Enjoy this article from the June 2009 edition of The Atlantic. It details the Harvard Study of Adult Development, which has probed the mental and physical development of 268 men (former Harvard University students) since the 1930's.
I love a good solid psychological study - and this one just makes me downright giddy. There is amazingly tenacious longitudinal research here. The study director is an enigmatic sort. The subjects are such an interesting, thriving group. Although in their late eighties, close to half of them are alive.
Who doesn't want to uncover the secrets to health, longevity and happiness? To understand what advantage No. 218 possesses over No. 47? Although I suspect that the study may pose more questions than answers in the short term, it's an intriguing look into an arena with vast uncharted territory.
Sunday, June 28, 2009
Tuesday, June 23, 2009
Peewee Potions: Sildenafil (Viagra)
Yes, Uncompromised Airways is a blog centered around the care provided to newborns in the neonatal ICU. Yes, Peewee Potions is the section that deals with interesting medications that we give to those newborns. And yes, believe it or not, sildenafil (most widely marketed under the trade name of Viagra) does have a place in the treatment of our NICU babies.
In 1998, sildenafil made headlines when Pfizer introduced it as the first FDA-approved oral treatment for erectile dysfunction. The drug had not always been envisioned as a prescription aphrodisiac, however. Initially, work at one of Pfizer's labs in England focused on its potential as an antihypertensive (blood pressure drug) and a treatment for angina pectoris.
Although sildenafil was found to be pretty ineffective for those two original purposes, the Sandwich, UK researchers did discover the drug's ability to render a man... tumescent. And apparently, someone kept thinking about the drug's cardiovascular properties. Now sildenafil is used in both adults and children for the treatment of pulmonary hypertension.
Persistent pulmonary hypertension of the newborn (PPHN) results from complications before, during or after delivery. Instead of the lung blood vessels relaxing in the moments to hours following delivery, they remain constricted as they were during pregnancy. This restricts the normal flow of blood to the lungs for oxygenation. Depending on the degree of constriction and the tension produced, the severity of PPHN varies greatly. Some patients have no symptoms, while others may die within days or survive with chronic oxygenation issues.
In babies, sildenafil was initially only employed at large academic medical centers in research protocols, often after the mainstay treatment (inhaled nitric oxide) had failed. Now it is making its way into non-academic NICU's. One advantage of the drug is that it can be given in both IV form (for very sick babies that aren't orally fed) and oral form (allowing the drug to be given even after the baby is discharged to home).
I don't think we've even seen the end of sildenafil's potential. There is talk of its usefulness in preventing plant wilting (absurdly phallic but true), treating altitude sickness and even enhancing sports performance. We should all stay tuned for the next chapter in the exciting life of a versatile drug.
In 1998, sildenafil made headlines when Pfizer introduced it as the first FDA-approved oral treatment for erectile dysfunction. The drug had not always been envisioned as a prescription aphrodisiac, however. Initially, work at one of Pfizer's labs in England focused on its potential as an antihypertensive (blood pressure drug) and a treatment for angina pectoris.
Although sildenafil was found to be pretty ineffective for those two original purposes, the Sandwich, UK researchers did discover the drug's ability to render a man... tumescent. And apparently, someone kept thinking about the drug's cardiovascular properties. Now sildenafil is used in both adults and children for the treatment of pulmonary hypertension.
Persistent pulmonary hypertension of the newborn (PPHN) results from complications before, during or after delivery. Instead of the lung blood vessels relaxing in the moments to hours following delivery, they remain constricted as they were during pregnancy. This restricts the normal flow of blood to the lungs for oxygenation. Depending on the degree of constriction and the tension produced, the severity of PPHN varies greatly. Some patients have no symptoms, while others may die within days or survive with chronic oxygenation issues.
In babies, sildenafil was initially only employed at large academic medical centers in research protocols, often after the mainstay treatment (inhaled nitric oxide) had failed. Now it is making its way into non-academic NICU's. One advantage of the drug is that it can be given in both IV form (for very sick babies that aren't orally fed) and oral form (allowing the drug to be given even after the baby is discharged to home).
I don't think we've even seen the end of sildenafil's potential. There is talk of its usefulness in preventing plant wilting (absurdly phallic but true), treating altitude sickness and even enhancing sports performance. We should all stay tuned for the next chapter in the exciting life of a versatile drug.
Thursday, June 4, 2009
NICU 101: What's an assignment?
A little something today for the nonmedical readers. I often get email, IM or personal comments from you (although you slackers never leave comments on the actual blog) that some of my terminology sounds a little funny. The term assignment is one that has raised people's ears a little.
You guys are familiar with the word itself. But I'm not referring to homework, to a military operation, or to something out of Mission: Impossible. An assignment is simply the load of patients that a nurse is tasked with taking care of in a given shift.
