PARADIGM BYTES
Newsletter for Paradigm 97
September 07, 2007
September 07, 2007
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.
Our website...... http://paradigm97.blogspot.com/
MISSION STATEMENT
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.
Our website...... http://paradigm97.blogspot.com/
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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Please drop in ...the AOL chatroom is "manned" by GingerMyst for 45 min on Tuesday evenings: 9 pm EST, 8 pm CST, 7 pm MST, 6 pm PSTNow, the Paradigm97 chatroom is always there....door open, lights on, waiting for visitors to come in. Check your Buddy List.....and invite your friends in for a little chat Let me know if you want others involved.
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SNIPPETS
Look-alike, sound-alike drug names
Since the initial publication of the Joint Commission's Sentinel Event Alert in 1998, several issues have been devoted to the topic of medication errors and the identification, prevention, and reporting of specific types of medication errors either reported to Joint Commissionas part of the sentinel event reporting system or identified by Joint Commission at the time of survey. Medication errors can occur at any point in the process of providing drugs to patients-prescribing, documenting, dispensing, administering-and many factors can contributeto medication errors, including poor handwriting, similar sounding or looking drug names, drug abbreviations, misinterpretation of labeling or packaging, miscalculations, lack of knowledge or skill, and incorrect administration. This issue of Sentinel Event Alert focuses specifically on medication errors resulting from confusing look-alike or sound-alike drug names and recommendations for minimizing risk and preventing potential errors.With tens of thousands of brand name and generic drugs currently on the market, the potential for error due to confusing drug names is significant. "Health care professionals often report confusion between similar brand and generic names," says Diane Cousins, R.Ph., vicepresident, Practitioner and Product Experience department, U.S. Pharmacopeia. "Contributing to the confusion are complications such as illegible handwriting, incomplete knowledge of drug names, newly available products, similar packaging or labeling, and incorrectly selecting a drug from a computerized list," says Cousins. In fact, similar drug names, either written or spoken, account for approximately 15 percent of all reports to the USP Medication Errors Reportingprogram.New names that are similar to existing names continue to be approved and medication errors continue to occur despite review before introduction to the market by a number of U.S. and international organizations, including pharmaceutical manufacturers, the U.S. Pharmacopeia, the International Nonproprietary Names Committee of the World Health Organization, the Food and Drug Administration, the U.S. Adopted Names Council, and the U.S. Patent and Trademark Office. "This ever-increasing number of confusing name sets represents such a broad range of products and therapeutic drug classes that every health care practitioner is vulnerable to making this type of error," says Cousins. "While similarly named products may not be perceived to pose a public health threat, USP has received reports of patient harm and fatalities that have occurred as a result of this problem."In March, 2001, the USP released "Use Caution, Avoid Confusion," an updated list highlighting hundreds of confusing drug name sets and identifying more than 750 unique drug names that have been reported to the Medication Errors Reporting program. A poster and a laminated, quick-reference card are available for health care professionals free of charge from the USP by contacting USP's Practitioner and Product Experience department at (800) 487-7776. While the FDA recently instituted an intensive risk analysis system for the review and evaluation of proposed proprietary drug names, and in fact rejects approximately one-third of all proposed names because of their potential for confusion, it is important for health careprofessionals to integrate systems and establish practices to reduce the possibility of ordering, dispensing or administering the incorrect drug.At present, the Institute for Safe Medication Practices, USP and the FDA collect and track medication errors and make information available to health care providers and the public. "Coordinated efforts on the parts of these organizations and the reporting of medication errors has resulted in changes to the names of several commonly confused drugs," says Jerry Phillips, associate director, Medication Error Prevention, Office of Post Marketing Drug Risk Assessment, FDA. Information and alerts about confusing drug names