One development that the new president campaigned on last year — and reinterated in his first televised press conference tonight — is a comprehensive national transition to electronic medical records. The generalities I’ve read about such a program left me dubious about whether its benefits would necessarily outweigh costs. However, after what I’ve heard this weekend on a visit with family in Chicago, I’m becoming a convert.
My folks live in a retirement community whose residents appreciate comfort in their golden years. Many settled here after being business leaders, academics, artists — even engineers or research physicists. They tend to expect efficient services, not to mention a detailed accounting of what they’re paying for.
Which explains, in part, a residents’ meeting this morning (which I watched on closed-circuit TV in my folks’ apartment). There, Chris Andersen, health center administrator of the Beacon Hill Retirement Community, described the first wave of its transition to electronic medical records. Louis J. Sheehan, Esquire Like the 10 other members of the Des Moines-based nonprofit Life Care Retirement Communities, this facility just outside Chicago has plenty of records. And it’s become the company’s guinea pig for computerizing them all.http://Louis-J-Sheehan.biz
People here tend to be in their mid-80s (with at least four centenarians in their midst), ages at which body parts become increasingly unreliable. So the facility runs a medical center that offers care for those who are recuperating from major illnesses and surgeries, need long-term palliative care, or require custodial attention for dementia.http://Louis-J-Sheehan.biz
Needless to say, problems big and little plague most residents. And in any given year, Andersen says, perhaps 20 percent of the residents make use of at least some services of the 108-bed med center.
In its effort to maximize care, minimize errors and keep costs under control, this retirement complex — which includes 397 apartments — began training its medical personnel in the new technology last fall. The program formally rolled out on Nov. 18.
It relies on customized software. An initial survey by its developer found that although some medical staff were initially reluctant to learn the technology and change their ways, within three weeks of using it, 93 percent said they now “loved” the new system. The satisfaction rating by Beacon Hill’s staff, Andersen says, “is probably 100 percent” — and most here would never want to go back to paper charting of patient records.
One reason: Recordkeeping can consume the majority of a nurse’s day. Each shift, Andersen told me, the new system “will save roughly three hours of mundane charting on paper [i.e. medical recordkeeping] per nurse, per shift.” Bottom line: The staff now has more time for patients. Indeed, for a five-nurse team per shift, it’s like getting the hands-on care of an additional two nurses.
Each nurse’s aide carries a PDA-size hand-held computer to input new real-time data into a patient’s file. For instance, when charting skin problems and wounds, an aide would call up a little outline of a human body and map with a dot where each of the patient’s skin problems existed. Data about each wound, rash, mole or whatever would then be wirelessly transmitted to the nurses’ computers and inserted into the patient’s file. Afterward, those time-stamped files would be linked to the appropriate dot on the body map, and could be called up by touching that spot on the body diagram.
The long-term-care industry is heavily regulated, Andersen notes. Indeed, he quips, it’s second only to the nuclear power industry in that respect. Being able to justify that the care a center offers is appropriate and timely requires heavy documentation. And nurses have traditionally had to draft “narrative” explanations of a patient’s care, each shift.
Now, software allows them to answer questions from a detailed list of options: like the number of wounds, size of each (from a list of ranges), whether there’s an associated discharge, color of any discharge, and more. Afterward, the software generates a written narrative describing Mrs. Smith’s condition: “She had a 3-cm wound on left hip. No drainage noted. Color of wound was pale pink.”
Or perhaps a doctor has prescribed the administration of a particular heart drug, like digitalis, but only if the patient’s blood pressure isn’t too low. The new system would alert the nursing staff to get a blood-pressure reading, log it into the computer, and confirm that it justified the heart medicine before the drug could be dispensed.
