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Douwe Rienstra, MD Educational Activities2006 | 2005 | 2004 | 2003 | 2002 | 2000 - 2001 | 1988 - 1999 Most recent courses are listed first. 2008 March 21, 2008 Donald E. Low, MD, a surgeon at Virginia Mason Medical Center reviewed treatment of hepatitis B. March 7, 2008 Kimberly McLaren, MD of Virginia Mason Medical Center reviewed reviewed the boundaries physicians must put on relationships with patients. February 29, 2008 Andrew Ross, MD, a gastroenterologist at Virginia Mason Medical Center diagnosis of people with bleeding into the GI tract. In about 90% of people, looking into the stomach and colon with a scope will discover the cause. Dr Ross discussed the problem of diagnosis in that last 10%. Often the bleeding comes from the small intestine in these cases. There are now new methods of examining the small intestine using a swallowed capsule. Also, new endoscopes can get down into the small intestine, and allow identification and treatment. February 22, 2008 Shelly T. Karuna, MD, a research consultant at Virginia Mason, discussed Shared Decision Making: At the Confluence of Physician and Patient Expertise. Some of the patient decision aids they referenced are at www. decisionaid.ohri.ca February 15, 2008 Roger W. Bush, MD, of the Virginia Mason Medical Center discussed Quality and Change Management, Educational Theory and Social Learning. February 8, 2008 Michael J. Longo, MD, Deputy Section Head of Cardiology at Virginia Mason Medical Center discussed surgical complications. Such complications are much more common in people who already have serious medical problems, including history of stroke or heart attack, current heart disease, renal insufficiency, congestive heart failure, or diabetes. Additionally, if a patient cannot walk four blocks or climb two blocks of stairs, they are at much higher risk of cardiac complications during major surgery. Such patients can be protected by giving them a cardiac stress test prior to surgery, so that the surgical team can know how their heart will respond during surgery. Depending on the results of such studies, major reductions in surgical deaths occur with beta-blocking drugs. The same drugs may affect the heart adversely, so need to be used correctly and only in people who will benefit. February 1, 2008 - Joel Sheinfeld, MD from Sloan-Kettering Cancer Center in New York reviewed controversies in the management of Low-Stage Nonseminomatous Germ Cell Tumors. January 25, 2008 Drs Hugh W. Allen and Peter J. Manos of the Virginia Mason Medical Center discussed pain management and opiate treatment thereof. January 18, 2007 - Carrie Horwitch, MD, in internal medicine at the Virginia Mason Medical Center discussed the role of laughter in good health. January 11, 2008 Neil B. Hampson, MD, Medical Director of the Center for Hyperbaric Medicine at the Virginia Mason Medical Center reviewed the causes of carbon monoxide poisoning. Many people are not aware that carbon monoxide is a colorless, odorless, product of combustion. Dr Hampson has worked with governmental agencies to improve warning labels on charcoal briquets and portable generators, which resulted in dimishished death rates from those causes. Carbon monoxide poisoning results in headache, nausea, and eventually death. Dr Hampson estimates about half of people with carbon monoxide poisoning are identified by health care workers. 2007 December 14, 2007 Kris V. Kowdley MD, the Director of the Center for Liver Disease at the Virginia Mason Medical Center pointed out that 15 to 20% of the US population have some degree of fatty liver. Fatty liver is one more complication of the modern sedentary overfed lifestyle and resulting gain in weight. Fatty liver constitutes part of the metabolic syndrome, thet common constellation of excess abdominal weight, high blood pressure, slightly or greatly increased blood sugar, high cholesterol and triglycerides. Dr Kowdley calls this condition non-alcoholic fatty liver disease, or NAFLD, which he pronounces "naffle-dee." People with NAFLD can go to to develop cirrhosis, and about 3 percent progress to liver cancer. Considering everyone with abnormal liver function tests, about 30% have NAFLD, and another 30% have the second stage of NAFLD, which is a form of hepatitis called non-alcoholic steatohepatitis. . Reducing