Pioneers of Hospice: Changing the Face of Dying

I saw this video recently. Here is the first 18 minutes on Youtube:



The full video runs about 50 minutes. It's very informative, well worth watching the whole thing. I've been looking for a copy, but the DVD seems to be out of print, with no indication of when it might become available again. Does anyone know? https://www.academicvideostore.com/video/pioneers-hospice offers it for $249.00, but that's way beyond my budget.

I'm surprised the video has not been re-released and made more readily available. IMO, Hospice is a much misunderstood concept. This video does a lot to clear up those misconceptions. I hope that whoever owns the copyright will release the video for publication again, or else release it into the public domain, where it could do a lot of good.
     

Death and dying in America

Seeking a ‘Beautiful Death’

[...] Dr. Volandes, a staff physician at Massachusetts General Hospital in Boston, noted that “in the abstract, fighting every second of the way and pursuing aggressive life-prolonging interventions sounds admirable.” But he wants doctors, patients and families to consider the likely outcome of the fight and how much suffering it will involve.

He recognizes that “there are no right and wrong decisions about medical care at the end of life” but insists that all decisions should be fully informed. To ensure that patients and families understand the options, he has developed a video tour of what medical interventions like ventilation, CPR or placement of a feeding tube look like, which often prompts a change of heart. As one patient put it, “It looks so different on television.”

The video, produced by ACP Decisions, a nonprofit group devoted to advanced-care planning, is licensed to health care providers and insurers who can show it to patients and families to facilitate shared decision making in planning for care at the end of life.

In a randomized trial of the video’s effectiveness among 50 patients with advanced brain cancer, a quarter of patients in the control group who had only a verbal discussion about end-of-life care with their doctors chose life-prolonging care, half opted for limited medical care and only one-quarter chose comfort care. But none of those who saw the video opted for life-prolonging care, a handful chose limited medical care, and 92 percent decided on comfort care, Dr. Volandes reported. After watching the video, patients said they had a better understanding of their choices.

However, even just a discussion with their doctors about goals for end-of-life care can often make a huge difference. The one-third of patients in a 2008 national Coping With Cancer study who had such a discussion were less likely to undergo CPR, be put on a ventilator or be placed in an intensive care unit. Most enrolled in hospice, suffered less and were in better physical shape and better able to interact with others and for a longer time.

Their survivors, too, fared better; six months after the deaths, they were markedly less likely to experience major depression.

Options regarding end-of-life care should be discussed well before an emergency — or for those with dementia, during the early stages of mental decline. “The absolute worst time to contemplate decisions about medical care is when one is critically ill and in the hospital,” Dr. Volandes writes.

The kinds of questions doctors should be asking:

[...]

They are some good questions. Read the whole thing for embedded links and more.

     

One Conservative's Understanding of the Real and Genuine Need for Medical Marijuana

My trip to the pot shop

PUEBLO WEST, Colo. — It’s 9 a.m. on a weekday, and I’m at the Marisol Therapeutics pot shop. This is serious business. Security is tight. ID checks are frequent. Merchandise is strictly regulated, labeled, wrapped and controlled. The store is clean, bright and safe. The staffers are courteous and professional. Customers of all ages are here.

There’s a middle-aged woman at the counter nearby who could be your school librarian. On the opposite end of the dispensary, a slender young soldier in a wheelchair with close-cropped hair, dressed in his fatigues, consults with a clerk. There’s a gregarious cowboy and an inquisitive pair of baby boomers looking at edibles. A dude in a hoodie walks in with his backpack.

And then there’s my husband and me. [...]

It's a very compelling story she tells. And as usual, Michelle Malkin has done her homework, like a real journalist should. Read the whole thing for the interesting story and the embedded links.
     

What happens when vaccinations stop?

The green is Whooping Cough, the red is Measls:



The toll of the anti-vaccination movement, in one devastating graphic

[...] A couple of manifestations stand out. One is the prevalence of measles in Europe -- especially Britain -- and the U.S. Measles is endemic in the underdeveloped world because of the unavailability of the MMR (measles, mumps and rubella) vaccine.

But in the developed world it's an artifact of the anti-vaccination movement, which has associated the vaccine with autism. That connection, promoted by the discredited British physician Andrew Wakefield and the starlet Jenny McCarthy, has been thoroughly debunked. But its effects live on, as the map shows.

Vaccine panic also plays a role in the shocking incidence in the U.S. of whooping cough, also beatable by a common vaccine. Researchers have pointed to the effect of "non-medical exemptions" from legally required whooping cough immunizations -- those premised on personal beliefs rather than medical reasons -- as a factor in a 2010 outbreak of whooping cough in California.

