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Dogen

Dogen

Rabble rouser
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  1. Dogen

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    I'm not sure bashing BSN prepared nurses is a helpful addition to this conversation. It seemed like we'd done a pretty good job of covering the "we're all nurses" angle, so trashing your colleagues who have BSNs seems counterproductive. But what do I know? :)
  2. Dogen

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    Weeeeell, as with most things in research it's not as straight forward as it sounds. The researchers looked at nurse staffing and nurse education separately and together. Which is typical when you're studying multiple variables. What they don't mention is that in the study, specifically table 4, they found that neither education nor staffing was statistically significant alone, which means that the number of patients wasn't the single determining factor.
  3. Dogen

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    If I folded my diploma over three or four times I could probably make a pressure dressing out of it and save a life with it. So, in answer to OP's question, yes, but only if you get a bad cut in the vicinity of my garage.
  4. Dogen

    2/13/16 What I Learned This Week: Discipline is King

    I decided to teach myself sleep medicine, and then randomly I had a patient tell me they've been sleepwalking all of a sudden. One day she woke up in different pajamas, her iPhone was in the living room instead of the night stand, the front door was wide open, and she was wearing jewelry. Somnambulism is rare in adults, and it fits my theme, so I researched evidence based treatments. Here they are: 1. Another good reason to go to bed and get up at the same time everyday. Consistent sleep patterns reduce sleepwalking. 2. Treat sleep apnea and restless legs. The level of arousal caused by these conditions can trigger sleepwalking. 3. Rule out medications that can cause sleepwalking, like zolpidem (Ambien). 4. Don't drink alcohol within a few hours of bed (day drinking now evidence based, "I have to drink at lunch to avoid sleepwalking.") 5. Scheduled awakenings or a door alarm (buzzes and wakes you when door is opened).
  5. Dogen

    Don't Be SAD! - Seasonal Affective Disorder

    Sorry. Sometimes I ramble... Yes and no. I'm pretty sure AN is more interested in not getting in trouble than pushing the Big Pharma agenda, so I think the OP is tying to be helpful within the limits of the law. Big Pharma, though, would like you to go into your doctor and ask about Aplenzin, which costs $1,000/month before insurance. You're unlikely to be on both Wellbutrin and Aplenzin (d/t increased risk of seizures and serotonin syndrome), so if you go in asking about Aplenzin you're more likely to walk out with a prescription for that. Compare that to generic Wellbutrin, which runs about $100/month before insurance. I don't want to detract from the importance of people recognizing how their mood changes with the season by making this all about medication. I'm glad OP brought it up, and that people are starting to notice it. I was initially amazed how many of my patients loathe the holiday season because it brings with it things like a low mood, low energy, and a short temper. I'm glad so many people have gotten treatment that works for them, yourself included. :)
  6. Dogen

    Don't Be SAD! - Seasonal Affective Disorder

    There are multiple things going on in my head. The first is that depression is a symptom, and you treat the symptom of depression generally the same regardless of the cause. Someone with SAD can use the same medications as someone with Major Depressive Disorder, depression secondary to PTSD, etc. So, there are actually a lot of treatment options: all of the antidepressants (SSRIs, SNRIs, TCAs, MAOis, aminoketones...). Another thing, though, is that Wellbutrin and Aplenzin are the only FDA approved treatments for SAD. That means very little to me, but may be important to the author/AN for legal reasons. I can't fault them for not wanting to run afoul of the FDA, since advertising medications for off-label purposes can get you fined. FDA approval is a legal and financial hurdle, though, and it's common to prescribe off label when the literature supports the use. Sertraline (Zoloft) is approved for the treatment of PTSD while escitalopram (Lexapro) and mirtazapine (Remeron) aren't, but that doesn't stop anyone from prescribing them if they seem appropriate. Which brings to mind Sarafem, which is Prozac made into a purple pill and sold for premenstrual dysphoric disorder. They're even more closely related than Wellbutrin and Aplenzin - Sarafem and Prozac are the exact same drug. Sarafem is just a new name (Prozac has baggage), with a new effeminate color scheme to appeal to the market. So, I'm often leery of things like Aplenzin (a drug closely related to another drug that's now generic, marketed for a disorder that's new enough that most older drugs in the same class won't have FDA approval). But, that's my own baggage. :)
  7. Dogen