weight and intake of high-fructose soft drinks can improve liver health, as can appropriate treatment of diabetes, and orlistat or bariatric surgury to reduce fat intake. Although statins can increase liver function tests, people with NAFLD may experience a reduction in such tests. December 12, 2007 - Alan Greenwald, MD, orthopedic surgeon at Jefferson Healthcare Hospital, reviewed treatment of osteoarthritis of the knee. December 7, 2007 Michelle Z. Gurvitz, MD and Karen K. Stout, MD, are cardiologists who work at Children's Hospital in Seattle. They discussed the care of people with congenital heart disease, not so much the technical but the social and institutional aspects of such care. When people have serious medical issues, medical care becomes a team endeavor. November 30, 2007 - Residents at the Virginia-Mason Medical Center gave presentations on 1) syphilis 2) loss of consciousness associated with anti-thyroid antibodies 3) fatal stroke secondary to acetretin ( a synthetic cousin of vitamin A) given to a 42 year old man for psoriasis. November 16, 2007 Constance D. Lehman, MD, PhD, Director of Radiology at the Seattle Cancer Care Alliance in Seattle outlined the current value of MRI in the field of breast cancer. Standard mammography is still the best screening method for women at an average risk of breasts cancer. Women who have a strong family history, chest irradiation, or a genetic tendancy to breast cancer benefit from MRI in addition to mammography. Women who are known to have breast cancer benefit from MRI for cancer staging, identification of silent tumors in the opposite breast, and more accurate surgery planning. November 9, 2007 - Seth Schwartz, MD, an otolarygologic surgeon at Virginia-Mason Clinic gave a cost-analysis of treating hearing loss using cochlear implants. People with profound hearing loss can often regain some ability to hear through surgical implantation of a device into the nerve of hearing. October 19, 2007 - Rebecca Ringer, a Seattle attorney, reviewed Washington law regarding medical record keeping. October 5, 2007 Mary C. Pinder-Schenck, MD, of the Section of Hematology and Oncology at the Virginia Mason Medical Center detailed how breast cancer incidence dropped by about 5% in 2002 or so, probably because women decreased their use of estrogen replacement therapy. Catherine J. Potts, MD, an internist at the Virginia Mason Bellevue reviewed methods used at Virginial Mason to be sure women are regularly screened for breast cancer. September 21, 2007 Speaking at the Virginia-Mason Clinic Robert J. Keenan, MD of Drexel University College of Medicine in Pittsburgh, Pennsylvania reviewed current advances in treatment of lung cancer. Using a great deal of new technology, results are still poor, people surviving about an extra 18 months with the most intelligently applied chemotherapy. September 28, 2007 Richard L. Rapport, MD, neurosurgeon at Group Health Cooperative in Seattle spoke at the Virginia-Mason Clinic about the biological basis of memory. In brief, we remember things by creating new nerve terminals to increase the number of active synaptic connections between two neurons. As we grow older, this ability decreases, but the old connections remain. This is why a demented person may remember very well what happened decades ago, but nothing about yesterday. June 15, 2007 - Thomas Gallagher, MD, Associate Professor of Medicine
at the University of Washington spoke on "Disclosing Harmful Errors
to Patients: Recent Developments and Future Directions." May 18, 2007 - Kenneth Gross, MD, Head of Endocrinology and Diabetes at Virginia Mason Medical Center reviewed new concepts in the treatment of diabetes. He reviewed a number of studies on diabetes medications new and old. Much research is sponsored by pharmaceutical firms, and the results massaged to generate the image they wish to promote. Dr Gross made the unforgettable observation that "If you torture the data enough, it will tell you anything you want." And you, dear websurfer, would be amazed at the amount of time required to tease fact from fallacy in the field of medicine. May 4, 2007 - Richard Thirlby, MD, surgery, and Cynthia Kirtland, M.Div, Chaplain, both of Virginia Mason Medical Center, spoke on spirituality and medicine. These speakers did not impose their religious beliefs on the audience, and gave