These manifestations underscore the folly and irresponsibility of giving credence to anti-vaccination fanatics, as Katie Couric did on her network daytime TV show in December. We examined the ethics of that ratings stunt here and here.

Among other worthwhile examinations of the impact of the anti-vaxxers, see this piece about growing up unvaccinated in Great Britain in the 1970s, and this disturbing piece by Julia Ioffe about her battle with whooping cough, a disease no American should have. [...]

The original article has embedded links.

Measles Outbreak Spreads from Coast to Coast

State health officials in New York recently reported 16 cases of Measles in northern Manhattan and the Bronx, and others say the Measles are becoming a coast-to-coast problem. The New York City outbreak consists of 7 adults and 9 children, and while 2 of the children were too young for the immunization, 2 others were children whose parents refused to get them their shots. Massachusetts, Rhode Island and Pennsylvania have also witnessed a Measles outbreak in recent weeks.

Measles is a contagious illness spread through respiration. Classic symptoms of Measles include fever, cough, runny eyes or nose, and a recognizable rash. Less severe side effects of Measles include diarrhea to more serious and life-altering ones such as pneumonia, brain damage, and corneal ulceration. Risk factors for Measles are malnutrition, immun0deficiency, pregnancy and Vitamin A deficiency. In developed countries such as the U.S., children are immunized against Measles by the age of 18 months. Un-vaccinated individuals are at risk of contracting Measles. [...]

But what about the nine adults? Had they been vaccinated, and got it anyway? I got measles when I was 15, even though I had a vaccination when I was younger. I don't think it always works.
     

Nattokinase: a replacement for Warfrin?

I've been looking at Nattokinase as a supplement for my mother, who is suffering from a calcified heart valve, due to (I believe) her long term use of Warfrin. Warfrin is known to be a vitamin k antagonist. But without vitamin k (vitamin k2 specifically), the body can't regulate calcium properly, and it goes into the arteries instead of into the bones.

Nattokinase is known to prevent and even reverse atherosclerosis. Pure Natto is a source of vitamin k2. But even though the product description says that it contains pure nattokinase enzyme with all vitamin k removed, there are warnings to not take it if you are taking Warfarin (Coumadin), or to consult your doctor first if you are taking Warfarin. And from what I've read on the customer comments on Amazon, it seems that people use it to replace Warfarin:

Great results so far!

My husband has a blood clotting disorder and was placed on Coumadin for life. He wasn't doing well on Coumadin. There was so many nasty side effects so we looked for an alternative to Coumadin. This supplement was recommended to us 10 months ago. He is doing so much better since taking Nattokinase. He is off of Coumadin (without his Dr's blessing), it has brought his cholesterol down, brought his blood pressure down (along with vitamin C), and improved his cataracts. He just had an eye exam and his eye glasses prescription was the same as two and a half years ago. That has NEVER happened. His eyes have always gotten worse for every exam. His Dr wasn't happy with him when he got off of Coumadin, but he is happy with the results and can't believe hubby is off of cholesterol and high blood pressure meds. He has never see that happen in his patients. We are excited to see other benefits pop up in the future.

In the threads attached to that post, people ask for an update, and the author, Jennifer, replies one year later:

Hubby is still doing well on Natto. He also takes Vitamin E, Cod Liver Oil, and Ginko Biloba in order to get the thinnest blood that he can. His blood clotting disorder is serious, though.

Another person, Mary Turner, posts this under Jennifer's original post:

The first time I took Cumadin, my legs felt like they were on fire. I had to go every thursday to the clinic as you have to be monitored when taking cumadin which is really a low dose of rat poison (for real). They can never get it right. It's take one pill, take one and a half, go back to one pill and so on. I told my doctor, "I cannot keep taking this stuff. " He replied, "I don't know what else to tell you to take." I said, "yes you do but your hands are tied by the FDA."

I had already read about Natto and had been reading about natural cures for over 12 years. So I ordered Natto and stopped taking Cumadin. The Natto arrived the same day my brother passed away. I was off work for a week taking care of funeral arrangements but took the Natto everyday. The following Thursday, I went back to the clinic to give them a blood sample and went to work. They called my job to give me the results as usual.

The nurse was so excited and said to me, "your blood plattelets are perfect; how much Cumadin shall I tell the doctor you took?" I said, "tell the doctor I did not take any of that rat poison." She even got more excited and wanted me to tell her what I took to get these results. She looked it up on line as I spelled it out for her and gave me a big thank you as she wanted it for herself.

Now I had not spoke to anyone about what I had taken but they thought it was Cumidin that did the trick. So what does that tell you. [...]

