Saturday, September 29, 2007

Neuroscience anxiously anticipating NeuroArm!

In my past life, twelve years ago, was a neurosurgical intensive care nurse for 13 odd years. Neurosurgery stagnated with gamma knife, stereotactic surgery and high dose of steroids for major spinal cord injuries. My passion was neurosurgical pre or post care, AVM's, aneurysm clipping, neuro trauma, children and adults alike.
This revolutionary robot arm will greatly improve outcomes post neurosurgery. There will be less collateral damage to surrounding brain tissues during surgery.
Tip from Michael Fumento at NeuroArm/U of Calgary website here.

“Many of our microsurgical techniques evolved in 1960s, and pushed surgeons to the limits of their precision, accuracy, dexterity and stamina,” says Dr. Sutherland, professor of neurosurgery, University of Calgary Faculty of Medicine and Calgary Health Region. “NeuroArm dramatically enhances spatial resolution at which surgeons operate, and shifts surgery from organ towards cell level.”
Designed to be controlled by a surgeon from a computer workstation, neuroArm operates in conjunction with real-time MR imaging, providing surgeons unprecedented detail and control, enabling them to manipulate tools at a microscopic scale. Advanced surgical testing of neuroArm is currently underway, followed by the first patient, anticipated for this summer.
NeuroArm Project schedule for remainder of 2007
Completion of pre-clinical studies
Health Canada regulatory approval
First surgery anticipated for summer 2007
Neurosurgery online abstract in 2004 here, no follow up article since...
FDA approval?
Anticipating anxiously, moi!

Friday, September 28, 2007

President Lyndon Johnson

US President - 1963-1969. White House bio here.
The Great Society program became Johnson's agenda for Congress in January 1965: aid to education, attack on disease, Medicare, urban renewal, beautification, conservation, development of depressed regions, a wide-scale fight against poverty, control and prevention of crime and delinquency, removal of obstacles to the right to vote. Congress, at times augmenting or amending, rapidly enacted Johnson's recommendations. Millions of elderly people found succor through the 1965 Medicare amendment to the Social Security Act.
Philippine President
1961-1965 - Diosdado Macapagal
1965-1986 - Ferdinand Marcos

US presidents & corresponding presidents in the Philippines

1897 - 1901 - William McKinley, Republican.
White House bio here...

In the 100-day war, the United States destroyed the Spanish fleet outside Santiago harbor in Cuba, seized Manila in the Philippines, and occupied Puerto Rico. "Uncle Joe" Cannon, later Speaker of the House, once said that McKinley kept his ear so close to the ground that it was full of grasshoppers. When McKinley was undecided what to do about Spanish possessions other than Cuba, he toured the country and detected an imperialist sentiment. Thus the United States annexed the Philippines, Guam, and Puerto Rico.

1901-1909 - Theodore Roosevelt, Republican. WH bio here.

1909-1913 - William Taft, Republican. WH bio here.

Pres McKinley sent him to the Philippines in 1900 as chief civil administrator. Sympathetic toward the Filipinos, he improved the economy, built roads and schools, and gave the people at least some participation in government.

1913-1921 - Woodrow Wilson, Democrat. WH bio here.

1921-1923 - Warren Harding, Republican. WH bio here.

1923-1929 - Calvin Coolidge, Republican. WH bio here.

1929-1933 - Herbert Hoover, Republican. WH bio here.

1933-1945 - Franklin Roosevelt, Democrat. WH bio here.

1945-1953 - Harry Truman, Democrat. WH bio here.

First Philippine president of the 3rd Republic 7/4/46 - April 15, 1948 - Manuel Roxas

Monday, September 24, 2007

Filipinos in the UN through the years...

The Philippines was part of the present UN from its beginning in 1945.
In 1960, Philippine delegate, Lorenzo Sumulong parliamentary voice of support for freedom of the people of Eastern Europe communist occupied countries made the top shoe banging communist at that time very angry. Time article here.

hat tip:

Saturday, September 22, 2007

Socialistic Philippines!

Why present day Philippines tend socialistic even with American influence of freedom, self-reliance and limited government.

Present day Filipinos are influence by Roosevelt's New Deal. Much like today's US Democratic party who believe in government big role in our individual lives - social security benefits, medicare, medicaid.

But a limited US army research in 1980's shed a little light ...