the impression they would not impose them upon their patients. Events in the news and a few articles in the medical journals lead me to add that if any physician or healthcare worker does suggest to you that they might have something to teach you about religion, that you run away as fast as you can. Our job is service, respect for our patients' beliefs, and attention to our responsibilities. It is not to pass judgement upon you for yours. Who is going to see to your medical needs if your healthcare workers decide to take on the role of pastor or religious advisor? May 3, 2007 - Mary Disis, MD, a cancer researcher and physician at the University of Washington discussed immune system aspects of breast cancer. She and others are working on vaccines effective against breast cancer. April 27, 2007 - Christopher
Fellows, MD and Mark Hill, MD, both of the Heart Institute at Virginia
Mason Medical Center reviewed the treatment of atrial fibrillation. As
our population ages, this loss of rhythmicity of the heart's priming chambers
becomes more common. Atrial fibrillation reduces a person's execise capacity
and increases their risk of stroke. They discussed surgical treatment
only, although attention to magnesium and potassium status, as well as
thyroid disorders can be helpful as those sometimes play a role. In addition,
people who consume more fish oil have less atrial fibrillation. April 20, 2007 - Jakdej Nikomborirak, MD, sleep specialist, outlined some common-sense commandments of good sleep. April 20, 2007 - Linda Mihalov, MD, Section Head of Gynecology and Gynecologic Oncology at the Virginia Mason Medical Center discussed sexual health after menopause. She notes that glycerin-based vaginal lubricants can promote yeast growth, and that silicone based products like Pjur or Liquid Silk are least likely to cause adverse effects. Oral estrogen raises levels of sex-hormone binding globulin, which lowers testosterone levels. Transdermal estrogen is preferable in this regard. April 13, 2007 - Michael Westley, MD, the Medical Director of Critical Care and Respiratory Therapy at the Virginia Mason Medical Center reviewed hand-washing and other infection-control procedures. March 23, 2007 David Yu, MD, Department of Physical Medicine & Rehabilitation at Virginia Mason Medical Center discussed rehabilitation from stroke. He pointed out that contrary to our previous ideas, that the brain has the capacity to regenerate some of its function after damage. Modern stroke rehabilitation produces the best results when patients are prevented, for much of the time, from using their healthy limbs and forced to use their weakened limbs. March 9, 2007 - Christopher L. Fellows, MD, Head of the Cardiology department at Virginia Mason Medical Center reviewed Sudden Death in Young Athletes. Every year in the US, about 500 to 1000 young adults die during physical activity. Most always they have asymptomatic heart disease. They may have been born with heart muscle diesase or atypical coronary arteries. The other common cause is viral infection of the heart muscle. Most often these cause no symptoms. Considering there are perhaps 10 million young people participating in vigorous exercise, these conditions are rare. The question is, should we be screening our young athletes differently? A program in Reno, Nevada, ran about 6000 kids through a cardiology work-up and discovered about 10% with various heart abnormalities. After further testing, the cardiologists released all but 22 for athletics. One of those released later died during an athletic event. Much of the difficulty arises because strenous activity causes changes in the EKG and echocardiogram that are difficult to differentiate from the changes occuring in a weakened heart. While the idea of having a defibrillator at athletic events has appeal, experience shows that only about 1 of six of athletes who die on the field can be resuscitated. More often a spectator has the cardiac arrest. March 2, 2007 - The Tacoma Medical Society reviewed some state-of-the-art of aspects of cardiology. Dmitri Vasin, MD, a nephrologist (kidney specialist) from Bremerton pointed out that the goal is not just to reduce high blood pressure, but to reduce the likelihood of heart disease and stroke. These diseases are the outcome of metabolic abnormalities manifesting in increased blood