But of course, all that will soon change - what with Labour's plans. Why, I fully expect every carer to be bright, determined and committed. Not underpaid, undereducated and uncaring - that would never happen, and certainly never be the norm. I'll tell you what Gordon, Andy, and whoever the Conservatives will have as health secretary - let me come and explain why ambulances count as social care, it was something that your predecessor was surprised to hear from me.

Never mind, I'm sure that the numbers will show that there is more social care - but I bet they won't show the increased ambulance usage because the social care is so slipshod.

What is really sad is that I sometimes see superb social and residential care - it's just that it is increasingly rare.

-----

*However, I could not count the number of times someone has called for an ambulance, we've turned up four minutes later and on knocking at the door the occupants have asked who it is...

**I do of course jest - they don't go to sleep. They watch porn instead***.

***I love 'em really - mostly because a lot of them look like they box for a hobby and could take me in a fair fight.****

****Especially the women.

“Prescribed psychotropic medications are now high on the research agenda,” assert Lakhan and Hagger-Johnson. Their study advocates new approaches to research to address the rising concern over dramatic increases in psychotropic prescriptions for both children and young.

Our first post delineated the five erroneous myths often adhered to when prescribing youth’s psychotropic medication. Here are the three areas of recommended research to address this “alarming” problem. … [visit site to read more]

When you say or hear a concrete noun, such as “apple”, what happens in your mind? Even without seeing a physical apple in front of you, your brain is drawing up an image of an apple, maybe the last one you ate or saw in the stores or on TV. A team of researchers at Carnegie Mellon used an fMRI (functional magnetic resonance image) machine to find out. Rather than using complex transparent concepts, like “honesty”, the team used simple words that convey physical, everyday objects to see which parts of the brain was activated. The goal was to see how the brain functions when we think of an object, rather than just trying to see an object in our mind. The brain was activated in many different parts for the simplest words, showing a complex, networked effect for even the easiest thoughts. … [visit site to read more]

Product page: S5 HLM...

Press release: SORIN GROUP ANNOUNCES U.S. FDA CLEARANCE OF NEWEST GENERATION HEART LUNG-MACHINE (.pdf)...

GE press release: Ice-age mammoth in space-age scan at GE Healthcare ...

Exhibit: Mammoths and Mastodons: Titans of the Ice Age

Ah, the Nursing Olympics!

Here we see the U.S Synchronized Study Team.

The judge, visible at the end of the table, will look for uniform cap placement, the exact angle of the binders, the uniformity of handwriting and the perfect 90 degree angle of the elbows.

Should they meet the stringent criteria, they will receive the coveted Gold Stethoscope.

Which will inadvertently be taken by a physician who asks to borrow it.

(Here’s how long I’ve been a nurse: I was once told by a colleague to get a pink stethoscope because no doctor, being male, would walk off with a pink stethoscope. Yeah, I’m old!)

But in defense of doctors, I recently worked with an ED doc who was frantically searching for his stethoscope. Could not find it anywhere. Finally, one of the nurses found it. Around my neck. Along with my own stethoscope. Truly a red-faced moment.

********************

Change of Shift is now up at the INQRI Blog (The Blog of the Interdisciplinary Nursing Quality Research Initiative). The focus is on education, and was the inspiration behind this post. The next CoS will be hosted by Mamatrauma and submissions can be sent to “clynewarnr at earthlink dot net”.

Leslie at Getting Closer to Myself will be hosting the next Patients for a Moment blog carnival, so send your submissions! Check the link to her blog for the post with all the information!

********************

It was a quiet night in the ED; we were shooting the bull about various topics. I said I would be graduating in May with my BSN and applying to a PhD program next month.

And then came the question.

“Hey Kim, if you are going to go through all that education, why don’t you just become a doctor?”

I explained how nursing is an independent discipline with it’s own body of knowledge and research, that nursing and medicine were separate professions…

I wasn’t getting my point across.

But then I thought of a better question.

“If you are going to go through all that education, why don’t you become a pharmacist?”

Doesn’t make sense, does it?

Neither does the nurse/doctor question.

*****

Do you remember that old television commercial, “If caring were enough, anybody could be a nurse?”

Or this poster, which singlehandedly pulled me out of burnout?

Caring is the heart of nursing. I’d even say it defines nursing (see: Jean Watson).

But, the� foundation of nursing is comprised of anatomy, physiology, psychology, lifespan development, pathophysiology, philosophy, sociology, ethics, multicultural studies, critical thinking, leadership, statistics, research and …

Nursing Science!

Why is this so hard for people to understand?

What is the problem?

*****

Oh, I know the usual spiel: nurses used to be “trained” in hospitals, nurses deferred to doctors, nursing did not require a college degree, nurses could not practice independently, nurses just did basic care…yadda, yadda, yadda.

And that was all true.

About 70 years ago.

Well, it’s the 21st century, folks. Let’s drop those excuses once and for all.

There is absolutely no reason for anyone alive today to not understand exactly what nursing is and what nurses do.

We need to talk about it.

Hell, we need to bring it up. At every opportunity.

And please, spare me the nurse recruitment videos with the emotional music and nursing sitting there talking about how they feel they are making a difference. Show me a video with nursing talking about making a difference while discussing what it means to be a nurse. The education involved.� The ability to think critically. The ability to work under pressure. The ability to be flexible. The ability to stand up and advocate for your patient.

For your profession.

And why it is worth pursuing!

*****

Frankly, it takes a good pair of “cohones” to be a nurse. The education is intense and the profession is challenging.

If you want to “help people”, go volunteer at a convalescent home.

If you want to care for people as a professional nurse, you’ll study harder and work harder than you ever imagined.

And when you’ve done that, you’ll “make a difference” in ways you never dreamed of.

So yeah, I’m a little sensitive when someone asks me “Why don’t you just become a doctor?”.

I don’t want to be a doctor.

I’m a Registered Nurse.

Now let me tell you why….

Why Don’t You Just Become a Doctor?

It’s happening right now!

The Healthcare Information and Management Systems Society (HIMSS) conference is going full blast in Atlanta and Better Health is on the scene, bringing us interviews and information from the latest in telemedicine/emedicine!

The Ustream is live right now:

Live Video streaming by Ustream

Dr. Anonymous and Dr. Val are interviewing the leading healthcare technology entrepreneurs!

Unbelievable stuff for nursing here!

HIMSS From the Front Line

Chaos theory – Noun - The branch of mathematics that deals with complex systems whose behavior is highly sensitive to slight changes in conditions, so that small alterations can give rise to strikingly great consequences.

Alternative definition:

Chaos theory – Noun – The branch of healthcare that deals with making the payment system increasingly complex and ever changing. This complexity and confusion impact physicians and patients in such a way that appropriate services in care of the patient are subject to rules and regulations that are deliberately complex, making alterations from the momentary rules inevitable.  This exists so that even small alterations will free the insurance company from the responsibility to pay for said service.

I am no physicist, but I honestly think that a grasp and understanding of the first type of Chaos theory is more likely than that of the second.  Let me give a demonstration of the second chaos theory in action:

Step 1:  Patient comes in to be seen.

Step 2:  What insurance do they have?

Step 3:  Patient produces insurance card

Step 4:  Office has to verify that this plan is actually valid for this patient, with several alternatives:

1. The insurance is valid.
2. The patient has changed insurance but still holds an old card.
3. The patient has been dropped from the insurance due to nonpayment or losing employment.

Step 5:  Once verified, the patient does one of several things:

1. Pays copay where that is required.
2. Pays past due balance.
3. However, if past due balance is due to the insurance company not paying on a claim yet, the patient won’t be required to pay (as long as it is a reasonably short period of time).
4. Does not pay (either because of insurance like Medicaid that pays in full or because of indemnity insurance).