Jennifer also said in the thread that her husband didn't just stop taking Warfarin/Coumadin, that there was an overlap for about a month, where he took both but transitioned to just Nattokinase.

Many other reviewers reported that it lowered their blood pressure, and improved their overall blood circulation. A handful of people said it did nothing for them (I've found that is usually the case with supplement reviews; there are always some who say that). It does seem that it's used in place of Warfarin/Coumadin, rather than with it.

My sister says that my mother's doctor says, he would not object to any supplements as long as they don't interfere with what he has prescribed for her. It seems to me that the Nattokinase would interfere with the Warfarin.

I thought that I might try her on Vitamin K2 (Jarrow Formulas MK-7), because I read that vitamin k1 interferes with Warfarin's blood thinning, but vitamin K2 does not. Yet the K2 supplements also warn against taking them with Warfarin, or at least with consulting a doctor first before taking them.

So, is the only answer to stop taking Warfarin/Coumadin? That would be a tough sell for my mom. She's afraid to go against what the doctors tell her.


Here are a list of links about vitamin K2, and how it's been used to reverse calcification in arteries and heart valves. There have been studies that show reversal of arterial calcification in rats:

http://www.knowguff.com/2012/05/vitamin-k2-as-mk-7-restores-elasticity.html

http://www.natmedtalk.com/f25/1614-vitamin-k2-shown-reverse-arterial-calcifications.html

http://wholehealthsource.blogspot.com/2008/11/can-vitamin-k2-reverse-arterial.html

http://www.lef.org/magazine/mag2009/jan2009_Vitamin-K-Protection-Against-Arterial-Calcification-Bone-Loss-Cancer-Aging_01.htm


I've looked for information about reversing calcification of heart valves in humans. I could not find a lot of information, and what I did find was anecdotal:



http://www.vitamincfoundation.org/forum/viewtopic.php?f=11&t=7533

http://www.vitamincfoundation.org/forum/viewtopic.php?f=11&t=6207

But even mainstream medicine doesn't rule it out completely, they just say there are insufficient studies to prove it yet:

http://www.ncbi.nlm.nih.gov/pubmed/18196985?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=6

There seems to be no end to articles on the subject:

http://www.lewrockwell.com/sardi/sardi82.html

http://www.lewrockwell.com/sardi/sardi85.html

http://blogs.webmd.com/integrative-medicine-wellness/2007/11/vitamin-k-keeping-calcium-in-your-bones-and-out-of-your-blood-vessels.html

http://www.smart-publications.com/articles/vitamin-k-keeps-calcium-out-of-your-arteries-and-in-your-bones

http://www.preparemd.com/supplements-vitamins-categories-information/vitamin-k2-mk7-reduced-heart-attack/

There was even a book published in 2011, called "Vitamin K2 and the Calcium Paradox: How a Little-Known Vitamin Could Save Your Life":

http://www.amazon.com/Vitamin-K2-Calcium-Paradox-Little-Known/dp/1118065727/ref=sr_1_1?s=books&ie=UTF8&qid=1373147390&sr=1-1&keywords=vitamin+k2+and+the+calcium+paradox

But it's gone out of print, despite getting high ratings from readers. Only the Kindle edition is still available at a reasonable price. Used copies are very expensive. I hope they print more copies soon.


Update 07-12-13:

Our local health food store gave me a report about Nattokinase. It's quite informative, and I found it online in PDF format:

http://www.enzymedica.com/images/enzy/articles_handouts/pdf/CardiovascularHealthandNattokinase_H30.pdf
   

My Brilliant Career, Part III: Medical Coding

Medical Records and Health Information Technicians

It's not exactly exciting; it sounds like the medical equivalent of tax preparation. It's mostly sitting in front of a computer all day. But the stats at the site above (Occupational Outlook Handbook, by the Bureau of Labor Statistics) gives it a job increase outlook of 21%, up till 2020. And another reason to consider training for it now is this:

ICD-10 Medical Coding

[...] ICD-10 is an upgraded diagnostic and procedural medical coding system that, by law, must be implemented throughout the healthcare industry by October 1, 2014. This new coding system is radically different from the version currently in use, so it’s important to start preparing for and implementing the massive changes to the existing coding system.

This online program offers you comprehensive, robust training in diagnostic and procedural coding, using the ICD-10-CM (diagnostic) and ICD-10-PCS (procedural) coding manuals. This training includes detailed instructions for using the coding manuals, understanding the coding guidelines, and accurately applying the ICD-10 coding steps. There are more than 40 quizzes and exams for diagnoses and procedures by body system to test your knowledge and understanding.

In addition, you will find information on the impact of the coding changes on medical coders, healthcare staff, physicians, software systems, documentation, and information technology. [...]