and current initiatives to have confusing names changed may be obtained from the organizations' Websites: www.ismp.org, www.usp.org, and www.fda.gov.Risk reduction strategies "To prevent errors, we must never rely solely on one's memory ofproblem name pairs," says Michael Cohen, M.S., FASHP, president, Institute for Safe Medication Practices. "I strongly recommend that organizations routinely monitor information from the error reporting programs and then apply it. For example, through careful formularyselection of alternative medications without nomenclature problems or through the use of interactive reminders in computer systems or auxiliary reminder labels on product containers." Other suggestions for minimizing the risk of errors include: a.. Do not store problem medications alphabetically by name. Store such identified medications out of order, or in an alternate location. b.. Provide or ask for both the generic and brand names of drugs for medication orders in order to provide patients and staff with information to avoid unintentional duplication. c.. Write the purpose of the medication on the prescription. This inexpensive and efficient method to minimize errors helps the pharmacist in screening the medication order for proper dose, duration, and appropriateness, and it may also enable the pharmacist to intervenewhen multiple prescribers unknowingly order duplicative therapy for the same patient. It also minimizes the risk of confusion due to look-alike names of medications as well as the risk of misinterpretation due to poorly handwritten orders. d.. Develop a policy for taking verbal or telephone orders. For example, when taking verbal drug orders, clearly repeat the name of the drug, the dosage ordered, and request or provide correct spelling. This is particularly important for sound-alike drugs. The NationalCoordinating Council for Medication Error Reporting and Prevention recently released comprehensive recommendations to reduce medication errors associated with verbal prescription orders. The recommendations are on the NCC MERP web site at www.nccmerp.org. Provide the generic and brand name on all medication labels. JointCommission standards in all programs (e.g. TX.3.5.1 in ComprehensiveAccreditation Manual for Hospitals) require that all dispensed medications are appropriately and safely labeled using a standardized method in the most ready-to-administer form possible to minimize opportunities for error. This includes having both the generic name and, when different from the generic name, the brand name of the drug on the medication order. Surveyors will evaluate if the drug name on the medication order, medication label, and nursing MAR are the same. Providing both names on the label assures consistency between thedocuments and helps to prevent misinterpretation of orders.Provide patients with written information about their drugs including the brand and generic names. Inquire if the prescribed drug is a routine medication and withhold medications that the patient questions or does not recognize.RecommendationsJoint Commission standards for hospitals, ambulatory, and behavioral health organizations (e.g. TX.3.1 in Comprehensive Accreditation Manual for Hospitals) require that organizations maintain a list of medications that are always available within the organization (i.e. a formulary). Organizations must develop and follow criteria for selecting drugs that are stocked within an institution (i.e. added to the formulary), and one of the required criteria in the intent of thestandard that must be considered is the potential for medication errors. Sound-alike names and similar labeling of generic products should be considered in determining the formulary selection of products. When look-alike and sound-alike drugs are allowed on the formulary, or are ordered on a non-formulary basis, they should be identified as being medications at "high risk" for potential error and extra steps should be taken to assure safety in ordering, dispensing and administering such products.Organizations should review their policies and procedures regarding medication use to reduce the high potential for error from look-alike and sound-alike drugs, as well as other common sources of misinterpreted medication orders, and institute appropriate risk reduction strategies from the list above.
Published for Joint Commission accredited organizations and interested health care professionals, Sentinel Event Alert identifies the most frequently occurring 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. Organizations are expected to (1) review each Sentinel Event Alert, (2) consider the suggestions, as appropriate to the organization's services, and (3) implement the suggestions, or reasonable alternatives, or provide a reasonable explanation for not implementing relevant changes.