Step 6: Insurance card is scanned in, documenting what patient presented at the time of the visit and giving access to the card by clinical staff for the rest of the visit.

Step 7:  Once settled, the patient comes back to the office to be seen by the medical staff.

Step 8:  Patient is seen by clinician.

Step 9:  If procedures are performed, they may or may not be billed by clinician, depending on insurance coverage.  Several possibilities exist:

1. The procedure is covered.
2. The patient has Medicare or Medicaid, which does not pay for certain services.  In this instance, the procedure code pays less than simply coding the visit at a higher level (E/M) due to complexity of the visit.
3. The patient has HMO which is paid by cap and the procedure is not an “over and above” and so won’t be covered.  Here it doesn’t matter if the procedure is billed or not.

Step 10:  If immunizations are given, the insurance must be checked to see if the vaccine is covered.  Since there are numerous plans under a single insurer, simply knowing the name of the insurer (eg. Aetna, United Health Care) does not guarantee coverage.  Of ten this results in step 10a, which is for the clinical staff to call the insurance company and ask directly if the immunization is covered (the results of which are only somewhat reliable).

Step 11:  Once insurance coverage of the immunization is determined, several possibilities exist:

1. The immunization is covered and so is taken from regular stock and administered to patient
2. The immunization is not covered, but others are by the insurance company.  In this case, the patient is informed by the billing staff that they will have to pay out of pocket for this before the immunization is given.  The patient is generally aghast at the cost and often foregoes the immunization, making step 10 superfluous.
3. Immunizations are not covered by this insurer or the patient has no insurance and the patient is a child.  In this case, the immunization is taken out of a different stock of vaccines (“Vaccines for Children”) and given.  The procedure is billed under an entirely different code.
4. The patient has Medicare, and the immunization is not covered (like Zostavax, the shot for shingles).  In this case, the patient is given a prescription for the immunization and picks it up at the pharmacy, brings it back, and gets it administered by the nurse.

Step 12:  If the patient requires labs, the patient’s insurance needs to be checked so they can go to the proper lab.  A single payer such as Aetna cab have different policies that require different lab facilities to be used, so there is significant risk that the sample will be sent to the wrong lab.  Here, too, several possibilities exist:

1. The patient can get the labs drawn in the office, and it does not matter which lab is used.  In this case, the nurse sends the sample to the lab which is easiest for us to use.
2. The insurance company allows “pass through billing,” which allows our office to bill for the labs and pay the lab a negotiated amount.
3. The insurance company specifies a lab that picks up samples from our office, in which case we draw and put the samples in the collection bin for that lab.
4. The insurance company specifies a lab that does not pick up samples, in which case we send the patient with a printed requisition to get labs drawn at that facility.
5. The lab sample cannot be drawn here (needs to be frozen, for example) or the patient does not want the test drawn at the time of the visit.  In this case, the proper lab facility needs to be determined and the appropriate requisition filled out and given to the patient.

Step 13:  If the patient requires an x-ray to be done, it needs to be determined if the insurance requires authorization for that x-ray.  Several possibilities exist:

1. The insurance does not require authorization and does not specify where the x-ray must be done, in which case the patient is given a requisition and told to go to the preferred facility.
2. The insurance does not require authorization, but specifies a specific facility.  In this case, the patient is told to go to the appropriate facility.
3. The insurance requires authorization, in which case a note is sent to our referral coordinator (full time position), who gets authorization and then informs the patient where the procedure needs to be done.
4. The insurance does not require authorization, but the procedure must be scheduled.  In this case, the referral coordinator is notified of the request and schedules the procedure with the preferred facility.

Step 14:  If the patient requires a referral, it needs to be determined which physicians or facilities are on the list of providers for that insurance.  This too can vary under different plans, as HMO will be very specific, PPO’s will be somewhat specific, and indemnity insurance will not be specific as to which providers must be used.  Furthermore, some types of referrals do not require referrals (dermatology, ob/gyn, ophthalmology, psychiatry) and so the patient is told to make their own appointment.  Once it is determined which physician to use, there are several possibilities that exist:

1. The visit is urgent, and the insurance does not require authorization.  In this case, the patient stays until the appointment is made by the referral coordinator.
2. The visit is urgent, and the insurance company does require authorization.  In this case, the referral coordinator gets authorization from the insurance company, then calls the referral facility to make an appointment, giving them the authorization number.  The referral coordinator must know just how urgent the visit is (immediate, today, this week?) and depending on that, either makes the patient stay until the appointment is made.
3. The visit is non-urgent and the insurance does not require authorization.  The appointment is made by the coordinator and the patient is contacted by phone/email with details.
4. The visit is non-urgent and the insurance requires authorization.  Same as above, plus authorization.

Step 15:  If the patient requires a prescription, it several non-clinical factors come into play:

1. Is the drug on the formulary for the patient’s insurance?  This can vary with plans, and so may be different under a single carrier.
2. If on formulary, what tier is it?  If it is a higher tier, the patient may not be able to afford it or be willing to pay.
3. If not on formulary, which drugs in the class are?  Have others been tried?
4. If not on formulary and still necessary, what is the process to get this authorized?  In this case the prescription is given, the patient gets it filled, the pharmacy notifies us of the need for PA, and we try to obtain it.  This process can take up to 3 weeks.
5. If denied by the insurance company and still necessary, what is the process for appeal?
6. If patient has to pay out of pocket, then which drugs are cheap and which do we have coupons for?
7. If patient is Medicare, then we cannot give coupons (because for some reason it is wrong to make the government pay less).

Step 16:  The patient is dismissed with a plan and is scheduled for a follow-up appointment.

Step 17:  The patient is asked to pay the remainder of the balance at check-out, depending on what the doctor ordered and what was done in the office.

Pitfalls

There are a number of possible pitfalls.

1. If the patient supplies the wrong insurance information, then all of the above is invalid and may not be covered
2. If the patient (or their blood) is sent to the wrong lab, x-ray facility, or referral facility, the insurance company will not cover the procedure (even if appropriate)
3. If the patient is sent for an appropriate referral to an approved facility, but the proper authorization is not gotten, the visit will not be covered.
4. If the lab/referral/consult is sent with the wrong diagnosis code, or one that is no longer valid, the insurance will not cover.
5. If the lab is done at all early (under 3 months for a Hemoglobin A1c, for example), the insurance will not cover.
6. If the immunization is given even 1 day early, it will not be covered, and won’t be counted as being given.

Who pays for these pitfalls?  Either the patient (who then gets mad at the doctor for doing it wrong), or the doctor’s office.

Confusing?  Yes, that’s my point.  Multiply all of this times the number of different insurances the office accepts (including all managed Medicare and Medicaid), and watch what chaos ensues.  Who benefits?

Not the doctor.

Not the patient.

Not nurses.

Hm…. Who’s left?

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“He gave me the look,” the patient said to my nurse as he walked out of the exam room.

My nurse laughed and said, “I had a feeling you’d get it today.”

What were they talking about?  ”What look?  I didn’t know I had a look!” I asked my nurse.

The patient tipped his chin down and looked at me over his glasses.  My nurse laughed, pointing at the patient, “That one!  Exactly!  You give that look to me too!”

I was mystified.  I don’t like lecturing people or acting like their parent.  Patients do no harm to me when they gain weight, don’t take their medications, or eat a lot of Little Debbies.  My job is not to get them to do everything I say, it is to give them enough information and motivation to do it for themself.  I am the coach; they are the ones who have to go out on the field and play.  I may be disappointed when they mess up, but it’s not my job to patronize them and wag my finger.

