Archive for September, 2011

Simulation Labs: Helping Teach Nurses in Baltimore

Tuesday, September 27th, 2011

From nursing.jhu.edu

Any one who has ever had a hospital stay or knows a loved one or friend who has been in the hospital knows that the nurses play a vital role in caring for patients. Nurses do many of the day-to-day activities of caring for patients in hospitals and clinics. They are also often the first ones at the bedside if a problem arises – so -isn’t it essential that nurses be well trained in all forms of emergency procedures? Even when doctors are present, nurses often play vital roles in assisting the doctors in providing life-saving care to patients.

Law and Medicine Intersect Once Again

I have recently been working on a case in which both doctors and nurses were present during an in-hospital delivery that ended with a significant injury to the child. During the delivery, a problem was encountered that has a low incidence rate during deliveries.  In considering this problem, I wondered just how frequently doctors and nurses are able to practice the skills they would need to successfully and calmly deliver a baby in a situation like this.  Faced with this “emergency” situation, how many of the doctors and nurses in the room had not experienced this problem before? For those who had –  just how much “experience” did they bring to the problem they were facing?

Simulations Rooms and Simulation Patients Provide Training Opportunities

Thankfully, technology is making it more feasible for training healthcare providers to practice handling a myriad of clinical situations during their education process that they might otherwise not experience frequently enough for their skills to develop in real world settings. In Baltimore, the Johns Hopkins University School of Nursing (JHUSON) has simulation rooms in which nursing students are able to practice a variety of procedures and techniques using simulation patients in rooms that are designed to replicate the real patient areas of the hospital. There is also a whole family of simulators to help. This “sim fam” is not like the lifeless plastic dummies you might be imagining. They are a variety of different types of “…life-like practice manikins, including Sim Man, Vital Sim Man, Noelle with newborn, and Sim Baby [that] give nursing students the hands-on experience without the anxiety of working with actual human beings.”

Harvey the Cardiac Sim, SimNewB and Sim Man 3G  - All New Additions to the “Sim Fam”

From nursing.jhu.edu

Just this year, in March, JHUSON added Harvey to its collection of simulators.  While Harvey is new to JHUSON, he is not exactly new technology:

For almost 40 years Harvey, developed in cooperation between Laerdal Medical Corporation and Miami University Miller School of Medicine, has been a proven simulation system teaching bedside cardiac assessment skills that transfer to real patients, and remains the longest continuous university-based simulation project in medical education.

Harvey’s job is to be able to simulate “nearly any cardiac disease at the touch of a button: varying blood pressure, pulses, heart sounds, and murmurs. The software installed in the simulator allows users to track history, bedside findings, lab data, medical and surgical treatment.”  He joins a collection of other sim patients that enable healthcare providers to learn and practice critical life-saving measures such as CPR, defibrillation, intubation and yes – even the proper checking of vital signs. JHSON has adult, child and baby versions of these simulators. Some of them can even “talk” to the practicing nurses. (I wonder if they are programmed to be cooperative and informative or hostile and combative – hmmm.)

New Family Members Arrived this Past August

Even newer, in August, JHUSON added SimNewB and Sim Man 3G to the family. The SimNewB is:

…a 7 pound, 21 inch female baby, with realistic newborn traits. Students will be able to simulate a wide variety of patient conditions with her, including life-threatening ones. The department’s current Sim baby is the size of a 6 month old and is not as conducive to delivery room procedures.

She is also interactive, though she is not wireless like the Sim Man 3G. Some of the new Sim Man’s traits include “…breath sounds both anteriorly and posteriorly, … pupil reactions, [and] skin temperature changes.”

What about Obstetrics Cases?

So, what about the case I was mentioning that involved obstetrical care? Well, JHUSON also has a pregnant simulator, which is can be used to practice a whole host of obstetrically related procedures. These include “Leopold maneuvers, normal vaginal and instrumented delivery, breech delivery, C-section, and postpartum hemorrhaging, among other functions.” The JHUSON sim family also has the new Sim newborn – SimNewB.

