Sunday, April 8, 2007

PARADIGM BYTES

Newsletter for Paradigm97
April 3, 2007

Our website...... http://paradigm97.blogspot.com

PARADIGM DEFINED:

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.

Members, please take the time.to drop in to the AOL Paradigm97 chatroom which is
"manned" by GingerMyst for 45 min on Tuesday evenings: 9 pm EST, 8 pm CST, 7 pm MST,
6 pm PST (Please note that these are actially the same time)
The Paradigm97 chatroom is always there....door open, lights on, waiting for visitors
to come in. Check your Buddy List.....and invite your nursing friends in for a little chat
Let me know if you want others involved e.g. prospective new members.
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SNIPPETS
(Another JCAHO offering)
Medication errors related to potentially dangerous abbreviations
One of the major causes of medication errors is the ongoing use of potentially dangerous abbreviations and dose expressions.Underlying factors contributing to many of these errors are
illegibleor confusing handwriting by clinicians and the failure of health care providers to
communicate clearly with one another. Because medication safety and the identification,
prevention and timely reporting of medication errors are of primary importance to the Joint Commission, this issue of Sentinel Event Alert specifically addresses medication
errors related to the use of dangerous abbreviations and dose expressions used in prescribing medications.

Despite repeated warnings for more than 25 years by the Institute for Safe Medication Practices (ISMP)--and other organizations--about the dangers associated with using certain
abbreviations when communicating medication information, the practice of using these dangerous abbreviations continues, increasing the potential for patient harm. "Symbols and abbreviations are frequently used to save time and effort when writing prescriptions and documenting in patient charts," says Darryl S. Rich, Pharm.D., M.B.A., FASHP,
associate director, Surveyor Development and Management, JCAHO. "However, some
symbols and abbreviations have the potential for misinterpretation or confusion."

Examples of especially problematic abbreviations include "U" for "units" and "µg" for "micrograms." When "U" is handwritten, it can often look like a zero. There are numerous case reports where the root cause of sentinel events related to insulin dosage has been the
interpretation of a "U" as a zero. Using the abbreviation "µg" instead of "mcg" has also been the source of errors because when handwritten, the symbol "µ" can look like an "m". The use of trailing zeros (e.g., 2.0 vs. 2) or use of a leading decimal point without a leading zero
(e.g. .2 instead of 0.2) are other dangerous order writing practices. The decimal point is sometimes not seen when orders are handwritten using trailing zeros or no leading zeros. Misinterpretation of such orders could lead to a 10-fold dosing error. "To minimize the potential
for error and to maximize patient safety, prescribers need to avoid such specifically dangerous abbreviations and phrases," Dr. Rich says.

ISMP issues wake-up call

Following the tragic death of an infant due to the misinterpretation of a prescription for morphine, ISMP recently issued a wake-up call to health care institutions reminding them of the
dangers of utilizing certain dangerous abbreviations and dose expressions. (1) "ISMP and others have advocated abandoning the use of these abbreviations and expressions for almost three decades," says Michael Cohen, D.Sc., M.S., FASHP, president, ISMP. "ISMP has also
stressed that it is equally important to avoid these dangerous abbreviations and dose expressions in other communications such as computer-generated labels, Medication
Administration Records (MARs), labels for drug storage bins/shelves, preprinted orders and protocols, and pharmacy and prescriber order entry screens." A table of dangerous abbreviations and dose expressions most often associated with misinterpretation and patient harm (as reported to the USP-ISMP Medication Errors Reporting Program) may be obtained from the ISMP website at www.ismp.org.

In addition, NCC MERP (National Coordinating Council for Medication Error Reporting and Prevention) in 1996 issued "Recommendations to Correct Error-Prone Aspects of Prescription Writing" (2) and U.S. Pharmacopeia in 1997 issued "Recommendations for
Prescription Writing," (3) which discuss ways organizations can avoid medication errors and minimize risks to patients.
Risk reduction strategies
Though new technologies such as computerized order entry systems are being
introduced into health care, it is estimated that currently less than 5 percent of U.S. physicians utilize these systems and write their prescriptions electronically. The related costs and
training issues are most often cited as reasons why organizations do not adopt these new technologies. However, by moving toward electronic prescribing systems, organizations can most certainly minimize medication errors, including those related to poor handwriting, thus
drastically reducing the risks to patients and the costs associated with drug-related morbidity and mortality. (4) Realizing that most health care organizations will not be able to implement this new, costly technology in the near term, JCAHO has identified some cost efficient and effective risk reduction strategies that any health care organization can adopt:

a.. Develop a list of unacceptable abbreviations and symbols that is shared with all prescribers.
b.. Develop a policy to ensure that medical staff refer to the list, and take steps to
ensure compliance.
c.. Establish a policy that if an unacceptable abbreviation is used, the prescription order is verified with the prescriber prior to its being filled.
Recommendations
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Examples of correct and incorrect use of decimal points and zeros:

Correct Incorrect
2. or 2 2.0
0.2 .2

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The Joint Commission requires that medication orders have "the degree of accuracy, completeness, and discrimination necessary for their intended use" (JCAHO standard IM.3 in
all manuals). Standard IM.3 also requires the use of standardized abbreviations, acronyms and
symbols. Use of confusing and dangerous abbreviations is not consistent with the intent of this standard. Furthermore, hospitals are to assess/review orders in the medical record for "presence, timeliness, legibility, and authentication," and see that "action is taken to
improve the quality and timeliness of documentation that impacts patient care" (IM.7.10 in the Comprehensive Accreditation Manual for Hospitals). This should be done as part of the quarterly medical record review that hospitals undertake for record completeness and
authentication. As part of the review, standard IM.7.10 clearly requires that legibility be addressed as well as completeness and authentication.

In addition, MS.8.2.3 (Comprehensive Accreditation Manual for Hospitals) requires that data regarding "accurate, timely and legible completion of patient's medical records" be specifically addressed in the privileging and credentialing program, and that this
data must not only be aggregate data, but how specific physicians do compared to the norm. Failure to do so can result in multiple Type I recommendations, even if not part of a Medication Use Evaluation or Performance Improvement program. Multiple Joint Commission standards
require legibility of physician orders and that hospitals take appropriate action to improve the legibility of physician orders. Finally, standard TX.3.5.2 (Comprehensive Accreditation Manual for Hospitals) requires pharmacists to review all medication orders and to contact the prescriber, if questions arise. In order to achieve compliance with these standards, strategies to reduce the inappropriate use of dangerous abbreviations need to be taken, such as those
identified in this alert's risk reduction strategies.

References
1.. ISMP Medication Safety Alert!, May 2, 2001, www.ismp.org.
2.. "Recommendations to Correct Error-Prone Aspects of Prescription Writing," NCC MERP Council Recommendation, adopted Sept. 4, 1996, at www.nccmerp.org (under Council Recommendations).
3.. "Recommendations for Prescription Writing, " USP Quality Review, No. 57, Jan. 1997, www.usp.org (search keyword "abbreviations").
4.. Electronic Prescribing Can Reduce Medication Errors, white paper from the Institute for Safe Medication Practices, www.ismp.org.
Published for Joint Commission accredited organizations and interested health care professionals, Sentinel Event Alert identifies specific sentinel events, describes their common underlying causes, and suggests steps to prevent occurrences in the future.

During the on-site survey of accredited organizations, JCAHO surveyors assess the organization's familiarity with and use of Sentinel Event Alert information. Accredited organizations are expected to:

a.. Review and consider relevant information, if appropriate to the organization's services, from each Sentinel Event Alert.
b.. Consider information in an alert when designing or redesigning relevant processes.
c.. Evaluate systems in light of information in an alert.
d.. Consider standard-specific concerns.
e.. Implement relevant suggestions or reasonable alternatives or provide a reasonable explanation for not implementing relevant changes. Failure to do so will result in a type I
recommendation.

