Pinoy alleges nurses exam cheating in Oslo

The Pinoy nursing community in Oslo is reeling from an allegation that Filipino nurses were involved in cheating in a nursing exam conducted by a local college here.

The allegation stemmed from a report from the local paper, Dagavisen, quoting a Filipino nurse called “Romeo” revealing that he was part of cheating in an exam held by the Høgskolen i Vestfold in 2002 with the help of his recruiter, Rizalina Jenssen.

“Romeo” alleged that Jenssen was present during the exam and was giving his answers to other recruits of ASOR to make sure that they pass the exams and make them eligible to work in Norway as nurses.

Rizalina Jenssen is the owner of the recruitment agency, ASOR, that recruits nurses from the Philippines to work in Oslo.

Outraged by the allegations, around 50 nurses from Oslo met at the Philippine embassy last Friday to discuss what they are going to do about the revelations that they claim had tarnished the image of Filipino nurses in Norway.

The nurses belonging to two major nursing organizations, the Philippine Nurses Association (PNA) and the Filippinsk Integrering og Interessegruppe (FIIG), are considering launching a signature campaign condemning the allegations of cheating and calling for an investigation of the matter.

In the meeting at the embassy, Helen Locsin, leader of FIIG admitted that the scandal has affected all Filipino nurses in Norway.

“We are here to find a solution on how we can uplift the credibility of Filipino nurses and to stop the allegations kung hindi tutuo,” she said.

PNA leader Cynthia Baluyot said she seriously doubts the truth behind the allegations but she called an investigation of the college that conducted the probe.

Both Jenssen and the Vestfold College have denied that the cheating took place in separate newspaper reports.

The Statautorisasjonkontor (SAFH) called the college to verify the report and had been reassured that the allegations had no basis.

Filipino caregivers face hurdles

Kyodo News

MANILA — Filipino caregiver Stella Lelis trained in Japan for three years and speaks basic Japanese.

Like thousands of Filipino nurses and caregivers, the 28-year-old hopes to be among the first batch who will be allowed to care for Japan's seniors.

But notwithstanding the Japan-Philippines Economic Partnership Agreement that entered into force last week, Lelis and other Filipino caregivers face a tough hurdle: They will have to take licensing exams in Japanese.

Even Japanese nurses and caregivers are known to have flunked these daunting examinations, a fact that further dents the confidence of Filipino health workers wanting to work in Japan.

"Our Japanese friends in Okayama failed the exams. I'm not sure we'll fare better when we are not native speakers," Lelis said recently.

The entry of Filipino nurses and caregivers to Japan is one of the main highlights of the partnership agreement designed to strengthen economic links between the Philippines and Japan.

Under the agreement, Filipino nurses and caregivers are expected to arrive in Japan next April to June to undergo language training for half a year before going to work at hospitals and nursing-care facilities across Japan.

They will try to acquire national qualifications in three to four years from their arrival in Japan. The candidates, however, will have to return home if they fail to win Japanese qualification.

Separately, some caregiver candidates will try to win qualification by receiving training at schools in Japan. They plan to arrive in Japan next October and enter the schools in April 2010.

In the Philippines, more than 400 nursing schools are producing more nursing graduates than can be employed by hospitals and rest homes. Many of the fresh graduates are pinning their hopes on finding a job overseas.

News that Japan was opening its labor market to Filipino nurses and caregivers had been initially met with much excitement.

But as details about the language barrier came to light, more and more Filipino nurses and caregivers have opted to explore opportunities elsewhere, including the U.S., Canada, Australia, New Zealand, Britain and the Middle East.

"We hope Japan will treat our nurses professionally and with dignity," said Gisela Luna, dean of St. Luke's College of Nursing.

"The language barrier, low salary and their entry to Japan is not as welcoming compared with other destinations," Luna said. "That's the big drawback."

Besides providing a framework for liberalizing trade and investment between the two countries and allowing Filipino nurses and caregivers to work in Japan, the agreement also details possible cooperative programs, including training courses for the regulation of and supervision of financial institutions, trade and investment cooperation, cooperation in the field of small and medium enterprises, technical cooperation in the field of science and communications technology and promotion of tourism.

The agreement was signed in September 2006 between Philippine President Gloria Macapagal Arroyo and then Prime Minister Junichiro Koizumi, but it took the Philippine Senate nearly two years to ratify it after some senators called for renegotiation on grounds it was "riddled with constitutional defects."

Environmental activists also called on the government to junk the treaty, saying its provisions were "flawed" and more advantageous to Japan.

The Diet ratified it in December 2006, while the Philippine Senate, which is controlled by Arroyo's foes, followed suit last Oct. 9, ending an uphill battle for the president.

The Yawn Explained: It Cools Your Brain

Jennifer Viegas, Discovery News

Dec. 15, 2008 -- If your head is overheated, there's a good chance you'll yawn soon, according to a new study that found the primary purpose of yawning is to control brain temperature.

The finding solves several mysteries about yawning, such as why it's most commonly done just before and after sleeping, why certain diseases lead to excessive yawning, and why breathing through the nose and cooling off the forehead often stop yawning.

The key yawn instigator appears to be brain temperature.

"Brains are like computers," Andrew Gallup, a researcher in the Department of Biology at Binghamton University who led the study, told Discovery News. "They operate most efficiently when cool, and physical adaptations have evolved to allow maximum cooling of the brain."

He and colleagues Michael Miller and Anne Clark analyzed yawning in parakeets as representative vertebrates because the birds have relatively large brains, live wild in Australia, which is subject to frequent temperature swings, and, most importantly, do not engage in contagious yawning, as humans and some other animals do.

Contagious yawning is thought to be an evolved mechanism for keeping groups alert so they "remain vigilant against danger," Gallup said.

For the study, the scientists exposed parakeets to three different conditions: increasing temperature, high temperature and a moderate control temperature. While the frequency of yawns did not increase during the latter two conditions, it more than doubled when the researchers increased the bird's ambient temperature.

A paper on the findings has been accepted for publication in the journal Animal Behavior.

"Based on the brain cooling hypothesis, we suggest that there should be a thermal window in which yawning should occur," Gallup said. "For instance, yawning should not occur when ambient temperatures exceed body temperature, as taking a deep inhalation of warm air would be counterproductive. In addition, yawning when it is extremely cold may be maladaptive, as this may send unusually cold air to the brain, which may produce a thermal shock."

The parakeets yawned as predicted.

It's now believed yawning operates like a radiator for birds and mammals.

If air in the atmosphere is cooler than brain and body temperatures, taking it in quickly cools facial blood that, in turn, cools the brain and may even alter blood flow. Prior studies reveal yawning leads to a heightened state of arousal, so a morning yawn may function somewhat like a cup of coffee in providing a jolt of energy.

The new findings also explain why tired individuals often yawn, since both exhaustion and sleep deprivation have been shown to increase deep brain temperatures, again prompting a yawn-driven cool down. Yawning additionally appears to facilitate transitional states of the brain, such as going from sleep to waking periods.

Gordon Gallup, Jr., a State University of New York at Albany psychologist, did not work on the study, but, as Andrew Gallup's father, paid close attention to the research. The senior Gallup also happens to be a leading expert on the science of yawning and other widespread evolved traits.

"It is interesting to note that instances of excessive yawning in humans may be indicative of brain cooling problems," Gallup, Jr., told Discovery News, pointing out that patients with multiple sclerosis often experience bouts of excessive yawning "and MS involves thermoregulatory dysfunction."

"Bouts of excessive yawning often precede the onset of seizures in epileptic patients, and predict the onset of headaches in people who suffer from migraines," he added.

In the future, researchers may focus more on brain temperature and its role in diseases and their symptoms. But the new study on yawning changes the popular notion that yawns are mere signs of boredom.