It required 2 major changes to the post-war status quo for the Philippine govt to defeat the Huks. 1st, US had to recognize the severity of the insurgency and provide appropriate amounts of advice and military and economic assistance to help counter it. Luckily, this American advice was sound and well received by an enlightened Filipino leader; Magsaysay. 2nd; a government victory required an administration in Manila that was more concerned with improving the quality of life for its citizens than with self-enrichment. Ramon Magsaysay provided the latter when he accepted the position of Secretary of National Defense and later won the office of President.
What attributes made this former Zambales resident and son of a village school teacher so successful in winning his fellow Filipinos' loyalty? Certainly his well-known honesty helped him achieve his position in the Congress. But it was his deep and sincere concern for his fellows that brought him to national attention and paved the way for his becoming the Secretary of National Defense. He was a man dedicated to duty and blessed with a personality that blended persistance and charisma with an ability to listen to those around him. Perhaps his greatest attribute, an attribute certainly reinforced by his own war-time experience as a guerrilla leader, was his ability to see the Huk guerrilla movement as symptomatic of greater diseases that were threatening his country -- poverty, rising social expectations, and an uncaring and corrupt central government.
These were the targets that Magsaysay set his sights on. He combined military operations with civic-action projects to form his grand strategy, a strategy that, if successful, would improve Philippine living conditions and remove the base of guerrilla strength - popular support. He demanded that each soldier, regardless of rank, be dedicated first to the people, then, to killing the guerrillas. He changed the basic tactics used by the Philippine military and fostered unconventional operations, while concurrently developing a more professional and competent armed forces. The military and the government had first to win the respect of the people before their anti-Huk campaign could ever produce tangible results. Military abuses ceased and soldiers or policemen implicated in abusing civilians were dealt with swiftly and harshly. Without the people's support, whatever gains the military made would vanish as soon as the last trooper returned to his garrison. Without the people's support, Huks would be unable to move freely or sustain themselves in the field.
With American assistance and the fortune of having Edward Lansdale's advice, counsel, and friendship, Magsaysay's strategy proved a resounding success. EDCOR provided land for reformed guerrillas. Other tracts of government land were sold to the people, schools were established, transportation and communication networks were repaired and improved and, for the first time, the armed forces worked side by side with the people to secure their mutual future.
As an epilogue to his remarkable life, Ramon Magsaysay was honored with a commemorative stamp issued by the United States shortly after his death in 1957. At the ceremony accompanying the stamp's issue, President Eisenhower eulogized this progressive leader and his contribution to Philippine democracy.
If we are ready to do our full part in combating communism, we must as a unit stand not only ready, as Magsaysay did, to bare his chest to the bayonet, if it comes to that, but to work day by day for the betterment - the spiritual, moral, intellectual, and material betterment -- of the people who live under freedom, so that not only may they venerate it but they can support it. This Magsaysay did, and in this I believe is his true greatness, the kind of greatness that will be remembered long after any words we can speak here will have been forgotten.
United States Support
Without American economic and military assistance to the Philippine governments after 1950, the Huks might well have succeeded in their rebellion. But, before we applaud the U.S. effort too quickly, perhaps we should consider that U.S. neglect and short sighted helped put the government in jeopardy. Before 1950, U.S. policy makers concentrated their attentions on Europe, were tired of war in the Pacific, and seemed blind to the many problems that tore at the islands. The land-tenure question had been present since the days the nation became an American protectorate and very little had been done to ease its burden on the Filipino farmer. Although land-tenure was a major factor in the years preceding WWII, after the war, U.S. policy ignored it and was intent on divestiture of responsibility for the islands. Economic aid was made available to the government after the war but the programs were poorly managed and did little other than increase the size of many Filipino elite's bank balances. Other programs, such as the various economic trade acts and the issue of collaboration served only to widen the gap between the people and their government. American foreign policy makers simply did not understand Filipino concerns and aspirations and therefore chose to ignore them. Many incisive and worthwhile reports on conditions in the Philippines (such as Bell Mission) went unheeded until the government in Manila nearly fell in 1950.
Luckily, once the American government realized how close to collapse the Quirino administration was in 1950, Washington reacted. JUSMAG reports, long ignored or given only summary attention, suddenly gained new respect and concern. The JUSMAG was expanded, aid began to flow in, and opinions expressed by some of the JUSMAG's exceptional advisors began to receive attention. Thanks in great measure to the Korean War that was attracting the lion's share of attention in Washington, advisors found themselves with great latitude and were able to develop comprehensive assistance programs that worked hand-in-hand with Magsaysay's objectives for integrating the armed forces with social reforms. Although the Philippines received large amounts of military aid and equipment from the United States during this period, most of it came from surplus WWII stocks. The equipment was simple to use and maintain, and allowed the AFP to adapt quickly to it and keep it operational. One should remember that the vast preponderance of newer equipment was committed elsewhere, Europe and Korea. Another result of the Korean War was that no U.S. troops were readily available for deployment to the Philippines and, with very few exceptions, American advisors were prohibited from taking the field with their Filipino counterparts until the latter stages of the insurgency. This was perhaps one of our greatest contributions to the Philippines during this period. Without foreign troops to assist them, the Philippine military was forced to develop on its own, under its own leaders, and fight to protect its own land and people. Once the Army became convinced that they were fighting to protect their countrymen, and not as an occupation force trying to subdue an unruly foreign
population, they began to receive the people's support. As already described, the alliance of the military with the villagers, and in turn the villagers reliance on the government, spelled the end for the Huk movement.
JUSMAG advisors did all they could to foster a sense of Filipino self-reliance. Whenever possible, they assumed back-row seats for themselves so that govt officials could look good and receive the credit for successful operations. Even when programs succeeded as direct results of American efforts, the advisors played down their own role and let a Filipino become the moment's hero. This built pride and self-esteem in both the officials involved and, more importantly, in the Filipino people. They saw themselves succeeding where others had failed and they tried to continue the pattern. When advice was given, it was given directly to the Filipino leader who needed it, as low in the organization as possible, and given by an advisor who the recipient knew and trusted. And how did they develop this trust? General Lansdale put it quite simply - treat them as equals, treat them fairly and honestly, never lie to them, and prove your intentions by displaying courage and willingly accepting the same hardships and inconveniences that they do. In essence then, you must demonstrate that you consider them as good as yourself and that you trust and respect them as much as you want them to trust and respect you.
By following these guides US helped the Philippine government solve its internal insurgency. The American government provided most of the material with which the Philippine military fought, provided the money that paid them, and provided advice when it was needed. But, it was Filipinos who fought the battles and defeated the guerrillas under the leadership of an unusual man endowed with the insight to see the larger problem that fostered the resistance, and a leader who aggressively sought to remove the causes for internal unrest in the future.

