PARADIGM BYTES

PARADIGM BYTES

Newsletter for Paradigm97
May 24, 2007

Our NEW 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.

Please take the time...only 45 mins or less to drop in ...the AOL Paradigm97 chatroom 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 times are, in essence, the same time). The Paradigm97 chatroom is always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends in for a little chat
Let me know if you want others involved e.g. prospective new members.

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SNIPPETS

Sentinel Event Alert
Issue 28 - January 22, 2003 (Yes, I know it is old, but still important)


Infection control related sentinel events

Despite the small number of infection-related sentinel event cases reported to the Joint Commission, the number of patients acquiring infections in the health care setting, as well as the number of patient deaths due to an acquired infection, remains high. According to estimates from the Centers for Disease Control and Prevention (CDC), each year nearly two million patients in the United States get an infection in hospitals, and about 90,000 of these
patients die as a result of their infection. Infections are also a complication of care in other settings including long term care facilities, clinics and dialysis centers.

The CDC works in conjunction with approximately 315 hospitals throughout the United States to collect data for its National Nosocomial Infections Surveillance (NNIS) System. A cooperative effort begun in 1970, the system describes the epidemiology of nosocomial infections and antimicrobial resistance trends, and produces nosocomial infection rates to use for comparison purposes. The most recent NNIS report was published in the December 2002
issue of the American Journal of Infection Control and is available on the NNIS website.

According to the Joint Commission database, only 10 infection-related reports have been reviewed under the sentinel event policy since its implementation in 1996. Fifty-three patients were affected, of which 14 died. While the age of the patients afflicted varied, the vast majority were infants (29) and seniors (19), many of whom were immunosuppressed. Settings included the newborn and pediatric intensive care units, long term care facilities or units, general medical/surgical units, and endoscopy and obstetrics units. The infecting organisms included HIV, Pseudomonas aeruginosa, E. coli, MRSA (methicillin resistant Staphylococcus aureus), salmonella, and Clostridium sordellii. The number of reported infection-related sentinel event cases represents an insufficient sample from which to draw any generalizable conclusions and recommendations.

Numerous high profile media reports of incidences of patient death resulting from hospital-acquired infections indicate that such cases are seriously under-reported to Joint Commission. Joint Commission emphasizes that patient death or permanent injury/loss of function as a result of a nosocomial infection does indeed meet the criteria for reviewable sentinel events. As such, each event should undergo a root cause analysis to identify risk reduction strategies,and should be considered for reporting to Joint Commission's Sentinel Event Database to expand the knowledge base about the scope and characteristics of serious nosocomial infections, the factors that lead to their occurrence, and effective strategies for prevention.

Multiple root causes and risk reduction strategies

As a result of the sentinel events arising from infections and in response to the identified root causes, health care organizations implemented various risk reduction strategies, including the implementation of relevant clinical pathways for MRSA, endometritis and urinary tract infection. These strategies include:

a.. Revising orientation and training processes and competency assessments.
b.. Revising equipment cleaning processes.
c.. Revising handwashing procedures.
d.. Switching to the use of single-use IV flush vials.
e.. Adding waterless handrubs. (I don't like the buildup...prefer soap and water)
f.. Defining supervisory expectations.
g.. Revising critical care privileging and ICU admission criteria.
h.. Conducting in-service and team trainings.
i.. Instituting tracking systems.
j.. CDC issues new handwashing guidelines

On Oct. 25, 2002, the CDC released new guidelines that advise the use of alcohol-based handrubs in conjunction with traditional soap and water and sterile gloves to protect patients in health care settings. The recommendations come as part of the new Guidelines for Hand Hygiene in Healthcare Settings, and reflect the positions of the Healthcare Infection Control Practices Advisory Committee and the Hand Hygiene Task Force (comprising members of the Healthcare Infection Control Practices Advisory Committee, the Society for Healthcare Epidemiology of America, the Association for Professionals in Infection Control and Epidemiology Inc., and the Infectious Diseases Society of America).

The hand hygiene guidelines are part of an overall CDC strategy to reduce infections in health care settings and to demonstrate that organizations can help prevent the spread of germs from one patient to another by improving hand hygiene. Information about the guidelines is available from the CDC, APIC, SHEA and IDSA, and promotional materials
may be obtained from the CDC at www.cdc.gov. "Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance in health care settings," says Julie Gerberding, M.D., director, CDC. "More widespread use of these [alcohol-based handrub] products that improve adherence to recommended
hand hygiene practices will promote patient safety and prevent infections."

Joint Commission plans to review its existing infection control standards and survey process with the help of a newly appointed infection control expert panel. One of the panel's goals is to support organizations' patient safety efforts by lowering nosocomial infection rates throughout the organization and in targeted specific vulnerable populations such as surgical, intensive care and immunosuppressed patients.