pressure, cholesterol, blood sugar, abdominal weight gain, and poor aerobic fitness. He reviewed the biochemistry of high blood pressure and vascular disease, and how to choose medicines for prevention wisely. Jaime Pugeda, MD reviewed recent understanding of the stents and other methods to reduce coronary blockages. Daniel Heller, MD reviewed Xray methods (CT and MRI) of evaluating heart disease without catheters. He pointed out that ultrasound of the carotid arteries produces accurate results only in the hands of highly qualified technicians using the very best equipment. Anyone offering that test in the supermarket parking lot most likely will not provide accurate information. Matthew White, MD identified patients in his practice at unusually high risk of heart disease and stroke. He worked with those patients to improve lifestyle and their medication plan. A year later, 75% of 34 people tested had reduced plaque in their coronary and carotid arteries. Greg Brown, MD of the University of Washington showed that by lowering total cholesterol with a statin, the rate of heart disease falls by 30%. Add niacin, and the rate of heart disease falls by about 66%. Further, plaque in the coronary arteries shrinks. David Clark, MD extended our understanding of heart failure, actually a much more common and subtle problem than usually recognized. February 16, 2007 - The "Morbidity and Mortality Case Presentation" is an ancient medical tradition, consisting of a review of a medical case, sometimes involving a patient who suffered some adverse consequence of medical care. Virginia-Mason clinic sponsored these presentations. The first involved a patient who had swallowed a camera in a capsule for diagnostic purposes, and the camera became lodged in an unexpected stricture of the distal small intestine. The capsule and stricture were removed successfully in surgery. The second patient had an irregular heartbeat that increased her risk of stroke. Doctors placed catheters in her groin which they advanced into the heart to treat the arrhythmia. The procedure was successful, but one of the catheters in the groin nicked an artery and the patient had bleeding into the groin requiring surgery. The surgeon noted that her anatomy was unusual, with the artery overlying the vein, rather than side-by-side as usual, thus explaining how the artery was punctured inadvertently. In fact, such a complication occurs occasionally during this type of procedure, even with normal anatomy. The final patient was post-radiation for neck cancer, with one carotid artery completely blocked by arteriosclosis, and the other severely narrowed by a combination of the radiation and arteriosclerosis. Surgeons at VM opened the artery using several different methods over a period of two years, but each time it closed up again. Finally they placed a drug-eluting stent in the carotid, even though little research has been done on such stents in the carotid artery. Fortunately, this was successful for this patient. February 13, 2007 - A psychiatrist from the Virginia-Mason reviewed delirium in hospitalized patients. February 9, 2007 - Craige Blackmore, MD, MPH, Associate Director of Radiology at Harborview Medical Center in Seattle spoke at Virginia-Mason Clinic about imaging studies. These include any diagnostic test that produces a "picture" of part of the patient, such as an X-ray, CT scan, MRI, ultrasound test, and such. The question that physicians face every day is "is this imaging study worth the money the patient will pay for it?" Insurance companies ask the same question, and Dr Blackmore referred us to the Blue Cross website for practical guidelines. February 2, 2007 - Lawrence Einhorn, MD, treated Lance Armstrong for testicular cancer. Mr Armstrong returned the favor, and Dr Einhorn now holds the chair of the Lance Armstrong Foundation Professor of Oncology at the Indiana University School of Medicine. He reviewed the treatment of testicular cancer, which along with choriocarcinoma is a highly curable cancer. January 26, 2007 - Fred Govier, MD of the Virginia-Mason Clinic reviewed the causes and treatment of urinary incontinence. As of age 60, about 40% of all women have significant involuntary loss of urine. There are many reasons both men and women can lose urine. Over the past twenty years an amazing amount of progress has been made. Here in Port