2-17-10: The iPad is a generational shift from the laptop computer to the handheld computer and will directly impact online continuing education courses. Mostly, the use of a laptop requires the user to be in an upright seated position whereas the iPad sports enhanced mobility similar to that of smart phones. The iPad allows users to shift from semi-mobile laptop computing to highly mobile handheld device computing thus opening up new possibilities to easily study continuing education courses on subways, at bus stops, at a park, in vehicle passenger seats, while waiting in a line, etc….

The iPad will increase mobile online continuing education usage far greater than other eReaders such as the Amazon Kindle and the Sony Reader Touch.  The Kindle text readout is a form of eInk that is visible in daylight without backlighting and has extremely long battery life. The iPad features only up to 10 hours of battery time and does not have the eInk advantages in daylight. However, sharper text resolution and improved ergonomics are major reasons for the inevitable success of the iPad in the eReader market.

Online continuing education programs are provided in several ways including the eBook  format which is often purchased online then downloaded in the form of Adobe PDF files. The iPad supports high definition, full color text with images. This enhances courses delivered in the PDF format over the black and white readout of the Kindle. The iPad’s combination of color text, photos, and video allows for a greater diversity of course content and layout thereby making a more user friendly experience for learners.

Online continuing education courses are also delivered through streaming media and downloadable video files, often in Apple’s Quicktime format. The Kindle and several other eReaders will falter in comparison to the iPad’s 3G and Wifi ability to deliver streaming video content. More than this, the iPad has an intuitive touch screen display allowing users to flip through eBook content in much the same way as turning the pages in a book. The iPad brings the tactile experience of opening and flipping through a book to the end user. A major factor in the adoption of the iPad into the continuing education marketplace is familiarity. The touch screen hand gestures used by the Macintosh computer mousepad, iPhone, and iPod touch devices are employed in iPad navigation. Millions of end users are already familiar with the ergonomics of Apple touch-screen hand gestures thereby making the cross-grade from the laptop to the iPad an intuitive process.

More speculative is the likability factor of the iPad’s handheld usability. Apple’s intention is to have the iPad become as comfortable as holding a pad of paper, leafing through a newspaper, or reading a book. It is likely that the comfort level for end users will reach this goal based on the reasonable size, weight, and thinness of the iPad. More than this, the iPad is compatible with many existing online content delivery systems such that specialized programming and development is unnecessary. This makes the iPad an out-of-the-box educational solution for both end users and content providers. Moreover, it is probable that the popularity of the iPad will encourage publishers to provide more textbook titles in eBook format.

The iPad requires no additional programming for educational providers using most learning management systems (LMSs). An LMS is the server side software used to host online schools and universities. LMSs allow students to register for courses, download course materials, take quizzes, receive certificates of completion, view grades, interact with other students and faculty, and view streaming video and media content. The LMSs of providers such as the Healthcare Medicine Institute (HealthCMI) and Lynda.com are compatible with the Apple Safari internet browser. Currently, the Safari browser functions on the iPad, iPhone, iPod Touch, Windows computers, and Mac computers. Learners at HealthCMI and Lynda.com will be right at home with the iPad and the downloadable materials and streaming media content will behave exactly the same way on the iPad as on desktop and laptop computers.

The iPad can act as a virtual stack of books or as a streaming media portal for learners. Online educational environments will move beyond the laptop generation and find its way into the handheld environment. In other words, mobile usage can move from sitting to standing and moving. This puts the iPad in the same range of flexibility offered by books and newspapers and also makes access to continuing education online as ubiquitous as a Wifi or 3G connection to the internet.

Learn more about continuing education online at HealthCMI by clicking Nursing Continuing Education.

1-25-2010: Apple’s iPhone is shining in areas not anticipated by continuing education providers. Online nursing continuing education and acupuncture continuing education courses at the Healthcare Medicine Institute (HealthCMI) were designed to function on Internet Explorer versions 6, 7, and 8 as well as Safari and Firefox for both Mac OSX and Windows PC users. HealthCMI developers were surprised to find out that some learners were accessing online courses with the iPhone. “The iPhone implementation required no planning or effort- it just works,” notes Allan Blake, HR Director for HealthCMI. He further notes, “We spent months getting our software to properly visualize IE (Internet Explorer) and yet the iPhone required no specialized programming or additional effort.”

HealthCMI developers did not anticipate cellular mobile computing to interest continuing education learners due to the small size of the iPhone display. However, users can easily magnify and therefore read the PDF course materials on the iPhone and are able to wirelessly transfer the course materials to laptop and desktop computers with simple iPhone apps. Others simply login to www.healthcmi.com at a later date from their home computers and re-download the materials.

