Salmonella and Eggs by Pat Iyer

September 6th, 2010

Inspections of Iowa egg production farms led to recalls of more than half a billion eggs. The visits to the farms were carried out to check compliance with new federal egg safety regulations that went into effect last month. Inspectors found unsanitary conditions in barns, including mice, maggots, flies, and piles of chicken manure as high as 8 feet. Escaped chickens tracked through the manure, and became infected with salmonella. As many as 1,500 cases of salmonella infected people have been reported since the spring of 2010. This is one kind of egg you don’t want on your face.

Salmonella is a bacteria that infects people, animals and birds. It creates a form of food poisoning marked by nausea, vomiting and diarrhea. Dehydration, blood infection and electrolyte imbalances can be fatal. The disease can be transmitted by raw eggs and meats, egg products, inadequately cooked meat, vegetables, cereal, pistachio nuts, and contaminated water. Humans can become carriers of the disease when the bacteria hides in the liver and gallbladder. The “wash your hands” signs in restaurant bathrooms are directed primarily to food handlers who may transmit salmonella from their feces to uninfected people.
eggs and salmonella
Although other factors can cause the same symptoms of Salmonella, such as infections with E. Coli, Shigella, viruses, and other toxins, the Salmonella organism can be cultured from a stool sample. Some experts believe Salmonella should be treated with antibiotics, while others say this is unnecessary in healthy people because the disease is self-limited. Dehydration is combated with IV fluids and water containing electrolytes. It can be tough to hold down even water. When I got food poisoning in India in 2008, I was unable to eat or drink anything for three days, and I gagged when I tried to drink water. I lost 10 pounds in 4 days.

What you can do:
Consider using Egg Beaters instead of eggs until the extent of the infected eggs is known.
Keep eggs refrigerated and discard any that are cracked or dirty.
Wash your hands with antibacterial soap and hot water after handling raw meat, poultry and eggs or using the bathroom. Avoid eating undercooked or raw meat or eggs.
Wash fruits, lettuce, and other vegetables before eating.
Don’t allow frozen meat to thaw at room temperature all day. Don’t let food with mayonnaise sit out on hot days.
You’ll reduce your risk of food poisoning by following these precautions.

Liability issues
The law allows for injunctions and criminal prosecution against the owners of the infected egg farms. Salmonella-related deaths would meet the criteria of significant damages for a potential lawsuit. Proving that contaminated eggs came from a specific farm would be difficult in some cases. But with the disgusting conditions uncovered by the egg farm inspections, it would not be hard to establish failure to comply with industry standards for sanitation.

Sources: http://www.medicinenet.com/salmonella/article.htm
http://www.nytimes.com/2010/08/31/business/31eggs.html?_r=2&emc=eta1
http://www.cdc.gov/Features/SalmonellaEggs/

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The Dangers of a Concussion by Pat Iyer

September 1st, 2010

When I was 19 years old, a frisky horse threw me and I landed on my head. I woke up sitting on my friend’s bed, having no memory of walking across the field with her to her house, and no understanding of how I had come to visit her. Her answers to my questions gradually made sense as my comprehension returned. After this concussion, I noticed I have trouble speaking fluently if I am very tired or stressed. I was fortunate. I was not taken to the emergency department to check for a skull fracture or brain bleed. My friend was a veteran of the rodeo circuit and said she had never seen anyone thrown as hard as I was. Her guilty–looking horse knew he had made a big mistake.

Soccer can cause head injuriesThe subject of head injuries associated with sports is in the news. A new study found high school-age athletes are more likely than younger kids to have sports-related concussions, but the rate of such injuries in both groups is on the rise. From 1997 to 2007, emergency department visits for concussion in kids aged 8 to 13 playing organized sports doubled, and the number of visits increased by more than 200 percent in older teens, according to the report. In related news, the American Academy of Pediatrics has issued new guidelines on what to do about sports-related concussions, with advice for both parents and physicians. The study and guidelines are published online and in the September print issue of Pediatrics. See the table for recommendations of action. Parents should know that “no athlete should go back to play on the same day they have their concussion. We recommend athletes who have a concussion be evaluated by a medical professional before they return to play,” Dr. Halstead said. Concussions can result in intracerebral hemorrhage, cerebral edema, and permanent damage. Repeated concussions, such as those suffered by boxers, can be disabling.