Joint Commission recommendations

Joint Commission recommends that health care organizations:

1.. Comply with the CDC's new hand hygiene guidelines.
2.. Manage as sentinel events all identified cases of death and major permanent loss of function attributed to a nosocomial infection (i.e. except for the infection, the patient would probably not have died or suffered loss of function). Note: This recommendation does not require any change in current surveillance methodology (see the "IC" standards in your Joint Commission accreditation manual).
Resources
1.. Emerging Infectious Diseases, Vol. 7, No. 2, March-April 2001, Centers for Disease Control and Prevention, http://www.cdc.gov/ncidod/eid/vol7no2/wenzel.htm.
2.. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System, http://www.cdc.gov/ncidod/dhqp/nnis_pubs.html.
3.. NNIS definition of nosocomial infection-a localized or systemic condition 1) that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s), and 2) that was not present or incubating at the time of admission to the hospital.
4.. Guidelines for Hand Hygiene in Healthcare Settings - 2002, Centers for Disease Control and Prevention, http://www.cdc.gov/.
5.. Association for Professionals in Infection Control and Epidemiology (APIC), http://www.apic.org/.
6.. Society for Healthcare Epidemiology of America (SHEA), http://www.shea-online.org/.
7.. Infectious Diseases Society of America (IDSA), http://www.idsociety.org/.

http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_28.htm

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MEMBER'S ANNOUNCEMENTS

jeanneolmsted@aol.com sent in the following:

Do not open any message with an attached filed called "Invitation" regardless of who sent it, It is a virus that opens an Olympic Torch which "burns" the whole hard disc C of your computer.

This virus will be received from someone who has your e-mail address in his/her contact list, that is why you should send this e-mail to all your contacts. It is better to receive this message 25 times than to receive the virus and open it.

If you receive a mail called "invitation", though sent by a friend, do not open it and shut down your computer immediately. This is the worst virus announced by CNN, it has been classified by Microsoft as the most destructive virus ever.

This virus was discovered by McAfee yesterday, and there is no repair yet for this kind of virus. This virus simply destroys the Zero Sector of the Hard Disc, where the vital information is kept

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MEDICAL NEWS

Thank you to Assemblywoman Aileen Gunther who introduced K367, memorializing the Congress of the United States to encourage the effort to create an Office of the National Nurse, into the New York State Assembly on March 26, 2007. The bill amassed 50 sponsors before it was sent to the floor of the Assembly and adopted unanimously by all voting
members.

The National Nursing Network Organization and Assemblywoman Aileen
Gunther's office has put out the following press release:

New York Assemblywoman Brings Oregon Nurse's Vision For National Nurse One Big Step Forward

The New York Assembly unanimously adopted a resolution Wednesday encouraging the Congress of the United States to create an Office of the National Nurse.

New York Assemblywoman and nurse Aileen Gunther (District 98) brought Oregon nurse
Teri Mills' vision to create the office a big step forward with Resolution K367.

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Two of the world's largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses. The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at
levels that might increase patients' risks of heart attacks or strokes. Industry analysts estimate that such payments - to cancer doctors and the other big users of the drugs, kidney dialysis centers - total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.
Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year.

Yesterday, the Food and Drug Administration added to concerns about the drugs, releasing a report that suggested that their use might need to be curtailed in cancer patients. The report, prepared by F.D.A. staff scientists, said no evidence indicated that the medicines either
improved quality of life in patients or extended their survival, while several studies suggested that the drugs can shorten patients' lives when used at high doses. Yesterday's report followed the F.D.A.'s decision in March to strengthen warnings on the drugs' labels.
http://www.nytimes.com/2007/05/09/business/09anemia.html?_r=1&th&emc=th&oref=slogin

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Medical News Today, Mon, 30 Apr 2007 1:05 AM PDT
Intrathecal Baclofen Therapy Can Provide Improved Quality Of Life For Amyotrophic Lateral Sclerosis Patients
An estimated 5,600 people in the United States are diagnosed every year with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, and as many as 30,000 Americans have the disease at any given time. Unfortunately, there is no cure for ALS, and it leads to
death most typically two to five years after diagnosis. http://www.medicalnewstoday.com/medicalnews.php?newsid=69294&nfid=rssfeeds

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Senate Approves Bill on Drug Monitoring The Food and Drug Administration would have to establish new systems to monitor the safety of medicines after they hit the market and for the first time could fine drugmakers for false or misleading advertising under a bill approved yesterday by the Senate.

The provisions are part of a major bill to reauthorize the current system that charges drugmakers hundreds of millions of dollars in fees each year to pay for speeded-up reviews of prospective new drugs. The government's authority to levy those fees will expire Sept. 30 unless Congress acts before then. The House has not yet taken up similar legislation.

