"The Daily Dose"

The DPHHS has confirmed our first case of Influenza B, a child in Deerlodge. Get your Flu shots!! For more information visit the website below…

 http://www.dphhs.mt.gov/PHSD/epidemiology/commun-disease-epi-surv.shtml

Happy Holidays!

My mother taught me TO APPRECIATE A JOB WELL DONE:
“If you’re going to kill each other, do it outside - I just finished
cleaning!”

My mother taught me RELIGION:
“You better pray that will come out of the carpet.”

My mother taught me about TIME TRAVEL:
“If you don’t straighten up, I’m going to knock you into the middle of
next week!”

My mother taught me LOGIC:
“Because I said so, that’s why.”

My mother taught me FORESIGHT:
“Make sure you wear clean underwear, in case you’re in an accident.”

My mother taught me IRONY:
“Keep laughing and I’ll give you something to cry about.”

My mother taught me about the science of OSMOSIS:
“Shut your mouth and eat your supper!”

My mother taught me about CONTORTIONISM:
“Will you look at the dirt on the back of your neck!”

My mother taught me about STAMINA:
“You’ll sit there ’til all that spinach is finished.”

My mother taught me about WEATHER:
“It looks as if a tornado swept through your room.”

My mother taught me how to solve PHYSICS PROBLEMS:
“If I yelled because I saw a meteor coming toward you; would you listen
then?”

My mother taught me about HYPOCRISY:
“If I’ve told you once, I’ve told you a million times - Don’t
Exaggerate!!!”

My mother taught me THE CIRCLE OF LIFE:
“I brought you into this world, and I can take you out.”

My mother taught me about BEHAVIOR MODIFICATION:
“Stop acting like your father!”

My mother taught me about ENVY:
“There are millions of less fortunate children in this world who don’t
have wonderful parents like you do!”

Youtube… There is some highly entertaining stuff on there, thats for sure. Alot of attempts made at healthcare humor.. This video, “Diagnosis Wenckbach” takes the cake! It appears to be written by medical students. Enjoy~

http://www.youtube.com/watch?v=GVxJJ2DBPiQ

Antibiotic-resistant bacteria strains are becoming increasingly common outside of hospital settings and are posing an increasing risk to communities, according to research findings presented at a conference of the Federation of Infections Societies.Irish researchers warned of bacteria that have evolved to carry enzymes called extended spectrum beta lactamases (ESBLs), because they are antibiotic-resistant. A strain of E. coli with ESBLs is thought to be responsible for an outbreak of cystitis in the UK in 2003 and 2004.

“In severe [cystitis] infections, patients may suffer serious complications if the first antibiotic given to them does not work,” said Dearbhaile Morris, of the National University of Ireland.
British researchers noted that strains of methicillin-resistant Staphylococcus aureus (MRSA) known as Panton Valentine leukocidin (PVL) have evolved to spread well outside of hospital settings, and Irish researchers warned of a new bacteria mutation that has allowed certain species, including E. coli, to develop antibiotic resistance and spread in communities.
According to Marina Morgan of the Royal Devon and Exeter Foundation NHS Trust, PVL strains of MRSA can spread via skin-to-skin contact. They also have a tendency to develop into a condition called necrotizing pneumonia, which destroys lung tissue and can kill a patient in as little as one day.

“These new strains of bacteria appear to be able to stick to damaged skin and airways better than the hospital MRSA strains, and they can multiply at a faster rate,” Morgan said.

In the United States, 12 percent of all MRSA infections occur outside of hospital settings.

“MRSA is often thought of as a hospital superbug,” said Kevin Kerr, a consultant microbiologist at Harrogate District Hospital in North Yorkshire, “but we are becoming increasingly aware of strains which are causing infections outside hospitals. The emergence of community MRSA underlines just how good bacteria are at evolving to present us with new and difficult problems.”

This article was found at http://www.naturalnews.com/Index-Satire.html

A potentially deadly intestinal germ increasingly found in hospitals is also showing up in a more unsavory setting: grocery store meats.

More than 40 percent of packaged meats sampled from three Arizona chain stores tested positive for Clostridium difficile, a gut bug known as C. diff., according to newly complete analysis of 2006 data collected by a University of Arizona scientist.

Nearly 30 percent of the contaminated samples of ground beef, pork and turkey and ready-to-eat meats like summer sausage were identical or closely related to a super-toxic strain of C. diff blamed for growing rates of illness and death in the U.S. — raising the possibility that the bacterial infections may be transmitted through food.

