Newsletter for Paradigm 97
February 14, 2007
Our NEW website...... http://paradigm97.blogspot.com/
HAPPY VALENTINE'S DAY !!!
1) an outstandingly clear or typical example or archetype.
2) a philosophical and theoretical framework of a scientific school or
discipline within which theories, laws, and generalizations, and the
experiments performed in support of them, are formulated.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPETS
Clean to Clean, Dirty to Dirty
by Geneviève M. Clavreul
Clean to clean and dirty to dirty– that’s one of the hard and fast rules of nursing that my instructors drilled into me during my first year of nursing school. This is such a truism that I continue to use it as a guide whenever I have doubts as to when universal precautions apply to a particular situation. Do you?
In today’s medical environment nurses need to follow universal precautions even more religiously than when I began my nursing career back in the 1960’s—yet I often see breaks in protocol that send shivers up my spine. Universal precautions protect the patient, and the nurse as well: all patients should be viewed as a potential source of contamination.
However, sometimes we overreact. A recent example is the edict handed down to by hospitals on the subject of acrylic nails. I wonder how many hundreds of thousands of dollars were spent on proving that acrylic nails might be a vector for bacteria and other little nasty bugs? I don’t think it takes a rocket scientist to figure that out. We all know dirty nails are a possible route of contamination in the unit—that’s why we scrub. So it would be only logical that acrylic nails would prove equally “bad.”
However, in the case of acrylic nails, many hospitals have chosen to go one step further and disallowed them altogether. This measure is rather useless especially when you consider that as nurses we should be using universal precautions whenever coming into contact with patients. Simply put, that means we should be wearing gloves, which would shield the acrylic nails so they will not be a possible source of contamination. But, as I have found so often when it comes to nursing, common sense often falls victim to bureaucrats.
Don’t get me wrong. The concern about acrylic nails is very real, but so is the concern about wearing rings, or even having long hair that is left to hang down where it could contaminate otherwise “clean” objects or transfer bacteria from infected patient to patient. Those of us who are old enough to remember the starched white hats and dresses of our early nursing days will remember that hair had to be worn short or up in a bun to reduce the risk of contamination. However, today I often see nurses break this protocol or wear rings without being gloved and without regard to universal precautions.
We all know that universal precautions also apply in the handling of bodily fluids, but when was the last time you gloved-up when handling that bottle of expressed breast milk? You’d be surprised how many NICU or post-partum nurses seem to forget that breast milk is a bodily fluid and should be handled using universal precautions. So relaxed are nurses about breast milk that I have even seen nurses store their own expressed breast milk in the communal refrigerator right next to a co-workers’ lunch. Sometimes breaches in universal precautions occur because we don’t see something as a potential contaminate. As in the case of breast milk, I think so many nurses are lax in this regard because breast milk is seen as nutrious and nurturing, but we also forget that it is a bodily fluid and should be treated as such.
I am defininitely a neat-nick. Often when I work, my fellow nurses give me a good and kindly ribbing on my habit of cleaning my work area, wiping it down, and even cleaning the chair I sit on since I usually work NICU. When they do rib me I remind them that a new mother has probably sat on that very same chair in her gown with lochia and just imagine all the little germs moving around on that seat. It usually takes only the telling of this story once for the nurses to pick up the habit.
How many of us have read that recently published article on doctors and how their ties are a source of contamination? (Presented at the 104th general meeting of the American Society of Microbiology.) So if ties can serve as a vector, just think about that long-sleeved sweater or sweatshirt that you wear to work. Do you leave it on over your uniform or scrubs? And if so, when was the last time you laundered it? If you are like most people, you probably don’t launder it after each time you wear it. You also don’t think about the possible contaminants the next time you brush up against your patient or reach into an isolette to touch that neonate.
What about your employee identification badge? I bet most of you wear it attached to one of those nifty badge holders that we often get for free at conferences. Is your holder the kind that hangs loosely around your neck or is it on a short lead close to your chest, or pinned on? If it is the first kind, then you are potentially exposing your patients to cross contamination. It probably swings loosely, touching your patient as you check vitals, change a dressing, administer an injection, or when you put forward a comforting hand. Some may think this example is absurd but it is far from the absurd—it is a very real threat to the practice of universal precautions and presents a break in protocol where less than optimal patient care is administered.