Source: http://www.healthfinder.gov/news/newsstory.aspx?docID=642556

Med League has worked on a few cases involving school-related head injuries. This is what I recall about these cases. In the first case, the school nurse became a defendant when a child hit her head on the wall. The school nurse was not clear enough to the parents about the need to have the child checked in an ER instead of going home. The child suffered a catastrophic brain injury; the plaintiff won the case.

In the second case, a college student was hit in his head during a soccer game, passed out, and was taken to the infirmary where an orthopaedic surgeon and college nurse examined him. Although they both advised him to go to the ER, he refused and went back to his dorm. A day later his roommate found him unresponsive and took him to the hospital, where he was diagnosed with a catastrophic brain injury. The judge dismissed the case against the defendants during trial.

The value of head injury cases is largely dependent on the liability issues and the extent and permanency of the damages. School personnel will need to be familiar with these guidelines so they obtain the urgent medical attention needed after a concussion. A delay in recognizing the development of swelling or bleeding can lead to permanent injuries.

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Improving the “stickiness” of your big ideas by guest author Stephanie Scotti

August 30th, 2010

made to stickThe title of this book certainly “stuck” with me over the past few months – it seemed it was being mentioned wherever I went. When I finally picked up my own copy and brought it on a recent flight, I was glad I did. Like a fun, upbeat friend, Made to Stick kept me company during the trip, with content that was at once entertaining, educational and exhilarating. Accomplished educators and idea collectors Chip and Dan Heath offer up practical, tangible strategies for making your ideas stick – a concept that should resonate with any presenter faced with a high-pressure, high-stakes situation.

Made to Stick is a book that will likely transform the way you communicate ideas. Here’s just a sampling of some thoughts from the Heath brothers that captured my attention:

Curse of Knowledge
Like sliced bread or indoor plumbing, once we know something, it’s hard to remember life without it. Knowledge is often “cursed” by being taken for granted, and it becomes difficult to share what we know in moderation. In an effort to be complete, we can’t discern the most important information we’d like to leave with our audience, and run the risk of overwhelming them. We keep going…and going…and going, and what sticks? Absolutely nothing. Check out the six principles outlined in Made to Stick that will help you overcome the dreaded Curse of Knowledge.

Velcro® Theory of Memory
Velcro material has two sides: one covered in thousands of tiny hooks, the other in tiny loops. Press the two together, and presto! – they stick. Our memories work the same way, with an infinite number of loops just waiting to cling to an idea with lots of hooks. The more hooks an idea has, the better it sticks. Think about a favorite class where the information presented really “stuck” with you. What did that instructor do to help Velcro that information to your brain? When developing your next presentation, stop and ask: How can I add more hooks to my content via interactivity, stories, or stronger visuals?

Human Scale Principle
What’s something we can all do better? Make statistics more human and dynamic. Made to Stick references a 1992 press conference where the Center for Science in the Public Interest revealed that the typical medium-sized buttered popcorn at a neighborhood movie theatre contains more artery-clogging fat than a bacon-and-egg breakfast, lunch of a Big Mac and fries, and a steak dinner with all the trimmings — combined. Certainly something we could easily grasp. Remember: The power is not in the numbers themselves, but rather in their scale and context.

Here’s a nice bonus …
Sprinkled throughout this accessible, quick-reading text are eight “Idea Clinics” filled with practical tips for applying what you’ve read in a fun, realistic way. In completing all eight clinics, I gained some intriguing new insights, while also being reminded of important “sticky” factors that were already on my radar. For example, Made to Stick challenges readers to distill the essence of their message, get back to core principles, and communicate in a memorable way — advice that parallels Professionally Speaking’s own C.O.D.E. process.