On the contrary, as Gallup said, "yawning more accurately reflects a mechanism that maintains attention, and therefore should be looked at as a compliment!"

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Nobel Winner: HIV Vaccine Within 5 Years

Therapeutic Vaccine - For Those Already Infected - Would Be Step Toward Preventative Shot

(CBS/AP) One of the scientists sharing the Nobel Prize in medicine for discovering HIV said Saturday he believes there will be a therapeutic vaccine to treat the virus within five years.

Luc Montagnier, of France, told reporters in Sweden that he believed it was "a matter of 4 to 5 years" before a therapeutic vaccine to treat HIV infection is developed. He did not elaborate as to why he believed scientists were close.

Scientists have developed lifesaving drugs that can inhibit the disease, but there is no vaccine to prevent or treat HIV infection. Finding a vaccine has proved elusive in the past, with the most recent trials ending in failure.

However, a therapeutic vaccine would be a key step in fighting the virus, he said. A therapeutic vaccine would be given to people who are already infected, in order to lessen the impact of the disease while a preventative vaccine would, ideally, protect people from HIV.

So far, scientists have focused on drugs to fight the disease because they have been proving effective. In developed countries, AIDS has become manageable, rather than fatal, because of the drugs.

HIV was first identified 25 years ago, but still poses difficult challenges. Scientists cannot explain, for example, why it causes the immune system to collapse.

Montagnier, together with other Nobel laureates, began arriving in Stockholm on Saturday ahead of a week of Nobel festivities that culminates with a lavish banquet and awards ceremony Dec. 10.

The 76-year old scientist shares one half the $1.2 million prize with 61-year-old Francoise Barre-Sinoussi, also of France, for their research on HIV. The other half goes to Germany's Harald zur Hausen, 72, for showing a viral cause for cervical cancer.

Sweden's King Carl XVI Gustaf will hand over the Nobel Prize in Physiology or Medicine on Wednesday along with the awards in chemistry, physics, literature and economics. The Nobel Peace Prize is presented at a separate ceremony in Oslo, Norway.

New treatments, philosophies extend time in which acute strokes can be stopped

By Pohla Smith, Pittsburgh Post-Gazette
Darrell Sapp/Post-Gazette
Dr. Andrew Ku adjusts CT equipment at Allegheny General Hospital. A CT scan finds the "penumbra" in the brain that is affected, but survives, after a stroke.

It was about noon last June 15, just another day at work as a supervisor for Armstrong World Industries, when John Janczura of Beaver Falls went into the office to look up a number in a phone book.

"[I] noticed the numbers looked fuzzy and that was it," said Mr. Janczura. "Next thing I remember was when paramedics came in."

Mr. Janczura, then 58, was having an acute ischemic stroke. That means a clot -- in medical terms an occlusive lesion -- was blocking a blood vessel in his brain, causing tissue damage that could result in permanent disability or even death if it were not quickly broken up and blood flow restored to the area.

Fortunately, a colleague also in the office recognized other symptoms of stroke: Mr. Janczura was unresponsive and the right side of his face was drooping. The colleague called 911.

Also fortunately, Mr. Janczura awoke in time to slurringly respond "Allegheny General Hospital" when the EMTs asked where he wanted to be taken. His cardiologist and other doctors he and his wife use are there and, he said, "I knew it was a good hospital to be at."
Symptoms of a Stroke

"The signs and symptoms of stroke are variable," says Dr. Ashis Tayal, medical director of the Comprehensive Stroke Center at Allegheny General Hospital. They include:

• Speech disturbances such as slurring or aphasia, a term which means use of wrong words, speech that is not fluent or an inability to understand speech.

• Vision disturbances such as abrupt loss of vision or blurred, double, or decreased sight.

• Drooping of one side of the face.

• Weakness of the extremities, typically on one side or the other.

• A loss of sensation or development of numbness.

• Sudden headaches that may be accompanied by stiff neck, facial pain, pain between the eyes, or vomiting.

• Altered consciousness.

• Confusion or problems with memory, spacial orientation or perception.

If you or someone you know experience any or several of these symptoms, seek immediate medical help. Time in which strokes can be stopped and permanent disability restricted is limited.

AGH is one of three Pittsburgh hospitals designated as Primary Stroke Centers by the Joint Commission. The others are UPMC Presbyterian and UPMC Mercy. There are about 600 such centers nationwide.

The Pittsburgh hospitals specialize in the use of cutting-edge technology involving catheter-delivered, mechanical clot-removal devices that allow neurologists to intervene up to eight hours from stroke onset. When a variety of factors, including a new one called "mismatch," permits, they also push the envelope on that time frame.

Mr. Janczura ended up benefitting from both the use of a clot-removal device called the Concentric Retrieval System, or a MERCI device, and a decision by his family to allow neurologists to begin the catheter-based intervention some 18 hours after the onset of his first symptoms.

"Once the clot was removed there were no physical or mental limitations at all," Mr. Janczura said, crediting skilled neurologists, the new technology and "answered prayers" for the outcome. "If they hadn't done it, I don't know what the possibilities might have been. I probably would have been in a nursing care facility. Instead, within four days I left the hospital. ... I went back to work four weeks after my stroke. I'm responsible for 40 people's actions. ... I can still golf. There are no limitations."

To understand how Mr. Janczura's outcome came about it helps to learn the evolution of stroke treatment.

"Back in '91, when I first started treating patients with strokes, the only thing we had was urokinase, which was a clot-dissolving drug that worked pretty well," said Dr. Andrew Ku, the neuro-interventional radiologist at AGH who did the stroke intervention on Mr. Janczura. "It's still used today, [but] usually we use tPA." Formally called Activase, tPA has been around since 1995.

If the patient arrives within three hours of onset, tPA is delivered intravenously, which means it courses through the entire body.

"The original trials that resulted in the approval [by the Food and Drug Administration] ... showed that tPA was effective and the benefits of it were larger than the risks if more people were treated within three hours," explained Dr. Ashis Tayal, medical director of the Comprehensive Stroke Center at AGH. "The longer you wait beyond three hours, the higher the risk of complications such as bleeding and, No. 2, the drug may be less effective."

A recent trial showed that tPA can be effective up to 4 1/2 hours from onset. "However," Dr. Tayal said, "the drug is not approved for that kind of use currently."

Even within three hours, he added, "the drug doesn't work for every patient and it doesn't open up all clots." The intravenous delivery cannot be used on patients taking blood thinners or those with bleeding problems.

But some 10 years ago, he added, neurologists began using a micro-catheter introduced through the groin -- in the same fashion as a heart catherization -- to inject a much smaller amount of tPA directly into the clot.

The advantages: "[It] can be done up to six hours from the onset of symptoms ... and it included many people who couldn't get tPA, like, for example, if you were on Coumadin. a blood thinner, for atrial fibrillation ... or if you arrive late or say you had major recent surgery for which injecting tPA into a vein was not indicated," Dr. Tayal said.

The risks: Bleeding can occur in the brain in 6 percent of the patients and worsen as a result.

Mr. Janczura has two heart valves and atrial fibrillation and takes an anticoagulant, or blood thinner, so he was not a candidate for tPA therapy.

He was, however, a good candidate for the MERCI catheter, which was approved by the FDA in 2005 and has gone through several design improvements since. The MERCI looks like a tiny corkscrew and works like one, too, albeit with added features to keep pieces of the clot from breaking off and floating off into the bloodstream.

"What you do is put in a larger tube, like for a main blood vessel, and then you put a small tube with the retriever through that larger tube," AGH's Dr. Ku said. The small catheter and MERCI device are sent on to the blood clot, while a balloon is inflated around the larger tube to briefly shut off blood flow. That's done to prevent the clot from being washed downstream as the interventionalist is retrieving the coil and blood clot back into the catheter, he added.