Most of the current coders are trained on ICD-9. So people who train for ICD-10 now, will be poised to "catch the wave".

But... it could still be too boring, sitting at a computer all day. In comparison, I think Pharmacy Technician actually looks better.

The Occupational Outlook Handbook had a lot of interesting information on Health Care jobs. Take this one for instance:


Home Health and Personal Care Aides

What Home Health and Personal Care Aides Do
Home health and personal care aides help people who are disabled, chronically ill, or cognitively impaired. They also help older adults who may need assistance. They help with activities such as bathing and dressing, and they provide services such as light housekeeping. In some states, home health aides may be able to give a client medication or check the client’s vital signs under the direction of a nurse or other healthcare practitioner.

Duties

Home health and personal care aides typically do the following:

• Help clients in their daily personal tasks, such as bathing or dressing
• Do light housekeeping, such as laundry, washing dishes, and vacuuming in a client’s home
• Organize a client’s schedule and plan appointments
• Arrange transportation to doctors’ offices or for other kinds of outings
• Shop for groceries and prepare meals
• Provide companionship

Aides often keep track of when a client’s prescriptions need to be filled or when the client has his or her next doctor’s appointment. Aides may prepare leisure activities, including exercise, to keep their clients active and healthy. They may go for walks with their clients or play games with them. In some states, home health aides may be able to provide some medical services. Aides may be expected to complete unpleasant tasks such as emptying a client’s bedpan or changing soiled bed linens.

Some aides are hired directly by the client or the client's family. In these situations, the client or the client's family supervises the aide and gives the aide tasks to do.

Home health aides, unlike personal care aides, typically work for certified home health or hospice agencies that receive government funding and therefore must comply with regulations. They work under the direct supervision of a medical professional, usually a nurse. These aides keep records of services performed and of the client's condition and progress. They report changes in the client's condition to the supervisor or case manager. Aides also work with therapists and other medical staff.

Home health aides may provide some basic health-related services, such as checking clients' pulse, temperature, and respiration rate. They also may help with simple prescribed exercises and with giving medications. Occasionally, they change simple dressings, give massages, care for skin, or help with braces and artificial limbs. With special training, experienced home health aides also may help with medical equipment such as ventilators, which help clients breathe.

Personal care aides—also called homemakers, caregivers, companions, and personal attendants—provide clients with companionship and help with daily tasks in a client’s home. They are often hired in addition to other medical health workers, such as hospice workers, who may visit a client’s home. Personal care aides do not provide any type of medical service.

Direct support professionals work with people who have developmental or intellectual disabilities. They may help create a behavior plan, provide employment support, and teach self-care skills, such as doing laundry or cooking meals. They may also provide other personal assistance services.

[...]

Job Outlook
Employment of home health aides is expected to grow by 69 percent from 2010 to 2020, much faster than the average for all occupations. Employment of personal care aides is expected to grow by 70 percent from 2010 to 2020, much faster than the average for all occupations.

As the baby-boom population ages and the elderly population grows, the demand for home health and personal care aides to provide assistance and companionship will continue to increase. Older clients often have health problems and need some help with daily activities.

Elderly and disabled clients increasingly rely on home care as a less expensive alternative to nursing homes or hospitals. Clients who need help with everyday tasks and household chores, rather than medical care, can reduce their medical expenses by returning to their homes.

Another reason for home care is that most clients prefer to be cared for in their homes, where they are most comfortable. Studies have found that home treatment is often more effective than care in a nursing home or hospital.

Job Prospects
Job prospects for both home health aides and personal care aides are excellent. These occupations are large and expected to grow very quickly, thus adding many jobs. In addition, the low pay and high emotional demands cause many workers to leave these occupations, and they will have to be replaced.

The Occupational Outlook Handbook has a lot of data on many different  Healthcare Occupations, so you can compare them. I've compared some that I was interested in:

Occupation:        Outlook (thru  2020):          Median Pay:

CNA                    20%                                     $24,010.
LVN                     22%                                    $40,380.
RN                       26%                                    $64,690.
Phrm Tchn           32%                                    $28,400.
Med. Coding        21%                                    $32,350.
Hme Hlth Aide      70%                                    $20,560.

Many of the higher paying jobs require two or more years of college. Pharmacy Technician still looks the best to me, considering the education requirements, job outlook, and pay rate. I didn't include the education requirements in my list here, but you can find them on the Handbook site, and much more too. It's a great resource.
 