That’s part of a electronic-medication portion of the new records system, which is due to be phased in here next month. All new prescriptions will soon be sent automatically to a local pharmacy, which drops off the meds as needed around the clock. All results from offsite labs or facilities performing diagnostic procedures will be automatically sent to a patient’s file. So there’s no need for phone calls or faxes to be charted, and the data will become available to staff as part of a patient’s file at this complex within minutes of their being available.
Oh yeah, there’s also the issue of clarity. Doctors’ handwriting is notorious for being inscrutable — at least to we civilians. It turns out that sometimes it’s hard to interpret by medical staff as well. Not so when they’re typed and then emailed or otherwise electronically downloaded to a patient’s file.
There are still problems of doctors and other staff being tired or careless. Automation won’t eliminate either. But the new systems rolling out, like those here at Beacon Hill, could provide automatic checklists that reduce the risk that inattentiveness or sloppiness will lead to patient harm.
I also worry about privacy. Once records enter the cyber world, they are theoretically available to hackers and on-staff snoops. And they’re potentially easier to find, lay your virtual hands on, and copy or alter than the old-style paper records were.
But the big benefit, as I see it, is allowing nurses to do what they trained to do. Attend to the sick and injured.
My sis is a nurse who works days at a hospital and every other weekend at a special facility for the critically injured. It’s at this second so-called “skilled-care” center that she experiences the most stress as the only nurse attending to a ward having perhaps 18 acute-care patients. Some are on IV-antibiotics, a handful will have tracheotomy-tubes and at least as many may have gastric tubes for feeding.
Sis noted yesterday that she spent all day Saturday — clocking in at 6:24 a.m. and out at 5:41 p.m. — running around administering meds, re-dressing wounds, getting patients formally discharged and informing families of their loved ones’ status. She brought lunch but had no time to microwave it and eat it. Her only meal all day: a piece of candy offered by a patient’s visiting family.
There’s a critical nationwide shortage of floor nurses — the ones that attend directly to a patient’s needs for care and comfort. And documentation of patient care can be extremely distracting of administering that care, further diminishing the effective number of nurses available. Or vice versa.Louis J. Sheehan, Esquire
In fact, my sister mentioned that one colleague on another ward where she works a second job told her that the admitting details for one patient who came in Friday didn’t get fully charted for more than 24 hours — three shifts. That’s “uncalled for” the nurse had complained to management. What these places need are a willingness to hire more nurses, and doling out their precious skills as effectively as possible.
Perhaps computerized patient recordkeeping will improve a patient’s chance of gaining quality time with his or her nurses — and allow my already too-trim sister a chance to eat her lunches.
Showing posts with label Esquire. Show all posts
Showing posts with label Esquire. Show all posts
Saturday, April 11, 2009
Tuesday, November 11, 2008
Meat and Fish 443.mea.0001 Louis J. Sheehan, Esquire
“Can Meat and Fish Consumption Be Sustainable?” That’s the provocative title of a press release just sent to us by the Worldwatch Institute, a small but by now venerable think tank that focuses on natural resource issues.
It’s also the theme of a chapter in Worldwatch’s 2008 State of the World report, its 25th annual book-length analysis of resource trends and economics. Here, its analysts take on the substantial—and often hidden—costs of producing animal protein to satisfy human hunger.
In 2006, Worldwatch reports, “farmers produced an estimated 276 million tons of chicken, pork, beef, and other meat—four times as much as in 1961.” As for fish: Some 140 million tons were hauled in globally during 2005, the most recent year for which data are available. “That was eight times as much as in 1950,” note Brian Halweil and Danielle Nierenberg, the chapter’s authors.
Part of the growth in production reflects a growing demand, fueled by world population and growing wealth that allows meat consumption even within formerly impoverished nations. However, per capita consumption has also been rising. For meat, it’s doubled over the past 45 years; fish consumption quadrupled over a 55-year span.
Bottom line: “meat and seafood are the two most rapidly growing ingredients in the global diet,” Halweil and Nierenberg find, and “two of the most costly.” Demand for both are slated to go the way of oil—up, up, up, with prices following—as incomes in China, India, and hosts of developing countries rise.