"It's approved for up to eight hours after the onset of stroke," Dr. Tayal said, and these specialized catheters continue to be revised and changed and modernized with increasing experience. Trials have shown using this catheter is effective in opening up arteries about 60 percent of the time. The risk again is bleeding.
New device

In January of this year, the FDA approved another catheter-delivered clot buster called the Penumbra System. "Penumbra" is the medical term used to describe the area of brain that has diminished blood flow because of the clot and is still alive but is threatened to die and result in permanent damage if blood flow is not quickly restored.

The Penumbra device works like a microscopic vacuum cleaner sucking the clot onto the catheter.

AGH's Penumbra device was delivered about two months ago, and Dr. Ku and the hospital's other neuro-interventionalist, Dr. Robert Williams, had at the time this article was printed used it four times, Dr. Tayal said. Presbyterian has purchased its Penumbra and was anxiously awaiting for delivery, said interventional neurologist Dr. Tudor Jovin, co-director of the UPMC Stroke Institute.

"Perhaps mechanical devices do a better job than lytic [clot-dissolving] drugs administered directly into the clot," Dr. Jovin said. "Those [drugs] tend to have a lower recanalization [vessel-clearing] rate, but it's still in the 60 percent range. In mechanical devices, it goes up to 70 to 80."

The Penumbra, like the MERCI, has a standard window of opportunity of eight hours.

"It's great that we now have more treatments available," Dr. Jovin added. "The challenge will be to see which clot is suited to which device."

Still, he said, "I think the most important aspect of acute stroke intervention is not what we treat with but whom we treat. What I mean by that is how do we select patients for these interventions. Right now most are done by time [of onset] ... [but] it turns out that perhaps time is not the best way to select patients."

The reason: "Within some currently used time frames, some may have major [permanent] damage in the brain and opening up the vessel won't help much," Dr. Jovin said. "But other patients within the same time frame or same blockage or occlusion [clot] can have very little permanent damage and these are very good patients for intervention. So we have taken the approach at UPMC Presbyterian that physiology [whether brain tissue at risk is damaged or salvageable] should be the most important factor in determining who gets treated."

In other words, he explained, "the larger the penumbra, the higher the benefit of opening up the vessel." That area is measured by one of two sophisticated imaging techniques called CT and MRI perfusion. Also measured is the area of brain tissue already dead, which is referred to as the "ischemic core."
Mismatch concept

Delineating the area of ischemic core from the area of the penumbra results in an entity called a "mismatch," and the larger the mismatch "the higher the likelihood of good outcome," regardless the time of onset, Dr. Jovin said.

"These are very revolutionary concepts in stroke interventions," Dr. Jovin added. "I think we have been leaders in that regard." This past spring, at a stroke meeting in Europe his department presented 47 cases of patients treated beyond eight hours of onset.

In a second category, he added, "We looked at these patients and compared them with about 150 in the database of acute stroke intervention that were treated within eight hours. ...

"The bottom line, the conclusion, is it's not more dangerous to treat after eight hours. The other conclusion is if you open the vessels, there was a strong prediction of a good outcome."

Dr. Jovin acknowledged that mismatch is, for now, not the only factor UPMC Presbyterian takes into consideration in deciding whether to intervene.

"It's a great hope there will be a time when this will be the only factor, but right now we do take a few other factors into consideration," he said. For example, patients with high blood sugar values don't do well with interventions so the surgeons tend to be conservative; similarly, thin and/or debilitated patients don't benefit from intervention because their condition can lead to poor recovery.

"We are aware of time, but more and more we're detaching ourselves from the concept of time," Dr. Jovin added.

At AGH, however, Dr. Tayal said, "it is rare for us to recommend intervening beyond eight hours [of onset]," but, on the other hand, "mismatch is a consideration in almost all interventional therapies.

"Other factors considered are younger age, an arterial clot in a location that can be treated with a catheter, [and] a large area of the brain at risk by perfusion."

A fluctuating course of stroke symptoms and a number of other factors went into the decision to intervene in John Janczura's stroke nearly 18 hours after onset of the symptoms.

"He had dramatically improved [following his arrival at AGH]," Dr. Tayal said. "His symptoms resolved in the emergency room, so we stopped the intervention and waited another 12 hours. He worsened again, so then we treated him with the catheter-based MERCI."

Dr. Tayal added, "Mismatch was a major factor in the decision. In fact, we demonstrated mismatch two times by CT perfusion, both at the time he came in, and just prior to treatment when he deteriorated for the second time."

Also considered were the facts that "he was young, had a clotted artery, had fluctuating and worsening neurological symptoms and a large area of brain tissue at risk."
Pohla Smith can be reached at or 412-263-1228.

CT scans found to be safe, accurate

Study says they can replace angiograms
Thursday, November 27, 2008
By Karen Kaplan, Los Angeles Times

Noninvasive CT scans are nearly as accurate at imaging coronary artery blockages as conventional angiography and are much safer for many patients, according to researchers who published a study released today in the New England Journal of Medicine.

Angiograms are considered the gold standard for detecting blockages. But the procedure involves inserting a guide wire and catheter into the groin, threading them through the blood vessels to the heart and injecting a dye that allows the blockage to be seen in an X-ray.

Using a CT machine instead to make a three-dimensional image of the heart could eliminate the risks involved with traditional angiograms, including heavy bleeding, damage to blood vessels and even death, said Dr. Julie Miller, an interventional cardiologist at Johns Hopkins University School of Medicine in Baltimore and lead author of the study.

More than 1.2 million patients in the U.S. undergo cardiac catheterizations each year, and 1 percent to 2 percent of those cases result in complications, according to the American Heart Association. The National Center for Health Statistics at the Centers for Disease Control and Prevention estimates that about 25 people die each year as a result of the procedure.

About 20 percent to 30 percent of those tests give patients a clean bill of health, and that means that hundreds of thousands of people are exposed to needless risk, Dr. Miller said. Many cardiologists see CT scans as a safer alternative because the scans are powerful enough to create a high-resolution image even when the contrast dye is administered by a simple intravenous line and thus more dilute.

Dr. Miller and her colleagues at nine hospitals in the U.S., Canada, Germany, Japan, Brazil, Singapore and the Netherlands identified 291 patients with symptoms of coronary artery disease who were candidates for traditional angiograms. Their median age was 59, and 74 percent were men.

Before the patients had their angiograms, their hearts were imaged in 8.5 seconds with a 64-slice CT scanner made by Toshiba Medical Systems, which funded the study along with the National Institutes of Health and private foundations.

Two physicians examined each image and graded the degree of narrowing in 19 places in the main coronary arteries. Then the researchers compared the results from both procedures.

In the 163 patients with the highest degree of coronary artery disease -- a narrowing of at least 50 percent in at least one artery -- the CT angiograms were 93 percent as good as traditional angiograms, according to the study. Overall, the CT scans accurately identified 85 percent of the patients who had the biggest blockages and 90 percent of the patients who did not.

The researchers also found that 91 percent of patients who were identified by the CT scans as having the most severe disease were correctly diagnosed, as were 83 percent of patients whose scans did not reveal large blockages.

POEA Freezes Hiring of RP Nurses to UAE

A report from Khaleej Times , a news website said that the a freeze order on the deployment of Filipino nurses to Unite Arab Emirates (UAE) General Authority for Health Services was issued by the Philippine Overseas Employment Administration (POEA) since September of this year.

The said order was released in connection with the court cases of 100 Filipino nurses working at Al Mafraq Hospital in Abu Dhabi who were terminated after failing to pass a clinical assessment tests done in Abu Dhabi. Also, the employment contracts of 17 of the 100 Filipino nurses working there were not renewed.  The cause and reason for termination of the nurses become controversial because the outcome of the tests is surprising and unbelievable.

The nurses who did not passed the exam have been working in the UAE hospital for 10-25 years and are also Commission on Graduates of Foreign Nursing Schools (CGFNS) passer.