“These data suggest that domestic animals, by way of retail meats, may be a source of C. difficile for human infection,” said J. Glenn Songer, a professor of veterinary science at the Tucson school, who talked with msnbc.com about work now under review by the federal Centers for Disease Control and Prevention.

But specialists from the CDC and scientists who study C. diff said the connection between the presence of C. diff bacteria and infection has not been established and that there’s not enough evidence about food transmission to warrant public alarm.

“There are no documented cases of people getting Clostridium difficile infection from eating food that contains C. difficile,” said Dr. L. Clifford McDonald, chief of prevention and response for a division of the CDC. “However, because C. difficile has been found in some retail meats, that possibility does exist.”

Songer’s samples included brands sold in grocery stores across the nation. Contamination ranged from 41 percent of pork products and 44 percent of turkey products to 50 percent of ground beef samples and more than 62 percent of samples of braunschweiger, a type of liverwurst.

Nearly three-quarters of the C. diff spores were toxinotype V, a type linked to illness in pigs and calves and, increasingly, in humans, Songer noted.

80 percent of infections occur in hospitals
C. diff has long been a common, usually benign bug associated with simple, easily treated diarrhea in older patients in hospitals and nursing homes. About 3 percent of healthy adults harbor the bacteria with no problem. But overuse of antibiotics has allowed the germ to develop resistance in recent years, doctors said, creating the toxic new type that stumps traditional treatment.

About 80 percent of C. difficile infections now occur in hospital or health care settings — and the number of infections is rising. About 13 in every 1,000 hospital patients is infected or colonized with the bacteria, a rate between 6.5 and 20 times higher than previously estimated, according to figures released last week by the Association for Professionals in Infection Control and Epidemiology, or APIC.

Every day, those infections likely cost $32 million, on average, and claim more than 300 lives, the study showed.

Especially worrisome has been a new, more virulent strain, called NAP1, which produces about 20 times the toxins of ordinary strains. It can cause severe, repeated diarrhea that resists all but the most powerful drugs. In worst cases, C. diff infection can destroy the colon and lead to blood poisoning and death.

It’s not clear, however, where the remaining infections — those that occur outside health settings, in the community — originate. Recent victims have included a 10-year-old girl with no history of antibiotic use who became very ill but recovered and a 31-year-old woman pregnant with twins who spontaneously aborted her babies and then died after becoming infected, according to a 2005 review by the CDC.

“For these community-associated sources, there has to be a source outside the hospitals,” Songer said. “It may well be that retail meats are a source or the main source.”

C. diff is a tricky bug, hard to kill with anything but bleach in the hospital and able to survive most cooking techniques in the kitchen. And, unlike scary infections like E. coli 0157:H7, which has transmitted illness through foods from ground beef to fresh spinach, C. diff can’t be traced quickly to its source.

“With difficile, you can eat a nice, thick braunschweiger sandwich today, then two weeks from now you get strep throat, take antibiotics and develop difficile-related disease,” Songer explained. “You’re weeks separated from the event.”

Songer detected C. diff in every type of meat he tested, including uncooked ground beef, pork and turkey; pork sausage and chorizo; and ready-to-eat products including beef summer sausage and pork braunschweiger, a spreadable liver sausage luncheon meat.

He collected 88 samples of retail packaged meats bought from large chain stores near Tucson on three occasions during a two-month period in 2006. Earlier analysis indicated that about 30 percent of samples showed C. diff, but that percentage increased under closer review, Songer said.

Thirty-seven of the samples, or nearly 42 percent, showed evidence of C. diff, including about 40 percent of the cooked products and nearly 48 percent of the ready-to-eat products.

All of the samples collected were national brands available in grocery stores across the country, except the pork chorizo, which was locally made. Songer declined to identify the specific brands, saying that it would unfairly target a single producer when the problem is likely endemic to all.

“My perspective on this is not to blow the whistle on the meat production or meat processing agencies but to point out that we may have a problem and if we do we should work together to solve it,” he said.

At least one meat industry official said Songer’s findings served as a warning to producers, but that the research hasn’t been replicated. Liz Wagstrom, assistant vice president of science and technology for the National Pork Board, said she’s awaiting confirmation from the CDC and other sources.

“I feel very confident in the safety of our product,” she said. “If there is any animal-to-human transmission, it is a very small part of the picture.”