Senators approved the measure 93 to 1, with Bernard Sanders (I-Vt.) casting the dissenting vote

"This legislation is going to make the prescription drugs that families take safer and our food safer," said Sen. Edward M. Kennedy (D-Mass.), chairman of the Senate Health, Education, Labor and Pensions Committee and a lead sponsor of the bill.
http://www.washingtonpost.com/wp-dyn/content/article/2007/05/09/AR2007050902383.html

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INTERESTING READING

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

Bystanders attempting to revive someone in cardiac arrest should skip the mouth-to-mouth ventilation component of cardiopulmonary resuscitation (CPR) and focus on chest compressions, according to Japanese researchers (SOS-KANTO Study Group. Lancet. 2007;369:920-926).
The researchers examined outcomes-survival at 1 month with no mental impairment-for adults who had an out-of-hospital cardiac arrest, including 439 who received cardiac-only resuscitation and 712 who received conventional CPR. Mortality was high for all patients, but those who had only chest compressions fared twice as well as those receiving conventional CPR. Among patients with apnea, about 6.2% of the cardiac-only group vs 3.1% of the conventional CPR group reached the 1-month survival mark; among those who had resuscitation initiated
within 4 minutes, 10.1% of the cardiac-only group vs 5.1% of the conventional CPR group had a favorable outcome.

CPR Reconsidered Joan Stephenson, PhD JAMA. 2007;297:1646. Vol. 297 No.15, April 18, 2007

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FDA informed healthcare professionals of criminal charges and civil liabilities brought against Purdue Frederick in connection with several illegal schemes to promote, market and sell OxyContin, a powerful prescription pain reliever that the company produces. The manufacturer's sales force was trained to make false claims about the product to healthcare professionals, thereby, misbranding OxyContin by illegally promoting the drug as being less addictive, less subject to abuse, and less likely to cause tolerance and withdrawal than other
pain medications. These practices falsely promote the product and may cause health risks
for consumers. http://www.fda.gov/medwatch/safety/2007/safety07.htm#OxyContin

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Working Hours. Last Thursday, House Ways and Means Committee Chairman Rep. Pete Stark, D-CA, introduceda new legislation to limit "the number of mandatory overtime hours a nurse may be required to work."
The bill cites as evidence, a study published in Health Affairs which found that nurses who worked shifts of twelve and a half hours or more were three times more likely to commit an error than nurses who worked standard shifts of eight and a half hours or less.
http://content.healthaffairs.org/cgi/content/abstract/23/4/202 [free access]

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Love Friday night surf and turf at your local pub? Got a bum knee or foot that often flares upon weekends? There may be a link. Eating foods that are high in purines (a protein) -- such as a seafood and steak dinner washed down with a cold beer -- can bring on gout, a particularly painful type of arthritis that primarily attacks leg and foot joints. If family history makes arthritis a potential hazard, turns out you can slash your risk of gout by eating more low-fat dairy foods (string cheese, yogurt, milk) and less surf and turf. An overload of foods high in purine is a requirement for gout. Your body converts purine into uric acid, a waste product that's normally eliminated through your kidneys. But when there's too much uric acid in yoursystem, it forms tiny, sharp crystals that take up residence in the lower leg and foot joints (the big toe is a favorite site), causing intense pain, redness, and swelling. People with certain inherited characteristics linked to rheumatoid arthritis are prone to uric acid buildup and gout. Although gout is on the rise, in one study, men who ate the highest amounts of low-fat dairy had a 44 percent lower risk of the condition compared to men who consumed the least. What else can you do? Watchyour weight -- extra pounds stress joints -- and avoid high-purine foods, including steak, lobster, and liquor.
References:Gout:epidemiology and lifestyle choices. Choi, H.K., Curhan, G.,Current Opinion in Rheumatology 2005May;17(3):341-345. Dietary risk factors for rheumatic diseases. Choi, H.K., Current Opinion inRheumatology 2005 Mar;17(2):141-146.

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Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspectives.
National surveys of registered nurses, physicians, and hospital executives document considerable concern about the U.S. nurse shortage. Substantial proportions of respondents perceived negative impacts on care processes, hospital capacity, nursing practice, and the Institute of Medicine's six aims for improving health care systems. There were also many areas of divergent opinion within and among these groups, including the impact of the shortage on safety and early detection of patient complications. These divergences in perceptions could be
important barriers to resolving the current nurse shortage and improving the quality and safety of patient care. http://content.healthaffairs.org/cgi/content/abstract/26/3/853