The said freeze order would remain until the court cases of 100 Filipino nurses are resolved in court.

Philippine Ambassador Libran N. Cabactulan, said: “This is the first time that Filipino nurses working at Al Mafraq Hospital in Abu Dhabi are said to have failed to qualify the clinical assessments. Indeed, this is very surprising.”

Cabactulan was also dismayed by the answer of a top Al Mafraq official when asked him if massive termination could ever happen in America, England or the Philippines.

Cabactulan said, “His answer was a ‘No’, citing labour unions there. It was as if they can do anything here or that the rights of the workers can be trampled upon because no one can stand up for their rights. I even said ‘go ahead’ when one of his comments seemed to suggest that they would recruit nurses from elsewhere.”


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Hospitals embrace laughter therapy

Friday, November 28, 2008
By Ula Ilnytzky, The Associated Press

The off-color jokes flew around the room. As the anecdotes got bawdier, the laughter intensified. Some recited from memory, others read from notebooks they brought along.

The setting for the hilarity was the Montefiore Einstein Cancer Center at Montefiore Hospital in New York City. The participants were cancer patients, some with advanced stages of the illness.

They were taking part in the hospital's monthly "Strength Through Laughter" therapy. It is one of several types of laughter or humor therapy being offered by medical facilities around the country for patients diagnosed with cancer or other chronic diseases.

The programs range from joke sessions to clown appearances to viewing of humorous movies.

While the verdict is still out on whether laughter plays a role in healing, the American Cancer Society and other medical experts say it reduces stress and promotes relaxation by lowering blood pressure, improves breathing and increases muscle function.

On a recent day before Halloween, many of the two dozen patients at Montefiore arrived in costume to "spook cancer."

"The session makes you feel better," said Luz Rodriguez, 57, a breast cancer patient now in remission, who came disguised as a security officer. "I feel healthy when I laugh."

The laughs generated a warmth among the group that was palpable, particularly when Ms. Rodriguez changed into an angel costume and went around offering a red rose and a hug or kiss to each of the participants.

Their facilitator, senior oncology social worker Gloria Nelson, started the session five years ago to help cancer patients focus on living, instead of dying.

"They have such amazing strength, but it's a constant challenge, the fear of it coming back, how to go on living knowing you have cancer," said Ms. Nelson, who came dressed as the mother of the bride. "Every time they laugh, it's like kicking cancer out the door. You're taking control, you're saying it's not controlling me."

The most famous case of laughter's therapeutic effects on the body was described by Norman Cousins, editor of the Saturday Review, in his 1979 book, "Anatomy of an Illness." He claimed that a combination of laughter and vitamins cured him of a potentially fatal illness.

"I made the joyous discovery that 10 minutes of genuine belly laughter had an anesthetic effect," he wrote.

Still, laughter therapy is not for everyone. Some cancer patients are so overwhelmed with their diagnosis that they are unable to participate. Medical experts stress that laughter and other complementary therapies like acupuncture, massage and meditation are not substitutes for traditional medical treatment but can be used to help relieve the anxiety brought on by the disease.

At the Cancer Treatment Centers of America in Zion, Ill., patients experience another form of laughter therapy that bypasses jokes. In this version, patients practice laughter sounds like "he-he," "ha-ha," and "ho-ho," greet each other with laughter instead of words and engage in games like a pretend snowball fight until laughter overtakes them.

The staff at the center first tried it in 2004. They felt "weird and silly" but when they tried it out with patients the next day, the laughter soon became contagious, said Katherine Puckett, a licensed clinical social worker and a mind-body medicine expert.

The therapy has since been integrated into the culture of the hospital, and is also offered at the center's facilities in Philadelphia, Tulsa and Seattle.

Steve Wilson, a psychologist who runs the World Laughter Tour, which also trains and certifies laughter club leaders, said about two dozen hospitals around the country have asked to be trained in the method just in the past two to three years. One hospital wants to try the therapy with lung transplant patients because laughter allows more oxygen to move through the body.

An international program with a similar goal but totally different approach is "Caring Clowns." The Thomas Jefferson University Hospital in Philadelphia uses the program of costumed volunteers to get patients to giggle -- or at least smile -- and open up.

"One of the challenges of being diagnosed with cancer is preserving your dignity ... when we tell you to put on a gown where the back half is missing and everyone's examining you and asking about bodily functions," said Dr. Richard Wender, former president of the American Cancer Society and the hospital's chief of family medicine.

The clown volunteers, he said, create a sense of comfort that helps narrow the "interpersonal gap" between patient and medical staff.

Robbie Robinson, 52, a non-Hodgkin's lymphoma survivor, became a certified laughter leader after witnessing the "coping mechanism" laughter offered him as a patient at CTCA.

"Some people came in wheelchairs, some were helped by family and friends. You could tell people were down ... then I noticed that through some stimulated laughter, people started smiling. They forgot their troubles. You could see the pressure come off them."

The nonprofit Rx Laughter, meanwhile, focuses on managing patient pain and improving mental health through comic entertainment, including films and TV clips. It is a unique collaboration between the entertainment and medical fields that was founded in 1998 by Sherry Dunay Hilber, one-time director of prime time programming for ABC and CBS.

Rx Laughter's participation in two large medical studies discovered that patients who watched funny videos during certain painful procedures were more relaxed and tolerated the pain longer. It also found that cancer patients had less pain and slept better after such entertainment. The organization offers a variety of programs for hospitals, nursing homes, cancer support groups and rehabilitation clinics.

"Comic entertainment is at our fingertips 24/7. ... Watching our favorite shows and films can get us through very stressful times -- all the more important in light of the cost of psychotherapy that many people cannot afford, and the problematic side effects of too many painkillers," said Ms. Hilber.
Copyright 2008 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Thousands of patients getting private healthcare for free

Under "patient choice", a policy launched in 2006 to allow people to choose from a range of hospitals, patients can also have non-emergency procedures in any private hospital that can carry out the treatment for the same cost as the NHS. 

A total of 147 private hospitals are now signed up to the scheme and carrying out treatments such as knee and hip operations. While non-paying patients are not entitled to any medication or implants not available on the NHS, they benefit from better accommodation, more staff attention and other perks of private facilities. 

The number of people taking up the offer has risen from little more than 300 per month in the summer of 2007 to more than 3,600 in September. This means the NHS spent £7.6million on giving the patients treatment in private hospitals, rather than their own.

However, Jacky Davis, a senior member of the British Medical Association and the co-chair of the NHS Consultants' Association, said the policy meant the NHS was losing money overall.

She told the BBC: "This is money that is being lost from the NHS. That can compromise services and patients should be told that by going private in this way they are potentially putting care they may need in the future under pressure." 

Opponents have long argued that the policy would see private hospitals "cream off" the easiest cases, depriving NHS hospitals of their everyday work and forcing them to focus on more expensive procedures. 

However, the Government insists the policy is the best way to drive up standards in all hospitals through competition for patients.

A Department of Health spokesman told the BBC: "Choice gives providers the incentive to tailor services to the needs and preferences of patients which, in turn, will lead to better outcomes and the reduction of health inequalities."

Study may boost nutrient's use against HIV

Tuesday, December 02, 2008
By David Templeton, Pittsburgh Post-Gazette

It has long been known that people infected with HIV/AIDS have lower levels of selenium in their bodies, with further evidence that supplements of the micronutrient slow the virus's progression.

Now a Penn State University researcher has explained how selenium effectively battles the human immunodeficiency virus, or HIV, that weakens the immune system and afflicts more than 33 million people worldwide.

K. Sandeep Prabhu, assistant professor of immunology and molecular toxicology, said his team's findings reveal for the first time how selenium succeeds in blocking replication of HIV by 10-fold or more.

The research appears this week in the Journal of Biological Chemistry.