Setting the Standard for Quality in Health Care
Joint Commission
Sentinel Event Hotline (630) 792-3700

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INTERESTING READING

Please remember that the REUTERS' articles are good for 30 days only

Finding it harder to do what you once did easily? Check your multivitamin. If your arms
start to feel like wet noodles after carrying groceries, pushing the vacuum, or
doing a normal workout, you may be low on magnesium. Your muscles require this mineral to function properly, yet two-thirds of us don't get enough. Meet your daily intake
with whole grains, nuts, leafy greens, and a multivitamin/mineral supplement that includes magnesium. More findings about magnesium . . . RealAge Benefit: Getting enough magnesium (400 milligrams per day for women, 333 milligrams for men) can make your RealAge as much as 0.9 years younger.
Your body needs magnesium to power your muscles (and your heart, nerves, and bones, too) and when you don't have enough, it shows. In one study, older adults who had the lowest magnesium levels also did the worst on strength tests, a risky combination that invites accidents
and threatens the heart. The reason? Without enough magnesium, your body struggles to carry out physical tasks, which pushes up your heart rate and can leave you gasping for oxygen. Gaps in your diet are largely to blame.
Here's what you can do about it: On your next trip to the supermarket, fill your basket with bran or shredded wheat cereal, brown rice, nuts, whole-grain breads, and leafy greens --
all are rich in magnesium. And to back up your improved diet, take a daily multivitamin/mineral
supplement that contains at least 100 milligrams of magnesium.
References: Magnesium and muscle performance in older persons: the In CHIANTI study. Dominguez, L. J., Barbagallo, M., Lauretani, F.,, Bandinelli, S., Bos, A., Corsi, A. M., Simonsick, E. M., Ferrucci, L., American Journal of Clinical Nutrition 2006 Aug;84(2):419-426.
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All that tension inside you? It's on the surface, too. When your life is a pressure cooker,
your skin pays the price. Stress throws off the skin's ability to recover, so scratches or
scrapes stick around longer. And your skin may be more easily inflamed by scratchy
wool sweaters, adhesive bandages, cold weather, or dry, itchy skin conditions like
psoriasis or eczema. What unknots you on the inside helps calm your skin side too --
a quiet walk, a little yoga, soothing music. But if that's not doing the trick, take this psoriasis assessment and get personalized advice on red, itchy, flaky skin. Stress appears to
interfere with the normal barrier function of skin, making it more susceptible to skin
disorders. This response was noted in a study on skin irritation, in which sticky tape was
applied and then removed from the forearms of participants. The skin of people who
were highly stressed took longer to recover than the skin of people who were not tense.
That's a good reason to find a mind/body relaxation method that works for you -- whether
it's meditation, knitting, or rhythmic running. References: Psychological stress perturbs epidermal permeability barrier homeostasis: implications for the
pathogenesis of stress-associated skin disorders. Garg, A., Chren, M.
M., Sands, L. P., Matsui, M. S., Marenus, K. D., Feingold, K. R.,
Elias, P. M., Archives of Dermatology January 2001;137(1):53-59.
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Hospitals Made Less Safe When Individuals Blamed
The Capital Times :: EDITORIAL :: A10

Wednesday, November 15, 2006 (yes, this is old, but good) SUZANNE GORDON

Wisconsin officials believe they've done the right thing by charging Madison nurse Julie Thao with a felony for making a fatal medication error at St. Mary's Hospital last July. "The circumstances of the case go well beyond a simple mistake," contends Mike Bauer of the Department of Justice.

Indeed they do. Which is why pressing charges against a veteran nurse is going to make hospitals less safe. Thao worked on a labor and delivery unit until she was fired four months ago. For 15 years, she had, by all accounts, been an exemplary RN. Yet she accidentally
delivered a powerful painkiller, rather than penicillin, to a young woman who was giving birth. The anesthetic stopped Jasmine Gant's heart, causing her death (although hospital staff were able to save baby)
Contrary to the theory of individual blame now being pursued by prosecutors, this terrible
tragedy confirms what a 1999 report by the Institute of Medicine found -- that medical errors are usually the result of system failures.
http://www.nursingadvocacy.org/news/2006/nov/20_captimes.html#gordon_section
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Women With Thrombophilic Defects on Oral Contraceptives Have
Higher VTE Risk
February 13, 2007 (Groningen, the Netherlands) - Women with hereditary
deficiencies of protein S, protein C, or antithrombin are at higher risk of venous thromboembolism (VTE) from combined oral contraceptives (COC) than women without such deficiencies, according to a retrospective family cohort study [1]. "This is the first study,
to our knowledge, to address the multicausality of VTE in COC-using women, including all the known thrombophilic defects and deficiencies," van der Meer said.
http://www.medscape.com/viewarticle/552153?sssdmh=dm1.247632&src=nldne
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More Data Support Switching to Aromatase Inhibitors in Early Breast Cancer
February 13, 2007 - Further data to support switching to an aromatase inhibitor (AI)
instead of continuing with tamoxifen in postmenopausal women with early breast cancer comes from a mature analysis of the Intergroup Exemestane Study (IES), published online
February 13 in the Lancet....
http://www.medscape.com/viewarticle/552135?sssdmh=dm1.247632&src=nldne
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FDA Staffer Urges Scrutiny of Lilly Drug WASHINGTON (Reuters) Feb 13 - Eli Lilly
and Co.'s antipsychotic medication Zyprexa carries risks that call for closer safety monitoring
by the U.S. Food and Drug Administration, an FDA whistleblower told Congress on Tuesday.
FDA scientist Dr. David Graham said there were concerns about weight gain from Zyprexa
and diabetes. Other antipsychotic medications also warrant closer scrutiny, he added.
http://www.medscape.com/viewarticle/552152?sssdmh=dm1.247632&src=nldne
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WHO Backs Glaxo's Rotariz for Mass Vaccination LONDON (Reuters) Feb 13 - GlaxoSmithKline Plc's vaccine Rotarix, designed to prevent gastroenteritis caused by rotavirus
in children, has been endorsed as suitable for use by U.N. agencies by the World Health Organization. The British-based drugmaker said on Tuesday it was the first such vaccine to
win so-called prequalification status from the international health body. The move certifies the vaccine's quality, safety and efficacy, allowing agencies like the Pan American Health Organisation, UNICEF and others to use it in mass vaccination programs.
http://www.medscape.com/viewarticle/552150?sssdmh=dm1.247632&src=nldne

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Increased Risk of Infection and Mortality After Blood Transfusion for
CABG Patients - A new study has shown that patients who receive blood transfusions
while hospitalized for coronary artery bypass graft (CABG) surgery are more likely to develop an infection after surgery and are at a greater risk of death than those who do not receive a blood transfusion [1].

These findings, say investigators, could help shed light on why women fare worse after surgery
than men. As women receive more blood transfusions than men, primarily because of their lower hemoglobin or hematocrit levels, this might explain the difference in death rates
between the sexes following CABG.
http://www.medscape.com/viewarticle/549791?sssdmh=dm1.234442&src=nldne

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This article was sent in by BAcello (Barbara) who wrote: "I sincerely
believe that many nurses need to learn how to properly manage
treatment refusals. They think hey have fulfilled their responsibility if they have documented the refusal and written something like "refuses bath"on the care plan. They often do not notify the physician, and they seldom try other creative ways of getting the resident to accept the treatment. I have been preaching about this forever, and although this rather lengthy article is gross, it is a good example of why the aforementioned is not sufficient
nursing intervention. I think this is an excellent article to use for teaching nurses about notifications and managing refusals" Barbara

URL: http://www.firstcoastnews.com/printfullstory.aspx?storyid=71819
Woman Treated For Maggot-Infested Wounds EVANSVILLE, Ind. (AP) -- A resident of a
long-term care facility had maggot-infested wounds so advanced that skin peeled off her legs
when a hospital emergency room nurse removed her clothing, state inspectors found.
Riverwalk Communities, which has a history of violating nursing home standards,
could face state action for the woman's care, said Jennifer Dunlap, a spokeswoman for the
State Department of Health.