    Don't Be SAD! - Seasonal Affective Disorder

    There's some good correlational data on vitamin D levels being predictors of depressive symptoms, however the link is not as strong as people tend to believe. The lead author of the linked study cautions that the effects of vitamin D supplementation are likely to be small, but that it has no down side (supplements are generally cheap, safe, and well tolerated), so it's worth using. It's worth noting that a review published last year found no evidence that supplementation was beneficial, but that the included studies generally lacked good data to begin with. Many of them didn't even include patients with depression at baseline. So, the question of whether supplementation actually helps is still up for debate. ETA: Wellbutrin is bupropion hydrochloride, Aplenzin is buproprion hydrobromide... not that your prescriber couldn't prescribe either of those for SAD, it's just odd to me that the two mentioned treatments are buproprion salts.
  8. This started making the rounds on Facebook recently...
  9. Well, it depends who is intentionally asphyxiating whom. There are 12 different codes associated with asphyxiation due to being trapped in a discarded refrigerator. Were you put in there by someone else, or did you go in it on purpose? T71.232A - Asphyxiation due to being trapped in a (discarded) refrigerator, intentional self-harm, initial encounter T71.233A - Asphyxiation due to being trapped in a (discarded) refrigerator, assault, initial encounter
  10. W56.22XD The 7th character denotes first medical encounter (A), subsequent encounter (D), or sequelae (S). So... if you were struck by an orca, suffered an injury, and then psychological damage you'd be W56.22XS. Except there's probably a code for psychological damage related to being struck by an orca, because ICD-10 is so f-ing specific. V50.7XXA - person on outside of pick-up truck or van injured in collision with pedestrian or animal in a traffic accident, initial encounter V80.920A - Occupant of animal-drawn vehicle injured in transport accident with military vehicle, initial encounter
  11. Technically, subsequent encounters means with a provider, but...
  12. This is the definition of a slippery slope argument. There's no rational reason that once you start protecting groups of people you can't stop, because that's not how we decide whom to protect. We decide based on the merits of each group. The fact that transgender people expressing their identity doesn't inherently (by its very nature) harm anyone and pedophiles acting on their desire inherently does is absolutely a rational differentiation between the two. Your second point is factually inaccurate and denies virtually all of the changes in laws in the last 20 years that are so strict teenagers having sex with one another can be charged as committing crimes against each other, but it's so far removed from reality I don't really want to engage you on it. I'm putting this here so other people reading this will know you're basically just making things up.
  13. Can you be more specific? I feel like people think science is wishy-washy, changing its mind all the time. This might seem true if you read about science in popular media, because they're pretty terrible about conveying anything realistic or meaningful about science. In reality science rarely completely overturns a theory, and if it does it does so very, very slowly. Usually what happens is a process of refinement, where an idea becomes more accurate over time. This the neatest part of science to me, because when ideas are initially studied they're very murky, as though you're looking at them through a fog. In order to grab onto the idea you have to use very broad research, which kind of firms up where the edges of the idea are but doesn't give you much depth. As research progresses you have a better idea of what the boundaries of a concept are, and thus you can do more precise research, which gives you more narrow results, but with greater depth. This is like taking a magnifying glass to a small part of the concept. Over time, as you and other researchers peer at various parts of a concept up close, you can start merging all the data into a very clear, very precise representation of the concept. And that's why things like mental illness change over time, as we develop better research based on earlier research, and answer questions we hadn't been able to answer before. ETA: Also, things that sound sensational in the news usually aren't treated as such by researchers. When research was published that supported the idea that schizophrenia may be multiple, distinct disorders it made the rounds on the news and Facebook like it was a brand new idea, but within the research community pretty much everyone had believed that was true for about a decade. We'd seen the signs in tons of other research, so that paper merely supported a theory that already had pretty solid foundations.
  14. This is, honestly, the most difficult thing about these conversations. The language is fluid, everyone has their preferred terms, and different communities of relatively similar groups of people will want to be called different things. I'm far, far from an expert, and am happy to defer to those with more experience. It's a lot easier to have these conversations with an individual patient because I can say, "Tell me what makes you most comfortable." I had a patient who referred to herself as a "bull d**e" (rhymes with Mike), which is something I probably would have jumped on if said by someone here (or anywhere). When in doubt, though, I always go "people first," which is a result of my generation seeming to be very aware of our language. I'm happy to drop the "ed," and I never mind the correction, so thanks. :) As I said above, the terminology is the most difficult part of these conversations, because no one seems to agree on what's right. Your rule seems generally applicable enough, though, that I can make that switch... at least until someone else corrects me.
  15. You guys have great discussions... but if I may: these are patients who are transgendered, maybe transgendered patients, but not "a trans." That's like saying "if a Chinese walks in..." I have to point out that people who aren't religious don't accept the Bible as evidence, so pointing out that it has "stood the test of time," doesn't mean much to me. I appreciate that you have strong convictions, but to me it's just a book. I like that the DSM changes, because that reflects the growth in our knowledge. If the DSM didn't change it would be like reading a biology textbook that described health and illness in relation to the four humors, or a medical text that suggested transfusing blood from pigs into people. I trust science because it doesn't claim to be infallible, and that being able to challenge, test, and prove ideas is its greatest strength. Put me in the "crap nurse" column, then. I change my approach with every patient. I talk softer to frightened patients, I'm less formal with young patients, more formal (at least at first) with very old patients, I bring my energy down with aggressive or anxious patients, and I'm more stern with borderline patients. I adapt my approach because people need different things from me; my patients aren't all the same.
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