Except for soldiers pension program in early 1776, there was no social security assistance for anybody in United States until President Roosevelt’s great society expenditure in 1935.
Roosevelt's New Deal has been debunk by many economist including economist at Mises Institute.

Philippine was granted independence in 1946 by US legislators.
The first Filipino president after the independence was Manuel Roxas. Last president before dictatorship was Diosdado Macapagal, the father of today's president. Father and daughter have economic background, academically but not in capitalistic practice.

Capitalism in the Philippines for years is a dirty word.

Spanish influence is socialistic.

In the beginning, US influence was benignly competitive, literate capitalism.

Filipinos know in their heart, the American way is better for themselves. Educate oneself to help yourself, then help others. Many Filipinos, my parents included, went to school taught by Americans or fluent English speaking Filipinos taught by Americans, in provincial capital schools, then went back and taught in their towns and barrios.

Something went haywire as the years go by. Filipinos are independent, self reliant, literate but never became entrepreneurs in business sense.

I have not talk to or met a literate Filipino who have read or heard of Adam Smith, my University of Visayas educated cpa/auditor hubby included.

Monday, September 03, 2007

Decider - n - Chief

Staff writer, Glen Kessler of Washington Post admit who is the Decider - n - Chief in America! 'Idea generator', he writes about Pres. Bush. (from
After seven years of an intense partnership, the president turns out to have been the idea generator after all, shifting Rice from her realist roots and infusing her with the idealistic desire to spread democracy throughout the Middle East. Now, in words that echo the president's, she awaits history's verdict.
"I'm enough of an historian to know that my reputation will be what my reputation is," Rice told reporters earlier this year. "It might be different in five months from five years to 50 years, and so I'm simply not going to worry about that."
This article is adapted from Glenn Kessler's "The Confidante: Condoleezza Rice and the Creation of the Bush Legacy," to be released tomorrow.