Townsend our urologist and physical therapy specialist can help the great majority of patients. Even with fairly severe incontinence, about 40% of women can expect to become completely dry, another 40% can expect to leak no more than once a week. January 19, 2007 - Janet Nagamine, MD at the Virginia-Mason Clinic reviewed patient safety. Communication failures constitute a majority of medical errors. At this point in time, medicine lags the aviation industry in quality of team communication and function. Dr Nagamine gave specific recommendations for improvement. Gillian Erlich, RN, who works occasionally at our office, spends most of her time working at Harborview in Seattle. She reports that Harborview is making excellent use of the system outlined by Dr Nagamine. January 12, 2007 - Several plastic surgeons at the Virginia-Mason Clinic reviewed newer techniques of breast reconstruction after mastectomy. December 1, 2006 - Kathryn "Kay" Koelemay, MD, MPH, a Medical Epidemiologist with King County, discussed measures being taken to deal with a bird flu epidemic, should one occur. She said the question was not "if" but "when." While government agencies are planning for this, I believe we are best advised to rely as much as possible on our own resources. Please see our January 2006 newsletter on personal and family disaster planning. For in a flu epidemic, one might need to remain at home for some time for reasons of isolation or quarantine. Whatever nutrients or vitamins you use to enhance immunity, you'd want to have on hand. November 25, 2006 - I completed a twelve-hour home study course on management of pain and other distressing symptoms, and end-of-life care. November 17, 2006 - Christian Guilleminault, MD, a professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine spoke at the Virginia-Mason Clinic about disorders of sleep. November 10, 2006 - Daniel Johnson MD of the Mayo Clinic spoke at the Virginia-Mason Clinic about CT examination of the colon. This technology seems safer than colonoscopy (using a flexible tube to examine the colon), and seems certain to diffuse from the medical centers out into the community as time passes. Of course, should something abnormal be found with CT, colonscopy would still be required to obtain tissue for examination. November 9, 2006- Francis Kim, MD, of the University of Washington cardiology department, reviewed the effect that certain dietary fats have on inflammation and vascular function. October 27, 2006 - Several doctors from the anesthesiology department at the Virginia-Mason Clinic reviewed newer methods of relieving pain. These include devices inplanted into the lumbar area to infuse drugs or use electrical stimulation to relieve intractable pain. October 19, 2006 - Jeffrey Probstfield and Steven Kahn of the University of Washington discussed research showing that rosiglitazone, currently used to treat diabetes type 2, can also be used to delay the onset of diabetes in overweight people. Lifestyle interventions, including weight gain, reduction in fat intake, and exercise, are a bit more effective. October 8, 2006 - Timothy Jacobs, MD, of the Virginia-Mason Clinic discussed genetic aspects of breast cancer. You can take a test to see of your family may carry one of the major genes for breasts cancer at http://www.myriadtests.com/provider/brca-risk-calculator.htm . September 15, 2005 - Steven L Hauser, MD, from the University of California at San Francisco, spoke at the Virginia-Mason Clinic about the causes of multiple sclerosis. MS occurs because of an autoinflammatory response, and so has more in common with rheumatoid arthritis than with most other neurologic diseases. MS occurs when people with a certain genetic makeup experience certain environmental challenges, which can be a viral infection or some still unknown trigger. There is no single gene that is responsible for MS. There are several, some of which increase susceptibility and some of which decrease it. Siblings of people with MS are about 40 times more likely to develop MS themselves, but often with different degrees of severity. September 8, 2006 - Paul Pepe,
MD, Medical Director of the Dallas Emergency Medical System, reviewed
cardio-pulmonary resuscitation. When the heart has stopped, careful physiologic
analysis shows that there is little benefit to breathing for the patient.