Whether you’re a non-profit, an entrepreneur, or a corporate executive, Made to Stick delivers some terrific tools for improving the way you communicate ideas. In fact, it got me so revved up that I overhauled an upcoming presentation to make it extra sticky! You know a book’s made a real impact when your copy ends up dog-eared, covered in highlighter, and dotted with margin notes. Hope your copy of Made to Stick ends up the same way!

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Death after being restrained by Pat Iyer

August 25th, 2010

alexis richieThe charge nurse found Alexis Evette Richie alone in a small room at SSM DePaul Health Center, motionless and sprawled facedown on a bean bag chair. Minutes earlier, the 16-year-old foster child had tried to hit, scratch and bite staff members in the adolescent psychiatric ward. Two aides grabbed her arms and took her down a hall and into a small room called the “quiet room.”

They held her facedown in the chair while a nurse injected a sedative into her hip. Alexis continued to struggle and then went limp. The nurse and the two aides left without checking her pulse or making sure she was breathing. Charge nurse Iris Blanks checked on her minutes later and didn’t think Alexis looked right. An aide helped Blanks roll the girl over. Alexis wasn’t breathing. Her pulse was faint. It was 12 minutes after she stopped moving before anyone tried to revive Alexis. By then it was too late.

Read more

Dr. Wanda Mohr and I did a teleseminar on the topic of death in restraints. She talked about a colleague of hers who did a study of pediatric deaths from restraints. Just simply looking at lawsuits and newspaper articles, within that 10-year period he found that 45 deaths had occurred and those deaths were specifically limited to children. The youngest child who had died was 6-year-old. The most common mechanism of death is restraint asphyxia. A person essentially asphyxiates or chokes to death. Her oxygen is cut off and that, most commonly, occurs in a prone position. This is associated with individuals actually putting pressure on people’s back and their lower back and despite their pleas that they were unable to breathe, the staff would not let the person up.

For a death in another treatment center, read about a 17-year-old boy who was strangled while being restrained.

One child dying of being restrained is far too many. There are safe ways to help agitated or violent people get back under control. Any healthcare provider working in a setting where this type of behavior could occur should know how to protect the patient (as well as the healthcare workers) from injury.

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correction

August 24th, 2010

This website erroneously published four paragraphs on Dr. James O’Donnell’s method of pain equilibrium written by Lorna Morelli-Loftin and Kevin McMullen. We regret this error. The reader may consult this material in August 2010 edition of the Vesper Trial Notebook.

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The aging motorcyclist by Pat Iyer

August 23rd, 2010

Motorcycle accidents can cause devastating injuries- shearing of skin, fractures, head injuries, massive bleeding. I have worked on several that resulted in fatalities, and a few that involved defects in the bike that resulted in the crash. All of the cases involved young men under the age of 30.

A new study shows that motorcycle owners in the United States are getting older. The researchers looked at injured motorcyclists aged 17 to 89 years in the National Trauma Databank invovled in crashes from 1996 to 2005. Age trends and injury patterns were assessed over time.

Injury Severity Score (ISS), length of stay (LOS), intensive care unit (ICU) use, comorbidities (other illnesses), complications, sdeath, injury patterns, helmet use, and alcohol use were compared for subjects 40 and older versus those younger than 40 years old.

There were 61,689 subjects included. Over the study period, the mean age increased from 33.9 to 39.1 years, and the proportion of subjects 40 years of age or older increased from 27.9 to 48.3 per cent. ISS, LOS, ICU LOS, and mortality were higher in the 40 years of age or older group. The rates of admission to the ICU (32.3 vs. 27.3%), pre-existing illnesses (20 vs. 9.7%), and complications (7.6 vs. 5.5%) were all higher in the 40 years of age and older group.

