“Borderless Healthcare Introductory Workshop"

Fly Free for Health, the largest medical tourism ecosystem in the world, is having the Philippines’ first medical tourism workshop entitled “Borderless Healthcare Introductory Workshop on October 10-11, 2009 in SM Manila. Nurses like you have a dual role in medical tourism: to help medical tourists find appropriate destinations in which to obtain healthcare and to inform them of ethical or legal dilemmas. To find out more about what medical tourism has for you, join us and take advantage of the following benefits:

1. Become the pioneer in borderless healthcare in the Philippines
2. Meet the best and leading experts in medical tourism and be a part of the dynamic Q and A sessions with them
3. Network with representatives from large healthcare institutions in Thailand and Singapore
4. Be part of the video CV and get the chance to be seen by international hospitals
5. Get 4 exclusive certificates from the large medical tourism institutions
6. With the expansion of medical tourism, increase your employability rate in hospitals around the world
7. Have the chance to be a medical butler, a healthcare trained online concierge

The 2-day workshop fee is as follows:

Solo Group of 3 Group of 10
Early Bird
(Sept.15-30) 2,750 2,500 2,250
After Sept.30 3,250 3,000 2,750

Reserve your seats now and get these early bird prices.

Reservation is a nonrefundable fee of PHP500. Email lloyd@flyfreeforhealth.com to reserve your seats. Register at www.medicalbutler.com. If you have questions, please email info@medicalbulter.com.

Borderless Healthcare Introductory Workshop

Fly Free for Health, the largest medical tourism ecosystem in the world, is having the Philippines’ first medical tourism workshop entitled “Borderless Healthcare Introductory Workshop on October 10-11, 2009 in SM Manila. Nurses like you have a dual role in medical tourism: to help medical tourists find appropriate destinations in which to obtain healthcare and to inform them of ethical or legal dilemmas. To find out more about what medical tourism has for you, join us and take advantage of the following benefits:

1. Become the pioneer in borderless healthcare in the Philippines
2. Meet the best and leading experts in medical tourism and be a part of the dynamic Q and A sessions with them
3. Network with representatives from large healthcare institutions in Thailand and Singapore
4. Be part of the video CV and get the chance to be seen by international hospitals
5. Get 4 exclusive certificates from the large medical tourism institutions
6. With the expansion of medical tourism, increase your employability rate in hospitals around the world
7. Have the chance to be a medical butler, a healthcare trained online concierge

The 2-day workshop fee is as follows:

PHP 2750- solo
PHP 2500- group of 3
PHP 2250- group of 10

These promo prices only run from Sept 10-20, 2009. Reserve your seats now and get these early bird prices.

Reservation is a nonrefundable fee of PHP500. Email lloyd@flyfreeforhealth.com to reserve your seats. Register at www.medicalbutler.com. If you have questions, please email info@medicalbulter.com.

Magnesium sulfate may be given to the asthmatic who is unresponsive to traditional therapy

Magnesium sulfate acts as a smooth-muscle relaxant and causes bronchodilation, which might be helpful in treating asthma. However, magnesium relaxes all smooth muscle including the heart which can lead to bradycardia and hypotension -- undesirable side effects in a patient already in distress!

Magnesium sulfate administered by itself (either IV or nebulized) does not improve pulmonary function sufficient to overcome an asthma attack. Given in combination with traditional treatment IV magnesium does improve pulmonary function in patients with moderate to severe asthma. Magnesium is not recommended for treatment of mild to moderate asthma.

Nebulized magnesium is an attractive alternative that might decrease cardiovascular side effects, but has not been shown to have the same benefits as IV magnesium.

Regardless of how sick the asthmatic appears, the first line treatment is always bronchodilators and steroids. Magnesium may be used as an adjunct to traditional treatment to improve pulmonary function when the cardiovascular side effects can be tolerated.

From:
Aggarwal P et al. (2006). Comparison of nebulised magnesium sulphate and salbutamol combined with salbutamol alone in the treatment of acute bronchial asthma: A randomized study. Emerg Med J, 23; 358-62.

Silverman, R.A., et al. (2002). IV magnesium sulfate in the treatment of acute severe asthma. Chest, 122(2); 498-97.

Complication of Pantoprazole Therapy

Acid-suppressive therapy with proton-pump inhibitors, such as pantoprazole, significantly increases the risk of hospital-acquired pneumonia, community-acquired pneumonia, and intestinal infections like C-difficile. Histamine-2-receptor antagonists, such as famotidine, did not increase the incidence of hospital-acquired pneumonia in a recent study.

Proton-pump inhibitors decrease stomach acid by blocking the mechanism (pump) that pushes acid into the stomach, thereby decreasing the amount of acid in the stomach and lowering the risk of ulceration. The unwanted side effect of decreasing stomach acid is that gastric contents become less acidic and make the stomach a better place for bacteria to live. Bacteria like C-difficile are not killed by the stomach acid and can reproduce and cause infection. In addition, microaspirations occur in most people (70% have some gastric reflux) and small amounts of gastric secretions migrate up to the trachea and into the lung causing infection.