People are more likely to recover from cardiac arrest when rescuers concentrate
on chests compressions for the first four minutes, and defibrillate as
soon as possible. When the heart has stopped, our need for breathing is
much decreased. Breathing for the patient at this time interferes with
the chest compressions, and results in about 10% survival compared to
15% survival when the rescuer concentrates on chest compressions. June 9, 2006 - Steven Kirtland, MD, of Virginia-Mason Clinic spoke about sarcoidosis. This disease can be frightening because we do not know what causes it and it can cause significant breathing problems. Occasionally it can cause death. Most of the time, however, it resolves on its own without treatment. June 2, 2006 - Richard Deyo, MD of the University of Washington spoke at the Virginia-Mason Clinic. He described how markteting, media, advocacy groups, and politics influence medical practice in such a way as to raise costs and reduce quality of care. Here are some of the points he raised. Direct-to-consumer advertising is legal only in the US and New Zealand, and ensures that a new drug is widely disseminated quickly. The National Sleep Foundation is an example of a purportedly health-oriented organizatiton that is actually mainly funded by pharmaceutical companies. Prior to the release of Lunesta, the Foundation sponsored a "National Sleep Awareness Week" and other similar activities. Also, around that time, companies "assisted" physicians in preparation of articles bashing older sleeping agents. These articles appeared in medical journals. Hi-tech improves hospital margin. Advocacy groups push treatments before they have been proven safe and effective. As an example, over a billion dollars was expended on bone marrow transplants for breast cancer patients. Studies eventually showed it to be no more effective than more established treatments. Media talk of 'breakthroughs' and 'catastrophes' sensationalizes medical news. 'Breakthroughs?' Real life advances are slow and steady. 'Catastrophes?' The more we attempt to achieve, the more painful and less understandable are our failures. The FDA doesn't require new drugs to face head-to-head comparisons with older drugs. It should. Sometimes the older drugs are more effective. Hydrochlorothiazide (HCTZ) is one example. Bob and Suzanne Fletcher were editors of the Annals of Internal Medicine. In 1992 they published an article by Michael Wilkes that impugned the accuracy of pharmaceutical ads in medical journals. Pharmaceutical companies reduced their advertising in that journal dramatically, and did not increase it until a new editor was appointed. (Sensitive, much?) Betty Dong, UCSF, agreed to study Synthroid for its manufacturer, Boots, Inc. Boots designed the protocol, monitored the project, but in the end the generic proved as effective as Synthroid. Dong had contracted with company not to publish without permission, and so she did not. The company published the study with an inaccurate conclusion favorable to themselves. When Boots sold Synthroid to Knoll Pharmaceuticals, Knoll relented and Dong's original findings were published in JAMA in 1997. There are similar stories about Herb Needleman, who studied the neurotoxicity of lead paint. And James Kahn, at UCSF, about an AIDS vaccine that was ineffective. And David Kern, who reported the lung toxicity of nylon flocking, and lost his job. All this raises costs. Less federal funding for research worsens problem. Deyo suggested
Dr Deyo is the author of "Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises" May 26, 2006 - Several researchers from the Benaroyal Research Institute spoke at the Virginia-Mason Clinic. They discussed how elastic tissue degenerates in the arteries in people with arteriosclerosis, about immune tolerance therapy in autoimmune disease, and about susceptibility to cancer. May 19, 2006 - Dan O'Connell, PhD, of the University of Washington spoke at the Virginia-Mason Clinic about the value of apology in health care. His charge was, to practice in such a way as not to harm patients. If patients are harmed by a medical error, they need to be recompensed. If patients are harmed, we need to hold the appropriate people accountable. May 12, 2006 - Michael Sarr, MD, professor of surgery at the Mayo Clinic, spoke at the Virginia-Mason Clinic about necrotizing pancreatitis. For various reasons the pancreas can become inflammed and destroy itself using its own digestive enzymes. The risk of death is high in this condition. Dr Sarr reviewed the various methods used to treat this condition over the past twenty years, and why treatment protocols have evolved to the current standards. May 9, 2006 - Scott Linquist, MD, Director of the Kitsap County Health District, updated the medical staff of Jefferson Healthcare Hospital on current infectious diseases including staph infections and tuberculosis. May 5, 2006 - John Corman, MD, of Virginia-Mason Clinic spoke on treatments of prostate cancer using vaccines and other immunologic techniques. May 4, 2006 - Daniel Drucker, MD, of the University of Toronto spoke about signalling molecules in the gastrointestinal tract. Much research in this area is leading to new drugs for diabetes and weight loss. Learn more at www.glucagon.com. April 28, 2006 - Arnold Milstein,