"We hope this will be incorporated into the clinic, and this research will lead to new therapeutic interventions with selenium and selenium-dependent compounds," Dr. Prahbu said. "It could lead to a whole new line of research."

It also suggests the over-the-counter supplement could provide a cheaper way to combat HIV/AIDS in impoverished countries, especially in Africa.

"Most of the HIV population lives below the poverty line and most can't afford drugs," Dr. Prahbu said. "Selenium and selenium compounds are less expensive but still provide protection by decreasing the viral load."

The research, he said, should encourage wider usage of selenium in the United States, where health officials have been reluctant to prescribe it without understanding how it works.

Dr. Prabhu's research reveals that selenium, which the body uses to maintain normal metabolism, makes its way into selenoproteins via an amino acid known as selenocysteine.

Once a person is infected with HIV, the virus begins replicating and producing a Tat protein that causes inflammation in cells. But the body counters with the selenoprotein TR1 that upsets the chemical structure of Tat and reduces HIV's ability to replicate.

During the battle, TR1 degrades, so supplementation is necessary to restore the body's supply. It explains why people with HIV/AIDS who aren't taking selenium supplements have low levels in their system.

Dr. Prabhu's team isolated bloods cells from healthy human volunteers who did not have HIV and then infected the cells with the virus. Next they added tiny amounts of the selenium compound, sodium selenite, into the cell culture and inhibited HIV replication by at least 10-fold, which Dr. Prabhu said could be a low estimate. Once production of TR1 was reduced, HIV resumed dividing rapidly.

"Once we fully understand the function of these selenium proteins, it will give us a handle to come up with more effective drugs," Dr. Prabhu said.

Epidemiological data already suggested that people with HIV/AIDS who used selenium showed better health results.

"Now we're coming out with the mechanism of how it works," he said.
David Templeton can be reached at or 412-263-1578.

Nurses Shine, Bankers Slump in Ethics Ratings

Annual Honesty and Ethics poll rates nurses best of 21 professions

PRINCETON, NJ -- For the seventh straight year, nurses enjoy top
public accolades in Gallup's annual Honesty and Ethics of professions
survey. Eighty-four percent of Americans call their honesty and ethical
standards either "high" or "very high."


This year's results are based on a Nov. 7-9 USA Today/Gallup poll rating the honesty and ethics of workers in 21 different professions.

Nurses have topped Gallup's Honesty and Ethics ranking every year
but one since they were added to the list in 1999. The exception is
2001, when firefighters were included on the list on a one-time basis,
shortly after the Sept. 11 terrorist attacks. (Firefighters earned a
record-high 90% honesty and ethics rating in that survey.)

Bankers Take a Hit

The standing of most of the professions surveyed in 2008 is similar
to that of a year ago. The only significant change is a 12
percentage-point decline in positive ratings for bankers, from 35% to
23% -- not surprising given that the banking industry is at the center
of the Wall Street meltdown currently gutting many Americans'
investment accounts and destabilizing the U.S. economy. (Earlier this
year, Gallup reported a similar decline in public confidence in banking as an institution.)

The 2008 Gallup Honesty and Ethics poll marks the first time since
1996 that the honesty and ethics of bankers has registered below 30%.
The last time bankers took a hit of similar magnitude to their image
was in 1988, when it fell from 38% to 26% during the savings and loan
crisis. However, the 23% recorded today marks a record low for the


2008 Integrity Rankings

Nurses have no peer in the Gallup rankings today, but they are
followed by pharmacists, high-school teachers, and medical doctors, all
with close to two-thirds of Americans rating them highly. Just over
half of Americans consider the honesty and ethics of clergy members and
the police high or very high.

While fewer than half of Americans consider funeral directors or
accountants to be highly ethical, these professions are much more
likely to be viewed positively than negatively.


Building contractors, bankers, journalists, and real estate agents
each receive relatively neutral ratings. About as many Americans think
each of these professions has low honesty and ethics as rate them
highly, while the plurality or majority consider these professions of
"average" integrity.


While bankers could be faring much worse, a year ago they were in
the top-rated category, with 35% rating their ethics high or very high
and only 15% rating them low or very low.

Indeed, several professions suffer from a heavily negative tilt in
their image ratings. The worst of these are lobbyists, telemarketers,
and car salesmen, all of which are considered to have low or very low
honesty and ethics by a majority of Americans.

Although several other professions -- congressmen, stockbrokers,
advertising practitioners, business executives, lawyers, and labor
union leaders -- are not as negatively viewed as the bottom three, the
ratings for them skew negative by more than a 2-to-1 ratio. The 12%
very high/high honesty and ethics ratings for business executives,
although not appreciably different from the 14% recorded in 2007, is a
record low for that profession. It had registered as high as 25% in
1990 and 2001.


Survey Methods

Results are based on telephone interviews with 1,010 national
adults, aged 18 and older, conducted Nov. 7-9, 2008. For results based
on the total sample of national adults, one can say with 95% confidence
that the maximum margin of sampling error is ±3 percentage points.

Interviews are conducted with respondents on land-line telephones
(for respondents with a land-line telephone) and cellular phones (for
respondents who are cell-phone only).

In addition to sampling error, question wording and practical
difficulties in conducting surveys can introduce error or bias into the
findings of public opinion polls.

Blogged with the Flock Browser

Doctors transplant windpipe with stem cells

Breakthrough windpipe transplant uses stem cells Play Video AP  – Breakthrough windpipe transplant uses stem cells
In this image released by the Hospital Clinic of Barcelona on Tuesday, Nov. 18, AP – In this image released by the Hospital Clinic of Barcelona on Tuesday, Nov. 18, 2008, a procedure used …

LONDON – Doctors have given a woman a new windpipe with tissue grown from her own stem cells, eliminating the need for anti-rejection drugs.

"This technique has great promise," said Dr. Eric Genden, who did a similar transplant in 2005 at Mount Sinai Hospital in New York. That operation used both donor and recipient tissue. Only a handful of windpipe, or trachea, transplants have ever been done.

If successful, the procedure could become a new standard of treatment, said Genden, who was not involved in the research.

The results were published online Wednesday in the medical journal, The Lancet.

The transplant was given to Claudia Castillo, a 30-year-old Colombian mother of two living in Barcelona, suffered from tuberculosis for years. After a severe collapse of her left lung in March, Castillo needed regular hospital visits to clear her airways and was unable to take care of her children.

Doctors initially thought the only solution was to remove the entire left lung. But Dr. Paolo Macchiarini, head of thoracic surgery at Barcelona's Hospital Clinic, proposed a windpipe transplant instead.

Once doctors had a donor windpipe, scientists at Italy's University of Padua stripped off all its cells, leaving only a tube of connective tissue.

Meanwhile, doctors at the University of Bristol took a sample of Castillo's bone marrow from her hip. They used the bone marrow's stem cells to create millions of cartilage and tissue cells to cover and line the windpipe.

Experts at the University of Milan then used a device to put the new cartilage and tissue onto the windpipe. The new windpipe was transplanted into Castillo in June.

"They have created a functional, biological structure that can't be rejected," said Dr. Allan Kirk of the American Society of Transplantation. "It's an important advance, but constructing an entire organ is still a long way off."

So far, Castillo has shown no signs of rejection and is not taking any immune-suppressing drugs, which can cause side effects like high blood pressure, kidney failure and cancer.

"I was scared at the beginning," Castillo said in a press statement. "I am now enjoying life and am very happy that my illness has been cured."

Her doctors say she is now able to take care of her children, and can walk reasonable distances without becoming out of breath. Castillo even reported dancing all night at a club in Barcelona recently.

Genden said that Castillo's progress needed to be closely monitored. "Time will tell if this lasts," he said. Genden added that it can take up to three years to know if the windpipe's cartilage structure is solid and won't fall apart.