"He indicated he soaked her right foot in warm water for 45 minutes and bugs/cockroaches were crawling out of the house slipper. Upon removing the house slipper, he indicated the skin came off of the right foot and toes," the report said. When the nurse removed the woman's pants, the material pulled the skin off the woman's legs, from the knees to the
ankles, according to the report.

The state's survey report found, among other things, that Riverwalk officials had failed to notify the woman's physician when she refused his prescribed treatment. While residents can refuse treatment, "that does not absolve the facility from protecting the resident," said Michelle Motta,
Vanderburgh County's long-term care ombudsman.
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The Older Nurse in the Workforce......does Age Matter? In this article
of the Six articles, we concentrate on a different but increasingly important component of the RN workforce - the growing proportion of older RNs.
Palm Beach Post wire services Wednesday, February 28, 2007LOS ANGELES - In what some are hailing as the most important development in HIV therapy in a decade, two new classes of drugs havebeen found to block virus replication in patients who have become resistant to existing drugs, researchers said Tuesday.The two new classes, called integrase inhibitors and CCR5 inhibitors, doubled the number of patientsin a group of studies whose infections could be brought under control, researchers said at the Conference on Retroviruses and OpportunisticInfections.This is "a pivotal moment" for patients who have become resistant to most AIDS drugs, said Dr. Eric Daar ofHarbor-UCLA Medical Center.Daar, who was not involved in the research, estimated that about 20percent of his patients are resistant to the existing classes of drugs.
http://www.palmbeachpost.com/search/content/nation/epaper/2007/02/28/a2a_HIV_0228.html ************************************
Texas, take care of nurses the way they care for us. Limiting the RN-to-patient ratios in hospitals saves lives. Imagine, being alone and sick in the hospital. It's a frightening and stressful experience, but you can always count on one person to be at your bedside: the registered nurse. RNs are on the front lines of our medical system, and every family in the state will eventually rely on their care.That is why a coalition of Texas lawmakers has joined with the National Nurses Organizing Committee and introduced the Texas Hospital PatientProtection Act of 2007, which will significantly improve patient safety in our hospitals with enhanced standards for nurses and stronger protections for patients.The sad fact is that Texas nurses do not have the support they need to do their job. We're seeing an exodus of RNs from the hospital bedside because of hazardous working conditions and dangerously unsafe assignments that are not up to national standards.This must change. Right now, for example, hospitals can assign an RN an unlimited number of patients to care for, meaning they don't have the time to assess and properly care for any of them. This problem is particularly acute because patients who stay in hospitals today are much sicker and have more complex medical treatments and drugs requiredthan in pastyears... (Florida, is not any better)
http://www.chron.com/disp/story.mpl/editorial/outlook/4591290.html ***************************** ***
End-of-life care, palliative care, hospice, death and dying; these are terms that many advanced practice nurses deal with in our work lives.We know that planning carefully for this stage of life can bring about comfort and satisfaction despite the inevitable outcome. Many of us may be workingwith adults who are planning for the future for themselves or older family members. Although end-of-life care may not be an overt goal in planning, comfort and quality of life usually are. Patients and families look to advanced practice nurses for information, resources,advice, and support during this time of decision making. Learn about the Nursing Home Quality Monitor, which provides a state-by-state breakdown of nursing homes that are likely to provide better-qualitycare and those that provide poorer-quality care. Topics in AdvancedPractice NursingeJournal 6(4) 2006http://www.medscape.com/viewarticle/548968?src=mp

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To check out your knowledge of Business etiquette......try this site:www.etiquetteexpert.com/eti_quiz.htm ( I found several surprises when Itook the test.
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Much Wider Use of M.R.I.'s Urged for Breast Exam By DENISE GRADY
Two reports call for greatly expanded use of M.R.I. scans but radiologists are not equipped for more demand...
http://www.nytimes.com/2007/03/28/health/28mri.html?th&emc=th

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Hospitals set standards for wristband use The Business Journal of Phoenix - March 2, 2007 by Angela Gonzales The Business Journal
Imagine getting rushed to the hospital and, in the frenzy of your heart attack, a nurse slaps on a yellow wristband. The yellow bands have different meanings depending on the hospital. In some, they mean "do not resuscitate." This actually happened to a patient in Pennsylvania. Luckily, another nurse caught the mistake in time for doctors to save the patient's life.In Arizona, the do-not-resuscitate wristband is purple. Hearing about the standardization, other states are adopting Arizona's protocol. "The goal is for every hospital in Arizona to have this implemented by the end of this year," said BarbAveryt, program director of the hospital association's Safe and Sound patient safety program. "When you have eight different colors being used for one wristband, the hospitals then came to us and said, can we do something about this collectively?" she said. Hospitals across the state will be rolling out the program throughout the year, making sure to educate doctors,nurses, pharmacists and even ancillary staff such as housekeeping."Every hospital wants patient safety," said Dawn Horak, risk managementconsultant for John C. LincolnHospital-Deer Valley. "We want it to happen so we can avoid near-miss incidents." With many nurses traveling to work at several facilities throughout the state and nation, standardization is essential, she said.
http://phoenix.bizjournals.com/phoenix/stories/2007/03/05/story7.html?

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WASHINGTON (Reuters) -- An antibiotic often used in hospital intensivecare units to treat serious staph infections resistant to other medicines may cause a sometimes-fatal bleeding condition, researchers said Wednesday. A study in the New England Journal of Medicine linked the antibiotic vancomycin to a disorder called thrombocytopenia. It is associatedwith abnormal bleeding and marked bya decrease in blood platelets....Vancomycin, in use for about three decades, can be used to treat infections in many parts of the body, and is seen as the drug of choice for serious staphylococci infections that are resistant to most other antibiotics. It can have other serious side effects, including hearing and kidney damage.The study's senior researcher, Dr. Richard Aster of the Medical College of Wisconsin in Milwaukee and the Blood Center of Wisconsin's Blood Research Institute,said the findings should not reduce use of vancomycin, which he said remains an important life-saving drug for certain patients.
http://www.cnn.com/2007/HEALTH/02/28/antibiotic.blood.reut/index.html

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Wits Scientists invent cutting-edge medicine Independent Online - Cape Town,South Africa One method he has invented, the wafer delivery system, will minimise the use of injections and deliver medicine into the body almost immediately, ...
http://www.iol.co.za/index.php?set_id=14&click_id=117&art_id=vn20070331121412544C365335

<<<<<<>>>>>>
CME/CEU
Those that are free and otherwise
Nursing Spectrum's CE address is now: www.nurse.com

A website offering free CEUs: http://www.medscape.com/cmecenterdirectory/nurses

This site is loaded with CE/CME offerings......http://www.medscape.com/nurses/ce
A huge offering of CEUs for LPNs and RNs. ......for$24.99
https://nursing.advanceweb.com/Common/CE/Main.aspx

Medical Adherence: America's "Other Drug Problem". Introduction:The Challenge of Adherence http://www.medscape.com/viewprogram/6450?src=mp 0.75 ceu's

Genital Warts: Best Practices for Diagnosis and Management Twenty million people in the United States have HPV but are largely unaware because genital warts, the most common clinical manifestation, are not recognized. http://www.medscape.com/viewprogram/6385Nurses - 1.2 nrs (0.6 hrs.are in the area of pharmacology)