Setting the Standard for Quality in Health CareJoint Commission Sentinel Event Hotline (630) 792-3700 http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_19.htm
~~**~~**~~**~~**~~**~~ MEDICAL NEWS
Please take the time to read this....very well written. The U.S. is facing a severe nursing shortage. An estimated 8.5 percent of the nursing positions in the U.S. are unfilled -- and some expect that number to triple by 2020 as 80 million baby boomers retire and expand the ranks of those needing care. One solution, of course, is increased pay, but will this be enough to lure more candidates to the field? See what other factors are contributing to the shortage....
http://jobs.aol.com/article/_a/a-critical-shortage-of-nurses/20070904105409990001
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N.Y. medical center named for retired nurseBon Secours Community Hospital in Port Jervis, N.Y., will honor Roberta "Bobbi" Glinton, a retired nurse who served the hospital for more than 50 years, by naming its new medical center after her.http://r.smartbrief.com/resp/hHqgnilqnvxuAIWbYr
Since the initial publication of the Joint Commission's Sentinel Event Alert in 1998, several issues have been devoted to the topic of medication errors and the identification, prevention, and reporting of specific types of medication errors either reported to Joint Commissionas part of the sentinel event reporting system or identified by Joint Commission at the time of survey. Medication errors can occur at any point in the process of providing drugs to patients-prescribing, documenting, dispensing, administering-and many factors can contributeto medication errors, including poor handwriting, similar sounding or looking drug names, drug abbreviations, misinterpretation of labeling or packaging, miscalculations, lack of knowledge or skill, and incorrect administration. This issue of Sentinel Event Alert focuses specifically on medication errors resulting from confusing look-alike or sound-alike drug names and recommendations for minimizing risk and preventing potential errors.With tens of thousands of brand name and generic drugs currently on the market, the potential for error due to confusing drug names is significant. "Health care professionals often report confusion between similar brand and generic names," says Diane Cousins, R.Ph., vicepresident, Practitioner and Product Experience department, U.S. Pharmacopeia. "Contributing to the confusion are complications such as illegible handwriting, incomplete knowledge of drug names, newly available products, similar packaging or labeling, and incorrectly selecting a drug from a computerized list," says Cousins. In fact, similar drug names, either written or spoken, account for approximately 15 percent of all reports to the USP Medication Errors Reportingprogram.New names that are similar to existing names continue to be approved and medication errors continue to occur despite review before introduction to the market by a number of U.S. and international organizations, including pharmaceutical manufacturers, the U.S. Pharmacopeia, the International Nonproprietary Names Committee of the World Health Organization, the Food and Drug Administration, the U.S. Adopted Names Council, and the U.S. Patent and Trademark Office. "This ever-increasing number of confusing name sets represents such a broad range of products and therapeutic drug classes that every health care practitioner is vulnerable to making this type of error," says Cousins. "While similarly named products may not be perceived to pose a public health threat, USP has received reports of patient harm and fatalities that have occurred as a result of this problem."In March, 2001, the USP released "Use Caution, Avoid Confusion," an updated list highlighting hundreds of confusing drug name sets and identifying more than 750 unique drug names that have been reported to the Medication Errors Reporting program. A poster and a laminated, quick-reference card are available for health care professionals free of charge from the USP by contacting USP's Practitioner and Product Experience department at (800) 487-7776. While the FDA recently instituted an intensive risk analysis system for the review and evaluation of proposed proprietary drug names, and in fact rejects approximately one-third of all proposed names because of their potential for confusion, it is important for health careprofessionals to integrate systems and establish practices to reduce the possibility of ordering, dispensing or administering the incorrect drug.At present, the Institute for Safe Medication Practices, USP and the FDA collect and track medication errors and make information available to health care providers and the public. "Coordinated efforts on the parts of these organizations and the reporting of medication errors has resulted in changes to the names of several commonly confused drugs," says Jerry Phillips, associate director, Medication Error Prevention, Office of Post Marketing Drug Risk Assessment, FDA. Information and alerts about confusing drug names and current initiatives to have confusing names changed may be obtained from the organizations' Websites: www.ismp.org, www.usp.org, and www.fda.gov.Risk reduction strategies "To prevent errors, we must never rely