The changing face of healthcare

I recently came across this article, which is aimed at American physicians:

Getting ready for emerging care models

Like it or not change is coming to healthcare. The government, employer groups and other purchasers of healthcare are demanding higher quality and lower costs in the delivery of healthcare. The Affordable Care Act of 2010 started this evolution and whatever you call it -- value-based purchasing, accountable care, patient-centered healthcare, etc. -- it is taking root and starting to grow rapidly.

[...]

To get an idea of what you should be thinking about, let’s look to a healthcare market where these “new” healthcare delivery models are the norm and have been in place for years. One such market is in the Netherlands, where 90 percent of demand for care is generated in the primary care setting and providers (private) are paid a lump sum based on conditions and work in integrated care networks.

In the Netherlands today, 99 percent of physicians use a computer, 97 percent are Internet-enabled, 90 percent store all types of health records electronically, 84 percent receive lab results electronically, and 26 percent exchange data electronically with other providers – all benchmarks that the United States aims to achieve in the next 3-5 years. The international standards used in the Netherlands are consistent with U.S. conventions, as HL7 and ICD-9 are used in healthcare and ICD-10 is being adopted. Also, as in the United States, Holland does not have a dedicated health ID number or “smart card” for patients that some European countries have adopted but which are not relevant in this country. In these respects, the Dutch market is extremely similar to the U.S. market. This market is where our own company history started, and where our care collaboration and disease management solutions have matured.

Here is what you need and why
To participate in a value-based delivery model you must be willing and able to coordinate and collaborate on patient care with other ambulatory providers; the goal is to render the right amount of preventive care, avoiding health complications and resulting in better patient care with lower attendant costs. Once this mind shift has taken root -- a very different and, for some, a difficult way of thinking -- you need the basic tools and capabilities to engage in care coordination. These tools must:

Enable you to store patient information electronically. This does not have to be the typical full-blown EMR that legacy vendors have been marketing. These EMRs were developed in the fee-for-service model to optimize billing and reimbursement and resemble digital renditions of paper records. Not to mention they are expensive to acquire and maintain even when they may be subsidized by the ACO. Instead, you need a platform that is designed for the new delivery model focused on optimizing patient care, with a workflow that fits your practice pattern. For more on this see the 2010 PCAST Report titled "Realizing The Full Potential of Healthcare Information Technology to Improve Healthcare."

Enable patient-centric care, including making sure that patients receive reminders for preventive services through multiple channels based on their personal profile.

Support the care team network, allowing all providers, physicians, facilities, etc., involved in treating particular patients to share relevant information through collaborative and coordinated care.

Manage patients proactively.

Be able to generate electronic referrals.

Be a cloud-based solution. Cloud-based solutions require little or no local IT support and investment. This is really important for the average physician practice. Also the pricing level and payment structure with predictable cash flow more closely matches the size of the practice.

To distill down these capabilities into specific tool sets means you should expect to have the following: an EHR; a care collaboration/coordination solution; and the ability to exchange electronic referrals. The key in selecting the right solutions for your practice is to pick one with the right workflow for your practice. The solution(s) must be cloud-based so you can avoid the costly hassle of purchasing and supporting local software installations, which is expensive and not your core competency. If you do not have these capabilities you either might not be a candidate to participate in an ACO, clinically integrated care delivery network or PCMH, or the ACO will force you to use their solutions.

You should expect the ACO to provide other required solution capabilities such as clinical decision support (CDS), analytics, population health tools, health information exchange platform (HIE); reporting tools, etc. These are expensive solutions tailored for a large organization to manage and support. [...]

It goes on to describe the current inefficient, entrenched ways of doing things, and how they are going to be forced to rapidly change, as has happened in many other industries (It has an embedded link to an article in Forbes).


Also see:

Have Smart Phones to do Medical Work
     

A new kind of sleeping pill: "Dora-22"

A Sleeping Pill Without The Sleepy Head?

[...] DORA-22 is part of a class of new drugs — one of which the Food and Drug Administration is already considering for approval — known as orexin antagonists.

“It’s high quality research,” says Jerome Siegel, professor of psychiatry at University of California Los Angeles, who was not associated with the study.

The authors compared the sleep-inducing effects of DORA-22 to those of three well-known sleeping pills: diazepam (Valium), zolpidem (Ambien) and eszopiclone (Lunesta), which work by slowing down brain activity. Immediately after giving the animals the drugs, the scientists tested the animals’ memory and reaction time. (While most people take sleeping pills before going to bed, such effects are important to document so researchers, and users, can fully understand how their brains and bodies are affected by the medications in case people don’t take the drugs as prescribed.)

“It’s very enticing because there are some clear results that show [that these drugs] differ from old hypnotic drugs in terms of affecting cognition and memory in two animal species,” says Dr. Emmanuel Mignot, director of the Stanford Center for Sleep Sciences, who wrote a commentary on the research, which was published in Science.