James “Bo” Reagan, chairman of the Beef Industry Food Safety Council, declined to discuss specific strategies for addressing C. diff. Instead, in an e-mail to msnbc.com, he said beef producers have spent $27 million on research to identify new food safety technologies and processes.

“Our efforts have resulted in new safeguards throughout the beef production chain and we continue to work with our partners in beef production to find ways to ensure beef is safe,” Reagan wrote in an e-mail.

‘Yes, it’s there’
Songer’s study follows a 2007 report in the CDC journal Emerging Infectious Diseases, which showed Canadian researchers detected C. diff in 12 — or 20 percent — of 60 retail meat samples collected in 2005.

Neither report, however, definitively answers questions about C. diff in the food supply, said the study’s lead researcher J. Scott Weese, an associate professor of pathobiology at the University of Guelph in Ontario, Canada.

“Yes, it’s there,” he said. “But we need to find out how much is there.”

Processed meats like those Songer studied may be more likely to show contamination because they combine sources of meat and because they require more handling than, for instance, a pork chop from a single pig, Weese said.

In addition, scientists don’t know when C. diff exposure sparks infection in people — or how much of a dose is necessary to cause infection, said Dr. Dale N. Gerding, a national expert in C. diff epidemiology and a professor with the Stritch School of Medicine at Loyola University in Chicago.

“With a real susceptible source, it only takes a few spores,” he said.

Bug might be in water, soil — even vegetables
But Gerding also noted that C. diff has been found in many places other than hospitals and meat counters, including water sources and soil.

“We actually wouldn’t know if a carrot in the dirt would have it just as much as hamburger,” Gerding said.

That’s little comfort to Mary Woodard, 51, of Rock Falls, Ill., whose 6-year-old granddaughter, Nichole Lilly, contracted a C. diff infection in October. The child hadn’t had antibiotics for six months and she’d been nowhere near a hospital or health center. But she wound up doubled over on the floor with severe cramps and diarrhea for nearly two weeks, until a clinic cultured her stool and diagnosed the illness.

Woodard is scared the infection will return, or that it will strike one of her other grandchildren. Word that C. diff has been detected in meat made Woodard think twice, despite CDC assurances to the contrary.

“I’ll cut back, probably, on my meat eating,” she said. “After seeing her with the bad cramping, I don’t want to see her like that again.”

Most consumers worried about C. diff infection should pay closest attention to hospitals and health care settings, Gerding said. Lax hand hygiene, improperly cleaned hospital rooms and overuse of antibiotics are far more likely to transmit C. diff than food products.

Although C. diff spores can be hard to kill, even Songer said most healthy consumers don’t need to change their diets because of the bug.

Read the entire article at http://www.msnbc.msn.com/id/27774614/

About a year ago, my mother told my father there was a movie she really wanted to see and suggested they catch it that evening. Great idea — except that, as my dad gently reminded her, they had just seen it.

Though he tried to make light of it at the time, Mom’s memory lapse was not an isolated event. She often repeated herself, misplaced one thing after another, and neglected commitments she didn’t remember making. A woman with a gift for banter, she now found it difficult to carry on a conversation because she was so easily distracted. Most disturbing of all: She was only 61.

Mom, too, sensed something was wrong.

A teacher of English as a second language, she was known for her supple mind but now felt as if her brain was shrouded in fog. “I’m not as smart as I used to be,” she told me recently. Fearing she might be suffering from some kind of early onset dementia, she made an appointment with a neuropsychologist and asked me to go with her.

I said I would, even though I suspected another culprit: the potent brew of medications she was taking for the litany of medical problems that has plagued her for years. She consumed so many drugs every day — 21 of them, prescribed to her by five different physicians—that she lugged them around in a toolbox. A partial list: two blood pressure medications, four for asthma, a cholesterol-lowering statin, and several others to treat her diabetes, fibromyalgia, depression, fatigue, and acid reflux. I assumed that, to coordinate this chemical assault upon her ailments, my mom’s doctors talked to each other regularly, that her internist was closely monitoring her medications to prevent any dangerous interactions, and that every pill Mom popped was part of a carefully crafted treatment plan.

How naive.