Saturday, September 01, 2007

Intensive Care Unit in US hospitals

Dr. W. E. Dandy, a neurosurgeon at John Hopkins Hospital, Baltimore, Md started a 3 bed unit for post surgical neuro patients in 1923.
Barrow Neurological Institute site has a good historical narrative of the genesis of intensive care units as well as its own development.
Dedicated neuroscience units represented a relatively new concept to both St. Joseph's Hospital and the nursing profession at large. While Dr. W. E. Dandy is credited with opening a three-bed specialized care unit for postoperative neurosurgical patients in 1923 at the Johns Hopkins Hospital, the concept of such dedicated units was not widespread, nor did the concept of intensive care units (ICUs) take root for decades. ICUs were just beginning to appear in the late 1960s and early 1970s and typically were designated as postanesthesia care or coronary care units. In the nursing literature, a dedicated neuroscience ICU was first mentioned in 1975. At the time Barrow was founded, there were no dedicated neuroscience units in Arizona. Consistent with the national trend, the first ICU at St. Joseph's Hospital was the coronary care unit; the second ICU was the NICU. That first NICU housed a total of 6 beds. Four beds were clustered in a general ward setting, and there were two private rooms and one hyperbaric chamber. Despite the neurosurgical title of the NICU, nurses working there treated patients with disease processes other than those with a neurological dysfunction. The NICU included patients undergoing hyperbaric oxygen therapy and renal dialysis, patients requiring support by an iron lung, and burn patients. Ultimately, these services remained a part of the care provided at St. Joseph's Hospital, except for patients with burns. The latter were automatically transferred to Maricopa County Hospital when the burn unit opened there in the 1970s.
During these early years, scant assistive technology was available. Consequently, nursing care relied on close observation of patients and changes in their level of consciousness (LOC). As nurses and neurosurgeons recollect, the calls made to physicians from the ICU nurses were in response to changes in a patient's LOC. When reports of a decreased LOC were communicated to the physician, nurses were instructed to give patients a "pinch of mannitol." The LOC was the single most important assessment parameter. The NICU had no cardiac monitors. There was no invasive blood pressure monitoring. Temperatures were measured with mercury-filled thermometers, and blood pressure was measured with traditional sphygmomanometers. The only invasive lines were urinary catheters and nasogastric tubes.
In 1962, one registered nurse (RN) cared for one or two patients in the NICU. However, the staffing pattern was different on the general neurological-neurosurgical floor. Because specialized neurological units were new, it was difficult to establish staffing patterns and appropriate patient-to-nursing care ratios on the floor. At the time, the popular nursing model for patient care was referred to as Team Nursing. The Team consisted of an RN, a licensed practical nurse (LPN), and one nurse's aide to provide nursing care for 5 or 6 patients. The RNs were responsible for performing patient assessments, reviewing laboratory results, noting orders, and all communications with physicians. The LPNs administered all medications to the patients cared for by the team. The nurses' aide or orderly helped with the manual demands of patient care such as lifting, turning, and getting patients out of bed.
The physical component of neuroscience nursing was demanding. There were no specialized chairs to facilitate getting patients up or specially constructed slide boards to move patients from one horizontal surface to another. There were no special rinse free soaps for use during bathing. There were no electric beds. Hand cranks were used to raise or lower the head or knee position. The work was demanding, but as a former nurse who worked on the general neurosurgical ward for 20 years quipped "Of course it wasn't easy; if it was, any nurse could do it." The nurses who elected to work at Barrow and the physicians with whom they worked were committed to the ideal that every patient deserved a nurse who specialized in the care of the neurologically impaired.

My personal professional experience reflects above article. Most hospitals in the 60's, ICU started as coronary care units with cardiac monitors. Cardiologist train and certify nurses to read EKG and give appropriate treatment and meds in cardiac emergencies - defibrillation in V-fib, Lidocaine for V-tach, Atropine for bradycardia, Epinephrine for standstill among others. First and foremost, nurses observe, assess first before action!
My neurosurgical nursing experience started in early 80's. Observation and Assessment still first and foremost skill. Level of consciousness with coma scale and pupillary changes were important nursing observation and assessment skill.