Let’s not forget about those oh so adorable stethoscope covers. They are definitely cute and can act as a real icebreaker, especially with pediatric patients. However, unless you are prepared to launder it every day (or more precisely between every patient) then perhaps you should rely on a cheerful and warm personality to break the ice rather than add one more potential source of cross-contamination.
And while I am on the subject of stethoscopes, I would like to remind my nursing cohorts that if we are truly striving to practice universal precautions then there would be a stethoscope at the bedside of each patient. Though it may seem costly for a hospital to provide a stethoscope at each bedside, it is actually only a small upfront cost compared to the thousands of dollars of additional care that it costs to fight hospital-borne infections, specifically nosocomial infections.
Here is a story that I hope no one finds familiar, but it has happened and is probably still continuing in a hospital unit that shall remain anonymous to protect the guilty. In this particular unit there is a great deal of esprit de corps. The nurses are quite close and take meals together whenever they can, often serving potluck style. One of the favorite treats during these potluck meals is particular ethnic bread made with garlic and onion that is best eaten when warm. So the creative nurses in that unit have come to use the blanket warmer (yes you read that line correctly) to warm the bread before serving it. I just about choked when I realized that the blanket warmer—the same warmer that we put our blankets in to warm before putting them on the preemies in our NICU—was being used to warm bread! Meanwhile, the nurses wondered why we had flies and roaches in this particular unit.
Often when I am working on a research paper, and doing it as a nurse, I play a little game and track just how many breaks I can find in universal precautions on given shifts. Does this mean that these nurses are bad nurses? Not usually. But it does mean that there is bad nursing practice going on and a patient’s health is placed at risk. Nurses have so much to worry about—a single needle-stick can have a tremendous impact on our lives—that we need to make sure that taking universal precautions is not an option, but an everyday work habit.
I believe that breaks in universal precautions occur most frequently for a handful of reasons. They are lack of knowledge, poor training, feeling overwhelmed with the workload, lack of equipment, and laziness. Of the five reasons, the most dangerous reason for breaks in universal precautions is laziness since this would imply that the nurse is demotivated and not interested in her work and thereby placing at risk her patient and co-workers, as well as herself. The other four reasons are training issues. I find that most individuals can and do respond well to training, especially when done in a constructive and positive environment.
With the advent of diseases such as SARS, HIV and Hepatitis, we should always use universal precautions. However, doing this does not mean that we have to be unkind and without compassion when giving care. By always-practicing good technique, you are ensuring to the best of your ability that your patient is receiving good care and that also means limiting your patients’ exposure to sources of contaminants as well as yourself.
So when in doubt remember—Clean to clean and dirty to dirty.
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FORGOTTEN HISTORY
MEMBER'S ANNOUNCEMENTS
This was sent in by KTMeter2@aol.com (thanks Kat).... check this out !!!
dead as storm batters Europe.......OR it may have a subject heading
...all the headlines seem innocuous..... 46 others......with attachments !!!!!!!
go to the link and read.....bad news
http://www.snopes.com/computer/virus/storm.asp
Please remember that the REUTERS' articles are good for 30 days only
I think this Evidence Based article is so important...wanted this to be first In a growing number of small and large hospitals across the country, including ones in Florida and North Carolina, nurses involved in a results-driven rounding protocol are finding their shifts less stressful, their time more productive, and patient safety and satisfaction scores at all-time highs.
The new interest in rounding comes after research results from 27 nursing units in 14 hospitals showed that a consistent strategy of checking on patient needs effectively reduces monthly call light use by 38%, patient falls by 50%, and cases of skin breakdown 14%, while satisfaction scores move upward.
“The response has been amazing,” says Christine Meade, executive director/chief researcher of the Studer Group’s Alliance for Health Care Research, Gulf Breeze. “Nurses know rounding works, especially those who have been practicing for 20 years. But nobody’s ever done a study to prove it.”
