Medical Research

Earlier this month, the Journal of the American College of Radiology (JACR) published an article based on advice from the Society of Breast Imaging (SBI) and American College of Radiology (ACR) which contradicted the U.S. Preventative Services Task Force (PSTF) and stated that annual mammograms should indeed begin at age 40 and even earlier if you’re at risk. Unlike the PSTF’s earlier recommendations, the SBI/ACR based its recommendations on several different trials and studies.

It’s good to see that medical professionals are recommending what women have known for years and what is just good, common sense – if you are 40+, go get yourself a mammogram and get one annually.

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P.S. Comment and share whether you agree or not.

Certified Legal Nurse Consultants have long known that the pharmaceutical and medical device industries have a vested interest in not only making sure that their products get wide distribution on the market, but also that they gain favorable press coverage in the healthcare and mainstream media. The extent of the “full court press” they make to gain such coverage takes on different extremes. Everything from parties, trips, gifts and research sponsorships are used to help influence writers. Another popular but hidden measure is the use of ghostwriters. They are often hired by the pharmaceutical or device industries themselves to write the articles, which are then submitted under the signature of an “impartial” doctor. Sometimes the so-called “ghost” may simply have ties, such as a sponsorship from the related industry or manufacturer, but other times the ghost may actually be part of the industry being written about. Just to name a few, many of you will remember the controversy surrounding disclosures of this practice related to Fen-Phen, Vioxx^® and Premarin^®.

According to The New York Times, many major medical journals are taking baby-steps in the right direction to identify and hopefully stop this practice, while others are not yet committed to the process. The Public Library of Science in its PLoS Medicine journal has called for a “zero-tolerance” ban on such ghostwriting and has suggested various remedies, including sanctions in situations where the ghostwriting is not disclosed.

Given the fact that many medical and other healthcare providers rely on these journals for unbiased information to make decisions regarding the use of different drugs, devices and treatments or even when creating standards of care, policies and procedures, etc., the information should be free of slant, spin or other bias. But apparently this isn’t true or at least doesn’t happen as often as we would hope.

The author of an article should be the person or persons who wrote or contributed the majority of the article, not the person who signs their name to it or submits it to a medical journal or other publication. At the very least the ghosts should be disclosed in the article’s acknowledgments, contributions or references.

Unfortunately, it appears that the major medical journals have not completely adopted nor have they enforced this policy. I am also not aware of any research being done to determine whether the professional nursing journals have adopted a similar policy. Until an impartial organization looks into this, or at least until the nursing journals adopt a policy of transparency, we’ll have to assume that nursing journals have the same potential level of bias or influence as do the medical journals.

What should be done? First the journals (scientific, medical or nursing) should put into effect a sanction policy for those situations in which a ghostwriter, sponsorship or other potential for bias is later disclosed or discovered. The second is for those same journals to adopt a transparency policy which then should disclose such bias as soon as it is discovered.

It’s imperative that healthcare professionals and ultimately the consumer are able to fully trust professional journals. Until ghostwriting is “ghostbusted,” we’re not in a position to place that trust. Until that day, Certified Legal Nurse Consultants should continue to question and challenge the validity of research studies where indicated.

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Just about every doctor and nurse in hospitals own a Sharpie^® at one time or another. Some use them for marking patients and others to label their lunch. It turns out that two different studies on infection risk found that good old fashioned Sharpies out-perform surgical markers in protecting patients from the risk of infection.

The 2008 study was conducted in Canada at the University of Alberta followed in 2009 with a study on reducing surgical site infections (SSIs) at Duke University in the U.S.

So long as an alcohol-based Sharpie is capped (and the outside properly swabbed) between uses on patients, the risks of passing on four common resistant bacteria – Staphylococcus aureus (MRSA), E. coli, vancomycin-resistant Enterococcus faecalis (VRE) and Pseudomonas aeruginosa – are much lower with a Sharpie than with a surgical pen.

Changing from surgical markers is a great way to do some cost-cutting at your facility while keeping down the risk of wrong-site surgeries. Why not kill two birds with one stone and still have a pen to make your more subtle points?

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As a Certified Legal Nurse Consultant, do you use Google^® to search on a regular (or exclusive) basis? If you’re like me, you’re tired of seeing only 10 results per page. You know, scan the page, click next on the Gooooooooooogle link and then see the next 10 links, repeat – next 10, repeat – next 10, repeat – ad nauseum and if you’re as tired as I am of that basic white Google homepage that offers little in the way of excitement other than an occasional logo change, it’s time to take matters into your own hands. Open your Internet Explorer^® or Firefox^® browser and point it to Google. Next, create an account with Google. It’s quick, easy and it’s free (plus they know all about you anyway – they’re Google after all).

After you create your account, go back to Google and click on iGoogle (in the top right corner of the page). You may not need to, it may take you right to iGoogle^TM. When you get to iGoogle (you’ll know) you can select a theme from the “Create your own homepage in under 30 seconds” box. Check a few of the options in the Select Interests box. You can change them later. When you’re done click on “See your page.”

