Today was my first exam of this semester. It was in Diagnosis and Management II, from the lectures on GI, urinary, hepatitis of all ilks, and emergency preparedness. It went fine, with the usual mix of questions that range from obvious to esoteric. Of course, I want them to post the grades ASAP...
After this, I have few actual assignments ahead of me. This class has two more exams, and my other class requires one case presentation and one paper. However, the paper is our "capstone", intended to serve as a master's thesis, and has been in the works since early 2009. That's it. The vast majority of the work will be in clinical, where I have to see patients and present them to my preceptor. This semester's preceptor is a character, who prides herself on being "forceful" and having "a big mouth" but also seems like a very good clinician who cares a lot about her patients.
Because of the extra day of clinical (two per week instead of just one) this semester has been more challenging for most of us than previous semesters. This is especially true for those of us who are working. I've been keeping a mental tally of the weeks completed; my friend has made a paper chain with one link per remaining week, which she can tear off on Saturday nights. Her husband ruefully noted it was longer than he had been hoping. Another friend happily told me last night there were only 73 more days until December 23. Nice.
Monday, October 12, 2009
Monday, October 5, 2009
flu and H1N1 vaccine: can they make us?
A recent NYS mandate that all health care works get both a seasonal flu shot and an H1N1 vaccine has stirred some controversy. Hospital workers have objected to making the two shots a requirement for continued employment, saying that it's "anti-American" for medical treatment (or in this case, prophylaxis) be mandated. The state has countered that in the past when the vaccine was voluntary, only 40% of workers got it. I have nurse friends who are passionate about public health who have up until now declined to get the shot. They question its efficacy in young, non-immunocommpromised workers, and point out that the shot only contains the fews strains epidemiologists guess will be most prevalent this season, and thus is far from a sure thing.
I believe (and I may be wrong) that as a student working in health care, I am subject to the same mandate. I am certainly required to get both shots. A few weeks ago, my school notified all health care graduate students (nursing, medical, dental, and possibly the physical therapists) that we were required to get the seasonal flu shot ASAP and could not do our clinical rotations, mandatory as a part of the curriculum, without them. Those students who had student health insurance could get the shots at student health services; those who did not had to go elsewhere. I ended up going to an NYS Department of Health site to get mine. I am not sure what I will do when H1N1 comes out. Frankly, I felt that if they were going to require I get the shot, they should have at least offered me the convenience of paying for it at student health services, as they offer us the convenience of buying books at the campus bookstore.
Anyway, to the few people who read this blog, I would be interested to hear what you all think. Should it be mandatory for nurses, doctors, and everyone else, to get the flu shot by order of NYS?
I believe (and I may be wrong) that as a student working in health care, I am subject to the same mandate. I am certainly required to get both shots. A few weeks ago, my school notified all health care graduate students (nursing, medical, dental, and possibly the physical therapists) that we were required to get the seasonal flu shot ASAP and could not do our clinical rotations, mandatory as a part of the curriculum, without them. Those students who had student health insurance could get the shots at student health services; those who did not had to go elsewhere. I ended up going to an NYS Department of Health site to get mine. I am not sure what I will do when H1N1 comes out. Frankly, I felt that if they were going to require I get the shot, they should have at least offered me the convenience of paying for it at student health services, as they offer us the convenience of buying books at the campus bookstore.
Anyway, to the few people who read this blog, I would be interested to hear what you all think. Should it be mandatory for nurses, doctors, and everyone else, to get the flu shot by order of NYS?
Sunday, October 4, 2009
long island hospital moves towards EMRs
North Shore Long Island Jewish Health System, a network of 13 hospitals, has announced its intention to digitize its record system. The hospital hopes the new system will provide both a competitive advantage for itself and improved care for patients, mostly by better integrating records kept across the system. The estimated cost: $400 million. NYC's government has historically been a leader in encouraging the adoption of EMRs, but most of that has been in small private practices, nothing on the scale of a network like this.
Wednesday, September 16, 2009
NP stats
The Kaiser Family Foundation recently released a fact sheet on the number of nurse practitioners in the US, with a breakdown by state. In total, the US has 147,295 NPs. The states with the most NPs are: California, with 15,230 NPs, and New York, with 14,272. The states with the least: North Dakota, with 343 NPs, and South Dakota, with 372.
Monday, September 14, 2009
good cop bad cop
NYC has been sending public health mixed signals!
A recent Post article notes an unexpected trend: a reduction in the number of uninsured people in NYC over the last several years. According to the article, of the 2.7 million New Yorkers enrolled in a public health insurance program (Medicaid, Child Health Plus, Medicare...) approximately one million of them first received benefits since 2002. Moreover, 90% of the city's children are insured, even if one includes the children of undocumented immigrants. So, according to the article, NYC is about halfway there: 1 million down, 1.3 million to go.
On the other hand, a Brooklyn judge recently ruled that the state has discriminated against thousands of mentally ill residents by placing them in "adult homes" instead of "supported housing". The New York Times reports the suit was brought by Disability Advocates, a nonprofit legal services group, under the auspices of the Americans with Disabilites Act. The judge ruled that these adult homes were "segregated settings"that did not provide residents with appropriate opportunities to cultivate daily living skills and personal independence. Interestingly, the cost per resident associated with an adult home is about $7,000 greater per year than the cost per resident in a supportive housing facility. ($47,936 vs. $40,253).