People who might benefit include children born with defective airways, people with scars or tumours in their windpipes, and those with collapsed windpipes.

Martin Birchall, who grew Castillo's cells at the University of Bristol, said that the technique might even be adapted to other organs.

"Patients engineering their own tissues is the key way forward," said Dr. Patrick Warnke, a surgeon at the University of Kiel in Germany. Warnke is also growing patients' tissues from stem cells for transplants.

Warnke predicted that doctors might one day be able to produce organs in the laboratory from patients' own stem cells. "That is still years away, but we need pioneering approaches like this to solve the problem," he said.

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The Male DR Nurse

by phatreecio

Being an intern is a challenging experience. We have to rotate unto several wards and sections in order to be able to fully appreciate all the fields of the Nursing profession. And what really was very upsetting on my end was being assigned at the delivery room. Well, I'm a male and sometimes, pregnant women feel awkward when the "xy" chromosomed human being joins this special section. And the dreadful day came, I can still imagine that very moment when our instructor announced my name being listed as one of those who will have their duty inside the delivery room. "Mr. Stuart, you'll be reporting this Thursday at the delivery room. Ms. Smith, Ms. Jones and Ms. Roberts will join you as well!"

In order to save myself from being nervous on my first day, I went to the place ahead of time. I was wearing my scrubs but still, my hands were cold and my heart is pounding like crazy. I just can't seem to relax. My instructor called our names. "Stuart, Patrick?!". Silence. "Again?! Stuart, Patrick?!" "Oh my! Ma'am, I am very sorry, Present!" My thoughts were flying. I keep on telling myself that this feeling shall pass soon. The instructor introduced herself. “I am Ms. Cindy Periwinkle, and I will be assisting you here in the delivery room. You will be graded according to your skills, knowledge, and the application of your related learning experience. “

We were distributed all throughout the section to maximize our workforce. I was assigned at the pre-natal area. As I walked along the aisle of the reception area, I noticed a woman around her late 30’s. She was brown-skinned, with thin hair, dry lips, and bulging eyes. I looked at her tummy and I roughly estimated that she’s on her due date. She looked at me with a curious look and I sat down in front of my assigned seat. I looked at her chart. It says G4P3 and I was not wrong, she’s approaching her due date. My instructor brought here inside the examination area. While I was writing down something on the logbook, I heard my instructor calling my name. “Patrick! Wear your mask, cap, and sterile gloves!” My heart started to throb. Lub-dub. Lub-dub. I started to become nervous again. I entered the room and voila. I saw the woman on the examination table with legs spread apart revealing her privates. She looked at me again with this curious stare. My instructor called my attention and said, “I’m going to teach you how to do the internal exam to assess how many cm the cervix had dilated. You first need to spread the labia with your thumb and little finger and then slowly insert your index and middle finger.”

It felt so uncomfortable and due to my overwhelming anxiety at that moment, what I did was to immediately insert my index and middle finger and it did enter the vagina without that much trouble. My instructor told me that it was wrong and I have to do it again. So, I removed my gloves and put on a new set of sterile gloves. I slowly spread the labia but it kept on going back to its previous position. I can’t seem to perfect it. Next thing I knew was I am slowly forcing my fingers deep into the vagina to feel the cervix. My instructor told me, “You will feel something hard. It feels like touching your ears. Pretending that I felt it to end this misery as soon as possible, I said, “Yeah! It’s there. Wow. Amazing!” She then asked me, “How many cm?” And because I was upset, I shouted, “Umm. 20 cm” I can see my instructor was about to burst in laughter but she didn’t to be professional. “No, she has a 6 cm dilatation and she will be giving birth for the next 24-48 hours. I felt that I turned red that moment and said “Oh! I’m, I’m sssorry Ma’am, T-TTThanks for the information!”

I went out and rested for a while outside to relax. I saw the full-term pregnant woman and she was smiling and her eyes looked funny. I returned a smile and I believe I blushed at that moment.

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New marrow transplant has success against sickle cell

Doctors at UPMC Children's Hospital of Pittsburgh and two other centers have completely cured sickle cell anemia in six out of seven patients using a new, less toxic approach to bone marrow transplantation.

The patients, five of whom were treated at Children's by Dr. Lakshmanan Krishnamurti, got bone marrow from siblings after a reduced-intensity preparation of their bodies for the transplants, according to a study being published in the journal Biology of Blood and Marrow Transplantation.

The less intensive use of chemotherapy and radiation before the transplants cut the risks that come from completely wiping out a patient's bone marrow before the procedure.

Sickle cell anemia is an inherited disease that damages red blood cells and is particularly prevalent among African-Americans. It causes pain, breathing problems, strokes and organ damage and can shorten lifespans by 25 to 30 years. Bone marrow transplants, which create the ability to make healthy red blood cells from the donor, are the only known cure.

Blogged with the Flock Browser

Hope College estimates 400 students, staff struck by norovirus-like illness

HOLLAND -- Hope College looked like a ghost town on Sunday -- day four of a contagious noroviris-like outbreak which caused Ottawa County Health Department officials to order the campus to close Friday.

Hope College officials say since Friday, more than 400 staff and students have come down with symptoms of the nasty flu that has been knocking down people like bowling pins.

The small liberal arts college is now unlikely to open before Wednesday, according to the college.

Earlier Sunday, the college said the number of reported cases of the flu-like illness causing vomiting and diarrhea for 24 to 48 hours climbed to 180, but many students felt those numbers self-reported to the health department are low.

"About half my friends have gotten sick and several didn't go to a clinic because it's a viral illness and doctors can't really do anything for you, anyway," said Katie Opatik-Duff, a freshman.

She created a Facebook page for the campus community called "Hope College: The Great Plague of 2008," because she wanted to find out how many people the brief but miserable illness laid low.

About one third of the 3,200 campus community had registered at the site Sunday, 14 percent of whom said they are sick or had been.

"It's a pretty good representative sample, and based on it my estimate is that 400 people got sick," said Duff, who returned home to Middleville on Friday to try to avoid getting sick. She lives in Dykstra Hall, which was hard-hit by the virus.

By Sunday evening, the college had updated its sickness numbers.

"Many of the reports are coming from students who chose to leave campus when the order was issued on Friday and are now ill," reads a statement from the college issued around 5:30 p.m.

Health officials strongly urged students to remain on campus, but not congregate, to help stop the spread of the infection. Many students able to travel decided to go home, anyway. People typically remain contagious three days after recovering, health officials said.

Students are trying to keep a sense of humor about the mystery bug. The Facebook page offers T-shirts for sale that say "Norovirus '08" on the front and "Victim -- The college is not being quarantined ... students are encouraged to remain calm" on the back.

Campus cleaning crews were busy last weekend inside all campus buildings, sanitizing common surfaces. Phelps Dining Hall, the main cafeteria on campus, has re-opened for take-out orders served in disposable containers.

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Nurses Speak Out, About Doctors

Published: October 27, 2008

In our transparency-seeking, report-card-issuing, memoir-happy climate, not much about medicine goes unexamined these days. One exception, oddly, is an aspect that used to be at the center of attention: the ever-titillating relationship between doctors and nurses.

From Cherry Ames to Dr. Kildare, the folks in the stiff, white uniforms once waltzed around providing vicarious fun for all. A few serious academic analyses from those days confirmed the intensely stereotypic sexual gamesmanship and complicated power plays underlying even trivial doctor/nurse interactions.

Now, of course, all that has changed, with nursing established as a powerful and educated profession, with gender stereotypes erased, salary disparities shrinking and job descriptions overlapping.

But has it really changed? Do we know for sure? In theory, doctors and nurses are now heading for a happy paradise of equality, collaboration and mutual respect. Human nature being what it is, though, one wonders if we are not first condemned to weather a Reconstruction-type era of confusion and ongoing mutual abuse, as all parties struggle to regain their footing.