Motorcycle riders are getting older and more seriously injured

Motorcycle riders are getting older and more seriously injured

The average age of the injured motorcyclist is increasing. Older riders’ injuries appear more serious, and their hospital course is more likely to be challenged by illnesses and complications contributing to poorer outcomes. Motorcycle safety education and training initiatives should be expanded to specifically target older motorcyclists.

The Aging Road Warrior: National Trend toward Older Riders Impacts Outcome after Motorcycle Injury
Authors: Brown, Joshua B.; Bankey, Paul E.; Gorczyca, John T.; Cheng, Julius D.; Stassen, Nicole A.; Gestring, Mark L.

Source: The American Surgeon, Volume 76, Number 3, March 2010 , pp. 279-286(8)
Publisher: Southeastern Surgical Congress

The next time you see an older motorcyclist, give him or her a wider berth and be extra considerate. Think about the slowed reflexes in an older person and the higher risk of injury. If you ride cycles, check out the tips at this site for avoiding injury.

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“To Negotiate Successfully … Whose Ethical Compass Do You Follow” by Guest author Greg Williams

August 18th, 2010

When you negotiate, do you have problems with your ethical compass? Do you assess those with whom you negotiate to determine the direction in which their ethical compass points?

During negotiations, people get caught up in the moment. As a result, sometimes they say and/or do things that are misleading, misaligned with their core values, and even downright fraudulent. Nevertheless, one’s ethical compass is a matter of perception.Consider the following situations and in your own mind assess who’s right from an ethical point of view.

As the result of a new state law, the local police have the right to stop anyone that does not look a certain way. Some people are cheering, because they’ll get relief from local crimes that have occurred. Other people think the law will serve as a tool used to stop and possibly harass people that look a certain way. Are there ethical misalignments at work in this situation, or a genuine concern for the public’s safety?

You’re stuck in a plane, on the tarmac for hours. Airline authorities indicate they don’t want to let passengers deplane, because conditions could change at a moment’s notice and they need to be in a position to take off sooner versus later. Are they lying, or are they trying to avoid the hassle of going through the rigors of deplaning passengers?

Your stockbroker suggests you buy a financial product, while telling others they should sell the same financial product. Some say financial reform is the answer. Others say financial reform will be too restrictive. Is greed the factor that’s causing the ethical compass to be off center in this situation, or is it self-preservation. To what degree is the stockbroker’s ethical compass askew?

In the above situations, who is ethically right and what’s the real source of motivation? Are the people in these situations duplicitous in their lack of ethics? Are they simply viewing situations from the perspective that the solution will solve a problem? It really depends upon the perspective from which you view each situation and the goals participants are striving to accomplish. In reality, people on either side of the continuum could be manipulating their ethical compasses for their financial and/or self-satisfying betterment.

In this negotiation tip, I’m not passing judgment on any negotiator, nor the practices he uses. To each I say, to thy ownself be true. Let your conscious be your guide.

When negotiating, determine ahead of time what you’re willing to do to obtain what you’re seeking. Assess the other negotiator’s capacity to bend the truth in his efforts to get what he wants. In the balance will lie to what extent you and the other negotiator are willing to go to achieve the outcome being sought. To the degree that your assessment is accurate, you’ll have more control of the negotiation, from which you should be able to craft a more beneficial outcome … and everything will be right with the world.

The Negotiation Tips Are …

When you negotiate, if you find yourself in a state of lying, consider the consequences of your actions. You don’t want to win a battle, at the expense of losing the war.
Where possible, never knowingly pressure the other negotiator into a position whereby he has to lie to sustain or embellish his point. Be cognizant of his body language to gain insight into his source of motivation.
Seek to understand what may motivate someone to lie. In so doing, you can guard against that source and use it to your advantage if the situation is warranted.