solely on one's memory ofproblem name pairs," says Michael Cohen, M.S., FASHP, president, Institute for Safe Medication Practices. "I strongly recommend that organizations routinely monitor information from the error reporting programs and then apply it. For example, through careful formularyselection of alternative medications without nomenclature problems or through the use of interactive reminders in computer systems or auxiliary reminder labels on product containers." Other suggestions for minimizing the risk of errors include: a.. Do not store problem medications alphabetically by name. Store such identified medications out of order, or in an alternate location. b.. Provide or ask for both the generic and brand names of drugs for medication orders in order to provide patients and staff with information to avoid unintentional duplication. c.. Write the purpose of the medication on the prescription. This inexpensive and efficient method to minimize errors helps the pharmacist in screening the medication order for proper dose, duration, and appropriateness, and it may also enable the pharmacist to intervenewhen multiple prescribers unknowingly order duplicative therapy for the same patient. It also minimizes the risk of confusion due to look-alike names of medications as well as the risk of misinterpretation due to poorly handwritten orders. d.. Develop a policy for taking verbal or telephone orders. For example, when taking verbal drug orders, clearly repeat the name of the drug, the dosage ordered, and request or provide correct spelling. This is particularly important for sound-alike drugs. The NationalCoordinating Council for Medication Error Reporting and Prevention recently released comprehensive recommendations to reduce medication errors associated with verbal prescription orders. The recommendations are on the NCC MERP web site at www.nccmerp.org. Provide the generic and brand name on all medication labels. JointCommission standards in all programs (e.g. TX.3.5.1 in ComprehensiveAccreditation Manual for Hospitals) require that all dispensed medications are appropriately and safely labeled using a standardized method in the most ready-to-administer form possible to minimize opportunities for error. This includes having both the generic name and, when different from the generic name, the brand name of the drug on the medication order. Surveyors will evaluate if the drug name on the medication order, medication label, and nursing MAR are the same. Providing both names on the label assures consistency between thedocuments and helps to prevent misinterpretation of orders.Provide patients with written information about their drugs including the brand and generic names. Inquire if the prescribed drug is a routine medication and withhold medications that the patient questions or does not recognize.RecommendationsJoint Commission standards for hospitals, ambulatory, and behavioral health organizations (e.g. TX.3.1 in Comprehensive Accreditation Manual for Hospitals) require that organizations maintain a list of medications that are always available within the organization (i.e. a formulary). Organizations must develop and follow criteria for selecting drugs that are stocked within an institution (i.e. added to the formulary), and one of the required criteria in the intent of thestandard that must be considered is the potential for medication errors. Sound-alike names and similar labeling of generic products should be considered in determining the formulary selection of products. When look-alike and sound-alike drugs are allowed on the formulary, or are ordered on a non-formulary basis, they should be identified as being medications at "high risk" for potential error and extra steps should be taken to assure safety in ordering, dispensing and administering such products.Organizations should review their policies and procedures regarding medication use to reduce the high potential for error from look-alike and sound-alike drugs, as well as other common sources of misinterpreted medication orders, and institute appropriate risk reduction strategies from the list above.
Published for Joint Commission accredited organizations and interested health care professionals, Sentinel Event Alert identifies the most frequently occurring 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. Organizations are expected to (1) review each Sentinel Event Alert, (2) consider the suggestions, as appropriate to the organization's services, and (3) implement the suggestions, or reasonable alternatives, or provide a reasonable explanation for not implementing relevant changes.
Setting the Standard for Quality in Health CareJoint Commission Sentinel Event Hotline (630) 792-3700 http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_19.htm
~~**~~**~~**~~**~~**~~ MEDICAL NEWS
Please take the time to read this....very well written. The U.S. is facing a severe nursing shortage. An estimated 8.5 percent of the nursing positions in the U.S. are unfilled -- and some expect that number to triple by 2020 as 80 million baby boomers retire and expand the ranks of those needing care. One solution, of course, is increased pay, but will this be enough to lure more candidates to the field? See what other factors are contributing to the shortage....