The Apple tablet, the iPad, iis now on the minds of HealthCMI developers. HealthCMI developers now expect Apple’s tablet to become a preferred mobile computing platform. Allan Blake  notes that the comfortable screen size coupled with high resolution and respectable dot pitch makes Apple’s new tablet a formidable mobile reading device. “It’s about the sharpness of the text,” notes Blake on the topic of reader preference and eye strain. “Learners will choose the Apple tablet based on ergonomics and reading comfort. They will experience less eye fatigue than other, less sharp, mobile devices and will therefore naturally gravitate to this technology.” Mr. Blake comments that he is expecting the tablet to be compatible with HealthCMI acupuncture and nursing continuing education online courses because it will be built on the Mac OSX operating system, the same system that both the Safari browser and the iPhone are built on.

About the Author: Adam White, L.Ac., Dipl.Ac. is an Acupuncture Continuing Education provider with the Healthcare Medicine Institute (HealthCMI). To learn more about medical news and medical continuing education visit http://www.healthcmi.com .

1-01-2010, Soquel, CA: Poverty and environmental pollutants have a lot in common. Both contribute to adverse living conditions and ill health. The cure may be a prescription for green manufacturing jobs. There are no factories producing complete wind and solar systems in the USA. Major components for solar panels and wind turbines are assembled domestically but are manufactured oversees. In the wake of a job shortage and miles of rusting factories it seems logical for a national initiative to revive the domestic production of goods.

This requires a massive retooling project combined with powerful incentives for industry to come home to Uncle Sam. Our dear uncle seems to be on an oversees cruise at the moment. Ipods are produced in Malaysia, iPhones in China, many LCD TVs from Korea, and the list continues. The former technologies were pioneered in the USA and are manufactured overseas for domestic distribution. We’ve even lost our last Levi’s jeans factory. Apple computer and Levi’s jeans are about as apple pie as it gets! Yet, these companies cannot compete if they utilize domestic production. So, with a burgeoning industry of solar and wind energy production - why not push to have production at home?

Tax breaks and cheap loans are step number one. Current federal incentives often require mountains of bureaucratic paperwork for small and medium sized businesses to obtain loans.  This is an important area that needs to be streamlined.

Tax breaks are not enough. The government needs to work with industry to immediately build enterprise zones filled with factories to produce solar panels and wind turbine components. This, coupled with a program to put a solar panel on every sunny roof and wind farms in every state, creates the demand for these products. Current subsidies bring the cost of installing solar in the home down 50% in many areas. Nonetheless, most people will have a hard time coming up with the net cost of approximately $15,000 for a solar system. The federal government and state governments need to bring this price into the $5,000 range to make solar a realistic investment for home owners.

This is an investment and not an entitlement. Rebuilding the domestic manufacturing base creates wealth. If we plant a seed and grow corn we have created wealth. The government can incentivize industry to plant those seeds in domestic energy production to create wealth in our society. US steel and carbon fiber combined with American ingenuity can be tapped to create a wealth of green products needed to revive this economy, fight poverty, and provide for a healthier and self-sufficient society. The return on investment includes a reduction in healthcare costs associated with poverty and environmental pollutants. Another advantage to encouraging local solar energy production is solar’s independence from our aging national grid of power lines.

The power grid issue prevents wind farms from reaching their full potential. Many wind farms are hampered in their ability to transmit power because they will overload the power grid if they activate 100% of their wind turbines. Additionally, the fragility of the grid weakens our national defense by putting local, state, and federal agencies at risk and destabilizes the ability of our communities to function after disasters such as earthquakes, hurricanes, floods, fires, and tornadoes. The power grid needs shovels in the ground now. It seems that the government has an opportunity for job creation that will yield quick dividends.

Domestic manufacturing seems impossible in the face of cheap oversees wages in many factories without restraint from human rights protections and environmental & safety standards. Conversely, some countries provide healthcare coverage for workers unlike US industry which is bootstrapped to health insurance costs. It is reasonable to only allow imports from factories meeting the same standards as the demands placed on their US competitors.

The concept of federally mandating insurance coverage to employers is a well-intentioned yet unfunded mandate that has the potential to hurt the US production of goods. The disconnect with this approach is that jobs are tied to healthcare coverage. Healthcare costs often contribute to an industry moving oversees thereby reducing domestic jobs. Why do we want to burden the manufacturing base with healthcare costs if this may push jobs offshore? No jobs? This leads to poverty, malnutrition, and poor health.