So I was vexed when I learned about “the look.”  I’m honestly not sure how much of it is just a product of a guilty conscience on the parts of my nurse and the patient, but there is usually at least a grain of truth in this kind of revelation. I do know that I mysteriously intimidate new employees at our office.  The longer-standing ones think this is funny – realizing the softie I really am.

I’m also not sure if it is so bad that they don’t want me to look at them over my glasses.  I have had patients (and probably employees) assume my silence on an issue was a tacit approval.  ”He never told me I shouldn’t smoke,”  ”He never said I needed to lose weight.”  I’ve had people use my lack of lecturing as an excuse to continue behavior they already know is bad for them.

I also never told them it was bad to hit themselves in the head with a hammer.  I hope that omission isn’t resulting in head trauma.

I saw another patient recently, who said to me before I could sit, “I am sure you noticed I gained 6 pounds.  Christmas and Valentine’s Day were bad for me.”  I hadn’t had the chance to check the chart, but returned a remark about how there is a clear correlation between eating too much and gaining weight.  I could tell he had a guilty conscience, so I didn’t say anything more.

As I wrapped up the visit he asked me, “Aren’t you going to say something about the six pounds I gained?”

I smiled, realizing that he was expecting “the look” from me.  I told him that it was not good to gain weight and then looked at him over my glasses.

We’ll see how much power it has.

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Here are some comments from other hospitals who I contacted for my Sunday article on hospital readmissions and new data published by Medicare on its Hospital Compare Web site:

The Carle Foundation Hospital sent a statement from Mike Billimack, vice president of marketing and strategic planning.  The Urbana hospital had a higher-than-average readmission rate for seniors with heart attacks.

"We continually look into the data for patients discharged from our hospital after AMI [acute myocardial infarction) and subsequently readmitted.  Unfortunately, the (Hospital Compare) performance report includes patients discharged from Carle Foundation Hospital and readmitted to any other hospital for any reason (except stent placements and [coronary artery bypass] procedures).   We do not have access to data for those patients admitted elsewhere.  Therefore, the data is somewhat misleading."

It's true that the Medicare data includes readmissions to any hospital -- not just the hospital where the patient was originally treated.  But hospitals like Carle have the opportunity to learn from Medicare where their patients are being readmitted and to initiate conversations with those institutions about how care for patient can be improved, said Dr. Stephen Jencks, a former top official with Medicare responsible for quality improvement.

Billimack also said that Carle ranked highly on other measures of performance for heart attack patients. It's important to acknowledge this and note that readmissions data doesn't tell the whole story. 

Arnie Kimmel, chief executive officer of MetroSouth Medical Center in Blue Island, noted that the hospital, formerly known as St. Francis, is under new ownership.  The 36 months of Medicare data only reflect eight months of the hospital's operation under new management, he said.

"Not all of the responsibility is the hospital's," he said, referring to why patients are readmitted within 30 days of discharge.  "A significant part of the reason we have to attribute to [patients] lack of compliance" with medical recommendations.  While the hospital is analyzing its criteria for admission through the emergency room,  Kimmel said, he doesn't think it needs to make any other changes.

Kimmel observed that death rates for MetroSouth patients were well below the national average in the most recent period reported;  a check of the Hospital Compare Web site confirmed this.   Overall, he appeared to dismiss the signifiance of the readmissions data.

Ingalls Hospital in Harvey made available Linda Ambrosecchia, director of quality assurance, infection control and patient safety to discuss its higher-than-average readmissions rate for seniors with pneumonia.  "We find a disconnect in the (Medicare measurements)," she said.   The death rate for Medicare patients at the hospital is lower than the national average yet its readmission rate for pneumonia patients is higher, she observed.

Ingalls has been reviewing its readmissions for pneumonia and the trend line is moving downward.  "In the last year, our rate was at the national average," Ambrosecchia said. She noted that the senior population Ingalls serves tends to be lower income and have multiple chronic conditions.  "Some patients may not have basic resources to support their care at home," she said.

Medicare's data using sophisticated techniques to adjust for how ill patients are, a spokesman said. Therefore, patients' chronic illnesses shouldn't skew a hospital's results.

Advocate Health Care played up the good news -- lower-than-expected death rates for seniors at six of its hospitals -- in a statement.   Regarding lower than-average readmissions rates for seven hospitals, the system down-played the significance of the data on the second page of a press release:

"Advocate continues to address opportunities to reduce readmission rates.  The newly released data includes cases from up to four years ago, so the numbers do not capture improvements that are being made on an ongoing basis," said Dr. Lee Sacks, chief medical officer. "Also, the [Medicare] readmission rate is calculated without taking into consideration why the patient is being readmitted, if the patient followed the post-acute care plan and other factors not related to the quality of hospital care during an intial admission."

 

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.

Attention deficit disorder is a serious mental health issue that affects the lives not only of children and teens, but millions of adults as well. So we’re pleased to announce the launch of our latest blog, ADHD In Focus, that will focus on topics in attention deficit disorder (ADHD).

ADHD In Focus is hosted by Kathryn Goetzke. Kathryn is the driving force behind the non-profit organization for depression called iFred (the International Foundation for Research and Education on Depression). iFred is dedicated to encouraging research on depression and reducing the stigma associated with the disease.

In addition to her incredible work on iFred, Kathryn is someone who actually battles attention deficit disorder, hence the reason she agreed to write for this blog. I’m proud to welcome her to the Psych Central family, as I expect that the sharing of her experiences here will help us all better understand not only what ADHD is about, but also strategies one can use to help combat it in everyday life.

Check out the new blog today: ADHD In Focus

Read the full news story: Napping Makes You Smarter

References:

Milner, C.E. & Cote, K.A. (2008). A dose-response investigation of the benefits of napping in healthy young, middle-aged and older adults. Sleep and Biological Rhythms, 6(1), 2-15.

Waterhouse, J., Atkinson, G., Edwards, B., & Reilly, T. (2007). The role of a short post-lunch nap in improving cognitive, motor, and sprint performance in participants with partial sleep deprivation. Journal of Sports Sciences, 25(14), 1557-1566.

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.

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I should buy her. Found her at Ruby Lane, which has a bazillion shops, but if you type “nursing” into the search box you will find a treasure trove of nursing ephemera. Diplomas, pins, yearbooks, prints, journals – I’ve found stuff I didn’t even know existed.

Bought an entire year of the American Journal of Nursing (‘58) and it is in my closet, just waiting for me to scan!

I see a resemblance.

Must be the freckles.

********************

Looking to hire nursing staff?

You might want to check out All Health Jobs and All Nursing Jobs. They will post your job openings for free – just use the coupon code “Emergiblog”.

Are you looking for a new job? They’ve got hundreds of positions listed. I know, I’ve checked it out. Not that I’m looking for a new job, or anything. Just like to keep an eye on what is going on out there.

********************

The discussion regarding the entry level for nursing has been ongoing for decades. I have articles written in the 1940s extolling the virtues of the BSN long before the first ADN program opened in 1952.

Every now and then, someone broaches the topic of making the BSN the entry level and BAM! the flames that ensue make the health care reform debate look like Mr. Roger’s Neighborhood.

Why the rancor?

Well, if one states that the BSN should be the entry level for a registered nurse, then it follows there must be a reason why an ADN should not.

That does not sit well with ADN graduates.

It sure didn’t sit well with me.

*****

Now, 5 months away from graduating with my BSN, I see a difference.

Or, I guess you can say I feel a difference.

I am a different nurse than I was 2 1/2 years ago.

Notice, I didn’t say “better”.

*****

My clinical skills are the same.

If you want to define nursing as the ability to put the right tube in the right orifice using the right technique, the BSN gives no advantage. Clinical skills for the ADN and the BSN are taught in class but honed in practice. While the ADN program may include more clinical hours, it has been my experience that neither program produces nurses ready to “hit the road running”.

My understanding of nursing has broadened.