Rats given high enough doses to cause sleep of the three currently available drugs had difficulty recognizing whether they had seen an object previously presented to them, while those dosed with DORA-22 did not show such compromised recall. Similarly, all of the drugs except DORA-22 reduced rhesus monkeys’ ability to react to a touch screen and correctly choose a colored square associated with a reward. In fact, even at doses 30 times higher than the lowest amount needed to affect sleep, the drug did not impair performance on this task.

What makes this new class of drugs different? Orexins, which are also known as hypocretins, are brain chemicals that promote wakefulness. Of the brain’s billions of neurons, only tens of thousands produce orexins. People with narcolepsy who have difficulty staying awake and are prone to suddenly falling asleep without warning are missing almost all of the neurons that produce these chemicals. DORA-22 and similar drugs work by blocking orexins by essentially producing a brief and reversible bout of narcolepsy. [...]

It's an interesting concept. But how many years till we find out the long term side effects?
     

Real Pharmaceutical Marijuana?

Is it comming? Maybe:

Pot in a pill: All the pain relief without the smoke

[...] Let me introduce you to dronabinol. It turns out that the miracle that is modern psychopharmacology has now shown it IS possible to render pot's analgesic effects into capsule form. And according to a new study, it works just as well as smoked marijuana at tamping down pain. But the capsule's effects last longer, and they come with fewer of the "abuse-related subjected effects" (i.e., feeling high) than does smoked marijuana.

Face it, potheads: You knew it was just a matter of time before "the man" got a hold of weed and snagged all the profits. But who knew he'd suck the fun out of it too?

For the record, dronabinol did induce some of smoked marijuana's other side effects, some of which have medicinal value to certain populations: It did increase appetite, decrease nausea and improve sleep.

The new research appeared Monday in the Nature journal Neuropsychopharmacology. It was authored by a group from Columbia University's College of Physicians and Surgeons. [...]

The full article goes on with details about how it was tested, which I also found interesting.

     

My Brilliant Career, part II

Previously, I explored Tax Preparer as an additional source of income. This time, I'm going to look at Pharmacy Technician.

It's a better option than Chickenblogging, and it seems that for the foreseeable future, healthcare is where the most jobs are.

I've been taking some accounting courses from Ed2go.com, and I was perusing some of the other non-college credit courses, and this looked interesting:

Explore a Career as a Pharmacy Technician

Health care is a booming field these days, and pharmacy technicians are in high demand. In this course, you’ll take a look at the many job settings and career paths open to you if you become a pharmacy technician. In addition, you’ll master the skills you need to get an entry-level position as a pharmacy tech or clerk.

You’ll start by learning basic terms for medical conditions and anatomy, gaining the skills you’ll need to read prescriptions and patient records easily. In addition, you’ll find out how common classes of drugs are made and how they work.

Next, you’ll master the simple math that every pharmacy tech needs to know. You’ll learn how to calculate dosages accurately, practice using simple formulas and math tools, and find out how to translate metric measurements into familiar household measures like teaspoons and tablespoons. Turning to the business side, you’ll look at sales and find out how prescription pricing works.

In addition, you’ll learn about the important laws and regulations that govern pharmacies. You’ll also hone your communication skills, learning how to handle customers courteously and efficiently. And finally, you’ll explore the steps you can take to enhance your career prospects becoming a Certified Pharmacy Technician (CPhT). By the time you’re done, you’ll be prepared to start your career in this popular and rapidly-growing field.

Note: This course is designed to give you an introduction to the profession of pharmacy technician. It will not supply enough information to sit for the national exam. If your goal is to become a Certified Pharmacy Technician (CPhT), then upon completion of this introductory course, enrollment into the advanced course is recommended. The advanced course is located in the online Career Training section of the ed2go catalog: http://www.gatlineducation.com/pharmacytechnician.html.

The Advanced Course is 330 hours, and prepares you to take the State Exam. Both courses are on-line (which allows great flexibility), and offer demos so you can see how they work. The introductory course offer's an entire lesson and quiz free. I think I may take the introductory course, just to see if I have what it takes, and if I can see myself doing it. No point in taking an advanced course till I know that.
   

Death by Alzheimer's is increasing

U.S. deaths from Alzheimer's growing, data shows
(Reuters) - Deaths and the risk of dying from Alzheimer's disease have risen significantly in the United States during the last decade, according to two reports released on Tuesday.

[...] Data from the U.S. Centers for Disease Control and Prevention showed the risk of death from the degenerative brain disease rose 39 percent between 2000 and 2010 even as mortality rates for other conditions such as cancer, heart disease and stroke fell significantly.