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Are you busy sitting all day? (If you are, please tell me what area of nursing !) Some days there's no way around it. Stuff you need to do -- drive, work, plan a get-together, deal with e-mail, pay bills -- is stuff you do sitting down. But yet another study has shown that getting as little as 30 minutes of activity a day is all it takes to reduce mortality risk by 14 percent. So sweep the patio, have a pillow fight with the kids, walk while you talk on the phone. It all adds up. You don't have to train for a triathlon to reduce your risk of life-shortening diseases. You just need to increase your daily moving time -- that is, activities that get your heart going -- to at least 30 minutes. Know what else can help you live longer? You guessed it: eating more fruits and veggies. Just one extra serving each day --an apple or pear or a cup of leafy greens --cuts your risk of dying from anything by 20 percent. Huge benefits for modest efforts. References: Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer andNutrition. Khaw, K. T., Bingham, S., Welch, A., Luben,R.,Wareham, N.,Oakes, S.,Day, N., Lancet 2001 Mar3;357(9257):657-663. Work and leisure time physical activity assessed using a simple, pragmatic, validated questionnaire and incident cardio vascular disease and all-cause mortality in men and women: The European Prospective Investigation intoCancer in Norfolk prospective population study.Khaw, K. T., Jakes, R.,Bingham, S., Welch, A., Luben,R., Day,N., Wareham, N., International Journal of Epidemiology 2006Aug;35(4):1034-1043

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Methadone is found to be a silent killer of patients with chronic pain Record-Searchlight (subscription) -Redding,CA,USA Several local physicians who specialize in pain management were contacted by the Record Searchlight last week but either declined to comment or did not...The warning came after a West Virginia newspaper, the Charleston Gazette-Mail, published a series of articles last summer that found the drug in pill form -- not the liquid variety given to heroin junkies --was killing more people nationwide than any other prescription narcotic. Until that point, the paper reported, most news stories and even some in the medical community assumed those who died had taken the drug illegally.
http://www.redding.com/news/2007/mar/11/methadone-is-found-to-be-a-silent-killer-of-with/

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Women on the low-carbohydrate Atkins diet lost at least twice as much weight as those on three other popular diets,a new study shows. The study, described as the largest and longest comparison yet done on the four diets, is published today in the Journal of the American Medical Association."Many health professionals, including us,have either dismissed the value of very low-carbohydrate diets for weight loss or been very sceptical of them," says Christopher Gardner, assistant professor of medicine at the Stanford Prevention Research Center in California and lead author of the study."But it seems to be a viable alternative for dieters," he adds, for whom the basic message is cutting down as much as possible on refined carbohydrates such as white bread and soft drinks. http://www.abc.net.au/science/news/stories/2007/1865091.htm?health

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Alternatives to Nursing Homes "NewOptions (and Risks) in Home Care for Elderly" (front page, March1) depicts the lengths families will go to keep a loved one out of a nursing home. Unfortunately, many families remain unaware that assisted living,even in the most expensive communities, can be as little as one-half the cost of even "gray market help" provided at home.According to the most recent survey, the average annual cost of an assisted living community in the New York area was $40,452. This amount would pay for perhaps five hours a day of a private agency aide,or nine hours of a gray-market worker. In assisted living an elderly person typically has access to 24-hour assistance, with the cost additionally including housing, utilities,food, housekeeping, laundry, security and activities. http://www.nytimes.com/2007/03/05/opinion/l05elderly.html?_r=1&oref=slogin \

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Market for Medical Care National Center for Policy Analysis -Dallas,TX,USA Long before a patient enters a doctor's office, third-party bureaucracies have determined which medical services they will pay for,which ones they will not... http://www.ncpa.org/pub/st/st296/

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Every nurse can identify with the amount of medical waste that is generated in the clinical practice setting. We have all seen, and contributed to, mounds of used and contaminated dressings, catheters, and more. However, what may not be in the forefront is the impact
medical waste has on the environment, our own health, and the well-being of the patients and communities we care for. Fortunately, this is exactly what is on Anna Gilmore Hall's mind constantly. Anna's passion about health and the environment are part of her mission as the
executive director of Health Care Without Harm (HCWH) Anna has always been interested in environmental issues and now contributes to this effort worldwide.
http://www.medscape.com/viewarticle/555467?src=mp

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Cocoa 'vitamin' health benefits could outshine penicillin. The health benefits of epicatechin, a compound found in cocoa, are so striking that it may rival penicillin and anaesthesia in terms of importance to public health, reports Marina Murphy in Chemistry & Industry, the magazine of the SCI. Norman Hollenberg, professor of medicine at Harvard Medical School, told C&I that epicatechin is so important that it should be considered a vitamin. Hollenberg has spent years studying the benefits of cocoa drinking on the Kuna people in Panama.He found that the risk of four of the five most common killer diseases: stroke, heart failure, cancer and diabetes, is reduced to less than 10 percent in the Kuna.They can drink up to 40 cups of cocoa a week. Natural cocoa has high levels of epicatechin http://www.sootoday.com/content/news/full_story.asp?StoryNumber=23253