Some disdain nursing theory and say it has no basis in daily practice, but have they really looked at what theories are out there? All nursing programs are based on one. For me it was Sister Calista Roy’s Adaptation Model. Theories give a framework, a way of approaching assessment and care, a nursing philosophy.� You can argue that it’s useless, but you are using one every day, whether you realize it or not.� Now, it will be a cold day in Hades before I use “Energy Field Disturbance” as a nursing diagnosis but until I studied theory, I had no idea that Rogers’� Science of Unitary Human Beings even existed.� When I saw Jean Watson’s Theory of Human Caring, it was like getting hit by lightening. Watson’s theory, to me, is nursing.

Do my patients know which nursing theory I adopt? No. Do they care? No.

But I know. And I care. My nursing care has more depth, more perspective and a greater meaning to me because of the wider knowledge obtained through an in depth study of nursing theory.

I didn’t get that in my ADN program.

The nursing profession is more diverse than I imagined.

Okay, yeah I knew there was home health and public health was something done “out there” somewhere and some nurses worked 9-5 in a clinic, but like a horse wearing blinders, all I saw is what was right before me. Bedside hospital nursing.� That’s what I was educated to do.� Anything outside of bedside nursing required a BSN, minimum. No way was I going to do that! Blech! I lived nursing full time as it was.

As a result, I was never able to take advantage of opportunities that were there when I was so burnt out at the bedside I left crumbs when I walked.

Case management, nurse practitioner, becoming a nursing professor, home health, nursing research, school nursing and lord almighty, public health!!!!� I had no idea about public health – I thought it was visiting people in homes and running immunization clinics. It’s is that, but it is so much more!

You can advocate for patients, thousands at a time, in so many ways!

I was not exposed to that in my ADN program.

*****

I guess you could say the last 2 1/2 years have been a transforming process for me. The BSN program has enriched my life, my practice and, although they would never know it, my patients.

So, do I think the BSN should be the entry level degree into nursing?

Well, if I said yes, I’d need Secret Service protection!

I would say if you are just entering the profession and it’s at all feasible for you, go the BSN route from the start.

I think it should be required – BUT (hold your fire!) there much to be said for being an ADN grad and then going for the BSN. In fact, I would almost recommend that. I know that I have gotten so much more out of the BSN education with many, many years of clinical practice behind it.

When you are an ADN and you are studying for the BSN, you have perspective, a place to assimilate what you are learning into your current practice. Subjects like nursing theory and research take on a clearer perspective, as opposed to being vague ideas and dull methodologies.

The BSN is worth getting.� I know I have developed both personally and professionally.

(Now, if I can just get through this last semester…)

Speaking of Degrees…

David Williams of the Health Business Blog hosts the latest edition of the Cavalcade of Risk.  Some of the highlights include:

• Having sex can boost your immune system
• Is bullying health insurers the best way to restrain rate increases?
• How much health insurance do you want?  The government may not know unless it keeps at least some form of private health insurance.

• Tax credits for Health Insurance Premiums.  This will do nothing to change how much health care costs, it will just change who pays the premiums.  For middle class individuals, these subsidies will help make health insurance more affordable.  Because the wealthy won’t receive any subsidy (the maximum family income to be eligible for the credit is $88,000), they will simply pay higher taxes.
• Health Insurance Mandate.  Obama does not call this a mandate, but rather titles this section of the proposal “Improve Individual Responsibility.”  Individuals who don’t buy health insurance will be fined.  A health insurance mandate in and of itself doesn’t make much sense to me (if you don’t want it or can’t afford it, you shouldn’t be punished).  However, if laws that prohibit-pre-existing pricing insurance plans based on pre-existing conditions, a mandate may be needed so individuals can not avoid paying health insurance premiums until they fall ill and only then pay the premiums.
• Employer Mandate.  If you don’t provide health insurance for your worker, you have to pay a fine of $3,000.  This is true for firms with 50 employees or more.  The employer mandate does not make much sense.  Business could offer health insurance to attract employees, but firms should not be forced into being in the health insurance business.  It makes more sense to instead make it easier for businesses to provide insurance.  For instance, the government could allow small businesses to band together to buy health insurance product under the umbrella of a common organization.  The economies of scale should reduce insurance costs.
• Federal financing to all States for the expansion of Medicaid.  Helps the state budgets, hurts the federal budget.
• Closing the Medicare prescription drug “donut hole” coverage gap.  This will increase the cost of the program, but it makes sense to have a more standardized benefit package with a deductible and flat coinsurance rate rather than the complex product with the donut hole.
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid.  This is a throw-away point.  Every politician tries to do this, but it is often difficult to determine what is fraud, waste and abuse and what is just expensive care for a needy patient.
• Eliminate Pay-for-Delay.  Pay-for-dealy occurs when brand-name pharmaceutical companies pay their generic competitors to keep its drug off the market for a period of time.  This generally seems like a good idea, but one economist says eliminating these payoffs may make it less likely generics will be developed in the first place.
• Increasing the threshold for the excise tax on the most expensive health plans.  I am not a supporter of this bill.  Health insurance is expensive either because 1) the health plan is very generous or 2) the person is sick and it is expensive to cover them.  The excise tax will cut down on the number of super generous plans, but it will punish sick individuals in the non-group market.  Eliminating the deductibility of group health insurance benefits makes more sense and will raise more revenue to help pay down the deficit.
• Broaden the Medicare Hospital Insurance (HI) Tax Base.  This means that unearned income (capital gains, dividends, interest) will now also be subject to Medicare taxes.
• Creating a new Health Insurance Rate Authority.  Many states already have a body that regulates insurance companies.  Having an additional body may just be a waste of taxpayer dollars.  The federal government may think health insurance rate increases are “too high” but I doubt the government will know what the “right” premiums would be more than a private insurance company.
• Invest in Community Health Centers.  Community health centers can help people who fall through the cracks: those without health insurance, immigrants.  However, a more comprehensive health reform (which would fund a majority of the health insurance cost for these disadvantaged individuals) would allow poor people to choose which health care provider they wanted rather the having to rely on community health centers.  Expanding Medicaid may be a more effective use of these dollars than investing in these centers if Medicaid could be expanded to all individuals.  If the U.S. wants to provide immigrants with poor medical care (i.e., make them ineligible for Medicaid) as a disincentive to immigrate, than community health centers may be a better option than additional Medicaid funding.
• More federal funding for SCHIP.
• Eliminating the Nebraska FMAP provision.  Eliminates one example of pork, but there are likely many others in the bill.

Other commentaries worth reading:

• The bill will increase the marginal tax rate for the poor.
• Which groups will be helped most if health reform passes?
• What will be the impact for Californians?
• BBC on Obama’s plan.

Scientists at Birmingham University in the UK are developing a new healthy chocolate bar where the fat content is replaced with... water.

It sounds too good to be true, but it isn't! The researchers have been looking into ways to replace the fat particles in a normal chocolate bar with calorie-free alternatives like air, water or gels.

Continue reading...

The study, published in the February issue of the journal Addiction, found that non-smokers scored seven points higher on IQ tests than did smokers and, as a result, no-smoking campaigns to teens should be geared towards kids with poorer IQ scores.

To come to this conclusion, the researchers reviewed the files of 20,211 18-year-old healthy men who were in the Israeli military. None of the men had a history of major mental illness. They found tht:

• 28% of the men smoked at least once per day
• 3% used to smoke (were ex-smokers)
• 68% had never smoked

The researchers then reviewed the IQ test results and they found that the smokers who began smoking before entering the military had “significantly lower test scores” (average of 94) than did the non-smokers (average of 101). Men who began smoking after entering the military scored on average 98. Not only were the differences significant, the more cigarettes smoked per day, the lower the IQ score. The average dropped to 90 for men who smoked a pack of cigarettes per day. IQ tests can sometimes be affected by socioeconomic status, so this was taken into account when tallying up the outcomes.

