Learn more about healthcare and insurance issues affecting nurses, doctors, and patients at HealthCMI Online, http://www.healthcmi.com .

Learn more about nursing and medical continuing education news at HealthCMI by clicking Nursing Continuing Education Online.

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.

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 .

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).  To learn more about medical news and medical continuing education visit http://www.healthcmi.com .

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.

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.

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

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 .

Nurse to Patient Ratio Issues

Job Burnout and Quality Patient Care

HealthCMI will feature important nursing continuing education courses on quality of life factors for nurses. Nursing continuing education will focus on important roles that nurses can empower themselves with in the working environment. Look forward to nursing continuing education online at HealthCMI!

In one of the most interesting studies concerning the nursing profession (JAMA. 2002 Oct 23-30;288(16):1987-93), important results were tabulated concerning nurse to patient ratios. Research articles are often dry. Not this one. The opening description of the abstract notes, “The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.” The research was conducted by the Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania. The results showed, “each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction.” The study was conclusive that the mortality rate for surgical patients is higher with fewer nurses per patient and job burnout for nurses increases as well.

Registered nurses represent the largest number of healthcare providers in the United States.  There are 2.5 million nurses and over 50 percent of them work in the hospital setting.  The educational preparation for a career in nursing may include a bachelor’s degree, an associate degree, or a diploma from a dedicated nursing program.  There is an increasing demand for nurses in the US and over a 500,000 new nursing positions are expected to be created by the year 2015. 

Registered nurses (RN’s) work with both patients and the general public in an effort to educate people about treatment paths for medical conditions.  Nurses treat patients, perform and analyze diagnostic tests, and administer medications.  Nurses also perform record keeping responsibilities and work with patient rehabilitation.  Very importantly, nurses provide emotional support to patients and their families. 

Nurses are essentially on the “front lines” of medicine.  They may be responsible for reviewing and explaining issues concerning post-operative recovery, dietetics, and for helping patients to understand their responsibilities regarding recovery from illness and also how to maintain wellness.  Many nurses operate in a public health capacity in an effort to education the public concerning the signs and symptoms regarding disease processes.  Other efforts include working at immunization clinics, physical therapy centers, blood drives, and the operation of important medical equipment for diagnostic, analytic, and treatment purposes. 

Nurses provide an important role in monitoring and administering medications including the checking of dosages.  Other nurses may be charged with administering intravenous (IV) fluids including pharmacological agents and blood.  Nurses may also oversee and manage nursing aids.  Nurses with advanced certifications may have the power to prescribe medications.

Specialization in nursing takes several directions.  Many nurses perform perioperative procedures for work in operating rooms and act as assistants to surgeons.  Other nurses manage long term cases of illness involving the careful monitoring of lifestyle, medications, and follow-up visits.  Nursing specialties can be quite specific to a particular demographic, organ, or disease type.  There are several major categories of nursing specialties.  They include perioperative nurses, rehabilitation nurses, long-term care nurses, ambulatory care nurses, emergency nurses, hospice care nurses, infusion nurses, home health care nurses, transport nurses, critical care nurses, palliative care nurses, radiology nurses, perianesthesia nurses, mental healthcare nurses, transplant nurses, and more.  The income for nurses ranges from approximately $40,000 to over $80,000.