Separate findings from the Alzheimer's Association based on CDC data, but looking at actual deaths, found mortality up 68 percent over the same decade.

While the risk of death depends on a patient's age, gender, race and even where they live, it is clear that it has been increasing steadily for a long period of time, the CDC said in its report.

Those 85 and older are far more at risk of dying from Alzheimer's than those age 65 to 84, CDC said. Whites and women are also at higher risk, it added. [...]

     

Rawanda Healthcare: Lessons for us all?

Rwanda's Historic Health Recovery: What the U.S. Might Learn

[...] Over the last ten years, Rwanda's health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 percent over the last decade and the maternal mortality ratio dropped by 60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda's economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.

The rest of the world, wealthy countries and well as poor, can learn from Rwanda's rapid rise.

[...]

Rwanda achieves exceptional results not from how much money they spend on health, but from how they spend it. A recent article in BMJ, led by Farmer, examined World Health Organization data and sought to identify why Rwanda developed so rapidly, and to clarify the lessons for other countries. Rather than a single cause, the authors identified a series of interconnected factors that contributed to the country's turnaround.

First and foremost, credit belongs to the government of Rwanda's centralized planning. In 2000, the Rwandan government created a plan, called Vision 2020, to develop economically into a middle-income country over the next two decades. Dr. Agnes Binagwaho, Rwanda's Minister of Health, explained that "health is a key pillar of our development" and that without improving health, they will never alleviate the country's poverty.

[...]

While the specific context of Rwanda cannot be replicated, Dr. Farmer contends that Rwanda's focus on evidence-based policy, central planning, health systems, and equitable access to care should be heeded both by countries looking rebuild their health system and those with strong systems already in place. "In our commitment to understanding complexity," said Farmer, "we need to not forget that there are generalizable lessons to delivering care that are not acceptable to ignore."

While the United States still exceeds Rwanda in most traditional health metrics (such as life expectancy), and its hospitals and medical care surpass those in Rwanda, U.S. health outcomes still falter because too many patients fall through the cracks. The U.S. health system relies too heavily on doctors and hospitals to provide care. A growing body of research suggests that more frequent health care use and higher costs may lead to poorer health.

Farmer believes that, if the United States extended health care into the community like Rwanda, care for chronic diseases would markedly improve while costs would over time drop. Indeed, community-based pilots in the United States have proven effective in settings from inner-city Boston to rural Mississippi. [...]

There is much more in the full article. Lots of food for thought.
     

Five Tips for Saving Money on Drugs

Dos and Don'ts for Saving Money on Rx Drugs

If you think you’re spending a lot of money on prescription drugs, you’re probably right. In 2008, American patients and insurance companies spent more than $234 billion on prescriptions, up from $40 million in 1990. In 2020, annual spending on prescription drugs is expected to top $512 billion.

With all signs pointing to more spending increases, this article covers the dos and don’ts of how to save on prescription drugs. [...]

Follow the link for the tips.
     

"Watson" the game-playing talking super computer is getting a job at your doctors office

But he won't replace your doctor. At least not right away:

IBM's 'Jeopardy' computer lands health care job

NEW YORK (CNNMoney) -- IBM's Watson computer thrilled "Jeopardy" audiences in February by vanquishing two human champs in a three-day match. It's an impressive resume, and now Watson has landed a plum job.

IBM is partnering with WellPoint, a large health insurance plan provider with around 34 million subscribers, to bring Watson technology to the health care sector, the companies said Monday.

[...]

The goal is for Watson to help medical professionals diagnose and sort out treatment options for complicated health issues. Think of the system as an electronic Dr. House.

"Imagine having the ability to take in all the information around a patient's medical care -- symptoms, findings, patient interviews and diagnostic studies," Dr. Sam Nussbaum, WellPoint's (WLP, Fortune 500) chief medical officer, said in a prepared statement.

"Then, imagine using Watson analytic capabilities to consider all of the prior cases, the state-of-the-art clinical knowledge in the medical literature and clinical best practices to help a physician advance a diagnosis and guide a course of treatment," he added.

WellPoint plans to begin deploying Watson technology in small clinical pilot tests in early 2012.

[...]

IBM said early on that health care is a field where it anticipated commercialization opportunities for Watson. Other markets IBM is eying include online self-service help desks, tourist information centers and customer hotlines. [...]

So it's going to be used as a tool, like an interactive voice-activated database. The clinical pilot tests should be interesting. If it doesn't work out, perhaps Watson can get a job as a Radio DJ. "Denise" had better watch out!

I've posted about Watson previously:

      "Watson" won. But did it really?
     