This CE is for Pharmacists Understanding Migraine http://www.medscape.com/viewprogram/6095?src=mp

Aspirin Found to Reduce Esophageal Cancer Risk in Barrett's (CME/CE) SEATTLE --Aspirin and other NSAIDs decrease the risk of progression of the most aggressive form of Barrett's esophagus to esophageal cancer, researchers here reported.
http://www.medpagetoday.com/HematologyOncology/OtherCancers/dh/5167

Vitamin D Insufficiency in Patients with End Stage Renal Disease: the Role and Effect of Vitamin D analogues on Survival CME/CE 0.9 hrs03/30/2007
What impact do vitamin D analogues have on survival in patients with secondary hyperparathyroidism? Join Drs. Craig Langman, Francesca Tentori, and Csaba Kovesdy as they discuss. http://www.medscape.com/viewprogram/6857?sssdmh=dm1.259168&src=nlcmealert

Improving Adherence in Childhood and adolescent ADHD CME/CE03/30/2007 0.4 hrs
Find out what 3 of the top experts in ADHD recommend to improve treatment outcomes for kids with ADHD, and why it's important.
http://www.medscape.com/viewprogram/6884?sssdmh=dm1.259175&src=nlcmealert

Making the Difficult Diagnosis: Detecting Autism in a Toddler CME/CE03/30/2007 1.5 hrs Autistic disorders can be detected in toddlers, and early intervention is in increasing demand. Learn how to respond to anxious parents and the best approach to this challenging diagnostic problem. http://www.medscape.com/viewprogram/6876?sssdmh=dm1.259175&src=nlcmealert

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WEBSITES/LINKS
Always on the lookout for interesting websites / links.Please send them to: RNFrankie@bellsouth.net A - Z Guide onHealthTopics

http://www.webmd.com/a_to_z_guide/health_topics.htmRozalfaro's website (Roz)

http://www.alfaroteachsmart.com/Raconte's website (Geneviève)

http://www.solutionsoutsidethebox.net,I am not certain...but probably most of us and all our information isat this website. "Believe it" !!! Zabasearch:http://www.zabasearch.com/

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HUMOR
(If anyone has ever tried Medical Transcription, this is typical. Can become very difficult)

We were thoroughly confused. While transcribing medical audiotapes, myco-worker came upon the following garbled diagnosis: "This man haspholenfrometry"."
Knowing nothing about that particular condition, she double-checked with the doctor.
After listening to the tape, he shook his head."This man," he said, translating for her, "has fallen from a tree."

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MEDICAL RECALLS/ NOTICES
FDA and Bristol-Myers Squibb notified healthcare professionals of Clinical Studies/Special Populations sections of the prescribing information for Baraclude. The revised labeling is the result of a case report in which a human immunodeficiency virus (HIV) variant containingthe M184V resistance substitution was documented during Baraclude treatment for chronic hepatitis B virus(HBV) infection in an HIV/HBVco-infected patient who was not simultaneously receiving highly active antiretroviral therapy (HAART). Current treatment guidelines recommend Baraclude as an option for treatment of HBVin the HIV/HBV co-infected adult patient who does not qualify for HAART. Healthcare professionalsare advised that when considering therapy with Baraclude in an HIV/HBVco-infected patient not receiving HAART, the risk of developing HIV resistance cannot be excluded based on current information.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#Baraclude

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FDA notified healthcare professionals and patients that Novartis has agreed to discontinue marketing Zelnorm, a drug used for the short-term treatment of women with irritable bowel syndrome with constipation andfor patients younger than 65 years of age with chronic constipation. FDA analysis of safety data pooled from 29 clinical trials involvingover 18,000 patients showed an excess number of serious cardiovascular adverse events, including angina, heart attacks, and stroke, in patients taking Zelnorm compared to patients given placebo. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Zelnorm

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NURSING HINTS
Sorry Next Time
Used with permission from 1,001 Nursing Tips & Timesavers,ThirdEdition, 1997, p. 49, Springhouse Corporation/www.springnetcom

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ADVERTISEMENTS
From the members

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NEW MEMBERS
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Please send the prospective members'screen names with first names to me: RNFrankie@bellsouth.net

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ADDRESS CHANGES
NOTICE: I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the e-mail address until you contact me with an updated e-mail address; I have no way to reach you without a corrected-mail address.... Remember most ISPs do not send the updated e-mail address.You could always send me your home number.......lol So pleasesend your new name/address to 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 section below) : Check by your screen name's first letter.........If you have any questions...feel free to write either the Bio/Profile person or myself. Be very glad to help you.
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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 97Co-Founders:
MarGerlach@AOL.com (Marlene) rnfrankie@bellsouth.net (Frankie)

+*+*+*+*+*+*+*+*+*+*+*+
DISCLAIMER:
The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the links and information provided by our members.The articles and websites are not personally endorsed by the editors, nor do the articles necessarily reflect our opinions.

<<<<<<<<<<<<<<<<>>>>>>>>>>>>>>
THOUGHT FORTHE DAY

Sent in by MJSolon@AOL.com(Melva)

Anger or hatred is like a fisherman's hook.
It is very important forus to ensure that
we are not caught by it.-

DalaiLama

Write me.....offer suggestions for theNewsletter/ share articles, etc. Frankie
(rnfrankie@bellsouth.net)
Posted by at No comments:

PARADIGM BYTES

PARADIGM BYTES
Newsletter for Paradigm97
March 9, 2007

I have "misplaced" the latest Newsletter for April......and then found that this one wasn't on the website, either. Will continue to look for April's tome. OH JOY !

Our website...... http://paradigm97.blogspot.com

PARADIGM DEFINED:

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.

Members, please take the time.to drop in to the AOL Paradigm97 chatroom which is
"manned" by GingerMyst for 45 min on Tuesday evenings: 9 pm EST, 8 pm
CST, 7 pm MST, 6 pm PST (Please note that these are actially the same time)
The Paradigm97 chatroom is always there....door open, lights on, waiting for visitors
to come in. Check your Buddy List.....and invite your nursing friends in for a little chat
Let me know if you want others involved e.g. prospective new members.
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SNIPPETS
This snippet information is from JCAHO
Tubing misconnections-a persistent and potentially deadly occurrence
Tubing and catheter misconnection errors are an important and under-reported problem in
health care organizations. In addition, these errors are often caught and corrected before
any injury to the patient occurs. Given the reality of and potential for life threatening
consequences, increased awareness and analysis of these errors-including averted errors-
can lead to dramatic improvement in patient safety.

To date, nine cases involving tubing misconnections have been reported to the Joint
Commission's Sentinel Event Database. These resulted in eight deaths and one instance of permanent loss of function, and affected seven adults and two infants. Reports in the media
and to organizations such as ECRI, the Food and Drug Administration (FDA), the Institute for
Safe Medication Practices (ISMP), and United States Pharmacopeia (USP) indicate that misconnection errors occur with significant frequency and, in a number of instances, lead to
deadly consequences.

Types of misconnections
The types of tubes and catheters involved in the cases reported to the Joint Commission
included central intravenous catheters, peripheral intravenous catheters, nasogastric feeding
tubes, percutaneous enteric feeding tubes, peritoneal dialysis catheters, tracheostomy cuff
inflation tubes, and automatic blood pressure cuff insufflation tubes.
The specific misconnections involved an enteric tube feeding into an intravenous catheter (4 cases); injection of barium sulfate (GI contrast medium) into a central venous catheter (1 case);
an enteric tube feeding into a peritoneal dialysis catheter (1 case); a blood pressure
insufflator tube connected to an intravenous catheter (2 cases); and
injection of intravenous fluid into a tracheostomy cuff inflation tube (1 case).