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NEW YORK (Reuters Health)Mar 12 -Older bacillus Calmette-Guerin (BCG)vaccines, which are used to immunize against tuberculosis, may be more effective than some of the newer vaccines currently in use, new research suggests.This finding, which is reportedin the Proceedings of the National Academy of Sciences early edition for March 12, is based on a genetic comparison of several BCG strains used in vaccine development. Dr. Stewart T. Cole, from the Institut Pasteur in Paris, and colleagues identified several genetic differences that developed as the BCG strains were cultured overtime. Moreover, some of the genetic changes appeared to compromise vaccine efficacy. http://www.medscape.com/viewarticle/553509?sssdmh=dm1.254191&src=nldne

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Cost Benefit Study Supports the Use of Longport's Technology in Pressure Ulcer Prevention Longport, Inc. (OTC PK: LPTI), a medical technology specialist in high-frequency high resolution ultrasound imaging, today announced interim results from a cost benefit study supporting the use of its EPISCAN I-200 system as an evidence based pressure ulcer prevention tool http://www.redorbit.com/news/health/919245/cost_benefit_study_supports_the_use_ of_longports_technology_in/index.html?source=r_health .

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THE NURSING PROCESS

The nursing process is based on a nursing theory developed by Ida Jean Orlando. She
developed this theory in the late 1950's as she observed nurses in action. She saw "good" nursing and "bad" nursing. From her observations she learned:

a.. The patient must be the central character
b.. Nursing care needs to be directed at improving outcomes for the patient; not about nursing goals
c.. The nursing process is an essential part of the nursing care plan

Not As Complicated as it Seems
The nursing process is really not as complicated as it seems. It consists of basically five steps. Originally, Ms. Orlando had four, but through practical application over the past 40 years, one step became two and now there are five. All nursing personnel take part in the
nursing process. The RN has the primary responsibility however.

The Five Steps
a.. Assessment
b.. Diagnosis
c.. Planning
d.. Implementation
e.. Evaluation
http://nursing.about.com/od/nursesgeneralinfo/a/nursingprocess.htm

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NEW YORK (Reuters Health) Apr 27 - No-scalpel and incisional vasectomy are equally effective methods of restricting fertility in men, but the former procedure is associated with less bleeding, infection, and pain, according to the results of a review published in the April 18th online issue of The Cochrane Library.

"The no-scalpel methodology is the preferable method to use, as it has a lower rate of adverse events," lead author Dr. Lynley Cook, from the University of Otago in Christ church, New Zealand, said in a statement. "But the no-scalpel technique requires more training and a higher level of skill."
http://www.medscape.com/viewarticle/555813?sssdmh=dm1.266920&src=nldne

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The cause of high blood pressure may lie within the brain, rather than with problems relating to the heart, kidneys or blood vessels, research suggests. Scientists at Bristol University say the findings could lead to new ways of treating the condition, which affects about one in five
Britons.

They isolated a protein, JAM-1, in the brain which appeared to trap white blood cells, obstructing blood flow. This can cause inflammation and result in poor oxygen supply to the brain.
Brain blood pressure

Professor Julian Paton and colleagues believe these, in turn, trigger events that raise blood pressure, the journal Hypertension reports.

Their studies in rats show JAM-1 is linked to raised blood pressure, but the exact mechanisms behind this are still unclear. They are now looking at the human brain to understand more.
http://news.bbc.co.uk/2/hi/health/6551553.stm

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NEW YORK (Reuters Health) Apr 27 - A new risk scoring system is useful in predicting the outcomes of patients with non-ST-segment elevation chest pain and normal troponin levels, according to a recent report.

Dr. Juan Sanchis of the Universitat de Valencia and colleagues in Barcelona, Spain categorized
a group of 1,449 patients with chest pain related to non-ST-segment elevation into four groups. A risk score was calculated based on five variables related to death or myocardial
infarction at one year: ...
http://www.medscape.com/viewarticle/555821?sssdmh=dm1.266920&src=nldne

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A new study reports that the insomnia drug zolpidem temporarily improved brain function in an adult patient with akinetic mutism caused by anoxia. The48-year-old woman suffered akinetic mutism related to a post anoxic encephalopathy a few days after a suicide attempt by hanging. Two years later, she was prescribed zolpidem to treat a bout of insomnia. Within 20 minutes of receiving a 10 mg dose of the drug, the subject, who had been unable tos peak or walk and was fed by a gastrostomy, was able to communicate, walk, and eat without assistance. These effects lasted for up to 3 hours. http://www.medscape.com/viewarticle/553513?sssdmh=dm1.254191&src=nldne