Extending Medicare coverage to all US citizens is one fix. Industry will be freed from healthcare costs. If big government seems too scary with the fears of outrageous tax hikes associated with national healthcare coverage then perhaps the addition of competition may help bring down the costs associated with healthcare. This requires the federal government to repeal anti-trust protections from insurance companies and to provide a public option with competitive pricing. Looking to Congress for a streamlined and efficient healthcare package? On this one, the lobbyists have scored the first touchdown. Right, left, center, whatever the political solution may be… until we, as a nation, pull together and provide some kind of comprehensive healthcare coverage to all US citizens without forcing the burden onto the manufacturing base - we will not see the type of job creation needed to move this economy forward.

Green manufacturing is a great way to test our economic fortitude. The US must combine the knowledge base of US industry and universities with efficient financial structures to support the rebuilding of domestic factories for this to work. Are we to replace foreign oil with foreign wind turbines and solar panels? A sound domestic energy policy is one wherein the US can provide for its own power. Job creation, a cleaner environment, and a healthier populace are the rewards for this effort.

December 23, 2009, Capitola, CA: The healthcare reform bill has passed in the US Senate. However both the US House of Representatives and the US Senate bills have yet to address important details affecting patient care. Oversight concerning the determination of medical necessity as well as provider network inclusion issues have greatly affected medical reimbursement and patient access to care.  Many insurance companies reimburse medical expenses based upon a determination of medical necessity by the carrier’s claims department. In the absence of external oversight or regulation, the insurance carrier is free to deny care solely based upon their on private internal review.

Another key issue not addressed is how provider networks create financial barriers to care. Many insurance carriers reimburse medical expenses at lower rates or refuse reimbursements for out-of-network providers. Medical practitioners may also be excluded from insurance company networks for a variety of reasons. Practitioners may be required to limit medical procedures for patients and the number of office visits as a precondition for inclusion in the insurance network. Medical practitioners may also be required to accept lower rates of reimbursement for services provided to patients as another precondition to network inclusion. Some medical networks charge medical practitioners a fee for inclusion in networks.

The patient’s right to choose their own medical practitioner is not federally guaranteed by law. Additionally, there is no guarantee an insurance company will pay for medical services and patients often have no way to determine what will be paid until after a claim is submitted and a response is generated the insurance company’s claims department. The federal government seeks to mandate health insurance coverage for all US citizens yet has not stipulated that insurance companies must reimburse patients for medical expenses nor is there language to address oversight of the determination of medical necessity.

The determination of reimbursements is often based on what is termed as ‘usual and customary.’ Insurance companies have sole discretion over this aspect of reimbursement for general health insurance policies and may choose to exclude many procedures, office visits, and medical tests whether or not teams of doctors agree that such medical services are vital to the patient’s survival, recovery, or comfort.

The US House of Representatives and the US Senate have not addressed these details which represent core issues affecting healthcare outcomes for patients. Until these unresolved issues are rectified, it is unclear whether or not US citizens with health insurance coverage will have adequate access to medical care.


About the Author: Adam White, L.Ac., Dipl.Ac. is an Acupuncture & Nursing Continuing Education provider with the Healthcare Medicine Institute (HealthCMI).  

Palatal Myoclonus

Nursing Continuing Education Online

Palatal myoclonus is a spasmodic action of the palatal muscles which are located on the roof of the mouth. This often results in a clicking noise that can be heard both by the patient and people nearby.  Lesions of the central tegmental tract are often involved.  Once important and effective treatment is acupuncture to alleviate this disorder.

Nursing Continuing Education FYI

Focus: Ulcertative Colitis and Crohn's Disease

Chronic inflammatory disease of the large bowel is divided into two major entities-nonspecific ulcerative colitis & Crohn's disease  of the large bowel (regional enteritis, granulomatous colitis).  Both involve abdominal pain, diarrhea, and rectal bleeding.  Crohn’s disease is  one-fifth as common as ulcerative colitis in the US.

Crohn's disease is a nonspecific chronic transmural inflammatory dz that most commonly affects the distal ileum and colon but may also occur in any part of the GI tract from the mouth to the anus and perianal area.  Chemicals and low-fiber diets of industrialized nations facilitate this onset of this disease.  It occurs more commonly in Jewish people of Eastern European descdent and has familial tendencies.  Most cases begin before age 40 and have peak incidence in the 20's.

The earliest macroscopic lesions of Crohn’s disease appear to be tiny focal "aphthoid" ulcerations of the mucosa, usually with underlying nodules of lymphoid tissue.  The inflammation may regress or progress to involve all layers of the intestinal wall.

The transmural inflammation, deep ulcerations, edema, and fibrosis are responsible for obstruction, deep sinus tracts and fistulas and mesenteric abscesses.  Chronic diarrhea associated with abdominal pain, fever, anorexia, weight loss, and a right lower quadrant mass or fullness are the most common presenting features.  However, many patients are first seen with an "acute abdomen" simulating acute appendicitis or intestinal obstruction.