A review by USP of more than 300 cases reported to its databases found
misconnection errors involving the following:

a.. Intravenous infusions connected to epidural lines, and epidural solutions (intended for epidural administration) connected to peripheral or central IV catheters.
b.. Bladder irrigation solutions using primary intravenous tubing connected as secondary infusions to peripheral or central IV catheters.
c.. Infusions intended for IV administration connected to an indwelling bladder (foley) catheter.
d.. Infusions intended for IV administration connected to nasogastric (NG) tubes.
e.. Intravenous solutions administered with blood administration sets, and blood products transfused with primary intravenous tubing.
f.. Primary intravenous solutions administered through various other functionally dissimilar catheters, such as external dialysis catheters, a ventriculostomy drain, an amnio-infusion catheter, and the distal port of a pulmonary artery catheter.
Many of the misconnection cases involved luer connectors-small devices used in the connection
of many medical components and accessories.
There are two types of luer connectors-slips and locks. A luer slip connector consist of a
tapered "male" fitting that slips into a wider "female" fitting to create a secure connection.
The luer lock connector has a threaded collar on the "male" fitting and a flange on the
"female" fitting that screw together to create a more secure connection.
Examples of isconnections involving luer connectorsinclude the following:

a.. Capnography sampling tube to an intravenous cannula.
b.. Enteral feeding set to a central venous catheter.
c.. Enteral feeding set to a hemodialysis line.
d.. Noninvasive blood pressure (NIBP) insufflation tube to a needleless IV port.
e.. Oxygen tubing to a needleless IV port.
f.. Sequential compression device (SCD) hose to needleless "piggy-back" port of an IV administration set.
Root causes identified:
The basic lesson from these cases is that if it can happen, it will happen. Luer connectors are implicated in or contribute to many of these errors because they enable functionally dissimilar
tubes or catheters to be connected. Other identified causes include the routine use of tubes or catheters for unintended purposes, such as using IV extension tubing for epidurals, irrigation,
drains, and central lines, or to extend enteric feeding tubes; and the positioning of functionally
dissimilar tubes used in patient care in close proximity to one another. In the cases reported to
the Sentinel Event Database, contributing factors included movement of the patient from one
setting or service to another, and staff fatigue associated with working consecutive shifts.

Risk reduction strategies:
There are currently no published standards that specifically restrict the use of luer connectors to certain medical devices. Consequently, a broad range of medical devices, which have different functions and access the body through different routes, are often outfitted with luer
fittings that can be easily misconnected. Organizations in Europe and
the U.S. are now dveloping standards to restrict the types of devices that use luer
fittings in an attempt to mitigate misconnection hazards.
According to Jim Keller, vice president, Health Technology Evaluation and Safety for ECRI,
and Stephanie Joseph, project engineer for ECRI, the solution to reducing-even
eliminating-misconnection errors lies in both engineering controls respecting how products and devices are designed ("incompatibility by design"), and in re-engineering work practices.

"A well-designed device should prevent misconnections and should prompt the user to take
the correct action," explains Joseph, author of a guidance article published in the March 2006
issue of ECRI's Health Devices journal. As a first step in prevention, Joseph urges hospitals
to avoid buying non-intravenous equipment (such as nebulizers, NIBP devices, and enteral
feeding sets) that can mate with the luer connectors on patient IV lines. In addition, Joseph emphasizes that the single most important work practice solution for clinicians is to trace
all lines back to their origin before connecting or disconnecting any devices or infusions.

Other solutions include specific education and training regarding this problem for all clinicians
and having practitioners take simple precautions such as turning on the light in a darkened room
before connecting or reconnecting tubes or devices. The risk of waking a sleeping patient is
minimal by comparison. Errors have also occurred when patients or family members attempt
to disconnect and reconnect equipment themselves. Staff should emphasize to all patients the
importance of contacting a clinical staff member for assistance when there is an identified need
to disconnect or reconnect devices.

Other approaches to reducing the risk of misconnections that have been identified also have significant potential for unintended consequences.
These include:
a.. Labeling all tubes and catheters-This may not always be practical and may therefore lead
to inconsistent implementation. However, the labeling of certain high-risk catheters (epidural, intrathecal, arterial) should always be done.
b.. Color-coding tubes and catheters-This can lead users to rely on the color coding rather
than assuring a clear understanding of which tubes and catheters are connected correctly to
which body inlets. In addition, the training and educating of all staff (including temporary
agency and travel staff) about the institution's color-coding system requires continuing attention. Finally, color-coding schemes often vary across institutions in the same community, creating increased risk when agency and travel staff are used.

Joint Commission recommendations:
The Joint Commission offers the following recommendations and strategies to health care organizations to reduce tubing misconnection errors:

1.. Do not purchase non-intravenous equipment that is equipped with connectors that can physically mate with a female luer IV line connector.
2.. Conduct acceptance testing (for performance, safety and usability) and, as appropriate,
risk assessment (e.g., failure mode and effect analysis) on new tubing and catheter purchases to identify the potential for misconnections and take appropriate preventive measures.
3.. Always trace a tube or catheter from the patient to the point of origin before connecting any new device or infusion.
4.. Recheck connections and trace all patient tubes and catheters to their sources upon the patient's arrival to a new setting or service as part of the hand-off process. Standardize this
"line reconciliation" process.
5.. Route tubes and catheters having different purposes in different, standardized directions
(e.g., IV lines routed toward the head; enteric lines toward the feet). This is especially important
in the care of neonates.
6.. Inform non-clinical staff, patients and their families that they must get help from clinical staff whenever there is a real or perceived need to connect or disconnect devices or infusions.
7.. For certain high-risk catheters (e.g., epidural, intrathecal, arterial), label the catheter and do
not use catheters that have injection ports.
8.. Never use a standard luer syringe for oral medications or enteric feedings.
9.. Emphasize the risk of tubing misconnections in orientation and training curricula.
10.. Identify and manage conditions and practices that may contribute to health care worker fatigue, and take appropriate action. In addition, the Joint Commission urges product
manufacturers to implement "designed incompatibility," as appropriate, to prevent dangerous
misconnections of tubes and catheters.

Resources
ISMP Medication Safety Alert, June 17, 2004,
www.ismp.org/MSAarticles/tubingprint.htm

Nursing 2005, 35 (9), September 2005, pg. 73, by Melissa Eakle, R.N.,
MBA, MSN; Beverly Albrecht Gallauresi, R.N., B.S., MPH; and
AudreyMorrison, R.N.

FDA Patient Safety News, Show #31, September 2004; Show #20, October
2003; Show
#46, December 2005

"Fatal Air Embolism Caused by the Misconnection of a Medical Device
Hoses to Needleless
Luer Ports on IV Administration Sets" [hazard report], ECRI, Health
Devices, June 2004;
33(6):223-5

"Misconnected Flowmeter Leads to Two Deaths" [special report], ECRI,
Health Devices
Alerts, January 25, 2003

"Preventing Misconnections of Lines and Cables," ECRI, Health Devices,
March 2006; 35(3):81-95

"Safe Systems, Safe Patients: Common Connectors Pose a Threat to Safe
Practice."
Texas Board of Nursing Bulletin, 37(2):6-7, April 2006