Once you do you’ll see that your new iGoogle homepage has changed considerably. There will be new content like a useless clock, perhaps weather, news from CNN or perhaps your local paper or The New York Times. Ignore these changes for now, we’ve got important work to do.

First, go to the top of your new iGoogle homepage and click on either Preferences or Search Preferences (depending on which one you see). You can then tell Google to display 100 (really 100!) search results per page. You can also tell it to open search results in a new window. This is way cool – your original 100 results remain in place and each link opens in a new window. This way, as you evaluate each result for a case you’re working on for your CLNC^® business, you don’t lose the original results and can close each page (or follow its links) as you wish. Save your preferences and go back to iGoogle.

Next, you can select your theme or change your theme. You’ll have pages and pages of customizable themes (header images and page colorations) that will change the way you look at Google forever (or at least until you change themes). Vickie loves trekking and hiking in the mountains so she selected a cool theme that reminds her of the Bhutanese Himalayas. I’ve got an electro-techno-looking theme that charges me up. Some themes are static – the same all the time. Other themes change throughout the day. (Try Pocoyó for a fun, changing theme). You can search the themes by keywords to find one you like.

The Institute has also developed a theme specific to Certified Legal Nurse Consultants. You can get the iGoogle CLNC^® theme by logging into the NACLNC^® Community. Once logged into the Community, click Member Seal and Other Downloads. Select the iGoogle CLNC^® theme to easily upload it to your iGoogle homepage.

Now that iGoogle’s looking different, your next step is to address the new content that’s been added to your homepage, courtesy of iGoogle’s Gadget APIs (you’ve learned a new tech word. Now, instead of saying “I can’t go out with you Friday, I’m washing my hair,” you can say “I’m staying in Friday to use Core JavaScript Features and Standard XMLHttpRequest class objects to customize the APIs for my iGoogle homepage.”)

The APIs allow you to drag and drop, add and delete and even resize feeds on your iGoogle homepage. To take advantage of this, the first thing to do is navigate to Vickie’s Blog and click the Subscribe to Feed link at the top left. Now, instead of subscribing by email, select the option under Subscribe Now! to read the blog with your iGoogle or My Yahoo! web-based reader. It’ll then take you back to your iGoogle homepage and should show a box listing the last four headlines. You can then grab the “Vickie’s Blog” box with a left click and drag it anywhere on your page. Use the little icons in the top right of each feed box to delete a feed from your page or to move it around your iGoogle homepage.

Now visit other blogs, news sites (NYTimes.com) or alert sites (FDA.gov) and add their feeds to your homepage. Do a Google search for medical-malpractice news and feeds or other types of cases that interest you to find a wealth of news, facts and opinions. Almost all of these information sources for your Certified Legal Nurse Consulting business can be added to your new homepage. On mine I keep the local weather, a stock market ticker, global and local (Houston Chronicle) news and legal feeds. As you learn of new, interesting feeds you can add them, deleting the feeds you no longer need.

I haven’t tried this in IE8 yet, but in my Firefox browser I have multiple tabs that open each time I start Firefox. My homepage and primary display tab hold legal feeds, my secondary is tech feeds (natch!) and the last is news and current events (like movies). Every time I open a browser, I take 2-3 seconds to scan the headlines and then get to searching. One more tip is to use both IE8 and Firefox. I’ve set IE8 to Google, and Firefox to Yahoo!^® and I’ve got different content on each browser. My ultimate search destination (legal, news or research) helps me select which browser to open.

This blog has primarily been about Google but, with the exception of themes and colorizations, you can customize Yahoo! just as easily as you can Google.

Remember, use a combination of search engines to get the best results. You’re cheating yourself out of information gathering otherwise. Customizing your homepages will put more information at your fingertips. Just make sure it’s useful.

Keep on techin’,

Tom

Tom’s favorite search tool is Yahoo. Our director of education likes Google. My favorite search tool is Tom! Every day we field questions from CLNC^® consultants and even attorneys that are easily found through a quick Internet search. Tom has become a master at searching out the most arcane facts from the furthest reaches of the Internet. He uses a variety of search engines, constantly juggles and refines search terms, and even uses whole sentence searches. If you want to know what species of monkey is endemic to Canada, he’s the one to ask.

If I need a restaurant in Oslo or Poughkeepsie, he’ll not only find me a local review and suggestions on which species of sea urchin tastes best in October, but ferret out the name of the fisherman who sold it to the restaurant. Al Gore may have invented the Internet, but Tom is the one who has harnessed its power for the good of Vickie-kind. I may be exaggerating a little here, okay I’m exaggerating a lot. But with a little bit of mental sweat you can search as well as Tom.