When I took my mom to see the neuropsychologist, I was startled to learn just how naive my assumption was. The specialist dismissed outright my suggestion that polypharmacy (the use of multiple meds) might be to blame for Mom’s porous memory and perhaps some of her other ailments as well. Without even knowing what my mom was taking (never mind the sheer quantity), she confidently asserted that drug-related problems come on more suddenly. I’m not a medical doctor, either, but I do have a PhD in psychology and know that complex situations can be unpredictable. The neuropsychologist’s blithe dismissal irked me, so I did some research on my own.

Here’s what I learned: The use of multiple, often unnecessary medications — especially among older people — is an entrenched, escalating, frightening, and mostly unexamined problem in modern health care. Although medications can ease many conditions, multiple-drug use often exacerbates existing ailments and causes troubling side effects that are treated with yet more drugs. Many doctors, researchers, and pharmacists I talked to agree. “Overmedication is a true epidemic,” says Armon B. Neel Jr., PharmD, a clinical pharmacist in Georgia who evaluates medication plans for private and nursing home clients. “It’s completely out of hand.”

I also learned that, with the help of professionals, a determined patient can dramatically scale back her prescription drug use and eliminate, or at least reduce, the jumble of side effects that has clearly contributed to her downward spiral. That’s what my mom did, emerging from her med-induced fog to reclaim her former vibrant self. This is the story of her comeback — a cautionary tale for everyone who takes several medications every day.

What’s behind the Rx cascade
Polypharmacy is most common among people over age 65, about one-fifth of whom take at least 10 medications a week. Because the body absorbs, metabolizes, and rids itself of drugs more slowly with age, a dose considered safe for a middle-age woman can be toxic to her parent. In fact, the Institute of Medicine estimates that at least 1.5 million adverse drug events occur in the United States every year, thousands of them fatal. Studies indicate that about one-third of these drug reactions among senior citizens — and 42 percent of serious, life-threatening, or fatal events — are preventable. Doctors often mistake the ensuing physical response — memory lapse, fatigue, abdominal pain, swelling, or other ailments — as a sign of worsening disease. This can lead to a “prescribing cascade,” says Jeffrey Delafuente, FCCP, a professor of pharmacy at Virginia Commonwealth University. “The solution is to reduce the number of drugs. Adding more just exacerbates the problem.”

Seeing various doctors or specialists contributes to that cascade. According to the Agency for Healthcare Research and Quality, 81 percent of people with serious chronic conditions have two or more physicians, more than half have three or more, and a third have four or more. Specialists don’t always know everything a patient is already taking, says Paul Takahashi, MD, a geriatrician at the Mayo Clinic. Primary care physicians are supposed to oversee the management of their patients’ various medications, he says, but unless a new drug is clearly contraindicated, they’re often reluctant to second-guess specialists’ decisions. To be fair, doctors are not entirely to blame for rampant over-prescribing. In recent years, federal health panels have handed down more stringent targets for controlling chronic diseases such as hypertension and high cholesterol. Medication is often the quickest and surest way to get results — a strategy endorsed by insurance companies, which are reluctant to pay for less well-documented natural therapies.

Read the entire article at http://www.msnbc.msn.com/id/27645077/

There’s no phone and no television. Only a screen offers privacy. But heart patient Edward Gray understands why the hospital put him in a cardiac unit hallway.

“They sent me up here to make room for other emergency patients,” Gray, 78, said last week from his bed in the hall of a New York area hospital. “This is the way things are in hospitals.”

It may not sound like ideal health care, but hospital officials nationwide are being urged to consider hallway medicine as a way to ease emergency department crowding, and some are trying it.
Leading the way is Stony Brook University Medical Center at Stony Brook, N.Y., where a study found that no harm was caused by moving emergency room patients to upper-floor hallways when they were ready for admission.

The study’s lead author says all hospitals should look at the program’s success.

“This is yet another battle cry for hospitals to get off their duffs and stop stacking people knee deep in the emergency department,” said Dr. Peter Viccellio, who is clinical director of the hospital’s emergency department.

He is to present the study’s findings Tuesday at a meeting of the American College of Emergency Physicians in Chicago.

Hospital-wide problem
Crowding is a hospital-wide problem that has been handed off to emergency departments, Viccellio said. His idea hands the problem back to the entire hospital.

Before the change, when his hospital filled up, patients were admitted but held in the ER in a common practice called boarding. On busy days, “things would grind to a halt and people would wait to be seen,” Viccellio said. Infectious patients would wait in the ER’s hallway for isolation rooms to open up elsewhere in the hospital.