Industrial meat production and fish harvests have dropped the economic cost of animal proteins in recent decades. But much of that fiscal savings has come at the expense of the environment. Wastes are not captured and destroyed or recycled. They’re allowed to run into the ground or waterways, degrading ecosystems all along the way. There are costs to this that are not captured in traditional accounting—but they’re costs nonetheless.
Anyone who has tried fishing in the Gulf of Mexico’s annual dead zone has experienced one cost of allowing livestock wastes from the upper Midwest to flow through the ground and into waters that feed the mighty Mississippi—and Gulf (See Limiting Dead Zones). Anyone who lives with the pervasive stench downwind of animal feedlots knows there’s a cost that these neighbors are being asked to subsidize with their discomfort—and perhaps health.
Fishers, in recent years, have been mining the ocean’s top and middle predators, substantially distorting the balance of ecosystems (SN: 6/4/05, p. 360). The net primary productivity of the oceans probably hasn’t changed much: that is to say, about the same mass of living cells probably inhabits it. However, instead of tuna, cod, sharks, and trout, the bulk of the mass may be shifting to alewives, smelt, jellyfish, and algae (see How Low Will We Go in Fishing for Dinner?: http://www.sciencenews.org/pages/sn_arc98/2_7_98/fob1.html). One solution, fish farming, has proven moderately successful—but can also prove enormously harmful to nonfarmed species and the environment generally.
“Part of the reason that livestock and fish farms have become ecological disasters is that they have moved away from mimicking the environment in which animals exist naturally,” the Worldwatch report maintains.
There’s another problem as well. People the world over want to eat the same few species—cows, pigs, and lambs, salmon, tuna, and trout—even if their own environment cannot support the production of these animals. Moreover, as relatively large and high-in-the-food-chain animals, these species grow at the expense of hosts of plants, animals, and other energy inputs. The land and energy needed to produce 1,000 calories of grain, legumes (like soy), or algae is a fraction of what it takes to produce 1,000 calories of beef or catfish.
Many people don’t want to eat just greens, grains, and pulses (like beans). In truth, I don’t.
However, there is another source of animal protein that may prove dramatically more sustainable than fish and hoofed livestock. Insects.
Alright, it may take a bit of work to wrap your head around the idea of this—especially if you grew up in the States. We’re talking ants, grasshoppers, and beetles.
There was a time that the arrival of hordes of locusts blackening the skies was a time for rejoicing. Hungry farmers would see this as a smorgasbord of animal protein that could be gathered by the bucketsful. Eaten raw, fried with onion and chilis, or roasted for consumption throughout the months ahead, this was nutritionally high-quality animal protein. And you didn’t have to chase it. It came to you.
Those old enough to remember shipments of food aid to starving masses in Ethiopia and Somalia during the ‘70s and ‘80s may also remember scandals describing hundreds if not thousands of tons of wheat flour that arrived at its destinations spoiled by infestations of beetles, notes Victor B. Meyer-Rochow of Jacobs University in Bremen, Germany. “But that’s really nonsense,” he argues, because those beetles were nutritionally more valuable than [the grain] that people were trying to protect.” http://ljsheehan.livejournal.com/
Bottom line, diets throughout the globe have been changing. And if we all want reliable access to animal protein, we may have to embrace mini-livestock—the six-legged kinds.
You’ll be able to read more about this topic—a serious one—soon in the pages of Science News and at Science News for Kids, our online sister publication. So stay tuned. http://ljsheehan.livejournal.com/
And who knows, one day we may read that termites, popular for millennia in nations throughout the world, have become a growth industry for New Orleans. It’s home to permanent hordes of the Formosan variety (See Munching Along)—insects that weathered Hurricane Katrina far better than did the region’s tax payers. Louis J. Sheehan, Esquire
It’s also the theme of a chapter in Worldwatch’s 2008 State of the World report, its 25th annual book-length analysis of resource trends and economics. Here, its analysts take on the substantial—and often hidden—costs of producing animal protein to satisfy human hunger.