Offer:
To inquire about having The Master Negotiator as a coach or consultant, or to conduct ‘live’ instructional sessions, and/or keynote presentations at your company, group, or organization, please send an e-mail to GregWilliams@TheMasterNegotiator.com and start getting more out of life, when you negotiate. Please include the verbiage, ‘Negotiation Inquiry’ in the subject line.

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How confident are you? By Guest author Natalie Gahrmann

August 16th, 2010

Many ambitious high achieving professionals fear that they are not really as bright and capable as others tend to think they are. As they climb the career ladder they have apprehension and self-doubt. Although they have accomplishments, they tend to attribute these achievements to luck. All this weighs heavily on an already full plate.

Seemingly very successful business leaders at every level of the organization, entrepreneurs, rising stars worry that they’re not as great as others think they are. Although they’ve faced every challenge, received recognition and promotions, their customers’ think they’re a super star they fear that they will be found out!

The imposter syndrome can hold you back from pursuing dreams and goals. It prohibits you from feeling pride and a sense of accomplishment. It can cause you to work harder than anyone else to convince yourself that if you were really as smart and capable as everyone else believes, you wouldn’t have to work so hard. The fear can be paralyzing and terrifying, if you allow it!

Don’t allow it! Contact The Priority Pro for help stepping into your greatness! Be as bright and capable as others already believe you are!

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Nurse violates confidentiality on Facebook by Pat Iyer

August 9th, 2010

Oakwood Hospital Employee Fired for Facebook Posting

Cheryl James enjoyed her job at Oakwood Hospital, Michigan. She never imagined posting something on Facebook from her own computer on her own time would get her fired. “He died for us, protecting us,” said James. Like so many others, James was emotional following the shooting death of Taylor Police Corporal Matthew Edwards. She worked for the hospital organization that treated the police officer and the shooting suspect, Tyress Mathews.

One night, while at home, she posted on Facebook that she came face-to-face with a cop killer and hoped he rotted in hell. She also posted another remark we can’t repeat.

Tuesday, she got a call. Her bosses wanted to talk.

“They called me in, told me that they got notice and word that I had posted this specific post on Facebook, and that they had to investigate it,” James said.

She says she immediately removed the posting and thought she might get written up or suspended. Instead, she got fired.

Read more

The nurse who posted her remarks offered enough information that readers were able to determine who she was talking about. This violated HIPAA, a federal statute that protects the confidentiality of medical information.

This nurse’s story is a good reminder that anything posted on social media sites can be easily desseminated, can hang around forever, and can come back to haunt a poster.

In the World War II era, the phrase was “loose lips sink ships”. Our parents and grandparents could not have foreseen that loose fingers could destroy a job.

What do you think? Have you seen comments on social media that make you cringe?

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When should nursing staff call a rapid response team? by Pat Iyer

August 4th, 2010

A sudden deterioration in a patient’s condition should stimulate activation of emergency efforts. The goal of a rapid response team (RRT) is to avert a cardiac arrest – to take action before the patient stops breathing. here are some generally accepted reasons to call a team of professionals to the bedside:

Staff worried about patient
Acute change in heart rate
Acute change in systolic blood pressure
Acute change in respiratory rate

a rapid response team could save your life

a rapid response team could save your life


Acute drop in O2 saturation
Acute change in mental status
Drop in urine output
New, repeated, or prolonged seizures
Fractional inspired oxygen of 50% or greater
Failure to respond to treatment for an acute problem/symptoms

The composition of RRTs varies from hospital to hospital. A team typically consists of 2-3 people who are assigned to flexible responsibilities within the facility. The team may consist of respiratory therapists, physician assistants, nurse practitioners, critical care nurses, intensivist (critical care doctors), hospitalists (physicians employed within a facility to provide inpatient care) or residents. The team’s role is to assess and stabilize the patient, assist with communication with the attending physician, educate and support the nursing staff and family, and assist with transfer to another level of care, if needed.

The rapid response team serves a vital role, but not all hospitals have them. Does yours? Consider this important patient safety feature when you pick a hospital.

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