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MEDICAL NEWS


FDA Panel Okays Sanofi's Bird Flu Vaccine

Among fourteen FDA-commissioned outside panelists, thirteen voted today to recommend
that the agency approve a bird flu vaccine made by Sanofi-Aventis as an interim vaccine to
get the U.S. ready for unforeseeable pandemic bird flu worldwide.The majority of the experts mostly on infectious disease and vaccines agreed that the vaccine may not be potent enough to have a protective effect against the H5N1 virus. But FDA officials said that the protective response is real. In any case, the FDA stressed that this is an interim vaccine, suggesting that better future
vaccines can replace the vaccine. In a small bird flu vaccine trial of a couple of hundreds of
people,only 45 percent of participants developed protective immune response after receiving
a dose that was ten times higher than that of a seasonal flu vaccine, which in comparison yields a response in at least 75 percent of the vaccine recipients.
http://foodconsumer.org/7777/8888/Non-_food_Things_27/022704272007_FDA_panel_okays_Sanofi_s_bird_flu_vaccine.shtml
FROM THE MEMBERS
Best Doctors Associate Clinical Director-Boston (can work remotelyfrom anywhere) Best Doctors is a private, fast-growing company providing cutting-edge solutions to fragmented care and escalating healthcare costs. Ourcore business is connecting patientswith the best medical care. Best Doctors was founded in 1989 byphysicians affiliated with the renowned Harvard Medical School and currently serves over 10 millionpeople in 30 countries. With relationships with over 50,000 doctorsidentified as the best in their specialties by their peers, BestDoctors represents an unparalleled resource. We are a uniquecombination of medical experience, skill and insight that ourlients - employers, insurers and reinsurers -can access to help them manage complex medical problems confidently.This dynamic team-oriented environment is ideal for a candidate whoenjoys clinical challenges without direct hands-on care and can bring creativity and flexibilityto communicating with health professionals. The Associate Clinical Director is responsible for obtaininginformation on patients with catastrophic and/or serious injuries,facilitating medical review/analysis, developing/implementing plan ofcare and coordinating/communicating with all stakeholders includingbut not limited to: insurer, field case manager, patient, treatingphysician, the Best Doctors' medical team and experts, etc. The idealcandidate possesses clinical strengths, organizational and leadershipskills, and experience in the workers' compensation system. Other requirements include but are not limited to: BACKGROUND REQUIREMENTS AND SKILLS: BSN required, MSN preferred Certification in Case Management (CCM); additional certification(CRRN, CLCP, CDMS, etc.) desirable Solid direct care experience, preferably in critical care, emergencymedicine, and/or rehabilitation, with strong clinical knowledge andskills Proven excellent verbal and written communication ability, experiencein editing technical material a plus Superior organizational, analytical/problem-solving, research, andinterpersonal skills Self-starter who is also an effective team player Persuasive style and personality with ability to communicate withpatients and physicians Patient and customer focus, with commitment to improving treatmentsand outcomes for patients Facility with multiple forms of electronic communication Ability to use Word, email, Internet search, etc. Minimal travel Please forward your cover letter and resume to me atwhowland@bestdoctors.com Wendie A Howland RN MN CRRN CCM
***~~~***~~~***~~~***~~~*** INTERESTINGREADING
Please remember that the REUTERS' articles are good for 30 days only
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This is from Kurt Ullman....... check out all his articles on the following website. Proper adherence to medication regimens is an important yet frequently overlooked aspect of treatment for many diseases. A recent article by P. Michael Ho and colleagues found that more than one in five patients were not taking their medications for diabetes properly. Nonadherence was associated with higher glycated hemoglobin (A1C), blood pressure,and LDL cholesterol levels. In addition, every 25% increase inmedication adherence was associated with reductions in these three measures.1"Adherence is when the patient is taking the medication in a way that is both beneficial and agreed to by both the patient and the prescriber," says Jill Crandall, MD, associate professor of clinical medicine at Albert Einstein College of Medicine in Bronx, New York. "I define it this way because often the process is more one-sided, with the physician making a decision and then considering it poor adherence when the patient doesn't do exactly what the physician said. I think we need to take this discussion out of the context of unilateral decision-making and make it more of an agreement between the two."http://docnews.diabetesjournals.org/cgi/content/full/4/3/8?ct
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Here's a formula for sensational skin: You heard right. When eaten, flavanol-rich cocoa, the main ingredient in dark chocolate,improvesskin's texture, thickness, hydration, and blood flow. It may even boost your skin's defense against the sun by up to 25 percent! How? It packs serious antioxidant power. Just don't overdo it -- chocolate is high in fat and calories, too. And you still need to wear sunscreen every day..Chocolate's good for your skin? It's true! Antioxidantcompounds in cocoa, called flavanols, improve artery health by boosting blood flow,and that boost may be good for your skin, too.Researchers discovered this chocolate benefit in a study of women who consumed half a cup of cocoa (containing 329 milligrams of flavanolsper serving, the amount in a 3-½ ounce serving of dark chocolate) daily for 12 weeks. At the end of the study, the women experienced less skin dryness, scaling,and roughness compared to the beginning of the study.Also, their skin was thicker, exhibited improved blood flow, and was even more resistant to sun damage. Pretty amazing. Still, don't toss your sunscreen and indulge in mass quantities of chocolate. Consume the sweet in moderation and apply sunscreen everyday when you'll be outdoors for 20 minutes or more. For more skin tips,take the RealAge Skin Care Assessment for personalized advice andrecommendations. Reference: Long-term ingestionof high flavanol cocoaprovides photoprotection against UV-inducederythema and improves skincondition in women. Heinrich, U., Neukam, K.,Tronnier, H., Sies, H.,Stahl, W., Journal of Nutrition 2006Jun;136(6):1565-1569.
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What's better than climbing 150 stairs or taking 997 steps? Watching the time. The best way to measure your walking workout is with a watch.The time you take to walk -- at least 30 minutes each day -- is much more important than how many miles, steps, or blocks you've walked.That's because monitoring time is convenient and can be measured anywhere, and you're less likely to under- or overdo it. Using a watch to measure your walking progress can help keep you from cheating.That is, if you measure by some other means -- distance, for example --and have a lot of time on your hands, you may opt for a slower pace. If you walk for at least 30 minutes a day, you may find yourself getting farther and farther in that amount of time, and that feels like progress. So just put 30 minutes of walking on your schedule, andthendo it at a pace that feels good. Can't do it all in one stretch? Get a watch with a cumulative stopwatch function, and keep track throughout the day until you patch together at least 30 minutes.Reference: The RealAge Workout: Maximum Health, Minimum Work.Roizen,M. F., Hafen, T., New York: Harper -Collins, 2006.
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Patient elopement is the patient's departure without permission beyondthe facility, which places the patient at risk of injury or death.Those at risk for elopement include patients with dementia, young patientswith persistent mental illness, individuals with a family history of abuse, those exhibiting or having a history of violent behavior, and those who have been involuntarily hospitalized.A comprehensive initial assessment by qualified professionals can identify problems that could lead to elopement due to an individual's behavioral disorder, cognitive impairment, fear, poor judgment, or lack of insight. Because of these problems, the individual is at greater risk of harm if he or she leavesthe facility's protective environment.
http://www.doody.com/s8.asp?ID=1013-88139-JRM39455
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It should come as little surprise that Social Security numbers are posted on the Internet. But, says Betty Ostergren, a former insurance claims supervisor in suburban Richmond, Va., who has spent years trolling for them, "people are always astounded" to learn that theirs is one of them. Mrs. Ostergren, 57, has made a name for herself as a gadfly as she took on a lonely and sometimes frustrating mission to draw attention to the situation. With addresses, dates of birth and maiden names often associated with Social Security numbers, she said, they are a gift to data thieves. But in the last few weeks, Mrs.Ostergren's Web site, The VirginiaWatchdog - with the help of lobbying from an unexpected ally, America's farm bureaus - is having an effect.One by one, states and counties have started removing images of documents that contain Social Security numbers, or they are blocking out the numbers. Four states, including New York, have removed links to images of public documents containing SSNs.