One of the important components of an assignment is the ratio of babies to the nurse. On the level 3 side of the unit (the sicker kids on ventilators), I generally get two patients. With level 2 babies (kids who are more stable, often former level 3 babies), I'll have three or four. Because of the juggling involved in multitasking for four newborns, a level 2 shift can easily turn busier than a level 3 shift.
You may hear me, on this blog or in real life, use the word assignment with any number of modifiers (some more colorful than others, at times). Examples:
a tight assignment - I don't mean tight as a hip, modern synonym for really great. This means that I was so busy I could barely provide the minimum acceptable level of care to each baby.
an easy assignment - Sometimes you get multiple kids that arent yet feeding or who are feeding by tube. Those save you a lot of time versus caring for their pokey eater counterparts. Why didn't I bring a book? Oh yeah... because all hell breaks loose any time I think to bring a book.
an admission assignment - This is the nurse who probably has the easiest assignment (like three level 2 babies) and will accept the first (second, third, etc) new baby admitted to our unit.
There you have it. Questions?
You guys are familiar with the word itself. But I'm not referring to homework, to a military operation, or to something out of Mission: Impossible. An assignment is simply the load of patients that a nurse is tasked with taking care of in a given shift.
One of the important components of an assignment is the ratio of babies to the nurse. On the level 3 side of the unit (the sicker kids on ventilators), I generally get two patients. With level 2 babies (kids who are more stable, often former level 3 babies), I'll have three or four. Because of the juggling involved in multitasking for four newborns, a level 2 shift can easily turn busier than a level 3 shift.
You may hear me, on this blog or in real life, use the word assignment with any number of modifiers (some more colorful than others, at times). Examples:
a tight assignment - I don't mean tight as a hip, modern synonym for really great. This means that I was so busy I could barely provide the minimum acceptable level of care to each baby.
an easy assignment - Sometimes you get multiple kids that arent yet feeding or who are feeding by tube. Those save you a lot of time versus caring for their pokey eater counterparts. Why didn't I bring a book? Oh yeah... because all hell breaks loose any time I think to bring a book.
an admission assignment - This is the nurse who probably has the easiest assignment (like three level 2 babies) and will accept the first (second, third, etc) new baby admitted to our unit.
There you have it. Questions?
Wednesday, June 3, 2009
In my fourth year...
So things have been a little crazy of late. It's mostly good stuff, but a couple of weeks ago the blue screen of death popped up on my laptop. Pardon the interruption. I'm back in service now. I don't want to publish a heavy post tonight, so I was looking for something simple. Here goes.
Tonight I chuckled as I read my last post. I noticed that I referred to myself as being "in my fourth year" as a NICU nurse. Now that I think about it, I've even caught myself saying that a couple of times in real life. You know you're still a pretty green nurse when it sounds significantly better to say "in my ____ year" rather than "____ years of experience."
I think I'm at a point in my career where I have the experience and knowledge to comfortably manage most of the babies that I encounter. At times I can even give some useful input to other nurses. On a unit where there is a nice balance of highly experienced nurses and newbies, it feels great when I'm respected as a colleague.
With that said, the "come to Jesus" moments are still there with alarming frequency. One minute I'm teaching lectures in our nurse internship program and considering a career as a nurse educator. The next minute I'm barely treading water with a busy assignment and questioning whether I'm competent. I've had some successes, but should my head ever get too big, there's a baby with an obscure condition just waiting to bring me back down a notch.
I guess I've discovered how important it is to take those learning experiences and allow them to make me a better nurse. On the other hand, I've learned that controlled confidence is a powerful thing. So on I go, learning while appearing confident... even if I must use tricky phrasing to pad my experience level along the way.
Tonight I chuckled as I read my last post. I noticed that I referred to myself as being "in my fourth year" as a NICU nurse. Now that I think about it, I've even caught myself saying that a couple of times in real life. You know you're still a pretty green nurse when it sounds significantly better to say "in my ____ year" rather than "____ years of experience."
I think I'm at a point in my career where I have the experience and knowledge to comfortably manage most of the babies that I encounter. At times I can even give some useful input to other nurses. On a unit where there is a nice balance of highly experienced nurses and newbies, it feels great when I'm respected as a colleague.
With that said, the "come to Jesus" moments are still there with alarming frequency. One minute I'm teaching lectures in our nurse internship program and considering a career as a nurse educator. The next minute I'm barely treading water with a busy assignment and questioning whether I'm competent. I've had some successes, but should my head ever get too big, there's a baby with an obscure condition just waiting to bring me back down a notch.
I guess I've discovered how important it is to take those learning experiences and allow them to make me a better nurse. On the other hand, I've learned that controlled confidence is a powerful thing. So on I go, learning while appearing confident... even if I must use tricky phrasing to pad my experience level along the way.
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