Ulcerative colitis, however, is usually a series of attacks of bloody diarrhea varying in intensity and duration interspersed with asymptomatic intervals.  Onset of an attack may be acute and fulminant with  sudden violent diarrhea, high fever, signs of peritonitis and profound toxemia.

Psychological aspects of ulcerative colitis play a secondary role in attack onset.  The initial pathologic lesion is confined to the mucosal layer and consists of abscess formation in the crypts, as opposed to Crohn’s disease, which involves the entire thickness of the bowel wall.  Ulcerative colitis reveals a friable and intensely inflamed mucosa with exudate. Usually, the rectosigmoid area of the colon is involved.  The disease may extend from this area but always in a continuous fashion, in contrast with Crohn’s disease, which tends to skip.  Ulcerative colitis patients  may have narrowing of the bowel lumen as a result of fibrosis, which is generally mild compared to Crohn’s disase.  Age onset differs.  Ulcerative colitis peaks at 15-30 years and also 50-70 years of age.

Nursing Continuing Education Courses Online

Foucs: Peptic Ulcers

HealthCMI brings special FYI information on common questions in nursing continuing education and medicine.

Peptic ulcers are circumscribed breaks in the continuity of mucosa, extending below the epithelium. Strictly speaking, breaks in the mucosa not extending below are called erosions, although they are often referred to as ulcers. Chronic ulcers have scar tissue at the base. Peptic ulcers can be located in any part of the gastrointestinal tract exposed to the acid-pepsin gastric juice, including the esophagus, stomach, duodenum and after gastroenterostomy, the jejunum. Although the peptic digestive activity of the gastric juice is an important etiologic factor, there is evidence that this is only one of many factors in its pathogenesis. Both cortisone and aspirin produce qualitative changes in the gastric mucus which may facilitate its degradation by pepsin.

Aspirin, alcohol, bile salts, and other substances injurious to the gastric mucosa alter the permeability of the epithelial barrier, which allows back diffusion of hydrochloric acid with resultant injury to underlying tissues, especially blood vessels. Histamine is liberated, which stimulates further acid and pepsin secretion and increased capillary permeability to proteins. The mucosa becomes edematous, and large amounts of plasma proteins may be lost. The mucosal capillaries may be damaged, resulting in interstitial hemorrhage and bleeding. Severe stress, especially chronic, is another major cause of gastric ulcers. Overall, acidity is the major pathogenic factor, so that a malfunction of Brunner's glands, which produce a mucoid secretion that neutralizes the acid chyme, would lead to ulceration. If normal tissue resistance defense systems like this are overwhelmed- ulcer. Also important to tissue resistance is vascular supply, proper epithelial regeneration - normally replaced every 3 days. HealthCMI will feature food cures for nursing continuing education online courses on this topic- coming soon!

Other causes: Indomethacin, phenylbutazone, and corticosteroids, also- caffeine. Associated diseases: Liver cirrhosis, chronic pancreatitis, chronic lung dz, hyperparathyroidism, and Zollinger-Ellison syndrome. In addition, bile reflux from abnormal pyloric sphincter function disrupts the mucosal barrier.

CLINIC: upper abdominal pain usually 2 hours after a meal and is relieved by foods and antacids; sometimes pain in the middle of the night (duodenal ulcer), and weight loss (gastric ulcer).

COMPLICATIONS: intractability, hemorrhage, perforation, and pyloric obstruction. Some ulcers are malignant, others may lead to iron-deficiency anemia, shock in the case of bleeding. Perforation may lead to chemical peritonitis and therefore intense pain, a fear of moving and breathing, and a rigid abdomen. If the pancreas is involved, pain may radiate to the back. Obstruction may lead to anorexia, nausea, and bloating after eating and weight loss; also, sever pain and vomiting.

STRESS ULCER: Brain injury, shock, sepsis, burns and drugs

Nursing Continuing Education and Nutrition

Highlight on Food

Food delivers the staple nutrition required to maintain health and a proper diet also speeds recovery from illness.  It follows that hospitals need to focus on quality foods for patients, staff, and for the public.  Under a holistic model of health, the hospital setting is an opportunity to provide quality food for its health benefits and to set an example to the community for healthy eating.  One strong example of a quality food delivery system in the hospital setting is Sutter Maternity and Surgery Center in Santa Cruz, California.  This 30 bed not-for-profit hospital serves fresh locally grown and certified organic foods.  Patients can order meals in a similar fashion to food service in quality hotels.  In addition, the fresh organic foods are available in the food cafeteria for the general public and staff.  The process is accomplished with Sutter’s model of purchasing food directly from a farm.  By contrast, the food courts in many hospitals provide fast-foods that provide profits but miss the mark in terms of healthy eating.

For a link to the US FDA Click Here .