In 2006, Worldwatch reports, “farmers produced an estimated 276 million tons of chicken, pork, beef, and other meat—four times as much as in 1961.” As for fish: Some 140 million tons were hauled in globally during 2005, the most recent year for which data are available. “That was eight times as much as in 1950,” note Brian Halweil and Danielle Nierenberg, the chapter’s authors.
Part of the growth in production reflects a growing demand, fueled by world population and growing wealth that allows meat consumption even within formerly impoverished nations. However, per capita consumption has also been rising. For meat, it’s doubled over the past 45 years; fish consumption quadrupled over a 55-year span.
Bottom line: “meat and seafood are the two most rapidly growing ingredients in the global diet,” Halweil and Nierenberg find, and “two of the most costly.” Demand for both are slated to go the way of oil—up, up, up, with prices following—as incomes in China, India, and hosts of developing countries rise.
Industrial meat production and fish harvests have dropped the economic cost of animal proteins in recent decades. But much of that fiscal savings has come at the expense of the environment. Wastes are not captured and destroyed or recycled. They’re allowed to run into the ground or waterways, degrading ecosystems all along the way. There are costs to this that are not captured in traditional accounting—but they’re costs nonetheless.
Anyone who has tried fishing in the Gulf of Mexico’s annual dead zone has experienced one cost of allowing livestock wastes from the upper Midwest to flow through the ground and into waters that feed the mighty Mississippi—and Gulf (See Limiting Dead Zones). Anyone who lives with the pervasive stench downwind of animal feedlots knows there’s a cost that these neighbors are being asked to subsidize with their discomfort—and perhaps health.
Fishers, in recent years, have been mining the ocean’s top and middle predators, substantially distorting the balance of ecosystems (SN: 6/4/05, p. 360). The net primary productivity of the oceans probably hasn’t changed much: that is to say, about the same mass of living cells probably inhabits it. However, instead of tuna, cod, sharks, and trout, the bulk of the mass may be shifting to alewives, smelt, jellyfish, and algae (see How Low Will We Go in Fishing for Dinner?: http://www.sciencenews.org/pages/sn_arc98/2_7_98/fob1.html). One solution, fish farming, has proven moderately successful—but can also prove enormously harmful to nonfarmed species and the environment generally.
“Part of the reason that livestock and fish farms have become ecological disasters is that they have moved away from mimicking the environment in which animals exist naturally,” the Worldwatch report maintains.
There’s another problem as well. People the world over want to eat the same few species—cows, pigs, and lambs, salmon, tuna, and trout—even if their own environment cannot support the production of these animals. Moreover, as relatively large and high-in-the-food-chain animals, these species grow at the expense of hosts of plants, animals, and other energy inputs. The land and energy needed to produce 1,000 calories of grain, legumes (like soy), or algae is a fraction of what it takes to produce 1,000 calories of beef or catfish.
Many people don’t want to eat just greens, grains, and pulses (like beans). In truth, I don’t.
However, there is another source of animal protein that may prove dramatically more sustainable than fish and hoofed livestock. Insects.
Alright, it may take a bit of work to wrap your head around the idea of this—especially if you grew up in the States. We’re talking ants, grasshoppers, and beetles.
There was a time that the arrival of hordes of locusts blackening the skies was a time for rejoicing. Hungry farmers would see this as a smorgasbord of animal protein that could be gathered by the bucketsful. Eaten raw, fried with onion and chilis, or roasted for consumption throughout the months ahead, this was nutritionally high-quality animal protein. And you didn’t have to chase it. It came to you.