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NEW YORK (Reuters Health) Apr 27 - The long-term use of non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) appears to slightly reduce the risk of lung cancer,
according to findings published in the April issue of the International Journal of Cancer.
"Regular use of aspirin or other NSAIDs reduces the risk of colorectal cancer and might reduce the risk of other cancers as well," Dr. Sonia Hernandez-Diaz, of Harvard School of Public Health, Boston, and colleagues write. "The effect of NSAIDs on the development and
progression of other types of cancer remains controversial."
http://www.medscape.com/viewarticle/555828?sssdmh=dm1.266920&src=nldne

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CEU/CME

Those that are free and otherwise

Nursing Spectrum 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$24.99

https://nursing.advanceweb.com/Common/CE/Main.aspxCE0.25 hrs

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Urinary Tract Infections: A primer for Clinicians Nurses -
0.75 nursing contact hours (0.5 contact hours are in the area of pharmacology)
http://www.medscape.com/viewprogram/7049?src=mp

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WEBSITES/LINKS

Always on the lookout for interesting websites / links. Please send them to: RNFrankie@bellsouth.net

ISMP and FDA Campaign toEliminateUse of Error-Prone Abbreviations ISMP power point presentation: http://www.ismp.org/tools/abbreviations/abbreviationSlides.ppt
Poster and other resources: http://www.ismp.org/tools/abbreviations/A - Z

Guide on Health Topics: http://www.webmd.com/a_to_z_guide/health_topics.htm

Rozalfaro'swebsite (Roz) http://www.alfaroteachsmart.com/

Please visit : http://www.thebreastcancersite.com/ It won't cost you anything..... and helps the women who can not afford the exam. The site really needs us.

Raconte's website (Geneviève) http://www.solutionsoutsidethebox.net

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HUMOR

An 80-year-old man goes for a physical. All of his tests come back with normal results. The doctor says, "George, everything looks great. How are you doing mentally and emotionally?
Are you at peace with God?" George replies,"God and I are tight. He knows I have poor eyesight, so he's fixed it so when I get up in the middle of the night to go to the bathroom, POOF! the light goes on. When I'm done, poof! The light goes off." !!!"

Wow,that's incredible," the doctor says.

A little later in the day,the doctor calls George's wife. "Ethel,"he says, "George is doing fine!
But I had to call you because I'm in awe of his relationship with God. Is it true that he gets up during the night and poof ! the light goes on in the bathroom, and when he's done, poof! the light goes off ?"

"Oh my God!" Ethel exclaims."He's peeing in the refrigerator again!"

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MEDICAL RECALLS

NBTY and FDA informed consumers and health care professionals of a nationwide recall of
3 lots of Shark Cartilage Capsules the company manufactured in 2004 and distributed to consumers through mail and internet orders, and retail stores throughout the United States. The product was recalled because of possible contamination with Salmonella,
an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain. In
rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections, endocarditis and arthritis. Customers can return the product back to the place of purchase for a full refund.
Read the press release for specific names and lot numbers of the recalled product.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#NBTY

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May 23, 2007 (Anaheim) - The US Food and Drug Administration (FDA)'s request for more data before approving a prostate cancer vaccine was a blow to many doctors and patients who were anticipating its arrival, David F. Penson, MD, said yesterday at the annual meeting of the American Urological Association.

"I personally am disappointed by the FDA's decision," said Dr. Penson, an investigator in the Immunotherapy for Prostate Adenocarcinoma Treatment (IMPACT) study, an ongoing
phase 3 clinical trial of the vaccine.

Sipuleucel-T, usually referred to by its brand name, Provenge, is supposed to enhance a patient's response to chemotherapy by stimulating T-cell response to prostatic acid phosphatase. Dendreon, the Seattle, Washington company that makes the vaccine, is planning
to market it only to men with advanced androgen-independent prostate cancer.
http://www.medscape.com/viewarticle/557123?sssdmh=dm1.273833&src=nlconfnews

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March 15, 2007 - Manufacturers of 13 sedative-hypnotic drugs have been asked to strengthen safety label warnings regarding adverse events associated with their use, the US Food and Drug Administration (FDA) announced yesterday. The drugs are used in the treatment of insomnia.

The request, issued in December 2006, addresses the risk for engaging in activities while somnolent with no memory of having taken a pill, according to an alert sent Wednesday from MedWatch, the FDA's safety information and adverse event reporting program. Requested
label changes also emphasize the risks for anaphylaxis and angioedema, which can occur the
first time the drug is taken.

The FDA notes that sleep behaviors while taking these drugs can be complex and may include sleep-driving, making phone calls, and preparing/eating meals. Because of potential variations
in risk levels, makers have also been advised to conduct clinical investigations to assess event incidence rates for each individual product.