In the meantime, not many bulletins are coming in from the field. You can bet that no doctor out there is planning to publish a manuscript entitled “Reflections on Nurses” any time soon. I am assuming my colleagues concur that such a project would be best left for retirement incommunicado somewhere on a distant Pacific atoll, where the mailman never calls.

It is hard to say which would prompt more angry letters: outlining some of the bad nursing care the present system enables, or searching for exactly the right words to describe the miraculous best. “Saintly,” “selfless” and “devoted” all have condescending paternalistic overtones. “Professional” is just too cold. There is a limit to how many times you can use “fabulous” in one piece of writing. Better to keep quiet, we say, cowards all.

But nurses are made of sterner stuff. In “Reflections on Doctors,” they have produced something quite extraordinary in recent medical writings: a compilation of 19 brief essays musing on the current relationship between the species. The book comes from Kaplan Publishing, whose guides take aspiring professionals from SAT preparation to licensure, and it is apparently intended to prepare incoming nurses for the terrain.

It does so not by theory but by anecdote: these contributors hail from the trenches rather than the executive offices or classrooms, and while some are writers by avocation, few can muster anything in the way of literary style. Still, their casual stories deliver a remarkably wide perspective on their subject.

Karen Klein recounts the two occasions in the course of a career when she refused to take a doctor’s orders. The first time netted her a heartfelt apology when her judgment proved correct; the second time, for an equally correct judgment call, she got only a bloody handprint on the back of her uniform as the irritated doctor gave her a shove in the direction of the job she refused to do.

A heavily symbolic handprint, that, and in self-consciously literary hands it could have been fashioned into quite the metaphor. This nurse only hopes the doctor “got the help he needed.”

Other stories are similarly matter of fact. Cara Muhlhahn, a nurse-midwife in New York City, describes a complicated cord-around-the-neck home delivery: “Yay! One more unnecessary Caesarean avoided because of excellent clinical management and great collaboration with doctors.” Paula Sergi, a public health nurse, writes about the workaholic doctor she wound up marrying, “the person behind the woman who attends social functions alone.”

Anna Gregory, an occupational health nurse, ruefully reflects on her looping career arc: as a nurse she increasingly took on “the doctor’s job”; now, training as a doctor, she worries that when she finishes “all the docs will have been replaced by nurses.”

In war-torn Kosovo, a team of hip young female women’s health doctors and nurses groan when an elderly Albanian pediatrician joins their team, only to become captivated despite themselves by the old crone’s clinical prowess.

Each story represents a step in understanding the inherent differences that separate the professions. While working as a rehabilitation nurse, Mindy Owen stumbles on a big one in caring for a quadriplegic teenager, the victim of a car accident. She becomes transfixed by a picture of the boy with his old basketball team, and shows the photograph to the boy’s doctor. “Never do that again,” he snaps. Only then does she realize that the doctor takes the photograph as a reproof, a message that because he cannot “fix” the patient, he has failed.

Nursing is intensely reality-based; medicine, often, not so much. “It was the first time I really understood the philosophy of some physicians,” the nurse writes, “and the definition of failure to a doctor.”

These nurses despise the lazy and arrogant doctors they come across (one wonders if the modern empowered nurse elicits worse behavior from these characters than did the old subservient model). They adore the paragons who spend endless hours with chronically ill patients and then happily play Santa Claus at the Christmas party.

Mostly, though, they write in shades of gray, describing interactions and relationships that are colorless, courteous, businesslike. You might actually call them dull. You wouldn’t get a minute of good television out of them. You might, however, get some good medical care.

Get Over the Wall as a First-Year Nurse

Surviving your first year as a nurse will likely be one of the biggest challenges you will face in your career. Almost universally, first-year nurses have days, weeks or months when they feel overwhelmed, inadequate, disillusioned, stressed out or all of the above. If you're thinking, "Was I really cut out for this job?" these tips can help you get through your first year as a nurse with your sanity, confidence and love of the profession intact.

Accept Your Limitations (and Keep Your Ego in Check)

Nursing school can often leave new nurses with unrealistic expectations. "A lot of us nurses are Type A, brainy people who were used to getting good grades in nursing school," says Ashley Flynn, who has been an RN in a surgical unit at Children's Hospital Boston since late 2006. "Nursing school is so hard that when you graduate, you think you know what you're doing." However, you won't know everything all the time, but that doesn't make you a bad nurse, she says.

Don't Try to Do It All

Likewise, new nurses must come to terms with the fact that they may not be able to accomplish everything on their to-do lists everyday. "There were days I ran rampant and didn't eat lunch until 3 in the afternoon, and I left crazy and felt like I wasn't doing a good job," Flynn says. That's when her preceptor would have her write out what she needed to do herself, what she could delegate and what she could leave to the next shift. "You have to learn to accept that nursing is a 24/7 job, and you're only there for 12 hours at a time," Flynn says. "There's always going to be something that you can't be there for or that you can't get done. You have to rely on a lot of other people."

Ask for Help

Good nurses -- whether newcomers or seasoned veterans -- know when to call in reinforcements. For Andrea Kuehn, who has been an RN in the hematology-oncology unit at Cardinal Glennon Children's Medical Center in St. Louis since March 2007, that means asking doctors and more experienced nurses lots of questions. "I'm never scared to ask questions, and I don't care if I'm getting on someone's nerves," she says. "[My] patients' quality of care [is] at stake."

Anticipate Reality Shock

Many first-year nurses participate in structured orientation programs and enjoy low patient loads and lots of help from preceptors and mentors for their first few months on the job. Then reality shock hits when the first-year nurse starts working more independently. "It's common for nurses to go through a slump of discouragement and to feel inadequate and overwhelmed, starting anywhere from their fourth to sixth month on the job," says Stacy Thomson, RN, MSN, a nurse educator/intern coordinator at Wake Forest University Baptist Medical Center. "If they hang in there, they'll feel a greater sense of satisfaction and accomplishment around the nine-month mark."

Separate the Personal from the Professional

One of the biggest mistakes new nurses make is taking things personally instead of professionally, Thomson says. "Family members can be very challenging, and patients in pain can be very irritable," she says. "Professionally, you have to step back and pull out your psychosocial skills and realize that people are in stress, and it's not personal."

Seek Support

Socializing and sharing stories with your former nursing classmates or other new nurses at your facility will help put your struggles into perspective. Hearing a nurse who is a few months further along say, "Hang on, it will get better" or "I've done the same thing you just did" can validate your experiences and provide support, Thomson says.

Remember Why You Became a Nurse

In the end, Flynn and Kuehn both say the wonderful aspects of nursing outweigh the challenges. "There are days you argue or get your feelings hurt or get screamed at, and you go home and don't feel great," Flynn says. But then the next day, a child may draw you a picture or a parent will thank you, making you feel good about that part of the job, she says. "Whether or not we're happy all the time in what we're doing, most of us feel like we were meant to do it," she says.

Adds Kuehn: "I always thought it would be magical, saving lives every day. In fact, it is a very stressful job when you're first starting out. Just remember that everyone has to start somewhere."

Copyright 2007 - Monster Worldwide, Inc. All Rights Reserved. You may not copy, reproduce or distribute this article without the prior written permission of Monster Worldwide. This article first appeared on Monster, the leading online global network for careers. To see other career-related articles visit

Best of the best

Best of the best
For the first time, we rank Best Places to Work


Welcome to Modern Healthcare's first Best Places to Work in Healthcare supplement. In this issue, readers will learn the rank order of the Best Places to Work in Healthcare.

Our new awards and honors program, which we announced in January, recognizes workplaces in healthcare that enable employees to perform at their optimum level to provide patients and customers with the best possible care and services. To determine those workplaces, Modern Healthcare entered into a partnership with the Best Companies Group, a firm that conducts regional "best places to work" programs across the country. Organizations and companies from all segments of the healthcare industry with a minimum of 25 full-time employees were eligible.