Vitamin B12, and Alzheimers Disease

Apparently, a deficiency of the former is often mistaken for the later:

When Is Alzheimer's Disease Not Alzheimer's? When It's Vitamin B12 Deficiency!

[...] Vitamin B12 deficiency becomes more and more common as people get older. With some researchers estimating that over 800,000 elderly in the US have undiagnosed deficiency, this is NOT a small problem. Even worse is that few clinicians know about vitamin B12 deficiency or are trained to look for its symptoms. Many elderly who should be screened for this simple vitamin deficiency are, instead, diagnosed with ‘incurable’ diseases that rob them of any possible quality of life. That Mental Changes from B12 Deficiency can look EXACTLY like dementia was noted in 1902! Since then, this topic has been studied many times, and it has even been shown that CAT Scans and MRI’s that show lesions and degeneration of the brain and spinal cord are often REVERSIBLE when these lesions are caused by vitamin B12 deficiency! Yet, using these modern techniques, the presence of brain and spinal cord abnormalities is almost always used as evidence for patients and families of the Irreversible nature of their disease- when that is not necessarily the truth at all! [...]

Read the whole thing. Makes you wonder how many times Alzheimer's is a misdiagnosis.
     

A Double Arm Transplant? Yikes, it's true!

Sometimes truth is stranger than fiction:

World's First Double-Arm Transplant Recipient Calls 'Being Whole Again' Indescribable

MUNICH, Germany — A German farmer who received the world's first complete double arm transplant is recovering well and able to perform some basic tasks, though doctors said Wednesday it still could take up to two years before he relearns how to use his hands.

Doctors spent 15 hours on July 25-26 grafting the donor arms onto the body of 54-year-old Karl Merk, who lost his own just below the shoulder in a farm accident involving a combine six years ago.

"These are my arms, and I'm not giving them away again," Merk said at a news conference at the Munich University Clinic where the operation was done. [...]

He is already able to use them for simple tasks, like opening doors and operating light switches. Read the whole thing for more details.

I'm not against it, but it is weird. There is just something kinda... "Frankensteiny" about the whole thing. WHOSE arms are they, or should I say, WERE they? What would it be like to have hands that weren't the ones you were born with, but were actually someone elses? Someone elses fingerprints... wow. Our modern world.




Imagine if you knew the donor, and then you shake hands with this guy? Imagine... well maybe not, I think I've had enough of this for a while. Yikes indeed!
     

iGoogle and it's WikiHow offerings

For quite some time now, the home page of my Firefox web browser has been iGoogle, which is a customizable start page, which gives you many options to add content you enjoy or find useful. I've configured mine thus:


One of my favorite features of this has been the links under "How to of the Day", which links to randomly selected How-To articles from wikiHow. I often see something interesting or useful, where I think "I've always wanted to know how to do that" or "I wonder if it has some tips on how to do it better?" I have often found entertaining and useful information there. Here is a sample, of today's links:

How to Power Nap
Have you ever noticed that a short nap can be refreshing, while a longer nap can leave you feeling even more tired? There is a reason for that:

[...] What you're doing during a power nap is capturing the benefits of the first two of the five stages in the sleep cycle. These first two stages take place in the first twenty minutes. In addition to making you feel more rested and alert, the electrical signals in your nervous system strengthen the connection between neurons involved in muscle memory, making your brain work faster and more accurately.

[...]

Sleeping for any longer than 20 minutes will be counterproductive. A half hour can lead to sleep inertia, making you feel sluggish and more tired than ever. [...]

The wikiHow instructions also offer tips for the topic, and often have footnotes at the end to follow up on if you want more information.

The other tip for today was about a difficult task cat owners sometimes have to face:

How to Give a Cat Medicine


"Expect a struggle"

While anyone who has ever tried to do this with a cat knows it won't be easy, there are ways to make it easier, and the wikiHow gives you relevant tips. It also helps by telling you what NOT to do as well:

[...] DO NOT squirt liquid medication into the cat's throat or tongue. Liquids are likely to go down a cat's windpipe, making the cat choke. For liquid medications, insert the dropper between the cat's cheek and teeth. [...]

Just getting through the experience without getting scratched or bit is worth taking the time to read the wiki. If you can get the medicine down successfully as well, so much the better.

These two examples from wikiHow may not seem terribly exciting, but keep in mind that the subjects chosen are random, so over time you end up with quite a selection of topics. Even topics that may seem stupid or irrelevant to you can be amusing to read. Sometimes you discover that a topic you thought was simple actually is a lot more complex than you thought, because of factors you had not considered or didn't know about.

All in all, it's been educational and fun. I'm definitely a wikiHow fan now.