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An online report card is scheduled to be unveiled today in an ambitious attempt to compare more than 200 California hospitals on more than 50 quality measures ranging from maternity care to cardiac treatment and patient satisfaction.While a dizzying array of hospital report cards already exists, the developers of the Web site CalHospitalCompare.org(www.calhospitalcompare.org) say it's the most comprehensive sitefor people to use when making decisions about where to receive healthservices.
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FRIDAY, Feb. 23 (HealthDay News) -- About one in three American adultsis trying to lose weight at any given time, and while their track record for trying is good, their track record for succeeding is not.Within five years, most dieters will regain the weight they lost. And,after five years, they may even weigh more than when they started the original weight-loss effort, some studies have found.
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Eye Movements May help Diagnose Fetal Alcohol D/Os.Friday, February 23, 2007; 12:00 AM FRIDAY, Feb. 23 (Health DayNews) -- A simple test may be able to diagnose children with fetal alcohol spectrum disorders, Canadian researchers say.Fetal alcohol spectrum disorders (FASD) are a wide array of adverse developmental outcomes in children caused by prenatal alcohol exposure.FASD is morewidespread and less severe than fetal alcohol syndrome, but FASD is harder to diagnose because of a lack of objective diagnostic tools. In a study published in the March issue of Alcoholism: Clinical & Experimental Research, James Reynolds and Doug Munoz of Queen'sUniversity in Kingston, Ontario, collaborated with colleagues to find out if eye movement, oroculomotor, tasks could be used to assess FASD in children. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022300587.html
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Geriatric Populations and Patient Safety The elderly are a high-risk group in any setting because of their potentially numerous physical limitations. Poor eyesight and coordination, as well as a lack of muscle strengthand dizziness caused by multiple medications and/or medical conditions, make falls a common area of concern for this population. Patients who always need help with ambulation should have call buttons within easy reach. Staff must also be available to monitor these patients and provide assistance in a timely fashion. Patients who can walk on their own still need an environment that reduces the risks of falls. Areas should be well lit,and the path from the patient's bed to the bathroom should be free of equipment and furniture
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Don't play favorites with this pair. Invite them both to your supplement party. When calcium and vitamin D get together, their powersmultiply. Not only do they help build your bones and boost your immunesystem function, but, according to new research, they also help ward off type 2 diabetes. Research shows you'll be a whopping 33 percent less likely to develop the condition if you get at least 1,200 milligrams (mg) of calcium and 800 international units (IU) of vitamin D per day compared to an intake of only 600 mg of calcium and less than 400 IU of vitamin D daily. Although it's best to get many nutrients from food, the study showed that getting vitamin D and calcium from supplements -- not dietary sources -- was associated with a lowerdiabetes risk. It's difficult to get enough vitamin D and calcium from food, anyway -- especially vitamin D -- so make sure your supplement includes both. It's particularly important during the shorter winter days when you may get little sun light, which helps your body manufacture vitamin D.The RealAge Optimum (RAO) dose of vitamin D is400 IU per day for people under age 70 and 600 IU per day for people over age 70. But the upper intake level is 2,000 IU -- meaning anything up to that level is generally considered safe. References: Vitamin Dand calcium intake in relation to type 2 diabetes in women. Pittas, A.G., Dawson-Hughes,B., Li, T., Van Dam, R. M., Willett, W. C., Manson,J. E., Hu, F. B.,Diabetes Care 2006 Mar;29(3):650-656.
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Imagine this: You're on a beach, with a cold drink in one hand and the latest best-selling novel in the other.The salty beach breeze kissesyour face while the ocean tickles your toes.You hear gulls talking, waves crashing, and the steel-drum bandjamming. Feel like paradise? Great. That quick mental picture just improved your brain function. Keep your brain flexible by setting aside time each day to daydream about whatever you like.Daydreaming keeps your mind flexible. By stirring up the part of your brain that handles imagination, you keep your brain running outside of its normal thought process, which helps your cognitive function at the highest levels.Consider daydreaming an important part of your mental-health action plan.References: YOU: The Owner's Manual. Roizen, M. F., Oz, M. C.,NewYork: HarperCollins, 2005.
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This is also a CME/CE article....for Nurses : 0.3 hrs November 20,2006 - The target calcium intake for most postmenopausal women is 1200mg/day, according to the North American Menopause Society's (NAMS) updated position statement reported in the November issue of Menopause.The new guidelines update an earlier consensus opinion published byNAMS in 2001."Calcium, an essential nutrient for the human body, has received substantial attention in both the medical literature and laypress regarding its role in osteoporosis and several other chronicdiseases,"write Robert P. Heaney, MD, of Creighton University in Omaha,Nebraska,and colleagues. "In response to the need to define standards of clinical practice in North America as they relate to menopause-associated health conditions, The North American MenopauseSociety (NAMS) has updated this evidence-based position statement. The objective of this position statement is to provide guidance on the role of calcium in peri- and postmenopausal women to health professionals caring for this population.
http://www.medscape.com/viewarticle/548054?src=mp
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Here's a quick, easy, and inexpensive way to send your vitamin levels soaring. Hang out at a salad bar. Seems regular salad eaters have higher blood levels of lycopene, alpha and beta carotene, folate, andvitamins C, E,and B6 than people who shun "rabbit food." So step right up to the salad bar and get your fill of these cancer fighters, bonebuilders,and stroke stoppers. Here's to the green buffet! Although public-health campaigns have increased the average number of fruits and vegetables Americans eat daily, new research shows that more than half of us still aren't reaching the 5-A-Day goal set by the National Cancer Institute. And that means even fewer people are getting the daily four servings of fruit and five of veggies that RealAge recommends for optimum health, youth, and wellness.If at least one salad isn't alreadyon your daily menu, add it now. Two cups of fresh veggies a day will significantly boost your chances of meeting the recommendations for vitamins A, E, B6, and folate -- which can make a big difference in your health. References: Salad and raw vegetable consumption andnutritional status in the adult USpopulation: results from the ThirdNational Health and Nutrition Examination Survey. Su, L. J., Arab, L.,Journal of the AmericanDietetic Association 2006 Sep;106(9):1394-1404.
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In a growing number of small and large hospitals across the country,including ones in Florida and North Carolina, nurses involved in ar esults-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 hospitalsshowed that a consistent strategy of checking on patient needs effectively reduces monthly call light use by 38%, patient falls by50%, 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 havebeen practicing for 20 years. But nobody's ever done a study to prove it."Meade says she gets about 10 e-mails aday about the research results and is part of a team of coaches whopresent the rounding protocol to hospital units, including several inthe 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 freetime. http://www2.nurseweek.com/Articles/article.cfm?AID=24895
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Agitation in the Elderly Psychiatric Times - New York,NY,USA Consensusstatement ofthe American Association for GeriatricPsychiatry, the Alzheimer's Association and the American Geriatrics Society. ...http://www.psychiatrictimes.com/showArticle.jhtml?articleID=192300161
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Bradenton Herald, Sat, 17 Feb 2007 0:14 AM PST Nasty Noroviruses get jump on flu
The flu may be getting a late start this year, but we haven't escaped virus-induced misery. Noroviruses, which cause gastrointestinal illness, appear to be more widespread and severethan usual this winter, federal health officials say.
http://www.bradenton.com/mld/bradenton/living/health/16705799.htm?source=rss&channel=bradenton_health