It is important to prevent your patient from developing gastric ulceration, but it is equally important to know that proton-pump inhibitors increase the risk of pneumonia and to implement interventions to prevent pneumonia. Coughing, deep breathing, and incentive spirometry are part of a plan of great pulmonary hygiene that can help prevent pneumonia. Brushing the patient's teeth every 12 hours is the best intervention for preventing pneumonia.

Pantoprazole is metabolized by the liver and excreted in the urine, but rarely causes damage to either of these organs. Pantoprazole would not cause coronary artery spasm because it does not have vasoactive effects.

From: Herzig, S.J. et al. (2009). Acid-suppressive medication and the risk for hospital-acquired pneumonia. JAMA, May 29; 301:2120.

JUNE 2009 NLE-PASSER

After four years of hardwork and dedication in the College of Nursing it paid off a lot when i hear about the news that i was one of those successful examinees in the JUNE 6-7 2009 NLE.I was really anxious about it before the results were released I even experienced headache,DOB, palpitations and even stable angina. But when I learned about the news all those symptoms of severe anxiety was gone. I feel so blessed that time, I was in Manila with my friends and I am very thankful with my friend named Ariane she was the one who tried to reach me and ask me about my middle name because she wasn't sure about it, and when i confirmed it to her we both shout and said Thank you Lord God."RN na kami". After that text messages from my family and friends started to fill in my inbox saying congratulations and some words of wisdom and inspirations which i was very touched. I would like to give thanks to my FAMILY and Relatives for thier everlasting support and love for me. My ALMA MATER-UNIVERSITY OF PERPETUAL HELP SYSTEM DALTA-LP CAMPUS and My PRNster FAMILY for the knowledge and wisdom that i got from them most especially from Ms.Karleen and Sir REX Quilla who tried to reach me for the last minute I salute Him, and to my real friends for the continuous care and support.

Leukotriene inhibitors;can cause hallucinations and suicide

The Food and Drug Administration (FDA) completed a review of possible neuropsychiatric events of leukotriene inhibitors.. They analyzed post-market case reports and reviewed manufacturers' clinical trials. The FDA found a higher rate of suicide, hallucinations, agitation, aggression anxiety, irritability, insomnia, and tremor in leukotriene inhibitors compared to placebo. These effects were not found sooner because the clinical trials done by the manufacturers were not looking for them.

Leukotriene inhibitors are a relatively-safe medication that can help control the underlying allergy symptoms that lead to an asthma attack. Because the inhibit allergy symptoms, rhinorrhea (runny nose) would actually be decreased. Leukotriene inhibitors are metabolized by the liver and have little effect on the metabolism of other drugs, but should be used with caution in patients who have liver disease. They are not metabolized by the kidneys and will not cause acute renal failure. The most common side effect of leukotriene inhibitors is headache, but stomach upset can also occur. This is not significant enough to cause peptic ulcer disease.

The take-home point is that as nurses we need to evaluate our patients who are taking leukotriene inhibitors for neuropsychiatric side effects and report them to the patient's physician promptly. Many patients are depressed, but if that depression is caused by leukotriene inhibitors it can be life threatening, because the patient may become suicidal.

From: FDA Early Communication (2009). Early Communication About an Ongoing Safety Review of Montelukast (Singulair). Accessed June 17, 2009 from http://www.fda/gov .

Red Yeast Rice:an alternative herbal preparation that has been shown to be effective in lowering lipids levels

Statin drugs, such as atorvastatin, cerivastatin, fluvastatin, and lovastatin, are commonly used to treat high blood lipid levels. Although many of the side effects of statins are well-tolerated, statins can cause inflammation of the muscles that can lead to muscle injury and rhabdomyolysis -- a serious condition that can cause renal failure.

Red yeast rice has been studied to determine if patients who are intolerant to statins can get the same lipid-lowering benefits from this herbal supplement as they would get from statin drugs. In a recent study by Becker, et al. the authors suggest that red yeast rice may significantly reduce LDL levels and may be a suitable alternative for statin-intolerant patients. In order to achieve these results it is important to take red yeast rice from reputable manufacturers.

St. John's Wort is used to control symptoms of depression with the same effectiveness as prescription antidepressants, but with far fewer side effects. Ginkgo Biloba is touted for its ability to increase memory, although it doesn't ward off dementia or Alzheimers Disease. Watch for bleeding, especially if your patient takes anticoagulants or non-steroidal anti-inflammatory drugs. Acai berry has been touted as a dietary aid that does everything from increasing energy to weight loss to cholesterol control, however to date there are no randomized, controlled studies confirming any of these claims.

Please remember that research on the effectiveness of herbs used medical-grade herbal preparations. Most of our patients are not taking medical-grade preparations, but instead something that they got from the grocery store. Therefore, individual results will vary from one person to another based on the specific preparation of the herbal that the person used.

From: Becker, D.J., et al. (2009). Red yeast rice for dyslipidemia in statin-intolerant patients: A randomized trial. Ann Intern Med, 150: 830.