Meade says she gets about 10 e-mails a day about the research results and is part of a team of coaches who present the rounding protocol to hospital units, including several in the southeastern states. An interactive training video toolkit is also available for $1,495 that shows study data and demonstrates how recommended behaviors and actions by nurses on hourly rounds can improve efficiency and satisfaction rates and give nurses more free time. http://www2.nurseweek.com/Articles/article.cfm?AID=24895
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Diabetes - the impending epidemic - by Claire Sowerbutt
Attending several medical conferences over the past few weeks, I couldn't help but notice the concern physicians are expressing with regard to the rising numbers of people developing diabetes, particularly type 2 diabetes. From heart and kidney specialists to family doctors, it seems that health care professionals across North America are bracing themselves for an epidemic. Health Canada recently earmarked $115 million for development of a national diabetes surveillance program, and several other diabetes-related initiatives to be implemented over the next five years.This impending epidemic is not solely attributable to aging baby boomers. While it is true that people over 45 are at greatest risk for developing type 2 diabetes, new studies show that
we also have an alarmingly high amount of obese children in North America, and obesity is closely related with the development of type 2 diabetes. A recently completed study of obesity in 688 school children in North Carolina showed that seven per cent of those children already have three of the leading risk factors for heart disease and type 2 diabetes. Experts believe that within the next few years many of these children, both in Canada and the United States, will join the ranks of adults over the age of 45 who develop type 2 diabetes. And the good news? This rise in diabetes is preventable - we can do something about it.
... One of the biggest problems with type 2 diabetes is the complications associated with it. "People who have type 2 diabetes are at increased risk of having a heart attack. They are also at increased risk for stroke, kidney failure, nerve damage causing numbness, impotence and blindness," said Dr. Sheldon Tobe of Sunnybrook & Women's Hospital in Toronto. Very often people with type 2 diabetes have other risk factors such as high blood pressure, high levels of bad cholesterol (high LDL, low HDL) and blood sugar levels that must be brought down.
http://bodyandhealth.canada.com/channel_section_details.asp?text_id=2133&channel_id=10&relation_id=10998
trends in nursing home admissions since 1985. The percentage of adults over 65 years of
Where have these people gone? The report indicates several factors contributing to this
alternative long-term care facilities (e.g. assisted living facilities, residential care facilities
increased availability of private long-term care insurance and active efforts by state
http://www.mondaq.com/article.asp?articleid=45994&email_access=on&login=true
If your gums bleed a lot during cleaning -- a sign of subpar dental health -- your dentist may urge you to floss more. But chew gum more? It could help. In a recent study, gum chewers experienced less gingivitis-like bleeding than nonchewers, but only if their gum of choice was enriched with vitamin C. Better yet, they didn't have to chew for a long time to get the benefit, only for about . . .
Sound like a lot of chewing? Consider this: The benefits didn't stop at just healthier gums. Chewers also had less plaque and tartar on their teeth.
Tooth and gum trouble begins when tartar forms on the tooth near or under the gum line, causing gum inflammation and possibly periodontal disease. Daily brushing and flossing and regular professional cleaning will remove the troublesome substance. And although gum chewing isn't a substitute for good oral care, vitamin C-enriched gum did appear to help minimize tartar and plaque in this study, particularly in people whose mouths tended to produce lots of the stuff.
Chewing sugarless gum helps you in other ways, too. It sweeps away the sugar and nasty by-products of bacteria lurking in your mouth. Go for vitamin-C enriched sugarless gum and your pearly whites may be in even better shape. Look for gum that contains vitamin C at health food and supplement stores. References: The release of vitamin C from chewing gum and its effects on supragingival calculus formation. Lingstrom, P., Fure, S., Dinitzen, B., Fritzne, C., Klefbom, C., Birkhed, D., European Journal of Oral Sciences 2005 Feb;113(1):20-27.
(this also offers CE 0.25 for nurses) January 10, 2006 — The Societies of Paediatric Endocrinology and the Growth Hormone Research Society have issued a consensus statement about diagnosis and treatment strategies for small-for-gestational-age (SGA) children through adulthood. The new guidelines are published in the January 2 Rapid Electronic Publications issue of The Journal of Clinical Endocrinology and Metabolism.
"Low birth weight (LBW) remains a major cause of morbidity and mortality in early infancy and childhood," write Peter E. Clayton, MD, from the University of Manchester in the United Kingdom, and colleagues. "It is associated with an increased risk of health problems later in life, in particular coronary heart disease and stroke. A meeting was convened to identify the key health issues facing a child born small-for-gestational age (SGA) and to propose management strategies."