For a point of reference, have a look at this standard chart:

So, what do you say?

~~~

Image: MorgueFile.com

Post from: Healthbolt

• All athletes or celebrities do this
• It’s a sex addiction, give the guy a break
• He’s a role model who has fallen from grace

Why?

1- Not all athletes or celebrities “do this”

2- In my opinion, “sex addiction” is a cop out

3- Why is he a role model? Because he’s rich? Because he plays golf well?

Sex Addiction. It’s considered an actual problem, enough that there are sex addiction “clinics” and sex addiction treatments. I have an idea. How about we take responsibility for our actions and leave the word “addiction” to serious and real issues, like drug addiction.

Someone who wants a lot of sex is just that. Someone who wants a lot of sex. There’s no physical problem that occurs if they don’t have sex. There’s no mental breakdown if they don’t have sex. They just don’t have it. They may feel sorry for themselves that they’re not getting it, but it’s not like their body is going to fall apart because they have to be celibate for a few hours.

But, in our society, which these days doesn’t seem to want people to accept responsibility for their actions, has deemed that this is something we can’t control either. We now have sex addicts.

According to MedicineNet, sex addiction is:

The term “sexual addiction” is used to describe the behavior of a person who has an unusually intense sex drive or an obsession with sex. Sex and the thought of sex tend to dominate the sex addict’s thinking, making it difficult to work or engage in healthy personal relationships.

I have an idea: If you’re thinking about sex all the time, it’s time to take up a hobby.

I know a lot of people won’t agree with me and that this is an unpopular opinion, but I’m fed up with people not taking responsibility for their own behaviors. I have some things that I could focus on 24 hours a day, if I could. There are some things I’d love to do and yes, I may even pout if I can’t do them when I want to do them. I could go overboard and do them anyway, despite the consequences. For example, I’d love to put a lot of pretty things on credit so I can have them, but I know I shouldn’t, so I don’t. I’d love to not work and just play sometimes, but I know I can’t. It doesn’t make me happy to work when I don’t want to – but that’s what life is all about. We can’t always do what we want to do when we want to do it.

~~~

Image: Newscom.com

Post from: Healthbolt

I know, I know, it makes me choke on my words to admit it, but sometimes politicians can actually get science right. I'm referring to something that happened in the U.K., yesterday, when the Science and Technology Select Committee delivered its verdict on homeopathy. Indeed, the Committee has gone so far as to call for the complete withdrawal of NHS funding and official licensing for homeopathy. The report is called Evidence Check 2: Homeopathy, and I'll cut to the chase. This is what the report concluded:

By providing homeopathy on the NHS and allowing MHRA licensing of products which subsequently appear on pharmacy shelves, the Government runs the risk of endorsing homeopathy as an efficacious system of medicine. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy. Homeopathy should not be funded on the NHS and the MHRA should stop licensing homeopathic products.

It's about time.

In my recent rehashing, rebranding, and repurposing an article addressing many of the flaws in the so-called scientific arguments against animal research often made by animal rights activists and extremists, I only briefly discussed one common argument among many, namely that computer simulations can replace the use of animals in medical research by modeling human physiology. I pointed out that, for a simulation to be valid, we have to understand quite a bit about the system beforehand and that simulations aren't much good if they can't be tested against reality. Mark Chu-Carroll decided to weigh in, and he did it in much more detail than I could. He also did it in a lot more detail than I could, because, well, he's a computer geek and computer simulations are one thing he can do:

Let's start at the beginning: just what is a simulation? It's a model of a real system, which attempts to reproduce the effects and/or behavior of the system that it models. In the case of computer simulations, which is really what we're talking about, we produce a mathematical model and algorithmically describe how the model evolves over time. In other words, we write a computer program that runs a mathematical model of a process.

And right there is the problem. We produce the model, and we implement the model. It does exactly what we tell it to. We programmers have a saying which applies particularly well to simulations: garbage in, garbage out. Computers do exactly what you tell them to; if what you tell them to do isn't right, then no amount of computer power is going to change the fact that you didn't tell them to do the right thing.

Precisely. Mark then goes on to explain why.

Add computer simulations to the list of "alternatives" touted by animal rights activists and/or extremists whose efficacy they never manage to show to be greater than the methods they're supposed to replace.

have much effect on the more serious damage that aspirin can cause. �That�s a huge misunderstanding,� says David A. Johnson, a past president of the American College of Gastroenterology and a professor at Eastern Virginia Medical School. Here�s some background from Harvard Health Publications.

Aspirin can cause ulcers, which can lead to complications such as bleeding and perforation of the intestines or stomach. Though coating the pills can reduce the risk of stomach irritation as the drug is digested, that is not the only way that aspirin causes the more serious problems. They also stem from the systemic effects of the drug. Aspirin prevents production of the hormone-like substances called prostaglandins. That helps reduce pain and inflammation.

But prostaglandins also play a key role in maintaining a protective layer in the stomach. That layer can get depleted, thus exposing the stomach to digestive acids that can eat away at its lining and raising the risk of ulcers and bleeds.

Aspirin may also raise the risk of bleeding through its other main mechanism of action, which is as an anti-clotting drug. Without coagulation, bleeding can become a higher risk.

More about what aspirin does and doesn’t do is here and here.

Email Anna Wilde Mathews at anna.mathews@wsj.com, and follow her on twitter at twitter.com/annawmathews.

The big gulfs come down to three basic philosophical disagreements, the WSJ’s Capital Journal column says this morning:

� Is the goal comprehensive or incremental change? Dems want a big ball of wax that expands coverage, curbs costs and revamps insurance regs. Republicans want to go “step by step.”

� Is access or cost the top priority? Control costs and you make it easier for people to buy and keep coverage, the GOP says. The Democrats say expanding access will drive down costs.

� Should government or markets set the standards? Easy to guess how they come out on this. Dems think there has to be a government insurance referee; Republicans want to leave that to market forces.

Capital Journal calls all of these “honest disagreements,” and then notes President Obama’s closing summit comments about trying to bridge the philosophic divide. “I don’t know frankly whether we can close that gap,” the president said.

I’ll leave observations about the merits to our experts, who live-blogged the morning session. I found a few things interesting from a transparency perspective:

The format was far more conducive to productive discussion than procedures for “debate” in Congress. What generally happens in the House and Senate is display of members’ and senators’ well-settled views.  So today interested Americans could get a real sense of the issues and how their representatives think about them.

There seemed to be a division between representatives who knew the technical subject matter and those who—for lack of a better phrase—knew the emotional subject matter. Surprisingly astute commentaries on fiscal realities were met with appeals to the story of one constituent or another—or of members’ own families’ health predicaments.

Though there was much talking past one another, these are all good things to see. It will inform the public, and a better informed public will make better decisions about health care legislation, about individual representatives, and about the proper role of government. 

I know how I feel about these things. (I’m soft-pedaling my views here as hard as I can…) My opinions didn’t change, though I adopted new nuances to my thinking.

It’s doubtful that many people’s opinions will change. But I’m confident that a more open process will lead to better results in many senses: specific policy results; electoral activity; and people’s overall sense of the role of government.

Today’s meeting only scratched the surface, of course. Sessions like this in the days and weeks to come will do more to improve the transparency of the lawmaking process, in this issue and hopefully others. Today’s transparency precedent is something that the president and federal lawmakers should not retreat from.