The “Jury” Is Still “Out”

Can there be any doubt that additional hands-on practice opportunities with simulators is a good idea for situations that may not come up very often in everyday practice? Won’t it help healthcare practitioners gain skills and keep those skills up-to-date? Any opinion I might have on these issues is not based on evidence….yet. Luckily, JHSON is “…among 10 nursing schools nationwide collaborating on a landmark study to find out just how well patient simulators—high-tech manikins that respond to a nurse’s care—help prepare the nurses of tomorrow.”  I – for one – will certainly be interested in the outcome of that study.

What about you? Do you think that it makes sense for nurses in training to make use of simulation rooms and simulated patients? Would it be better for them to spend more time in real world situations doing real patient care under the supervision of experienced practitioners? What about techniques that might not come up very often?

If any of the readers of this post have used these sim patients in your training and can give us firsthand information as to how, if at all, it carried-over to make you more “experienced and skilled” when facing similar clinical situations with real patients, your comments would be most welcomed as well.

Attention Ward 7 & 8 Residents! Your Input is Needed!

Monday, September 12th, 2011

Are you living in Southeast and wondering how your money is being budgeted and spent?  Concerned about the direction of the United Medical Center?  Now is the time to act!

Let’s start with a little bit of background for anyone that is not living in Southeast or familiar with United Medical Center (formerly known as Greater Southeast Community Hospital.)  For years United Medical Center has struggled to pay its bills. In 2006 and 2007, the hospital was in danger of closing, requiring the city to step in to save it.   The Not-for-Profit Hospital Corporation, commonly known as United Medical Center, was established on July 9, 2010 through special legislation. Since then, the new leadership team, its medical staff, and nurses, clinical and support staff claim to be making major improvements in their quality of care, customer service, patient safety and campus security. The facility, which serves many of the city’s poorest residents, also received a new roof and generators, major improvements to the emergency department and replacement of nearly all radiology equipment.  Putting the hospital’s claims aside, have you noticed a difference?

The hospital has replaced most patient care diagnostic, monitoring and therapeutic equipment and upgraded most hospital physical plant systems. Over 75 physicians have joined the medical staff.  With changes being made everyday, now is the time to give your input and share your experience with the City Council.

On Thursday, September 29, 2011, at 10:00 a.m., Room 500, 1350 Pennsylvania Avenue, NW, Washington DC 20004, a public hearing will be held on issues related to the financial management of the hospital.  This hearing will be open to the public; however, only invited witnesses will be permitted to provide oral statements.  Members of the public may submit written testimony which will be made part of the official record.  Copies of written statements should be submitted to the Committee on Health no later than Thursday October 6, 2011.

Sufficiently concerned?  Make certain that you attend the hearing or, at a minimum, submit your written statements to the committee.

 

FES Equipment Coming to Baltimore’s Mount Washington Pediatric Hospital

Thursday, September 8th, 2011

Author - Sarah Keogh

Back in February, Jon Stefanuca wrote about a study in the Journal of Neurorehabilitation and Neural Repair about Functional Electrical Stimulation (FES) and the benefits it can provide to those individuals who have suffered spinal cord injuries. He explained how FES is able to provide electrical impulses to stimulate paralyzed muscles. The study’s authors found improvements based on using FES that led them to recommend using stimulation therapy in conjunction with occupational therapy for patients with incomplete spinal cord injuries. This technology is now also being used to help people with a wide range of injuries and illnesses including, stroke, multiple sclerosis, traumatic brain injury, and cerebral palsy, in addition to spinal cord injuries. According to the Christopher and Dana Reeves Foundation website, FES works by applying “small electrical pulses to paralyzed muscles to restore or improve their function”. The benefits can be extensive:

FES is commonly used for exercise, but also to assist with breathing, grasping, transferring, standing and walking. FES can help some to improve bladder and bowel function. There’s evidence that FES helps reduce the frequency of pressure sores. From: Christopher and Dana Reeves Foundation website

Improved Technology To Be Locally Available

Since FES was originally developed, the technology improved from being something that was typically integrated into large expensive equipment, such as exercise bikes and wheelchair based equipment, into smaller more portable devices. The good news for individuals with neuro-motor injuries in Baltimore City and the surrounding areas is that this type of FES treatment is about to become more available locally. At the end of August, Mount Washington Pediatric Hospital announced that they have received a “Quality of Life” grant from the Christopher and Dana Reeve Foundation. The article explains:

The money will help Mt. Washington Pediatric Hospital purchase Bioness® equipment for its Adaptive Equipment Rehabilitation Clinic (the clinic). The clinic works with patients with neuro-motor disorders to maximize their movement as much as possible given their physical limitations.