MD studies health care costs and talked about why they are high and how
to reduce them. He called for better measures of quality and cost. He
suggests that payments be set according to the efforts put forth by the
patient and doctor. He thinks that we should have more rapid ways of testing
which medical interventions are most cost-effective. April 21, 2006 - April Stempien-Otero, MD of the University of Washington spoke at the Virginia-Mason Clinic about end-stage heart failure. In the US, there are about 2000 hearts donated each year and available for transplant. Recipients have about a 70% chance to live for five years or more. She outlined details of mechanical pumps used to keep patients alive waiting for transplant. These are not fun devices, but recent experience shows that by using these devices for a year or so, that the rest gained by the heart sometimes allows it to recover. Then the mechanical pump can be removed. This still is investigational. April 20, 2006 - James Sevjar, MD of the National Center for Infectious Disease at Atlanta, Georgia spoke about mad cow disease. Actually, he titled his talk "Epidemiology and Clinical Features of Human Prion Disesase." These diseases occur not just in humans and cows, but also deer, elk, sheep, goats, cats, etc. The prototypical illness of this type is Creutzfeldt-Jakob Disease (CJD) which causes rapidly progressing dementia and coordination problems in about one person per million per year. Meat from infected cows can cause a variant of CJD. About 160 people have been detected with this, worldwide. The British authorities were prescient in realizing that mad cow disease might spread to humans, and killed millions of cows before any human beings were affected. You can read more about mad cow disease at http://en.wikipedia.org/wiki/Mad_cow_disease and CJD at http://en.wikipedia.org/wiki/Creutzfeldt-Jakob_disease. April 14, 2006 - Peter Manos, MD and Joan Braun, RN reviewed measures taken at the major Seattle medical centers to deal with "difficult patients." They gave the example of a patient who required very great amounts of narcotic for pain relief. The nursing supervisor thought the patient exaggerated his reports of pain. The patient seduced the male intern and female nurse into taking his side. The patient, together with another nurse in the emergency department, instituted a disciplinary action against the nursing supervisor. A psychiatrist was consulted and instituted a special protocol for narcotic use in the patient. By that time the patient was requesting so much narcotic that his breathing rate become very slow. (Narcotics slow breathing in high doses.) He convinced the intern and nurse to give him even more narcotic, at which point he stopped breathing. He was given a narcotic antidote which brought him back to consciousness. At this point the intern and nurse were replaced, and the patient left the hospital. A few days later the emergency room nurse asked to have her name removed from the complaint against the nursing supervisor. This is because the ER nurse had loaned her car and credit card to the patient on the day he was discharged, and had not heard from him since. The speakers reviewed other "difficult patients" with quite different situations, and how to deal with them. March 31, 2006 - Mary Ann Abrahms, MD of the Iowa Health System, titled her talk "Mistake Proofing: Physician-Patient Communication." She points out that about half of Americans are not literate enough to read a bus schedule. Studies show that such people and their children are less likely to have adequate blood sugar control if diabetic, or poorer control of asthma if they have that condition. According to the Institute of Medicine, people with poor health literacy have poorer health outcomes. The complexity of the US health care system is beyond the health literacy skills of MOST adults. There are competing information sources, such as newspapers, magazines, television, the internet. Filtering the misinformation and forming a coherent idea of the facts is difficult even for very literate individuals. March 24, 2006 - Carrie Horwitch,
MD, of the University of Washington School of Public Health spoke at the
Virginia-Mason Clinic about bird flu. He outlined the biology of the viruses
and birds involved, the likelihood of a pandemic, and how we should prepare
for a pandemic. March 21, 2006 - Yolande Duralde,
MD of Mary Bridge Children's Hospital spoke about the effects of methamphetamine
abuse on children. As I understood her, children can be severely abused
by their drug abusing parents and be returned to the parents after the
parents enter treatment. Child service workers tell me that in this county
there is inadequate supervision of drug-abusing parents. Such parents
can have positive drug tests on multiple occasions and still be allowed
to keep their children. January 20, 2006 - Timothy Dellit,
MD of Harborview Medical Center spoke in the growing problem of drug-resistant
staphylococcus. The acronym MSRA stands for methicillin-resistant staph
aureus. People will often note a red area that's becoming infected and
mistake it for a spider bite, when in fact this is resistant staph. There
are many forms of these staph, but in this area they are usually respond
well to the sulfa drug called SMZ/TMP, or to doxycycline. |
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