It looks as though we’ll be getting a straight one-year reauthorization of the expiring provisions of the Patriot Act, without even the minimal added safeguards for privacy and civil liberties that had been proposed in the Senate’s watered down bill.  This is disappointing, but was also eminently predictable: Between health care and the economy, it was clear Congress wasn’t going to make time for any real debate on substantive reform of surveillance law. Still, the fact that the reauthorization is only for one year suggests that the reformers plan to give it another go—though, in all probability, we won’t see any action on this until after the midterm elections.

The silver lining here is that this creates a bit of breathing room, and means legislators may now have a chance to take account of the absolutely damning Inspector General’s report that found that the FBI repeatedly and systematically broke the law by exceeding its authorization to gather information about people’s telecommunications activities. It also means the debate need not be contaminated by the panic over the Fort Hood shootings or the failed Christmas bombing—neither of which have anything whatever to do with the specific provisions at issue here, but both of which would have doubtless been invoked ad nauseam anyway.

The Viking and I ventured out early this morning to get the H1N1 vaccine and found long lines in the tony neighborhoods. SF Gate reports that the Marin public vaccination clinic was swamped. (The irony!--Marin is a hotbed of the anti-vaccination movement.) So where can you get the vaccine quickly? Downtown! We were in and out in less than an hour! There's almost no one there.

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.

Lilly’s Jan Lundberg Worries About Dropping The Ball (The Indy Star)

DOJ Probes Pfizer Over Rapamune Marketing (Dow Jones)

Germany’s Merck Paying $6B For Millipore (Associated Press)

Brain Image Suggests Alzheimer’s Drug Works (Reuters)

Astellas Launches Hostile Bid For OSI (TheStreet)

AZ Exercises Merck Option For $647M (Reuters)

Novartis Shareholders Back ‘Say On Pay‘ (Dow Jones)

Medicare Cuts Prompts Doc To Limit Elderly Patients (Bloomberg)

Coffee pix thx to chichcacha flickr creative commons

However, two drugmakers not only were listed, but were highly ranked. Placing fourth was the Novartis Institutes for Biomedical Research in Cambridge, Ma. Why? Postdocs cited equity and benefits, although they’re not crazy about the value of the postdoc experience or demands on family and personal life. At number five was Genentech, which was cited for research funding and benefits, but was rated as weak when it comes to the value of the postdoc experience, and training and mentoring. Here is the list.

lab shot courtesy of seattle municipal archives flickr creative commons

I’ve made my stance on bottled water quite clear before, but I’ll go ahead and reiterate: bottled water is a joke. It’s completely unnecessary, unless you’re in a nation with unsafe water quality, and the plastic bottles make for excellent landfill fodder. You could reuse the bottles, but then you’ve gotta worry about the plastic leaching into your water, especially the more you refill and reuse them (and don’t ever stick ‘em in the dishwasher). Poor taste is one thing – I can’t expect a person to happily drink tap water that tastes terrible – but tap is perfectly safe to drink, especially if used with a simple filter. And if it weren’t, most bottled water wouldn’t be any better, since it’s often just repackaged tap (check the label or cap – if it says “from a municipal source” or “from a community water system” or anything along similar lines, it’s tap water). Sparkling water in glass bottles is justifiable (tap isn’t bubbly, after all, although you could make it so at home, and the glass bottles are definitely reusable (I like filling them with homemade salad dressings).

But if you’re just after fresh drinking water, the tap will be fine. You can buy a filter if you like – I do, myself – or you could locate a nearby freshwater spring, if tap isn’t cutting it. The best water I’ve ever tasted came from a campsite faucet in Lake Tahoe. You could taste the minerals; it was like drinking from a fresh water stream before it got dangerous. I swear, if it didn’t mean a eight-hour drive each way, I’d get all my water from that tap. Oh well. I’m getting off topic. Just don’t buy crate after crate of water in plastic bottles is the essential gist of my spiel.

Still, bottled water is undeniably convenient, which is why it’s probably so popular (along with unfounded fears regarding tap water safety). I can’t ignore the convenience factor. I like it myself. Most people just reuse their old plastic bottles, those simple, unassuming polyethylene terephthalate (PET) bottles. It’s an environmentally friendly gesture, but it’s one that may promote health issues, including the leaching of DEHP – a potent carcinogen – with repeated use. And, of course, there’s always our old friend, Bisphenol A, to contend with when plastics are involved. He turns up in the darndest of places, but that doesn’t mean you should simply throw in the towel. Avoid those old plastic bottles. Then there are the glass bottles. Safe? Yeah, but they’re also heavy and fragile – not the ideal water vessel for active individuals like our readers.

A better option is to go with a permanent water bottle expressly designed for the purpose. There are dozens on the market, but it usually comes down to a standoff between bottles made of polycarbonate plastics, aluminum, and stainless steel. Let’s see if we can find a clear winner.

Polycarbonate bottles

These are the “safe” plastic bottles; the permanent ones. They’re incredibly durable, and they exude an air of impermeability. They don’t wither under heat, like the PET bottles, and they maintain their shape. Plus, they often come in neat colors and attractive mesh shoulder slings. All the cool kids are using them, but should you?

I’d stay away. Polycarbonates have been proven to leach BPA into drinking water. There are no good reasons to take any chances considering the reams of animal data showing definitive deleterious effects outlined in the last BPA post.

But what about “BPA-free” plastic water bottles? Despite BPA-free claims I remain skeptical of plastic water bottles. With misinformation and the unregulated state of bioaccumulating pollutants, for my money there are much safer options.

Aluminum bottles

Aluminum is a solid choice. They’re pretty durable and very light, but they’re also expensive. Aluminum water bottles have become pretty damn trendy, if that weighs on your decision at all. Sure, trendiness can be annoying and all, but at least it shows people are becoming more aware of the folly of buying several plastic bottles of water a day – and that’s always a good thing. Is aluminum the way to go?

I hesitate to give my unequivocal affirmation. While the newest (post 2009) aluminum water bottle models from Sigg are claiming to be free of BPA, all their earlier stuff has it in the interior lining. So, the most recent Sigg bottles are probably safe, but as for the bottles from other, less reputable companies? I wouldn’t take a chance. Sigg is the biggest name in the aluminum water bottle game, and if they’re only just now ditching the BPA (a move momentous enough for the president to turn into a public statement) in their bottles, I’d be careful about buying aluminum bottles from other companies. And definitely avoid filling an aluminum bottle with acidic liquid (not that PB folks are big lemonade drinkers or anything), which can cause the aluminum itself to leach.

Stainless Steel bottles

Stainless steel wins, in my book. Sure, it’s a bit heavier, but it’s a proven material, and it won’t leach (and if it could, you’d have pure steel running through your veins – a net win, if you ask me). If you’re attacked by a mountain lion, your stainless steel water bottle becomes a dangerous weapon. You can fell the vicious beast, wipe the blood off, then immediately take a sip of refreshing water. You think polycarbonate and aluminum bottles could do that? Please. Wild animals in this country have (sadly) seen more than enough used condoms and faded cans of Budweiser to last them a lifetime. They’d laugh at your plastics and pseudo-metals (who ever heard of a metal that a ten year-old boy could crush underfoot?). If you tried to face down a big wild cat with a polycarbonate bottle, you’d better hope that feral felines are highly sensitive to trace amounts of BPA.

Seriously, though, stainless steel is the best choice, followed closely by reputable aluminum bottles. With steel, you don’t have to worry about weird chemicals, nor do you have to spend a ton of cash to keep up with a trend, making it the clear choice for anyone interested in a durable, reliable permanent water bottle. Kleen Kanteen appears to be a trusted manufacturer.

What do you use to transport your H20? Is there anything I’ve overlooked? Any additional safety concerns? Share your infinite wisdom in the comment board!