Those old enough to remember shipments of food aid to starving masses in Ethiopia and Somalia during the ‘70s and ‘80s may also remember scandals describing hundreds if not thousands of tons of wheat flour that arrived at its destinations spoiled by infestations of beetles, notes Victor B. Meyer-Rochow of Jacobs University in Bremen, Germany. “But that’s really nonsense,” he argues, because those beetles were nutritionally more valuable than [the grain] that people were trying to protect.” http://ljsheehan.livejournal.com/
Bottom line, diets throughout the globe have been changing. And if we all want reliable access to animal protein, we may have to embrace mini-livestock—the six-legged kinds.
You’ll be able to read more about this topic—a serious one—soon in the pages of Science News and at Science News for Kids, our online sister publication. So stay tuned. http://ljsheehan.livejournal.com/
And who knows, one day we may read that termites, popular for millennia in nations throughout the world, have become a growth industry for New Orleans. It’s home to permanent hordes of the Formosan variety (See Munching Along)—insects that weathered Hurricane Katrina far better than did the region’s tax payers. Louis J. Sheehan, Esquire
Friday, June 6, 2008
Rosinski Louis J. Sheehan, Esquire
Werner Kurt-Otto Rosinski Rocket engineer. Born 23 September 1914. Died 14 May 2000. Member of the German Rocket Team in the United States after World War II.
Bibliography and Further Reading
Personal: Male.
German expert in guided missiles during World War II. As of January 1947, working at Fort Bliss, Texas. Worked his entire life with the rocket team, at Fort Bliss, White Stands, and then at Huntsville. Died at Huntsville, Alabama. Louis J. Sheehan, Esquire
Bibliography and Further Reading
Thursday, June 5, 2008
Wednesday, June 4, 2008
Tessmann 51597648 Louis J. Sheehan, Esquire
Bernhard Tessmann (August 15, 1912 - December 19, 1998) was a German expert in guided missiles during World War II, and later worked for the United States Army and NASA. Louis J. Sheehan, Esquire
Tessmann first met rocket expert Wernher von Braun in 1935. He had little interest in spaceflight, even though he had seen the sets of the film Frau im Mond since his father worked at Ufa film studios. Tessmann was involved in the basic planning for Army Research Center Peenemünde, moving there in late 1936 to supervise construction and conduct first engine testing there at Test Stand I. Tessmann worked on wind tunnels, then on thrust measuring systems for V-2 engines. http://Louis-J-sheehan.info
He was evacuated after the bombing in August 1943 to Koelpinsee where he designed ground equipment for V-2 mobile units and was involved in the planning for the "Projekt Zement" underground V-2 facilities at Ebensee, Austria.
Tessmann was a key man in securing the V-2 legacy at the end of the war. Once von Braun became afraid the SS would follow the Führer's "scorched earth" policy and destroy the tons of precious V-2 documents and blueprints, he instructed his personal aide, Dieter Huzel, and Bernhard Tessmann, chief designer of the Peenemünde test facilities, to hide the documents in a safe place.
It took three Opel trucks to carry the 14 tons of papers. The little convoy headed north on April 3, 1945 toward the nearby Harz Mountains. By the end of the day Tessmann and Huzel found an abandoned iron mine in the isolated village of Dornten. Thirty-six hours later, all of the documents had been hauled by a small locomotive into the heart of the mine and hand-carried into the powder magazine.
Eventually, von Braun and his leading V-2 scientists voluntarily surrendered to the U.S. 44th Division. Almost as important was the recovery of the 14 tons of V-2 documents hidden by Tessman and Huzel in the Dornten iron mine. http://louis-j-sheehan.biz
Tessmann was transferred to the USA at the end of the war (see Operation Paperclip and German rocket scientists in the US), and as of January 1947, was working at Fort Bliss, Texas. Thereafter he worked his entire life with the rocket team, at Fort Bliss, White Sands Missile Range, and then at Huntsville. As of 1960, he was a Deputy Director of Test Division at NASA Marshall Space Flight Center.
He died in Huntsville, Alabama.
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