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Under development by Sanofi-Aventis, Acomplia (rimonabant) is a selective CB1 endocannabinoid receptor antagonist indicated for the treatment of obesity. It works by blocking endogenous cannabinoid binding to neuronal CB1receptors. Activation of these receptors by endoegenous cannabinoids,such as anadamide, increases appetite. It is the most advanced endocannabinoid receptor antagonist in clinical development and offers a novel therapeutic approach to appetite control and weight reduction.The drug also has potential as a treatment for smoking cessation because the endocannabinoid system is involved in thebody's response to tobacco dependence.Sanofi-Aventis filed forregulatory approval with the US FDA and European EMEA in April 2005. In February 2006, however, the FDA declined to issue final approval until a number of (unspecified) issueswere resolved. The use of Acomplia as a treatment to aid weight loss received a letterof approval from the FDA but its use to aid smoking cessation was considered 'not approvable'.Despite this setback, analysts remain optimistic that Acomplia will eventually be approved in the US as an aid to weightloss.
http://www.drugdevelopment-technology.com/projects/rimonabant/September 4, 2006
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Judy Foreman's "Health Sense" column, published today in the Boston Globe and syndicated nationwide, focused on ways to prevent medication errors. "Be sure those pills you're given are the right ones" contains valuable information about how patients and healthworkers can work to reduce errors. The piece refers in passing to the fact that nurses give and can help to explain medications to patients.But it cites no nursing experts, relying instead on four different physician sources. And it misses the key role nurses play in catching most medication errors--a role that calls upon nurses to be critical thinkers and advocates, not just people who mechanically implement the plans of others, as the piece's description implies. The piece also ignores the extent to which the nursing shortage and the general undervaluation of nursing hampers efforts to reduce drug errors. Short-staffed nurses are less able to catch the errors, detect changes in patient conditions, and provide other care that enables drugs to work safely and well. Underpowered nurses have a harder time advocating for changes in medication plans and medication administration systems. And the piece repeatedly suggests that only "doctors" prescribe drugs,even though most of the over 200,000 U.S. advanced practice nurses regularly do so as well.
http://www.nursingadvocacy.org/news/2006/sep/04_foreman.html
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CME/CEU
Those that are free and otherwise
Nursing Spectrum CE was changed on January 1 to: www.nurse.com
This site is loaded with CE/CME offerings.......check it out.http://www.medscape.com/nurses/ce
A huge offering of CEUs for LPNs and RNs.......for$24.99
Asthma Pathogenesis and Management Contact hrs for NPs...4.0/2.5$32.95Kathleen Conboy-Ellis ARNP, PhD, AE-C, - Effective patient education involves a partnership between the patient and healthcare provider. Nurse practitioners have a major role in asthma education programs.
Postmenopausal Osteoporosis: Putting the Risk for Osteonecrosis of the Jaw into Perspective CME/CE 02/26/2007 Experts provide the latest information about incidence, risk factors, and approach to ONJ in patients treated for osteoporosis with bisphosphonate.
Cases From AHRQ WebM&M: Crossing the Borderline CME/CE02/27/2007 A24-year-old woman with borderline personality disorderwas admitted toan inpatientpsychiatry unit following a failed suicide attempt.
http://www.medscape.com/viewprogram/6680? sssdmh=dm1.250618&src=nlcmealert
Medical Adherence: America's "Other Drug Problem". Introduction:The Challenge of Adherence http://www.medscape.com/viewprogram/6450?src=mp 0.75 ceu s
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WEBSITES/LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@bellsouth.net
Rozalfaro's website (Roz) http://www.alfaroteachsmart.com/
Raconte's website (Geneviève) http://www.solutionsoutsidethebox.net,
I am not certain...but probably most of us and all our information is at this website. "Believe it" !!! Zabasearch: http://www.zabasearch.com/
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HUMOR
A dentist noticed that his next patient, an elderly lady, was looking very nervous so he decided to tell her a little joke as he put on his gloves."Do you know how they make these gloves?" he asked. "No, I don't" she replied. "Well," he spoofed, "there's a building in China with a big tank of latex. Workers of all hand sizes walk up to the tank, dip in their hands, let them dry, then peel off the gloves and throw them into boxes of the right size".
She didn't crack a smile. "Oh well, It ried," he thought.
But five minutes later, during a delicate portion of the dental procedure, she burst out laughing."What's so funny?" he asked. "I was just picturing how condoms are made!" she said. Gotta watch those little old ladies!
Their minds are always working!
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MEDICAL RECALLS
Baxter and FDA notified healthcare professionals of the potential forl ife threatening medication errors involving two Heparin products, Heparin Sodium Injection 10,000 units/mL, and HEP-LOCK U/P 10 units/mL.Baxter is aware of fatal medication errors that have occurred when two Heparin products with shades of blue labeling were mistaken for each other. Three infant deaths resulted when the higher dosage HeparinSodium Injection 10,000 units/mL was inadvertently administeredi nstead of the lower dosage of HEP-LOCK U/P 10 units/mL. The currently marketed 1 mL vials of both Heparin products use blue as the prominent backgroundcolor on their labels.http://www.fda.gov/medwatch/safety/2007/safety07.htm#
Heparin Nerve Agent Treatment Approved for Emergency Use http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#1
Alert on Counterfeit "One Touch" Glucose Test Strips http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#2
New Labeling Stresses Bleeding Risk from Coumadin http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#3
Possible Association between Lamictal and Cleft lip /Palate http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#4
Roche Diagnostics Recalls CoaguChek PT Test Strips http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#5
Severe Tissue Injury with IV Promethazine
Preventing Fatal Heparin Overdoses
FDA notified healthcare professionals that the manufacturers of all drug products approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) have been directed to develop Patient Medication Guides to alert patients to possible cardiovascular risks and risks of adverse psychiatric symptoms associated with the medicines and to advise them of precautions that can be taken. An FDA review of reports of serious cardiovascular adverse events inpatients taking usual doses of ADHD products revealed reports of sudden death in patients with underlying serious heart problems or defects, and reports of stroke and heart attack in adults with certain risk factors. FDA recommends that children, adolescents, or adults who are being considered for treatmentwith ADHD drug products work with their physician or other healthcare professional to develop a treatment plan that includes a careful health history and evaluation of current status,particularly for cardiovascular and psychiatric problems (including assessment for af amily history of such problems).
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NURSING HINTS
When it pumps, it pours Some of our patients lack the strength and coordination to pour water or juice from a pitcher into a cup. To make sure they get their required fluids, we give each of them a "pumppot"--a small picnic jug with a spout that dispenses liquid when you push down on the lid. Usually, patients can fill their cups themselves with this device, so they're encouraged to take more fluids. We like the pots, too: they save us the time of refilling cups... Since they're insulated, we don't have to refill the pots with ice.
Jeanne Sorrell, RN
Used with permission from 1,001 Nursing Tips & Timesavers, ThirdEdition, 1997, p. 49, Springhouse Corporation/www.springnetcom
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ADVERTISEMENTS from the members
This ad is from Decubqueen @aol.com (Gerry)......Accu-Ruler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford. FreeShipping with first order when you mention Paradigm97.
Visit us at http://www.accu-uler.com
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This ad is from: GShort @AOL.com (Gwen) These are great little cakes !
http://www.delightful greeting cakes.com/worlds greatest.php
*!*!*!*!*!*!*!*!*!*!*!*!
NEW MEMBERS
No new members with this issue. Please send the prospective members' screen names with first names to me: RNFrankie@bellsouth.net
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ADDRESS CHANGES
NOTICE: I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the e-mail address until you contact me with an updated e-mail address; I have no way to reach you without a correct e-mail address....Remember most ISPs do not send the updated e-mail address.You could always send me your home number.......lol So please send your new name/address to 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 section below) : Check by your screen name's first letter.........If you have any questions...feel free to write either the Bio/Profile person or myself. Be very glad to help you.
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 97Co-Founders: MarGerlach@AOL.com (Marlene) and
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DISCLAIMER:
The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the links and information provided by our members.The articles and websites are not personally endorsed by the editors, nor do the articles necessarily reflect our opinions.
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THOUGHT FOR THE DAY
Life may not be the party we hoped for:
But while we are here, we might as well dance.
Gingermax@AOL.com
Write me.....offer suggestions for theNewsletter/ share articles, etc. Frankie (rnfrankie@bellsouth.net)
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