Holding patients in ERs can cause deaths, doctors say. In a 2007 survey of nearly 1,500 emergency doctors, 13 percent said they personally experienced a patient dying as a result of boarding in the emergency department. The survey was conducted by the American College of Emergency Physicians.

The new study found slightly fewer deaths and intensive care unit admissions in the hallway patients compared to the standard bed patients. That was no surprise, Viccellio said, because the protocol calls for giving the first available rooms to the sickest patients. Intensive care patients never go to hallways.

The study is based on four years of Stony Brook’s experience with more than 2,000 patients admitted to hallways from the ER.

Other hospitals resist the idea, doctors say. Dr. Michael Carius, who heads the emergency department at Norwalk Hospital in Norwalk, Conn., would like it adopted at his hospital. But nurses and government regulators have resisted, citing safety issues, “as though the emergency department hallway is a safer environment,” he said in frustration.

“When you’re full of admitted patients, you’re no longer an emergency department, you’re just a holding area,” Carius said.

‘They could see the problem’
In Texas, all it took to convince nurses at Harris Methodist Fort Worth Hospital was a tour of the ER, said Barbara VanWart, emergency nurse manager.

“They could see the problem and help us make things happen because now it’s before their eyes,” VanWart said. The hospital started its hallway protocol in 2005.

Dr. Kirk Jensen of the nonprofit Institute for Healthcare Improvement in Cambridge, Mass., said the best reason to adopt the concept is the way it gets the whole hospital involved in finding rooms more quickly for admitted patients.

“It’s out of sight, out of mind, even if they know that patients are there in the emergency department,” Jensen said. With patients in their own hallways, “they get a lot more creative and aggressive with workflow practices.”

When Stony Brook began the hallway practice, the staff noticed “the miracle of the elevator,” said Carolyn Santora, who heads the hospital’s patient safety efforts. Somehow, rooms became available by the time hallway-bound emergency patients made it upstairs, she said.

Nurses hate seeing patients in their hallways, Santora said, and that’s fine with her.

“I want them to hate it. I want them to do everything to expedite flow to get the patient out of hallway.”

Gray, the hallway patient at Stony Brook, came to the ER with chest pains and was stabilized before being sent upstairs. He is a retired nurse and said hospital crowding deserves attention from lawmakers.

“I wish the $700 billion went for hospitals, roads and bridges and not to bail out those folks on Wall Street,” he said.

Read entire article at http://www.msnbc.msn.com/id/27389321/

Differences Between Graduate Nurse and Experienced Nurses
A Graduate Nurse throws up when the patient does.
An experienced nurse calls housekeeping when a patient throws up

A Graduate Nurse wears so many pins on their name badge you can´t read it.
An experienced nurse doesn´t wear a name badge for liability reasons

A Graduate Nurse charts too much.
An experienced nurse doesn´t chart enough.

A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run to codes.

A Graduate Nurse wants everyone to know they are a nurse.
An experienced nurse doesn´t want anyone to know they are a nurse.

A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their hand, paper scraps, napkins, etc.

A Graduate Nurse will spend all day trying to reorient a patient.
An experienced nurse will chart the patient is disoriented and restrain them.

A Graduate Nurse can hear a beeping I-med at 50 yards.
An experienced nurse can´t hear any alarms at any distance.

A Graduate Nurse loves to hear abnormal heart and breath sounds.
An experienced nurse doesn´t want to know about them unless the patient is symptomatic.

A Graduate Nurse spends 2 hours giving a patient a bath.
An experienced nurse lets the CNA give the patient a bath.

A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames everything on the nurse.

A Graduate Nurse looks for blood on a bandage hoping they will get to change it.
An experienced nurse knows a little blood never hurt anybody.

A Graduate Nurse looks for a chance “to work with the family.”
An experienced nurse avoids the family.

A Graduate Nurse expects meds and supplies to be delivered on time.
An experienced nurse expects them to never be delivered at all.

A Graduate Nurse will spend days bladder training an incontinent patient.
An experienced nurse will insert a Foley catheter.

A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before answering the phone.

A Graduate Nurse thinks psych patients are interesting.
An experienced nurse thinks psych patients are crazy.

A Graduate Nurse carries reference books in their bag.
An experienced nurse carries magazines, lunch, and some “cough syrup” in their bag.

A Graduate Nurse doesn´t find this funny.
An experienced nurse does.