In February 2006, a meeting was convened in Manchester, during which representatives from pediatric endocrine societies and the Growth Hormone Research Society evaluated current evidence relevant to the early-, mid- and long-term outcomes of children born SGA. http://www.medscape.com/viewarticle/550585?src=mp
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Objective: To compare the effectiveness of four weight-loss programs—'Dr Atkins' New Diet Revolution'; 'Rosemary Conley's Eat Yourself Slim Diet and Fitness Plan'; 'The Slim-Fast Plan'; and 'Weight Watchers Pure Points Program'.
Design and intervention: This community-based, 6-month, unblinded, randomized, controlled trial was sponsored by the British Broadcasting Corporation (BBC). Eligible participants were aged 18–65 years, had a self-reported BMI 27–40 kg/m2, and lived within 48 km (30 miles) of a study center. Exclusion criteria included diabetes, coronary heart disease, obesity caused by a medical condition (e.g. hypothyroidism), previous weight-loss surgery, eating disorders, and use of lipid-lowering, antihypertensive, or weight-loss medication. Participants assigned to Weight Watchers or the Rosemary Conley plan attended one class per week. Participants who followed the Slim-Fast plan were reimbursed for up to two meal replacements per day, whereas those in the Atkins' diet group received a copy of Dr Atkins' New Diet Revolution. The control group received no dietary intervention. Weight, height, waist circumference, blood pressure, and body fat were measured at baseline, and after 2 and 6 months. http://www.medscape.com/viewarticle/549137?src=mp
NEW YORK (Reuters Health) Jan 10 - A new sensor based on cellulose acetate/bromothymol blue detects crystalline biofilm produced by organisms that encrust indwelling bladder catheters, according to a report in the December issue of BJU International.
Dr. David J. Stickler from Cardiff University, Wales and colleagues sought to develop a simple sensor that could be incorporated into the catheter-drainage system to signal the presence of urease-producing bacteria, thereby providing early warning of impending encrustation and blockage of the catheter.
They examined the performance of their sensor in 20 patients undergoing long-term indwelling bladder catheterization. In all 15 patients in whom Proteus mirabilis was isolated from urine samples, sensors placed in the urine collection bags became dark blue to black and encrustation was found on the catheters when they were removed, the investigators report http://www.medscape.com/viewarticle/550637?src=mp
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What is the role of Ultrasound in Wound Care? Ultrasound is vibration transmitted at a frequency > 20 KHz, the approximate upper limit of human hearing. Ultrasound has been used for diagnosis and treatment of various conditions, including skin and wound evaluations.[1,2] The first article reviewed in this month's Evidence Corner addresses the question of whether gross ultrasound adds value as an adjunct in diagnosis and management planning for patients with traumatic wounds. Attempts to use ultrasound as a wound treatment modality have been reviewed elsewhere,[3,4] and authors have concluded that evidence to support efficacy was insufficient.[4] Studies using ultrasound as an adjunctive therapy for healing diabetic foot ulcers[5] and venous ulcers[6] attempted to define administration and dosage parameters, but questions remain regarding clinical healing efficacy. The second article is a systematic literature review that studied ultrasound effects on pressure ulcer healing, underscoring the need for further research of this effect. (part 1 of 4)http://www.medscape.com/viewarticle/549209?src=mp
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(this article was directed as a CME for the MD ...but nursing should be (or probably is) aware of this, also) January 8, 2007 — A single antenatal counseling session with educational materials improved breast-feeding practices up to 3 months after delivery, according to the results of a randomized trial reported in the January issue of Obstetrics and Gynecology.
"Exclusive and predominant breastfeeding rates in many developed countries often fall short of the practice recommended by the World Health Organization and the American Academy of Pediatrics," write Citra Nurfarah Mattar, MMed (O&G), of the National University Hospital in Singapore, and colleagues. "Despite increasing awareness of the many advantages of breastfeeding, the challenge remains to implement programs that can effectively improve short- and long-term breastfeeding rates, especially of exclusive and predominant breastfeeding." http://www.medscape.com/viewarticle/550406?src=mp
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(This is a CME/CE article... no mention of # of hrs., but it is of interest just for itself ) Atrial septal defect (ASD) and patent foramen ovale (PFO) represent congenital heart defects that involve the atrial septum. Knowledge of the embryologic development of the atrial septum provides the basis for understanding the pathophysiology, anatomy, and clinical manifestations of ASDs and PFO.