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Related posts:

1. Are Plastics Safe?
2. Blinged Out Water?
3. Is Canned Food Safe to Eat?

The following reader email brought to mind a NY Times article I read a few weeks ago. The article discusses a fairly new field of research that is uncovering the surprisingly fundamental and intricate ways our bodies influence our thinking and vice-versa. We’ve discussed the mind-body connection in the past, but embodied cognition puts the relationship in a new cast. Think motion-emotion, action-thought. It’s all integrated in ways you wouldn’t expect….

Hey Mark,

I’ve been a PBer for a couple years now and feel better than I ever have. I’m at this point interested in digging deeper into new areas of the PB. I’m intrigued by the mental-physical connection some of your posts and book refer to. Other than the relaxation and stress influence, what kind of sway does the mind-body thing really hold? How do you suggest harnessing it? Thanks and Grok on!

Thanks to Ben for the question this week. As he mentions, most of us are aware that our thoughts have the power to set off a chain of positive (or negative) physiological responses. But the picture is much more nuanced than meditation=good, chronic stress=bad. The field of embodied cognition is probing the connection right down to the evolutionary roots, measuring not just how one can influence the other but how the mental and physical realms largely operate as a unified, integrated recipient/responder to the outer world. Our bodies not only physically sense and move in response to external stimuli; they steer our emotional and intellectual reactions, and they subtly mirror – embody – even abstract social, cultural and intellectual concepts. Hmmm…I see some health and wellness implications coming, but first a quick rundown of the research.

• Subjects in a Yale University study (PDF) were more likely to rate the target person as interpersonally warm if they held a hot drink in their hand and, conversely, more likely to rate the person as cold if they held an iced drink.
• A University of Wisconsin study showed that subjects took longer to process negative statements when frowning muscles were deactivated by Botox injections.
• A University of California, Santa Barbara study showed participants an instructional video about exercising and followed up on their efforts in the week following the video. Although all subjects were told to imagine performing the exercises during viewing, those that were instructed to walk in place while watching exercised nearly 27% longer than those who were sedentary during the video. In a follow-up scenario, women participants who were allowed to hold dental floss during flossing instruction reported flossing more times in a week than those women participants who didn’t hold dental floss during the instruction.
• Subjects in a University of Illinois study were more successful at solving a given physics related problem when researchers instructed them to swing their arms for a short time.
• Other research showed that students judged a book as heavier when told it was key to their studies. In subsequent scenarios, participants further confirmed the weight-importance association, in one situation by assessing foreign currency as more valuable if they held heavier clipboards while recording their responses.
• A study recently published in Psychological Science demonstrated that participants shifted their bodies to reflect spatial metaphorical concepts by consistently leaning forward when talking about the future and reclining when recalling the past.

This is just a sampling of the research of course. Nonetheless, it’s enough I think to illustrate the breadth and depth of the power physical cues have on our thinking. (And, again, vice versa – the power of even unconscious thought over physiology.) Kinesthetic engagement has sway over everything from emotion to learning, memory to intention. In terms of intention, the research shows that passive instruction for fitness (or much else) isn’t as effective as incorporating physical experience. In other words, to bolster people’s intention to get their bodies moving, you have to – well – get them moving to begin with. It’s important to use the connection of physical action with motivation and intention to our benefit. Next time you log onto MDA, pick up some kettlebells or do some lunges as you read.

In this regard, maybe embodied cognition speaks to a larger lifestyle issue as well. There’s an inclination in our culture toward passive observation. Our entertainment pastimes, our communication modes as well as work setups for those of us with desk jobs leave us stuck in the “virtual” or one-dimensional experience. Like the researchers warnings about Botoxed-bounded expression, perhaps relating to the world so often through constrained means shuts off whole realms of experience and feeling. Real wellness, I believe, obliges the actualization of our physical selves. When we compartmentalize the corporeal or diminish the role of our bodies in our perception and experience, we neglect whole dimensions of fulfillment. As embodied cognition teaches us, we deny something fundamental in our nature when we diminish the inextricable connection between our physical and intellectual/emotional lives.

Grok lived an earthy and sensual existence. He was seamlessly of the world in ways that elude us now. As the research shows us, however, the hardwiring is still there. Give the moment – whether it be a workout, a walk, a dinner with the family – not just your full attention but your full physical engagement. Apply all the senses. Be wholly physically present. Imagine what that would mean in the day to day. What would that look like? Feel like? What would you gather or gain exercising – and living – that way?

Send me your thoughts. As always, thanks for the great questions and comments, and keep ‘em coming!

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Related posts:

1. Dear Mark: Healthy Body Weight?
2. Dear Mark: Gene Expression
3. Dear Mark: Primal Blueprint for Both Men and Women?

More job loss news to report, unfortunately. Pharmalot comes in with an item that fits with what I'm hearing, that Sanofi-Aventis appears to be making small cuts, over and over, at its various sites. There hasn't been a single big announcement that I've heard, but the company seems to be shrinking headcount nonetheless.

And I've also heard recently that Astra-Zeneca is ready to announce more layoffs, although I don't have a handle on the size. This appears to be some of the follow-through from their earlier nonspecific announcements - it looks as if they're finally going to start getting down to some details. Anyone with more information on either of these situations is welcome to add it in the comments. . .

(Editor’s Note: by popular demand, following goes the Spanish translation of an excerpt from The SharpBrains Guide to Brain Fitness, available in English by clicking on Debunking 10 Brain and Brain Fitness Myths)

10 MITOS SOBRE EL CEREBRO Y EL ENTRENAMIENTO MENTAL: VERDADERO O FALSO?

Extraído del libro electrónico “La guía de SharpBrains para un cerebro en forma” (The SharpBrains Guide to Brain Fitness). Con permiso de sus autores Alvaro Fernández y Dr.Elkhonon Goldberg.

Mito 1. Mis genes determinan el destino de mi cerebro

Realidad. La neuroplasticidad hace que nuestro estilo de vida, acciones y experiencias tengan un rol importante en la evolución física de nuestro cerebro a lo largo de toda la vida, especialmente dado el incremento de la esperanza de vida.

Mito 2. El envejecimiento acarrea automáticamente el declive cognitivo

Realidad. No hay nada inherentemente fijado sobre la trayectoria precisa de cómo nuestros cerebros evolucionarán con la edad

Mito 3. La medicación es la principal esperanza para la mejoría cognitiva

Realidad. Las intervenciones no invasivas pueden tener efectos comparables y más duraderos, libres de efectos secundarios

Mito 4. Pronto tendremos una “píldora mágica” o solución general para resolver los desafíos cognitivos

Realidad. La investigacion cientifica existente recomienda un enfoque multifacético, centrado en nutrición, regulacion emocional y ejercitación tanto física como mental.

Mito 5. Hay un solo “lo” en “úselo o piérdalo”

Realidad. El cerebro está compuesto de múltiples estructuras y funciones especializadas.Nuestra calidad de vida y productividad dependen de una multiplicidad de funciones, no de una sola

Mito 6. Todas las actividades o ejercicios mentales son iguales

Realidad. Diferentes actividades activan diferentes partes del cerebro, con lo cual es importante mantener un regimen de ejercicios variados y enfocados para asi estimular un amplio rango de funciones cognitivas

Mito 7. Hay una sola manera de entrenar el cerebro

Realidad. Las funciones cognitivas pueden impactarse de diversas maneras: a través de meditación, terapia cognitiva, biofeedback, y entrenamiento cognitivo

Mito 8. Todos tenemos algo llamado “edad cerebral”

Realidad. La “edad cerebral” es una ficción. No hay 2 personas con el mismo cerebro o manifestación de funciones cerebrales a una msma edad

Mito 9. Esa supuesta “edad cerebral” puede reducirse en 10, 20, o 30 años

Realidad. El entrenamiento cerebral puede mejorar determinadas funciones cognitivas, pero con las investigaciones disponibles actualmente no se puede decir que se puede reducir la “edad cerebral” en un cierto número de años.