Along with these label changes, the FDA also asked manufacturers to develop patient medication guides for distribution with each prescription. These easy-to-read pamphlets are intended to inform patients of the risks associated with therapy and that appropriate
precautions that should be taken, such as avoiding alcohol and contacting their physician before discontinuing therapy.

Affected products include zolpidem tartrate tablets and extended-release tablets (Ambien and Ambien CR, Sanofi-Aventis); butisol sodium (Medpointe Pharm HLC); pentobarbital/carbromal
(Carbitral, Parke-Davis); flurazepam HCl capsules (Dalmane, Valeant Pharm); quazepam tablets (Doral, Questcor Pharms); and triazolam tablets (Halcion, Pfizer).

Also included are eszopiclone tablets (Lunesta, Sepracor); ethchlorvynol capsules (Placidyl, Abbott); estazolam (Prosom, Abbott); temazepam capsules (Restoril, Tyco Healthcare); ramelteon tablets (Rozerem, Takeda); seconal sodium capsules (Ranbaxy); and zaleplon
capsules (Sonata, King Pharmaceuticals).

Adverse events potentially related to use of these sedative-hypnotic products should be reported to the manufacturer and to the FDA's MedWatch reporting program by phone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane, Rockville, MD 20852-9787.
http://www.medscape.com/viewarticle/553654?src=mp

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A black-box warning has been added to the safety labeling for erythropoiesis-stimulating agents (ESAs) to advise of the increased risk for death and other serious adverse events associated with their use in patients with cancer and renal failure, the US Food and Drug
Administration (FDA) said Friday.

Although the warning was based on data from 4 recently completed cancer trials that evaluated new dosing regimens, use of ESAs in a new patient population, and use of new unapproved
ESAs, the warning applies to all products in this drug class, including darbepoetin alfa (Aranesp,
Amgen, Inc) and epoetin alfa (Epogen and Procrit, Amgen), according to an alert sent Friday from MedWatch, the FDA's safety information and adverse event reporting program.

In a study of patients with chronic renal failure (CRF), adjustment of ESA dose to maintain target hemoglobin levels higher than 12 g/dL yielded an increased risk for mortality and nonfatal myocardial infarction, stroke, heart failure, and thrombosis. Similar dose
modifications in head/neck cancer patients receiving radiation therapy resulted in accelerated tumor growth.

Also, ESA therapy at recommended doses in cancer patients not receiving chemotherapy was linked to an increased risk for mortality with no reduction in transfusion requirements, and its use in the orthopaedic surgical setting led to an increased incidence of thrombosis.

"This new information is consistent with risks found in 2 clinical studies in patients with chronic renal failure treated with an unapproved regimen of an ESA that were reported in November 2006," the FDA said. http://www.medscape.com/viewarticle/553499?src=mp

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FDA informed healthcare professionals of a potential safety issue related to Avandia (rosiglitazone). An on-going analysis of safety data for the treatment of type 2 diabetes mellitus using Avandia showed differing rates of ischemic cardiovascular events including heart attack or heart-related adverse events, some fatal, relative to other drugs used to treat diabetes. The clinical studies reviewed to date vary with respect to their populations, treatment regimens, and length of follow-up. Based on these data, the risk of ischemic cardiovascular events due to Avandia remain unclear. Prescribers should continue to carefully make individualized treatment decisions for patients with diabetes mellitus.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#Avandia

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Spectrum and FDA informed healthcare professionals of a nationwide recall of 3 lots (TS0225, UK0821, and V11203) of Caffeine Citrated, Powder, Purified. The product was recalled because of complaints about potential sub potency. Caffeine Citrated is a cerebral and respiratory stimulant used primarily to treat idiopathic apnea of premature infants. Blood
levels of caffeine in patients were determined to be significantly lower than would be expected. The use of sub-potent compounded preparations may lead to sub-therapeutic caffeine blood
levels and an unacceptable risk of respiratory depression. Customers should examine their inventory, discontinue dispensing and using the product, quarantine the referenced lots of the product. and call the manufacturer to arrange to return the product for credit or replacement.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#Caffeine

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ResMed and FDA notified consumers and healthcare professionals of a worldwide recall of approximately 300,000 S8 flow generators (Continuous Positive Air Pressure or CPAP) used for the treatment of obstructive sleep apnea. In Model S8 devices manufactured between July 2004 and May 15, 2006, there is a potential for a short circuit in the power supply connector. ResMed plans to work with its distribution partners globally to provide a replacement device to patients who have an affected S8 flow generator. See recall notice for serial numbers for affected S8 models.