During the early stage of embryologic development, the right and left atria comprise a common chamber. At the fourth and fifth weeks of gestation, the division of the atria begins with the formation of the septum primum, which is a crest of tissue that grows from the superior-posterior wall of the developing atrium toward the endocardial cushions. The free margin of the septum primum creates a temporary communication between the 2 atria, called the ostium primum.
Before complete fusion between the ostium primum and the endocardial cushions, numerous perforations appear in the superior aspect of the septum primum. The coalescence of these perforations results in the formation of the ostium secundum. A second semilunar-shaped crest of tissue also begins to develop to the right of the septum primum, named the septum secundum. It overlaps the ostium primum, creating the foramen ovale. http://www.medscape.com/viewarticle/549944
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MILWAUKEE, Wisconsin (AP) -- A New York hospital is taking steps to offer the first uterus transplant in the United States, a radical experiment that might allow women whose wombs were removed or are defective to bear children.
The wombs would come from dead donors, just as most other organs for transplants do, and would be removed after the recipient gives birth so she would not need anti-rejection drugs her whole life.
The hospital's ethics board has conditionally approved the plans, although the hospital's president warned women not to get false hopes because a transplant is not expected "any time in the near future." http://www.cnn.com/2007/HEALTH/01/15/uterus.transplant.ap/index.html
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Nurse-led Prevention Programs Head off Trauma Mishaps, missteps, misadventures. Patients who have sustained trauma secondary to alcohol or drug use can get quite inventive when explaining the mechanisms of their injuries. However, alcohol- and drug-related visits to the ED or trauma center are no accident.
“Violence and drugs and alcohol go hand in hand, and it’s not an ‘accident’ if you choose to drink or do drugs and drive — it’s a crash,” says Dave Groves, RN, MSN, CCRN, trauma outreach coordinator at the Level I Trauma Center of Cooper University Hospital in Camden, N.J.
According to the National Council on Alcohol and Drug Dependency, alcohol is a contributing factor in about 100,000 U.S. deaths annually from falls, illnesses, and impaired driving crashes. In addition, 39% of all traffic fatalities in 2005 were alcohol-related, according to the National Highway Traffic Safety Administration. Alcohol and drug use is frequently involved in suicides, ATV and boating crashes, pedestrian trauma, diving injuries, hunting injuries, industrial and farming equipment injuries, hypothermia, burns, and smoke inhalation. It is also a factor in many homicides, domestic violence incidents, and rapes. http://www.nurse.com/
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LONDON (Reuters) January 12, 2007 - Telomeres may predict heart disease risk, study finds Telomeres, tiny strands of DNA at the ends of chromosomes that seem to contain secrets about aging, may also hold clues about who is more likely to suffer from coronary heart disease, British scientists report.
The researchers, who measured telomere length in the white blood cells (leukocytes) of 1,500 men between 45 and 64 years old, found short telomeres indicate a higher likelihood of developing heart disease.
"We have shown that leukocyte telomere length is associated with future coronary heart disease events in middle-aged, high-risk men," Professor Nilesh Samani, of the University of Leicester in England, and associates reported in The Lancet medical journal on Friday.
Telomeres protect the ends of chromosomes from fraying. They shorten each time a cell divides and the loss is associated with aging. As telomeres get smaller, the chromosomes can become unstable and at greater risk of mutation.
http://www.reutershealth.com/archive/2007/01/12/eline/links/20070112elin005.html
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You see 'em on those late night infomercials -- juicers that promise to save you time and transform your life. All hype? The juicer might be, but the juice isn't. Drinking pure juice regularly -- be it apple, tomato, or orange -- may help ward off Alzheimer's. How, you ask? It's
probably the polyphenols, the antioxidant-like substances that protect the brain from the damage that leads to Alzheimer's plaques. But you don't need a $100 gizmo to get the benefits. Drinking pure juice from a carton a few mornings each week works just as well.