There’s a wealth of medical, nursing, state and federal resources out there. You can learn about who can report Medicare and Medicaid fraud, what’s new in healthcare regulations and find answers to all sorts of questions simply by putting Google to work for you. Before you take the time to fill out that mentoring request to learn the definition of a legal term in your home state of Idaho just do a quick online search. We constantly answer mentoring questions that could have been answered with a simple trip to Google. Get the most out of your CLNC^® Mentoring by doing your search before you request mentoring. What’s good about this is that you will expand your knowledge and at the same time learn you can answer many of your own questions.

I always tell new CLNC^® consultants that, “we won’t do your work for you” and we won’t. We’re here to be your coach and to guide you on how to do the work, handle your CLNC^® business and to answer your questions (things you can’t necessarily find online). Don’t use the mentoring process to replace the thinking process or the nursing process. You’ve been trained to think critically as a nurse, you do it on the job and you do it naturally. Apply the nursing process to the legal nurse consulting process and you’ll come out a winner.

There’s a world of knowledge out there. Use it and use it wisely. Educate yourself and your attorney-clients. But, like Tom says, “Search smarter, not harder and don’t depend on Wikipedia unless you want to be road kill on the information superhighway.” Twitter you later!

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P.S. Comment on one interesting search you’ve done recently keeping in mind this blog is rated G.

Welcome to “Web 2.0″ with its completely new terminology for the blogosphere. But don’t be scared, I’m here to help you master the art of Web 2.0’s social bookmarking and get you hip.

When the Internet was relatively new and you saw a website that you wanted to share with friends, what did you do? Most likely, you picked up the phone or sent an email. Now there’s a new alternative - social bookmarking, which is awesome because who has time to phone a friend about a cool website? Social bookmarking allows users to ‘tag’ sites of interest. Once a site is tagged, your tags appear in two places: your user profile, and the homepage of the bookmarking network. The bookmarking network will display the tag temporarily, before it is replaced by newer ones.

Delicious is a social bookmarking network that allows users to tag, save, manage and share web pages from a centralized source. How many times have you bookmarked a website on your home computer, and then also needed to open it out of town? With Delicious, you can bookmark any website on the Internet and access them from any computer, anywhere.

Need to know the latest on Medicare fraud or toxic torts? Explore tags on Delicious.com and you’ll instantly get a list of all websites tagged by other users. If you’re working on a legal nurse consulting case that involves a specific drug, such as Vioxx^®, explore tags on Delicious. You’ll be amazed at what’s out there that someone else thought enough about to bookmark.

Bookmark what you like and it will be there when you come back - from any computer. Sounds good so far, right? It gets better. Since Delicious has an interactive “Web 2.0″ quality, you’re not just tagging websites, you’re conceptualizing with an entire community. Once a tag is entered into the bookmarking network, other users can rate it.

So, how is this beneficial to Certified Legal Nurse Consultants? Let’s say you want to reference a website on SIDs within a case report, but are unsure about the quality of the site’s information. If it has been tagged within a social network, chances are you’ll get an idea of what others think about it before including it in your work product for your attorney-client.

Social bookmarking can also help you market your CLNC^® business. After you’ve created your company website, let people know about it by creating a bookmark. Then ask other Delicious users within your network to rate your site. This even gives you a bit of page rank. Plus, it’s an excellent way to gain free traffic.

Using a social bookmarking network, such as Delicious, allows you to learn about new sites and tag your own sites while networking with new people.

Well, what are you waiting for? Go to Delicious.com and join. It’s FREE and easy! Make sure you bookmark Vickie’s Blog. Thanks!

Guest Blogger Profile

Brandy Mathews is a member of the marketing department at Vickie Milazzo Institute. She brings over 10 years of experience in computers, computer technology and the Internet to the Institute.

Having just been in the ED for 6 hours with a friend, I witnessed firsthand the secondhand, substandard grade the American College of Emergency Physicians (ACEP) has given to the state of emergency care in the U.S.

The care I witnessed wasn’t deplorable, but it wasn’t inspiring either. The staff’s empathy for a grieving family was hit and miss. The orthopedic resident’s technical ability as well as her interpersonal skills and judgment left a lot to be desired. And the hygiene of the department - well what can I say? It was as much of a hygiene risk as my 4-year-old godson’s preschool playground full of little Ebola viruses.

ACEP reported in a Report Card on the State of Emergency Medicine that the “Economic woes and a failing health care system mean more people than ever before are relying on emergency care at a time when the nation is receiving a substandard C- grade for its support of emergency patients.” Dr. Nicholas Jouriles, president of ACEP said, “Policymakers can no longer remain oblivious to what is happening in emergency departments.” He called on President-elect Obama to make emergency care a top priority in health care reform proposals.

Dr. Angela Gardner, ACEP’s president-elect, said “The emergency care system is a ticking time bomb… a failing health care system means more people than ever before will be relying on emergency care meanwhile, every minute of every day in this country people need emergency medical care, and that need is growing as our population ages and lives longer.”

Emergency care is becoming primary care - it’s the frontline of medicine, and America’s losing the battle. This substandard care will increase the number of medical malpractice emergency cases and increase the demand for Certified Legal Nurse Consultants on emergency care issues.

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