Mito 10. Todos los cerebros humanos necesitan el mismo entrenamiento

Realidad. Al igual que con la gimnasia física los usuarios deben preguntarse: “Qué funciones necesito mejorar?” “En qué tiempo?”, “Cuál es mi presupuesto?”

An autopsy performed on actress Brittany Murphy, who died this past December at the age of 32 years, has revealed that the actress had acute pneumonia and had been taking cold and flu medications before her death. There were also pain medications in her system and she suffered from iron-deficiency pneumonia, perhaps caused by heavy menstrual periods. According to CNN, her death is being ruled an accident.

While we’ll never know how much Brittany took of what, her death is a strong reminder of the dangers of self-treatment on top of medical treatment and it also reminds us that pneumonia is an illness that should be taken seriously.

Medications

Millions of people take medications that they buy over-the-counter to treat various ailments, from headaches, to PMS, to allergies and influenza. Sometimes, they have more than one ailment at a time, so they take more than one kind. Then, if they’re diagnosed with another illness, such as an infection, there’s yet another medication thrown into the mix.

In Brittany’s case, the CNN article, Cold medicines contributed to Brittany Murphy’s death, coroner says, reports that Brittany had in her blood:

• hydrocodone
• acetaminophen
• chlorpheniramine
• L-methamphetamine

Pneumonia

In 2008, many fans were shocked by the death of Bernie Mac. He also died of pneumonia. We hear so much about people we know who have so-called walking pneumonia, that we forget how deadly serious it can be.

Pneumonia is an infection in the lungs, usually caused by a virus or by bacteria although it can also be caused by a fungus. The infection causes fluid (pus and mucus) to collect in the alveoli (air sacs). With the infection and the building fluid, the linings of the alveoli swell and become less elastic, making it harder for the oxygen to get through.

As it becomes more difficult for the body to provide oxygen to the blood, the body can’t work as effectively. This can – and does – lead to death if it isn’t treated quickly.

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Image: ZumaPress.com

Post from: Blisstree

Brittany Murphy Had Pneumonia at Death

Prescribing medications can be tricky for some physicians, depending on what their patient  has, how they want to treat it, and what is available for prescription. And, it’s particularly difficult if the condition they are trying to treat is either not responding to the traditional treatments or there really isn’t anything yet that has been developed for it. This is where off-label prescribing comes in.

The FDA

When the FDA approves a medication, it approves it for one or more specific conditions. It okays the dosage ranges, the frequency it can or should be taken, how long it can or should be taken and who should or shouldn’t take it. They base their decision on multiple trials and studies, where they should be given accurate information on how patients responded to what and how. However, the FDA doesn’t practice medicine and can’t tell doctors what they can and cannot do with their medications.

What does off-label mean?

Many times, when doctors prescribe a medication, particularly a newer one, they may notice that the medication not only does what they wanted it to do, but it does other things. Instead of side effects, these are good outcomes. Let’s say you have asthma and you have severe hip pain. Your doctor prescribes you a new pain medication to help you with your pain, but then you find out that your asthma is under better control.

At first glance, that could be because the less pain you have, the less stress your body is under and this could result in better breathing. However, if more patients with the same two problems or similar problems, take that same medication and come up with the same results, news may begin to spread that the medication may not only be just good for problem A, it may also help problem B.

Later on, if a doctor is at a loss as to what to prescribe for someone but she’s read that this particular pill does what she’s looking for – although it’s not FDA approved for it – she just may prescribe it for a trial period. If it works, that news gets out and before you know it, there’s a new use for the drug.

Is it legal?

Yes, it is legal for a doctor to prescribe medications off-label. What is NOT legal is for pharmaceuticals to promote their medication for off-label use. They may only, by law, promote and sell their product for the FDA-approved indication.

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Image: MorgueFile.com

Post from: Blisstree

Are Off-Label Prescriptions Legal?

Here you have the February edition of our monthlyeNewsletter covering cognitive health and brain fitness topics. Please remember that you can subscribe to receive this Newsletter by email, using the box in the right column.

The recent SharpBrains Summit witnessed the convergence of Benjamin Franklin’s words (”Man is a Tool-Making Animal”)  with neuroscientist Santiago Ramon y Cajal’s  (”Every man can, if he so desires, become the sculptor of his own brain.”) The neuroplasticity revolution that may well transform education, training, healthcare, aging, is under way.

New Tools

Will the Apple iPad Be Good for your Brain: Prof. Luc Beaudoin lays out key criteria to assess Apple iPad’s potential value for our cognitive fitness, and judges the iPad against a comprehensive checklist.  His verdict? Thumbs-up.

Is Working Memory a better predictor of academic success than IQ?: Dr. Tracy Alloway summarizes  a recent landmark study, published in the Journal of Experimental Child Psychology, which  tracked children over a six-year period. Key finding: Working memory can be a more powerful predictor of academic success than IQ scores.

Old Tools

Building Fit Minds Under Stress: According to Science Daily’s take on a just published study, “a high-stress U.S. military group preparing for deployment to Iraq has demonstrated a positive link between mindfulness training, or MT, and improvements in mood and working memory”.

The Evolution of Empathy: Empathy is not a uniquely human trait, explains primatologist Frans de Waal in this Greater Good Magazine article. Apes and other animals feel it as well, suggesting that empathy is truly an essential part of who we are.

Reflections

Reflections on Creativity – Interview with Daniel Tammet:  Scott Barry Kaufman recently interviewed Daniel Tammet, known for vividly describing autistic savantism from the inside. Their in-depth conversation made Scott reflect that “Daniel Tammet’s feeling of a great loneliness and isolation growing up spoke to me, for sure. But I’m sure it also spoke to a great many people reading the interview.”

Summit Reactions

The SharpBrains Summit took place January 18-20th, helping engage over 250 participants in 15 countries. Here are a couple of reactions from participants:

5 Key Reflections on “Neurocentric Health”: Institute For The Future researcher Jake Dunagan summarizes his main take-aways, including this overall assessment – “Although the conference was virtual, aside from the rigors of travel and a basket of bagels on the hallway table, my level of intellectual stimulation (and fatigue) mirrored most of my face-to-face conference experiences. It was a technical success and the content was first-rate.” (Thanks, Jake!)

The Future of Cognitive Enhancement: Neuroethics researcher Peter Reiner ponders,  “Will brain fitness software dominate the world of cognitive enhancement?”.  His take: “Prior to this conference I was quite skeptical, but the overall impression that I was left with was that brain fitness software may turn out to have some distinct advantages over pharmacological approaches.” Read his article to discover why.

Community

Network for Brain Fitness Innovation (private LinkedIn group):  Members are engaging in many good discussions, including most surprising things learned during the SharpBrains Summit, how to deal with conflicts of interest in industry and academia, resources and conferences relevant to education and children, and ways to elicit a wider interest in brain health.

Looking for Speakers: We are always looking for best practices and research-based innovation. If you are interested in speaking at future SharpBrains events (including Games for Health brain tracks), please Contact Us and tell us about 1) your innovation or research, 2) its measured and/ or potential impact, 3) recent coverage in general, trade, or scientific media, 4) the typical audience you talk to, and a couple of descriptions of recent talks, 5) what you propose talking about.

Offer

Brain Fitness Information Package for Libraries:  libraries of all kinds can now  order a copy of our main report, The State of the Brain Fitness Software Market 2009, at 50% off price.  Using discount code sharplibrary leaves this premium report at $645 (offer valid until March 31st, 2010). Offer is  valid for individuals and organizations who commit to donating their copy to a library, in good shape, after consulting it.

Finally, a reminder that Brain Awareness Week (March 15-21, 2010) is approaching soon!