The recent study on the Alzheimer's-thwarting benefits of juice did not specify which kind of juice provides the most protection -- just that study participants who drank fruit or vegetable juice three times a week were less likely to develop Alzheimer's than people who drank juice less often (fewer than once a week). So you may get the benefits from any kind of juice.
However, other Alzheimer's research has shown that quercetin, a polyphenol found in abundance in apple juice, may be particularly protective of the brain. Still, many different polyphenols are found in many different kinds of juice, and they all have anti-inflammatory
properties, which also may be key in explaining how the juices preserve your cognitive powers. Then again, there could be another yet-to-be-discovered quality in fruit and vegetable juices that makes them so wonderful for your brain. Whatever the reason, bottoms up! Just make sure it's 100% pure juice -- no juice "cocktails," no fruit "drinks." Check the label to see that you're getting the real deal. References: Fruit and vegetable juices and Alzheimer's disease: the
Kame project. Dai, Q., Borenstein, A. R., Wu, Y., Jackson, J. C., Larson, E. B., American Journal of Medicine 2006 Sep;119(9):751-759.
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Does plate size really matter when it comes to watching your weight? Or is it a silly trick your stomach probably won't fall for? As it turns out, in this case, size does matter. Researchers found that when you dish up your meal, you're likely to clean your plate, regardless of serving size. And when you use a large serving spoon and a large plate or bowl, you're more likely to help yourself to over 50% more food than if you use smaller utensils and dishes. To avoid doubling the self-sabotage, think petite. Petite plates and petite spoons mean petite you.
It may be an optical illusion. The same amount of food that completely fills a small bowl may look lost in a large one, prompting you to spoon in -- and eat -- more. You also may find yourself more mentally satisfied if you eat from a small plate that's heaping full than from a large plate with a lonely-looking entrée in the middle of it, even though both have the same amount of food. Try using salad plates for dinner, martini glasses for ice cream, coffee cups for cereal, and petite salad forks and dessert spoons for all your meals. It may drive you or your family a little crazy at first, but you'll get used to it. And isn't it more fun to be unique? References Ice cream illusions bowls, spoons, and self-served portion sizes. Wansink, B., van Ittersum, K., Painter, J. E., American Journal of Preventive Medicine 2006 Sep;31(3):240-243.
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Most people breathe the way they dance: They think they know what they're doing, but they really don't have a clue. Stop for a second and focus on your breathing. Now look down. See anything moving? Probably not. That's because most people typically take very short,
shallow breaths -- the kind that simply come from your chest. For you to really improve your lung function, you need to practice taking deep, whole breaths. It should take about 5 seconds to inhale and 7 seconds to exhale. And your belly should get big, then small. Ahhh . . . that's
better. Remember what makes the lungs move? Your diaphragm. That's the muscle that pulls your lungs down, so your lungs expand and you can really circulate oxygen throughout the whole lung. As your diaphragm pulls your chest cavity down and you inhale, your belly button should be moving away from your spine as you fill your lungs. Your chest also will widen -- and maybe even rise ever so slightly -- as you inhale. When your lungs feel fuller than a sumo wrestler's lunchbox, exhale slowly. You can pull your belly button toward your spine to force all the air out of your lungs.
Okay, so now you know how to breathe deeply, but what are the benefits? There are lots, actually. For one, it helps transport nitric oxide -- a very potent lung and blood vessel dilator that resides in
your nasal passage -- to your lungs. So it makes your lungs and blood vessels function better. Taking deep breaths helps your lungs go from 98% saturation of oxygen to 100% saturation of oxygen. Another benefit is that it helps improve the drainage of your lymphatic system, which
removes toxins from your body. And the deep breaths act as a mini meditation, and from a longevity standpoint, that is an important stress reliever. Take 10 deep breaths in the morning, 10 at night, and as many as you need when shooting free throws or chasing your toddler
down the cereal aisle. References YOU: The Owner's Manual. Roizen, M. F., Oz, M. C., New York: HarperCollins, 2005.
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November 27, 2006 (London, UK) - Flying in the face of recent trial results that have found no benefit of folic acid for the prevention of cardiovascular events, a new commentary in the November 25, 2006 issue of BMJ says the combined evidence from cohort, genetic, and randomized controlled studies is indeed strong enough to support a modest protective effect of this nutrient [1].