http://jobs.aol.com/article/_a/a-critical-shortage-of-nurses/20070904105409990001
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N.Y. medical center named for retired nurseBon Secours Community Hospital in Port Jervis, N.Y., will honor Roberta "Bobbi" Glinton, a retired nurse who served the hospital for more than 50 years, by naming its new medical center after her.http://r.smartbrief.com/resp/hHqgnilqnvxuAIWbYr
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FROM THE MEMBERS
The National Registered Nurses Professional Association (NRNPA) is a professional organization for the Registered Nurse. Founded in 2007 by RNs who wanted an organization that the professional nurse could join that fostered the ideals of professionalism, and that helped nurses help each other develop, share, and fine-tune their skills to help one another shine the light of excellence of this time-honored profession. Advocate, Promote and Reform, three simple but powerful words are the core principles of this grassroots organization. The NRNPA is a professional organization formed by RNs for RNs join us in the adventure!For more information call Geneviève at 626-844-7812, email her at Clavreul@nrnpa.org or visit our website at www.nrnpa.org <http://www.nrnpa.org> .
You can also read more about the Geneviève¹s³spin² on all things nursing by visiting her blog at www.thenurseunchained.com.
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This was sent in by BAcello (Barbara)...this is authentic. She writes:
"I hate to be the bearer of bad news all the time, and I usually do not pass along all of the various warnings that come through my browser. However, in the past few weeks, I have had emails like the example below saying I have joined a recipe club, downloader heaven, and a few others. If you receive an email similar to the one immediately below this message, delete it. If you have a spam reporting mechanism through your isp or spamcop, report them. Also you can report them to the government using spam@uce.gov. These emails are a variation of the E-cards about which I emailed a few weeks ago. They are designed to steal your identity and plunder your computer for information. Do not be tricked into opening them." Barbara
This was sent in by BAcello (Barbara)...this is authentic. She writes:
"I hate to be the bearer of bad news all the time, and I usually do not pass along all of the various warnings that come through my browser. However, in the past few weeks, I have had emails like the example below saying I have joined a recipe club, downloader heaven, and a few others. If you receive an email similar to the one immediately below this message, delete it. If you have a spam reporting mechanism through your isp or spamcop, report them. Also you can report them to the government using spam@uce.gov. These emails are a variation of the E-cards about which I emailed a few weeks ago. They are designed to steal your identity and plunder your computer for information. Do not be tricked into opening them." Barbara
All the following is part of "SUSPICIOUS MAIL":
New file name for Storm Trojan/Bot - http://www.websense.com/securitylabs...php?BlogID=140Aug 20 2007 - "The Storm Trojan / Bot continues to spread like wildfire. The latest version has a variety of subjects and email bodies but now uses the filename applet.exe.>
New file name for Storm Trojan/Bot - http://www.websense.com/securitylabs...php?BlogID=140Aug 20 2007 - "The Storm Trojan / Bot continues to spread like wildfire. The latest version has a variety of subjects and email bodies but now uses the filename applet.exe.>
Email copy sample: Greetings, Here is your membership info for Downloader Heaven.Member Number: 2259948423 Temorary Login: user6278 Temp Password ID: gr272Please Change your login and change your Login Information.Follow this link, or paste it in your browser: http: //... Welcome, Technical Services Downloader Heaven..." http://isc.sans.org/diary.html?storyid=3298Last Updated: 2007-08-21 ...(Version: 3) - "Looks like Storm moved to a new mutation. The e-mails are now inviting users to become members in various "clubs". Here is a sample:> Subject: Login Information'Dear Member, Are you ready to have fun at CoolPics.Account Number: 73422529174753 Your Temp. Login ID: user3559 Temorary Password: jz438 Please Change your login and change your Login Information. This link will allow you to securely change your login info: http: //... Thank You, New Member Technical Support
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http://isc.sans.org/diary.html?storyid=3298CoolPics...' Do not go there !!!
