Hospitals

According to the US News and World Report rankings, here are the top 10 Adult Nephrology hospitals:

1. Mayo Clinic (Rochester, MN)
2. Cleveland Clinic (Cleveland, OH)
3. UCSF Medical Center (San Francisco, CA)
4. New York-Presbyterian University Hospital of Columbia and Cornell (New York, NY)
5. Johns Hopkins Hospital (Baltimore, MD)
6. Massachusetts General Hospital (Boston, MA)
7. UCLA Medical Center (Los Angeles, CA)
8. Barnes-Jewish Hospital/Washington University (Saint Louis, MO)
9. Vanderbilt University Medical Center (Nashville, TN)
10. University of California, Davis Medical Center (Sacramento, CA)

If it is a gram negative diplococci it is most likely from Neisseria (gonorrhoeae). You can take Ciprofloxacin, a single 250mg dose should do the trick. Other drugs include:

-Amoxicillin 2 g plus probenecid 1 g orally-Ampicillin 2 to 3 g plus probenecid 1 g orally-Azithromycin 2 g orally-Cefixime 400 mg orally[8]-Cefotaxime 500 mg by intramuscular injection-Cefoxitin 2 g by intramuscular injection, plus probenecid 1 g orally-Cefpodoxime (Vantin) 400 mg orally-Ceftriaxone (Rocephin) 125 to 250 mg by intramuscular injection-Ciprofloxacin 500 mg orally-Levofloxacin 250 mg orally-Ofloxacin 400 mg orally-Spectinomycin 2 g by intramuscular injection

Also be sure to check for Chlamydia (signs and symptoms may show up a few weeks later). Those two go together like peaches and herb.

Treatment includes:

-Azithromycin-Erythromycin-Doxycycline/tetracycline,-Cefpodoxim proxetil-Amoxicillin-Zithromax

Information systems will change the fundamental structure of the healthcare organization. Information systems are strategically designed to give an organization a competitive edge by supporting and shaping the structure and strategy of the organization (BNET, 2010). Advancements in information technology have increased the efficiency of healthcare services and staff as available technology reduces paper and recordkeeping errors (BLS, 2009). These technological changes allow information to be delivered and stored in unprecedented ways, allowing data to be tracked, analyzed and utilized in ways that help to deliver more efficient care (Young, n.d.). Because of the nature of the information that is accessible through healthcare information systems, the fundamental structure of the healthcare organization will adapt in accordance to the applicable data streams. These systems will impact not only direct-care services such as physicians and nursing departments, but will also have structural changes in non direct-care departments such as research and development, billing, medical records, and others (Fottler, Ford, & Heaton, 2010).

Structural changes in response to information systems are inevitable due to the changes in the way information is collected, stored and retrieved. The purpose of information systems is to answer questions (Young, n.d.). Nursing staff may use advanced decision systems to monitor patients' life signs; in turn changing the way that the care is delivered and the efficiency of response to declining health in hospitalized patients (Fottler, et al., 2010). Likewise, other expert information systems can be designed to safeguard against medication errors, interactions and allergies by utilizing rule-based software that identifies potential issues based on existing patient information and expert guidelines (Fottler, et al., 2010). In both examples of applied information systems, the structure of the healthcare organization would be altered in response to the increased use of technology, thereby decreasing the possibility of human error, increasing medical efficacy and furthermore increasing patient satisfaction and positive outcomes.

References

BNET. (2010). Strategic information systems. Retrieved online 30 January 2010 from http://dictionary.bnet.com/definition/strategic+information+systems.html.

Bureau of Labor Statistics (BLS). (2009). Career guide to industries, 2010-11 edition. Retrieved 30 January 2010 from http://www.bls.gov/oco/ocos280.htm.

Fottler, M., Ford, R., & Heaton, C. (2010). Achieving service excellence: strategies for healthcare (2nd ed.). Chicago, IL: Health Administration Press.

Young, R. (n.d.) Healthcare reform: the implications for health data systems. Retrieved 30 January 2010 from http://ageconsearch.umn.edu/bitstream/17136/1/ar930147.pdf.

Governorns, like presidents, don't control budgets. They can merely sign them into law or veto them.

The legislature controls purse-strings, not only at the federal level, but at the state level as well.

The real culpret was the "patients' rights" movement of the 1960s, in which the ACLU among others said that mentally ill persons should NOT be institutionalized against their will. It's a very nice sentiment and well intended and on part, I agree with them. However, like all paths leading to hell, it's paved with these good intentions, and often the unintended consequences are worse than the original "problem."

Further enabling the situation was the Community Mental Health Act of 1963 (CMHA), signed into law by President Kennedy. The law provided federal funding to establish a network of "locally based" community mental health facilities. The idea was that this was to be a local alternative to institutionalization.

In fact, it led to massive deinstitutionalization. The law did not require formerly institutionalized patients to be institutionalized at the local level. As a result, many people left the state mental hospitals as "free men" and just began roaming the streets. Most did not get treatment locally. ...meaning they did not get their meds.

The timing of all of this is interesting because the subsequent massive deinstitutionalization of the mentally ill over the next 15 years or so coincides with the massive increase in homelessness over the same period.

The Wikipedia entry is a pretty decent summation of the events.

http://en.wikipedia.org/wiki/Community_Mental_Health_Act

So to summarize, no, the eeeeeevil Ronald Reagan didn't shove the mentally ill out on the street. You can thank well-intentioned do-gooders for that.

on the other hand, right after he was elected the streets of New York City were flooded with a fresh wave of thousands of homeless people. Having lived there at the time I can tell you that before Reagan's presidency there were only a handful of homeless in my neighborhood and all the locals knew their names & their stories. After Reagan took office the homeless appeared in unprecedented numbers. So in fact Reagan is responsible for the appearance of thousands of newly homeless people in New York City. As far as New York is concerned yes, you can blame Reagan for shoving the mentally ill out on the street.