On behalf of Modern Healthcare, the Best Companies Group conducted two surveys of healthcare organizations and companies that volunteered to participate. The deadline to sign up for the program was June 20, and the two surveys were administered in July and August. The first survey was a questionnaire for a participating employer. The second was a satisfaction survey of a participating company's employees.

Participation was free to those that completed the questionnaire and survey electronically. There was a nominal fee for those that submitted their entry on paper. Healthcare employers that participated will receive a free summary report on the results of the questionnaire and survey. Some 238 healthcare organizations and companies participated in the survey. On Sept. 8, Modern Healthcare announced an alphabetical listing of the 100 healthcare companies that made the cut. And in this supplement, we reveal for the first time the ranking of those 100. We congratulate them for their achievement.

The Studer Group sponsored Modern Healthcare's Best Places to Work in Healthcare program. Per editorial policy, sponsors are not involved in the design, administration, tabulation or interpretation of the survey or the judging or determination of award recipients.

Modern Healthcare would like to thank frequent contributor Ed Finkel for writing the main story and three employer profiles that appear in this supplement. You can reach Finkel at

Most importantly, we'd like to thank all of the 238 healthcare organizations and companies that participated in this year's Best Places to Work in Healthcare program. Watch for an announcement of next year's program early next year.

Thank you.

David Burda, editor

Cytomegalovirus (CMV)

Q: I have heard that CMV can be a serious problem when contracted by a pregnant woman. What is it and how can it be prevented?

A: Cytomegalovirus (CMV) is a virus contracted by contact with infected body fluids like saliva, urine and blood. Most adults and children who get CMV may not even know they have been infected because the symptoms are often mild or vague, like fever, fatigue, sore throat or a mononucleosis-type illness. However, babies born with CMV (about 1 in 150 live births) may have a more serious illness.

Health problems occur most often in babies born to women who get their first CMV infection during pregnancy. In the United States, about half of expectant mothers have never been infected with CMV. Fewer than 4 percent of uninfected pregnant women will get a first CMV infection during their pregnancy. Only about 30 percent of those pregnant women will pass the virus to their unborn baby. Although most babies born with CMV never develop problems, the infection may cause hearing loss, vision loss and developmental disabilities in affected newborns.

CMV is most frequently found in day care and pre-school age children. Most infections among pregnant women are caused by contact with infected saliva or urine; therefore, mothers and child care workers are at high risk for contracting the infection.

Recommendations for pregnant women to help prevent contracting CMV:

• Wash hands often with soap and water, especially after contact with saliva or with diapers of young children.

• Do not kiss children under 6 years on the mouth or cheek.

• Do not share food, drinks or silverware with young children.

If you are pregnant and think you may have contracted CMV, talk to your doctor.

Daniel R. Lattanzi, M.D.
Obstetrics and Gynecology

Aggressive vaccine effort could cut cervical cancer

CHICAGO (Reuters) – An aggressive strategy of vaccinating older women against cervical cancer could deliver a crippling blow against the disease, cutting rates for that type of cancer in half for women through age 45, U.S. researchers said on Saturday.

Using a mathematical model, they showed that vaccinating women in the United States by ages 12 through 45 against the cancer-causing human papillomavirus, or HPV, could reduce cases of cervical cancer by 85 percent for 12-year-olds and up to 55 percent for 45-year-old women.

It could lower rates by 34 to 67 percent for 25-year-old women, Warner Huh of the University of Alabama told a meeting in Washington of the American Society for Microbiology and the Infectious Diseases Society of America.

The model assumed 100 percent vaccination rates, which would be difficult to achieve in the United States.

Most cases of cervical cancer are caused by the sexually transmitted human papilloma virus.

Merck and Co's Gardasil vaccine is designed to protect against HPV types 16 and 18, which are known to cause about 70 percent of all cases of cervical cancer. It also is designed to protect against HPV strains 6 and 11, which cause genital warts.

Gardasil is approved in the United States for use in girls and women ages 9 to 26, but Merck is seeking to expand its use to older women. The thinking has been that girls must be vaccinated before they are sexually active, because HPV is so common.

The vaccine does not protect anyone who has already been infected with one of the strains of HPV.

Huh's calculations included clinical trial data on GlaxoSmithKline's Cervarix vaccine, which is not yet approved for sale in the United States but which is approved in Europe.

He assumed Cervarix gave 95 percent protection against HPV types 16 and 18, and 27 percent efficacy against all other high-risk HPV types.

Vaccinating women over age 26 has not been approved by the U.S. Food and Drug Administration and is not included in U.S. Centers for Disease Control and Prevention guidelines.

An estimated 11,070 new cases of cervical cancer will be diagnosed in 2008 in the United States, and 3,870 women will die from their cancers.

(Editing by Maggie Fox and Vicki Allen)

Colon Cancer Drug Won't Help Those With Certain Gene Mutation

A new study suggests that people with advanced colon cancer who have a particular gene mutation won't benefit from the medication cetuximab (Erbitux).

While the drug can add months to the lives of people without a mutation in a gene called K-ras, those who have the mutation won't see any benefit from this additional therapy, reports the study, which is published in the Oct. 23 issue of the New England Journal of Medicine.

"We believe that, in the context of pre-treated advanced bowel cancer, the K-ras mutation status of the cancer should be determined before using cetuximab, and cetuximab should only be given to patients with tumors that do not have the mutation," said study author Dr. Christos S. Karapetis, a senior consultant medical oncologist and director of clinical research in the department of medical oncology at Flinders Medical Centre in Australia.

Karapetis said that about four in 10 people with colon cancer have the K-ras mutation.

Erbitux works by interrupting cell growth and division. It does this by binding to a receptor known as epidermal growth factor receptor (EGFR). A mutation in the K-ras gene is believed to interfere with cetuximab's ability to disrupt EGFR, according to the study.

For the study, 572 people with advanced colorectal cancer were randomly assigned to receive either weekly treatment with cetuximab and supportive care (287 people) or supportive care alone (285 people). All had undergone other treatment options without success.

Almost 400 tumor specimens from the study volunteers were tested for K-ras mutations (198 from the cetuximab group and 196 from the supportive care group). Just over 42 percent of the tumors evaluated were found to have mutations in the K-ras gene.

Even with cetuximab treatment, people with K-ras mutations had no significant changes in overall survival or in progression-free survival. Those without the mutations, on the other hand, appeared to benefit significantly from the therapy.

People with no K-ras mutations who were treated with cetuximab had nearly twice the overall survival rate compared to the supportive care group -- 9.5 months versus 4.8 months. And, the time of progression-free survival was also nearly doubled for those treated with cetuximab -- 3.7 months versus 1.9 months in the supportive care group.

"Patients with a colorectal tumor bearing mutated K-ras did not benefit from cetuximab," the researchers concluded.

"This study suggests that if someone has this particular mutation, they won't respond to this drug," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. "The bottom line is that this study is important and really has the potential to impact how we treat patients with colorectal cancer with this very expensive drug."

He added that other researchers have noted similar results for K-ras mutations in earlier-stage colorectal cancer.

"This is one more refinement on personalized medicine, and we're moving into an age of molecular markers that eventually will guide treatment. If someone has a cancer in the future, that cancer will be analyzed for what kind of cancer it is, and then we'll know what the best treatments are for that cancer," Lichtenfeld said.

Another important molecular marker that guides treatment is already in use for breast cancer treatment, according to Lichtenfeld. Breast cancers are tested for a type of receptor called HER2. Those with this molecular marker are likely to have a more aggressive type cancer, but also a type of cancer that responds to treatment with the drug trastuzumab (Herceptin), he said.

"I'm excited about the future, and this study shows we can be more targeted with our targeted therapies," said Lichtenfeld.