Lead author of the new paper, Dr David S Wald (Queen Mary's School of Medicine and Dentistry, London, UK), told heartwire that 0.8 mg of folic acid per day should be used for reduction of cardiovascular events: "It is simple, safe, inexpensive, and undervalued." While he
acknowledges that recent interventional trials have not produced positive results, he says that they have been "interpreted as negative when really they have been neutral or inconclusive."
While some of the authors of these recent trials are critical of the BMJ paper, other experts sympathize with its arguments but conclude that there is not yet enough evidence to support routine use of folic acid for the prevention of cardiovascular events. Dr Ian Graham
(Trinity College, Dublin, Ireland) says: "This is a good debate to have. It is naive to believe that folic acid is some nutritional wonder drug, but I don't believe it is dead in the water yet."
http://www.medscape.com/viewarticle/548317?sssdmh=dm1.227504&src=nldne
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The mainstays of treatment for the Charcot foot have traditionally been immobilization and offloading or non-weightbearing. More recently, clinicians have attempted to utilize other modalities, including pharmacologic management with bisphosphonate therapy (i.e. IV pamidronate), early operative stabilization and bone growth stimulation. However, reports on electrical and mechanical bone growth stimulation are limited. Accordingly, let us take a closer look at the current evidence of their efficacy as adjunctive modalities in managing the Charcot foot. http://www.podiatrytoday.com/article/6437
But if you expect your health to decline with age, you may actually encourage that to happen. How? By taking a why-bother attitude, especially about staying fit. Instead, buck the odds and stay active, no matter how old you are, 39, 59, or even 99 -- an age you should aim to reach.
There's a secondary payoff, too: Activity is a natural mood booster, and that makes the assets of aging -- from deep friendships to loads of experience -- feel even more rewarding. So tell gloomy friends to check their attitudes at the door and to bring their sneakers the next time they visit. References: The relationship between expectations for aging and physical activity among older adults. Sarkisian, C. A., Prohaska, T. R., Wong, M. D., Hirsch, S., Mangione, C. M., Journal of General Internal Medicine 2005 Oct;20(10):911-915.
http://www.mdlinx.com/DrugLinx/newsl-article.cfm/1758198/?user_id=157159&email=rnfrankie@bellsouth.net&news_id=1105
CHICAGO, IL -- January 23, 2007 -- Taking daily selenium supplements appears to increase the level of the essential mineral in the blood and may suppress the progression of viral load in patients with HIV infection, according to an article in the January 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Advances in antiretroviral therapy (ART) have given HIV patients a longer life expectancy, according to background information in the article. However, strict adherence to the therapy is required to keep HIV viral counts low, and there is a risk of toxic effects and metabolic dysfunction. "Thus, complete control of HIV over time using ART is unlikely, and pharmacotherapeutic limitations leave a significant void in the treatment arsenal," the authors write.
Selenium deficiencies have been observed in patients with HIV spectrum disease and evidence suggests that selenium supplements can improve immune functioning.
http://www.docguide.com/news/content.nsf/news/852571020057CCF68525726C00567957?OpenDocument&id=D82277BEB625E4E185256E3700509F48&c=&count=10
Is there an Autism Epidemic? The term "epidemic" has been with us for much of recorded history. Over the past few decades, however, the definition of the term has expanded to include a description of rapidly rising dilemmas that were formerly considered in the exclusive realm of chronic diseases, social problems, and even behaviors. Witness, for example, the public health clarions about the epidemic of lung cancer, associated with the rise of cigarette smoking, or the epidemics of obesity, handgun violence, and substance abuse.
When it comes to developing public health campaigns against specific health problems, the status of epidemic is definitely worth seeking, because governmental policies and research programs are typically developed to respond to epidemic health threats.