From Bioness.com

The Bioness website explains that they produce a variety of “medical devices designed to benefit people with Stroke, Multiple Sclerosis, Traumatic Brain Injury, Cerebral Palsy, and Spinal Cord Injury. These products use electrical stimulation to help people regain mobility and independence, to improve quality of life and productivity.” While I do not know what particular equipment will be available at the Mount Washington Pediatric Hospital, Bioness makes equipment to assist patients with hand paralysis, foot drop and thigh weakness among other conditions.

MWPH Uses Interdisciplinary Approach Combining FES and Therapy

The article about the grant explains some of the many wonderful things available for patients at the Mount Washington Pediatric Hospital (MWPH):

  • …[an] interdisciplinary approach to the assessment and management of adolescents and children with neuromuscular impairments, paralysis and/or movement disorders
  • … [a] team of 21 experienced specialists in physiatry, occupational therapy, and physical therapy.

The new equipment at MWPH will be used along with the other occupational and physical therapy options available to patients. A study described in US Neurology looked at stroke victims and found the combination of FES and traditional therapies that include repeated motion provide the best results:

Stroke patients with limited voluntary movement could now benefit from technologies such as functional electrical stimulation (fes) combined with necessary repetition of functional tasks (use-dependent plasticity) to enhance the neural repair process and improve outcomes, thus enabling them to begin to overcome their previous limitations and to improve their physical capabilities.

From Bioness.com

The goal at MWPH for children and adolescents is based on a similar idea:

Patients whose muscles can be retrained will require several months of therapy to gain normal range of motion and strength. For those patients with more severe conditions where muscles cannot be retrained, the Bioness® equipment will be used to augment their range of motion. Using these two therapy modalities, patients will acquire greater functionality, range of motion, muscle strength, and the ability to move independently.

This multi-disciplinary approach should allow these children and teens to have the best chances of improved motor use and the most independence in their future lives.

Related Articles:

Coming Soon? Restored Breathing for Spinal Cord Injury Patients

Spinal Cord Injury Updates: More Reasons for Optimism?

New Treatment Holds Promise for Patients With Spinal Cord Injuries

New Microchip Promises to Make Life Much Easier for Paraplegic Patients

DC Hospitals Step It Up During Prostate Cancer Awareness Month – FREE Resources You Need to Know About

Wednesday, September 7th, 2011

September is Prostate Cancer Awareness Month. To raise awareness about prostate cancer, hospitals in Washington, D.C. are stepping-up this September for a good cause indeed.  Did you know that an estimated 240,890 new cases of prostate cancer will be reported this year? About 33,720 men will die this year alone from prostate cancer. About 1 in 6 men will be diagnosed with prostate cancer during their lifetime.

Although prostate cancer is the most common cancer in American men, the good news is that the survival rate is quite high for patients who are diagnosed and treated early.  If you are a man, a key to your survival is to be familiar with the signs and symptoms of prostate cancer and to seek regular screening.

This year, Georgetown University Hospital will recognize Prostate Cancer Awareness Month by offering men free prostate cancer screening.

Who should get screened?

-          Men over the age of 35 – particularly African-American or Hispanic men over the age of 35

-          Men with a family history of prostate cancer

If you meet the above criteria, don’t miss out on this opportunity. Free screening will be offered on Saturday, September 17, 2011 from 8:00a.m. to 12:00p.m. in the Lombardi Comprehensive Cancer Center. Free parking will be available in the Leavey Center garage.  The Georgetown University Hospital is located at 3800 Reservoir Rd. NW, Washington, D.C., 20007. “The screening will consist of blood testing to determine PSA (prostate specific antigen) level, total cholesterol, and a digital rectal exam (DRE) to be performed by physicians.”

If you or someone you know has been diagnosed with prostate cancer, you might want to contact the Providence Hospital prostate cancer support group.  This group is specifically dedicated to helping patients live and cope with prostate cancer. Brothers Prostate Cancer Support Group meets every 4th Tuesday between 6:30p.m. and 8:30 p.m. at Providence Hospital’s Wellness Institute (1150 Varnum St. NE, 3rd Floor, Washington, D.C 20017).  For more information, please call 202-269-7795.

