not Working hard to Be Able to Work Hard as a Surgeon”

The preceding title is a quote from a letter written by a resident in the last year of his training (S. A. Teitlebaum, August 20, 1994). It reflects the gloom besetting the young in particular but certainly not them exclusively. We all are uneasy about our futures, professionally and economically. Bandied in the corridors at a national meeting was a dismal figure: 1:100,000, the presumed proper ratio, as determined by Health Maintenance Organizations, of plastic surgeons to population. That 1 million Americans need only 10 plastic surgeons seems wrong and idiotic to me, but it makes good economic sense to health providers and insurance companies. Their coffers swell as they collect the same or higher premiums while curtailing what they provide.

When I started in practice 31 years ago, Massachusetts had a population of about 4 million and had 14 board-certified plastic surgeons. Now, with a slightly increased population, there are 104 plastic surgeons. If we go by the 1:100,000 rule, we should expect only 60.………

Lisa Chu, MD has an essay, Burnout is common to teaching violin and practicing medicine, in which she discusses the topic:

I’ve recently started reading blogs and articles about “physician burnout” and I can’t help but notice that there’s a lot of blame being placed on “the system”. Doesn’t this kind of storytelling just reinforce that physicians are victims? I’d like to see physicians adopt a way of thinking that will enable them to create the desired changes in their own lifestyles, levels of satisfaction, and ultimately patient care…..

REFERENCES

"I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon"; Plastic and Reconstructive Surgery. 96(1):177-178, July 1995;  Goldwyn, Robert M.

"I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon"; Plastic and Reconstructive Surgery. 114():102-103, October 2004;  Goldwyn, Robert M.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

Dr. Muchandani's Medical Services is the host for this week’s Grand Rounds.   It’s the “LOL” edition.  You can read this week’s edition here.

I've had a rather interesting time compiling this post for this edition of Grand Rounds. I must say the motive for the theme being humour and laughter was purely selfish. This is the first time I am hosting here and I knew that if I had to keep up the good work of the previous hosts I would have to be totally involved with the selection process of so many many fantastic entries that this event brings on! The only way to screen them would be to enjoy reading every bit and what better way to do that than over a laugh.

So, in no particular order, here are this week's lol posts!……….

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Nurse Teeny, The Makings of a Nurse  is the host of the latest edition of Change of Shift (Vol 4, No 24) !   You can find the schedule and the COS archives at Emergiblog. (photo credit)

I’m honored to host Change of Shift: Volume 4, Number 24. Thanks to Kim at Emergiblog for this amazing opportunity to bring together the nursing community!

Without further ado, let’s get to the good stuff…

May signals transitions, and several CoS-ers addressed this very issue. the Muse, RN confronted the age-old issue of initiating new grad RNs into practice in “No, We Neglect Them“. As a new RN myself, all I can say about this post is THANK YOU! I only wish there were more nurses out there like you!

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There is an updated guideline for the prevention of alls in older patients.  It was produced by the American Geriatrics Society and the British Geriatrics Society.  It is available in an interactive online format here.

The screening for falls and risk for falling is aimed at preventing or reducing fall risk. Structuring and standardizing the screening process may improve adherence of providers to the guideline recommendations. The use of a finite number of simple questions, requiring a yes/no answer, may also simplify documentation. Any positive answer to the screening questions puts the person screened in a high-risk group that warrants further evaluation.

RECOMMENDATIONS

All older individuals should be asked whether they have fallen (in the past year).
An older person who reports a fall should be asked about the frequency and circumstances of the fall(s).
Older individuals should be asked if they experience difficulties with walking or balance.

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A Better Health post by Dr. John Mandrola:  Remembrance And Rules For Cyclists And Motorists.  Here are a few of the rules, read the entire post for all of them.

Rules of the Road
A cyclist must:

• Obey the instructions of official traffic control signals and signs. Stop at stop signs and for stop lights just like a motor vehicle.
• Ride a bicycle on the right side of the road with traffic.
• When riding at night, operate the bicycle with a white light visible from the front and a red reflector or light visible from the rear.
• DO NOT RIDE ON THE SIDEWALK
• Ride on a bike path adjacent to the roadway, if one is provided.
• Never ride more than two abreast so as to interfere with the normal movement of traffic.

A motorist must:

• Share the road with bicycles.
• Look for cyclists. Because of their narrow profile you will need to develop your eye-scanning patterns to include bicyclists.
• When you are turning right after passing a cyclist, leave ample room so you don’t cut him off when you slow for your turn.
• When opening your car door, check behind for cyclists. 

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Medgadget is sponsoring the The 2010 My Medical Museum Competition along with Dr. Allen Roberts, aka GruntDoc.

This contest is an opportunity to showcase your medical museum's treasures, as well as to document your local medical history and explain how clinicians and scientists in your area contributed to medicine. So, make a presentation and tell everyone a fascinating story.

To get everyone on equal footing, we've implemented a dynamic publishing platform where you create an online presentation. The My Medical Museum website will let you upload pictures, file reports, embed videos, and make a presentation that will impress the judges. Collaboration is fine, too -- form a group and grant access so your teammates can contribute.

The Grand Prize is a brand-new Wi-Fi 32GB Apple iPad, no less.

So, what else are you waiting for? Gather your friends, family or fellow medical geeks and head over to explore your local medical museum. Develop your presentation and finalize it by Sunday, June 13, 2010.

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It’s time again for the web-based quilt festival hosted by Amy – Blogger’s Quilt Festival, Spring 2010.  I submitted my “First Quilt” as part of the festival.  There is a long list of blogging quilters who are participating.  Grab a cup of coffee or tea and have fun checking them all out.

Welcome to the third Blogger's Quilt Festival!  I'm so glad that you are here - and I hope that you plan to enter a quilt in the Festival!  Everyone is welcome to participate, this is a relaxed festival with no judging, no gloves, and beverages are allowed, encouraged even!  :)

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Dr Anonymous’ BTR show guest this week will be Dr. Deb Clements, Family Physician who recently was in Haiti. The show begins at 9 pm ET.

Upcoming shows (9pm ET)

6/10: Ray Saputelli, NJ Academy of Family Physician