Patients may continue to use their S8 flow generators until they receive a replacement device. As with any electrical device, patients should make sure that it is placed on a hard clean surface and that the area around the device is clear during use. Patients should discontinue
use of the device if there are any signs of electrical failure such as intermittent power, cracking sounds, sparking or charred smell. Patients should not use supplemental oxygen with an affected device; patients using supplemental oxygen should immediately contact their
home healthcare provider for a replacement.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#ResMed

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Novartis, in compliance with an FDA request, has suspended marketing and sales of its irritable bowel/constipation drug Zelnorm (tegaserod maleate), after an analysis of its clinical database pointed to a higher incidence of MI, stroke, and unstable angina among patients taking the
drug.

According to a company press release [1, a statistically nonsignificant trend toward more angina was seen among people taking the drug in the clinical trial that led to the drug's approval in 2002. But in a recent analysis of 18 000 patients in the entire clinical database, adverse
cardiovascular events were seen in 13 out of 11 614 patients (0.11%) on Zelnorm, but in only
one patient (0.01%) out of 7031 taking placebo, a statistically significant difference.

The FDA plans to call a public hearing and advisory committee meeting to evaluate the risk/benefit profile of Zelnorm; the company, meanwhile, has stopped marketing the product but states in a press release that the 0.11% rate of adverse events is in keeping with the
expected rates for such events in the general public. It also noted that no effect of tegaserod maleate on the coronary arteries was seen in preclinical and clinical testing.
http://www.medscape.com/viewarticle/554407?src=mp

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FDA informed consumers and healthcare professionals regarding the dangers associated with the purchase or use of True Man or Energy Max products promoted and sold as dietary supplements throughout the United States. Both products, promoted as sexual enhancement products and as treatment for erectile dysfunction (ED), are illegal drug products that contain potentially harmful, undeclared ingredients. The undeclared ingredients may interact with nitrates found in some prescription drugs such as nitroglycerin and may lower blood pressure to dangerous levels. Both products contain either a thione analog of sildenafil, the active ingredient of Viagra, or a piperadino analog of vardenafil, the active ingredient in Levitra. Both Viagra and Levitra are FDA approved products for the treatment of ED. FDA has not
approved True Man and Energy Max, therefore, the safety and effectiveness of these products
are unknown. Consumers should discontinue use of these products and consult their healthcare
professional about approved treatments for ED.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#TrueMan

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FDA notified healthcare professionals and consumers that companies must stop manufacturing and distributing unapproved suppository drug products containing trimethobenzamide hydrochloride. These products are used to treat nausea and vomiting in adults and children. The products have been marketed under various names, including Tigan, Tebamide, T-Gen, Trimazide, and Trimethobenz. Drugs containing trimethobenzamide in suppository form lack evidence of effectiveness. This action does not affect oral capsules and injectable products containing trimethobenzamide that have been approved by FDA. FDA urges consumers currently using trimethobenzamide suppositories or who have questions or concerns to contact their healthcare professional. Alternative products approved to effectively treat nausea and vomiting are available in a variety of forms.
http://www.fda.gov/medwatch/safety/2007/safety07.htm#trimethobenzamide

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NURSING HINTS

Most of our coronary care unit patients receive oxygen by nasal cannula. But the part of the cannula that goes behind the ears can be uncomfortable. Here is what I did to solve the problem. Ibought foam curlers and removed that plastic part from the center of each.This left a hollow roll. I cut each curler up the side. After I put the tubing through the curler, I placed the curler behind the patient's ear. This is an inexpensive wayto prevent excoriation. To stabilize the tubing, place a small loop of tape--with the sticky side out--inside the curler. Of course, the curlers are discarded after theyare used or if become soiled [sic}. SueBiley, RN
Used with permission from1,001Nursing Tips & Timesavers,ThirdEdition, 1997, p.57, SpringhouseCorporation/ www.springnetcom (I always used 4x4 gauze...worked)

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MEMBER'S ADVERTISEMENTS

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. 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

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NEW MEMBERS

Welcome to : Veracidad @AOL.com (Isabel)

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 me your new name/address,ok? rnfrankie@bellsouth.net

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Editorial Staff:

GingerMyst @AOL.com(Anne), GALLO RN @AOL.com, HSears9868 @AOL.com (Bonnie), Laregis @AOL.com, (Laura), Mrwrn@AOL.com (Miriam), and Schulthe @AOL.com (Susan)

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Membership BIO Committee...

(if you haven't sent in yourBIO....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 theBio/Profile person or myself.

BCK131 @AOL.com(Chris) A thru B section,
Dick515@AOL.com(Eileen) C thru D section,
GALLORN @AOL.com (Sue) E thruI 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)

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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 opinion.

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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
--Hodding Carter, Jr.

Hope to hear from you,
Frankie

rnfrankie@bellsouth.net