Please share this information with your friends, fans, and readers. For more information about cancer support groups in the D.C. area, please visit DC Cancer Consortium.

We’re Launching a New Facebook Page for Washington, D.C.

Saturday, September 3rd, 2011

Washington, D.C. - D.C. Court of Appeals Building

By: Brian Nash, Editor 

We are very pleased to announce the launching of our new Facebook page, DC Eye Opener. For the many thousands of readers who have read our posts in Eye Opener over the past twenty or so months, we want to let you know that we will be continuing to post there as well.

Our blawgers have been posting articles and commentaries on issues relating to health, law and medicine for almost two years now. We have had over 150,000 visitors to our site since our inception. We thank each and every one of you who have stopped by and read our posts – particular thanks to our many subscribers.

So Why Washington, D.C.?

Well, the answer is quite simple – it’s one of the primary places where we practice law.

I moved from New Jersey to Washington, D.C. in 1965 and attended The Catholic University of America in Northeast D.C. While in college, I worked at the Safeway on 12th Street (sadly no longer there) as a grocery clerk and produce man, just up the road from Turkey Thicket and Providence Hospital. After I graduated from CUA, I taught for two years at Bullis Prep in Potomac, Maryland. I attended law school at the Columbus School of Law (Catholic University Law School) and obtained my Juris Doctor in 1974. I was admitted to the D.C. bar in 1976, two years after being admitted to the Maryland bar. I have been trying cases in the District of Columbia ever since. Frankly, I’ve lost track of the number of cases I’ve handled in D.C. over the years. There have been so many trials in the local and federal courtrooms of Washington, D.C. that some suggested I give up my office space and simply take up residence in the hallways of the Superior Court or in the federal district court across the street.

A number of the lawyers I began practicing with have now become judges on the Superior Court and the United States District Court for the District of Columbia. A few of my former law partners have donned the black robe and have made quite a career for themselves in the Superior Court. I am proud and pleased to call them my colleagues and my friends.

During the early part of my career, I represented numerous D.C. individuals, corporations and healthcare providers as a defense lawyer. As you can no doubt tell from our website, we are now representing people injured through the wrongdoing of others. It has been a wonderful journey, which continues on. Our lawyers at Nash & Associates, Marian, Mike, Jon and Jason, are all admitted to the District of Columbia bar as well as the Maryland bar. (Sarah Keogh is presently admitted to the Maryland bar only – we’re working on her to add D.C. to her impeccable credentials.) Simply put – the District of Columbia is our turf. One of our offices is located on Connecticut Avenue, N.W., just a half a block from the Red Line’s Farragut North Station on Connecticut and K Streets, N.W.

So Why the New Facebook Page for D.C.?

What we have seen and learned in our social media activities of blogging, Facebook, Twitter and LinkedIn is that our message can become diluted through worldwide distribution. We decided we needed to narrow our audience. Put another way, so many times we wanted to post information about what’s happening in law, medicine and health in the District of Columbia, but when your readers are from around the globe, there’s not much interest in the message and information if it’s just about Washington, D.C. Now we want to share our message and get to know you, who live and work in the District of Columbia. Frankly, our readers throughout the United States – “outside the Beltway“ as they say – don’t really care much about what’s happening in D.C.  Well we do and we know you do too!

Our Mission

Simply put, we’re going to bring you information that we hope will keep you informed about topics such as your health, trends in medicine, the laws that may affect you, what’s happening on the legal front in the areas of our expertise (negligence, medical malpractice and the like) and some postings about what’s happening around the city from our legal eye perspective. Our goal is to interact with you, have some fun, provide some useful information – all the things that social media is designed to do and has been doing so well for years now.

For those in the Twitterverse, we’ll soon be launching our new Twitter name/location. Collectively, our tweeps at Nash & Associates have over 5,000 followers. We should have our DC Twitter page up and running this week – we’ll post that new location here. In the meantime, if you want to connect on Twitter, we’re waiting to make your acquaintance at NashLawFirm.

Let’s connect! We’ve met so many great people and businesses on Twitter, Facebook and LinkedIn. We hope to soon count you among our friends and followers.

So, HELLO and WELCOME, D.C. – glad we finally get to share, meet and connect with you!

 

 

 

 

 

 

For close to two years now, our blawgers have been bringing

 

Photo from loringengineers.com