And hopefully, something gets done to ameliorate such burgeoning problems, which brings me to the topic of autism and its rise in incidence over the past 15 years. One would have to live under a rock not to notice the growing concern over a potential epidemic of autism. http://www.medscape.com/viewarticle/551540?src=mp
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Doctors' sloppy handwriting kills more than 7,000 people annually. It's a shocking statistic, and, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM),
preventable medication mistakes also injure more than 1.5 million Americans annually. Many such errors result from unclear abbreviations and dosage indications and illegible writing on some of the 3.2 billion
prescriptions written in the U.S. every year. http://www.time.com/time/health/article/0,8599,1578074,00.html?cnn=yes
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
http://www.medscape.com/cmecenterdirectory/nurses
This site is loaded with CE/CME offerings.......check it out.
http://www.medscape.com/nurses/ce
The Home Health Nurse's Role in Geriatric Assessment of Three Dimensions: Depression, Delirium, and Dementia Home Healthcare Nurse, October 2006Geriatrics http://www.nursingcenter.com/prodev/ce_article.asp?tid=691350
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@bellsouth.net
A - Z Guide on Health Topics http://www.webmd.com/a_to_z_guide/health_topics.htm
The list serv to join for nursing informatics is: listproc@listproc.listproc.net
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http://www.fda.gov/medwatch/safety/2007/safety07.htm#heatpad
Dramatic new data from a major morbidity and mortality trial have ended all hopes for
Pfizer's torcetrapib, a novel cholesteryl-ester-transfer-protein (CETP) inhibitor. Early data have shown an increased risk of mortality and cardiovascular events with the experimental high-density lipoprotein (HDL) cholesterol–raising drug, and as a result, Pfizer has halted its entire torcetrapib development program.
The news, announced Saturday night, is a tremendous blow to the company, as well as a disappointment to clinicians who hoped the HDL cholesterol–raising drug might be used with low-density lipoprotein cholesterol–lowering agents for a one-two punch in the fight against cardiovascular disease. Pfizer was so optimistic about torcetrapib that just last week it said it would seek early Food and Drug Administration approval based on the results of intravascular ultrasound (IVUS) and carotid intima-media thickness studies to be presented in early 2007. http://www.medscape.com/viewarticle/548725?sssdmh=dm1.228715&src=nldne
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- use a topical anesthetic approved by the FDA.
- use a topical anesthetic that contains the lowest amount of anesthetic drugs possible that will relieve pain.
- ask for instructions from your doctor on how to safely use the topical anesthetic.
dysfunction. Liviro3 is not approved by FDA to treat this condition. Tadalafil may interact with nitrates found in some prescription drugs and may lower blood pressure to dangerous levels. Consumers who have
Liviro3 should stop using it immediately and contact their physician if they experience any problems that may be related to taking this product.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#Liviro3
NURSING HINTS CORNER
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ADVERTISEMENTS from the members
This ad is from Decubqueen @aol.com (Gerry).......... Accu-Ruler ( I like them...work well)
Accurate wound measurement designed by nurses, for nurses.
Now carrying wound care and first-aid supplies at prices you can afford. Free Shipping with first order--be sure to mention Paradigm97 to get the free shipping.
Visit us at http://www.accu-ruler.com/.
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This ad is from: GShort @AOL.com (Gwen) These are great little cakes !
http://www.delightfulgreetingcakes.com/worldsgreatest.php
NEW MEMBERS
Welcome to : lamcon14@hotmail.com (Laurie) January 29,2007
Please send the prospective members' screen names and first names to
me: RNFrankie@bellsouth.net
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ADDRESS CHANGES
So please send me your new name/address, ok? rnfrankie@bellsouth.net
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Editorial Staff: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue),
HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com
(Miriam), and Schulthe @AOL.com (Susan)
Membership BIO Committee...(if you haven't sent in your BIO....Please send it to the appropriate
BCK131 @AOL.com (Chris) A thru B section,
Dick515 @AOL.com (Eileen) C thru D section,
GALLO RN @AOL.com (Sue) E thru I section,
rnfrankie @bellsouth.net (Frankie) J thru K section,
Jntcln @AOL.com(Janet) L thru M section,
GALLO RN @AOL.com (Sue) N thru Q section
Schulthe @AOL.com (Susan) R thru T section
Sandy1956 @AOL.com (Sandy) U thru Z section.
Paradigm 97 Co-Founders:
MarGerlach @AOL.com (Marlene) and RNFrankie @bellsouth.net (Frankie)
DISCLAIMER:
The intent of this PARADIGM BYTES Newsletter is to provide communication and information
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THOUGHT FOR THE DAY
There are two lasting bequests we can give our children:
One is roots. The other is wings.