I work in such a supportive housing facility, and I think it strikes an excellent balance for its residents. Medical care is provided by a GP and a psychiatrist, both of whom come in weekly, and medication administration and monitoring is performed by myself, an RN, who is in twice a week. Moreover, each resident has a social worker to help them with a huge number of issues: government benefits and the associated paperwork, bills and financial management, part time work, and coordinating medical care when it goes beyond the on-site staff. Meanwhile, the residents maintain a high level of independence and self-sufficiency. Overall, it's great.
A recent Post article notes an unexpected trend: a reduction in the number of uninsured people in NYC over the last several years. According to the article, of the 2.7 million New Yorkers enrolled in a public health insurance program (Medicaid, Child Health Plus, Medicare...) approximately one million of them first received benefits since 2002. Moreover, 90% of the city's children are insured, even if one includes the children of undocumented immigrants. So, according to the article, NYC is about halfway there: 1 million down, 1.3 million to go.
On the other hand, a Brooklyn judge recently ruled that the state has discriminated against thousands of mentally ill residents by placing them in "adult homes" instead of "supported housing". The New York Times reports the suit was brought by Disability Advocates, a nonprofit legal services group, under the auspices of the Americans with Disabilites Act. The judge ruled that these adult homes were "segregated settings"that did not provide residents with appropriate opportunities to cultivate daily living skills and personal independence. Interestingly, the cost per resident associated with an adult home is about $7,000 greater per year than the cost per resident in a supportive housing facility. ($47,936 vs. $40,253).
I work in such a supportive housing facility, and I think it strikes an excellent balance for its residents. Medical care is provided by a GP and a psychiatrist, both of whom come in weekly, and medication administration and monitoring is performed by myself, an RN, who is in twice a week. Moreover, each resident has a social worker to help them with a huge number of issues: government benefits and the associated paperwork, bills and financial management, part time work, and coordinating medical care when it goes beyond the on-site staff. Meanwhile, the residents maintain a high level of independence and self-sufficiency. Overall, it's great.
Wednesday, September 2, 2009
gross!
NYC is mounting a new ad campaign to prompt New Yorkers to think about the unhealthy drinks they consume daily. The ads, which feature a dark-colored drink being poured into a glass filled with fat, urge readers not to "drink yourself fat". These ads are in the same aggressive vein as the anti-smoking PSAs featuring "Maria from the Bronx", which showed a woman holding up her hands, both of which are missing several fingers due to multiple amputations. The Daily News reports that the NYC Department of Health spent $277,000 and used focus groups to develop the tough strategy.
Interestingly, Gothamist pointed out that one of the bottles featured in the posters looks an awful lot like Snapple, the official beverage of NYC. Snapple has exclusive rights to distribute in NYC public schools and to stock the vending machines of NYC-owned buildings. Hmmm...mixed message, much?
Interestingly, Gothamist pointed out that one of the bottles featured in the posters looks an awful lot like Snapple, the official beverage of NYC. Snapple has exclusive rights to distribute in NYC public schools and to stock the vending machines of NYC-owned buildings. Hmmm...mixed message, much?
Monday, August 17, 2009
back for more
OK, vacation's over, and I'm back to blogging. This post is kind of a grad student/public health combo. The grad student aspect of the blog is this: one more semester to go. I have one more semester until I am supposedly qualified to diagnose and treat a wide variety of ailments. Yike. The summer semester of my program, which ended just before my last post, was frighteningly bereft of clinical information. I had a class on violence and ways it may come up in clinical practice, which did make some excellent points. I had another class on the logistics of being an NP. It was devoted to admin things like licensing, practice agreements, insurance, etc. Important stuff, but it didn't really feel like it should take priority over, say, more diagnosis and management. Finally, we had a seminar where we presented cases, and that was useful. But we only met for two hours every other week, so...Anyway, suffice it to say I've gone online and bought some review books to supplement my already expensive education.
Now to public health. The President and CEO of the Kaiser Family Foundation, Drew Altman, recently wrote one of his "Pulling It Together" columns about the state of HIV prevention funding in the US. He notes that NYS is the top funder of HIV prevention, spending $88 of the $600 million spent nationally. This is slightly less impressive than it sounds, since NY is home to 17.6% of the people in the US living with HIV, and $88 million is only 14.6% of the overall funding. Still, a good start. However, the column notes these figures are for FY07, and things are likely to have changed since then thanks to the economy's shenanigans. The column also links to one of previous columns about attitudes towards HIV nationally.
Now to public health. The President and CEO of the Kaiser Family Foundation, Drew Altman, recently wrote one of his "Pulling It Together" columns about the state of HIV prevention funding in the US. He notes that NYS is the top funder of HIV prevention, spending $88 of the $600 million spent nationally. This is slightly less impressive than it sounds, since NY is home to 17.6% of the people in the US living with HIV, and $88 million is only 14.6% of the overall funding. Still, a good start. However, the column notes these figures are for FY07, and things are likely to have changed since then thanks to the economy's shenanigans. The column also links to one of previous columns about attitudes towards HIV nationally.
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