Barbara continues " I have seen about a dozen different ones so far. They are all "confirmations" in this style to various web sites. The web page offers again an "applet.exe" for download. In short: We don't need to enumerate variants of the e-mail message. If you are brave and know what you are doing, download the applet.exe and try to reverse it (not easy typically). Thunderbird warned me that the link is a scam. (I think it does so for all numeric IP links). My copy of applet.exe was about 114 kB large. While many AV scanners detect it as "evil" based on heuristic signatures, some well known scanners don't (maybe Virustotal is running them without heuristic turned on, or they just don't do it)..."
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I found this while on Amazon.com..........thought it would be nice for everyone to know that Rozalfaro@AOL.com wrote this.....she is a member of Paradigm97
Applying Nursing Process: A Tool for Critical Thinking by Rosalinda Alfaro-LeFevre Average customer review: List Price: $37.95Price: $33.64You Save: $4.31 (11%)
Rate this item: It was a five start rating !
Rosalinda Alfaro-LeFevre's Sigma Theta Tau Best Pick and AJN Book for the Year award-winning text is now in its Sixth Edition, with a new focus on using the nursing process as a tool for critical thinking. The greatly expanded... Read more
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I found this while on Amazon.com..........thought it would be nice for everyone to know that Rozalfaro@AOL.com wrote this.....she is a member of Paradigm97
Applying Nursing Process: A Tool for Critical Thinking by Rosalinda Alfaro-LeFevre Average customer review: List Price: $37.95Price: $33.64You Save: $4.31 (11%)
Rate this item: It was a five start rating !
Rosalinda Alfaro-LeFevre's Sigma Theta Tau Best Pick and AJN Book for the Year award-winning text is now in its Sixth Edition, with a new focus on using the nursing process as a tool for critical thinking. The greatly expanded... Read more
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INTERESTING READING
Please remember that the REUTERS articles are good for 30 days only
I have been representing nurses before the Texas Board of Nursing for over 10 years (it is the only type of law I practice) and I have seen a big change in the way the Board of Nurse Examiners reviews complaints against nurses. ... A Nurse Attorney's Thoughts - http://nurseattorney.blogspot.com/ By Taralynn Mackay http://nurseattorney.blogspot.com/2007/08/more-nurses-in-trouble-with-nursing.html
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(Oak Brook, Ill.-August 13, 2007) Joint Commission Resources (JCR) announced that nine of its publications appear in Doody's Core Titles in Health Sciences 2007. JCR is a not-for-profit affiliate of The Joint Commission.Doody's Core Titles in Health Sciences are selected each year by almost 200 content specialists and librarians. The Doody's list helps medical, nursing, and allied health librarians around the world make the book-buying decisions for their libraries. The list suggests core titles that represent essential knowledge needed by professionals or students in a given discipline.JCR titles listed as Doody's Core Titles in Health Sciences 2007 are:· The APIC/JCAHO Infection Control Workbook · TIPS: Techniques to Improve Patient Safety on CD-ROM, 3rd edition · Patients as Partners: How to Involve Patients and Families in Their Own Care · Infection Control Issues in the Environment of Care · 2007 Standards for Ambulatory Care · 2007 Standards for Ambulatory Surgical Centers · Getting Results: Reliably Communicating and Acting on Critical Test Results · Meeting JCAHO's Infection Control Requirements: A Priority Focus Area · 2005-2006 Accreditation Process Guide for Ambulatory CareTo order, call JCR Customer Service toll-free at 877.223.6866, 8 a.m. to 8 p.m. CT, weekdays, or visit www.jcrinc.com.
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(Oak Brook, Ill.-August 13, 2007) Joint Commission Resources (JCR) announced that nine of its publications appear in Doody's Core Titles in Health Sciences 2007. JCR is a not-for-profit affiliate of The Joint Commission.Doody's Core Titles in Health Sciences are selected each year by almost 200 content specialists and librarians. The Doody's list helps medical, nursing, and allied health librarians around the world make the book-buying decisions for their libraries. The list suggests core titles that represent essential knowledge needed by professionals or students in a given discipline.JCR titles listed as Doody's Core Titles in Health Sciences 2007 are:· The APIC/JCAHO Infection Control Workbook · TIPS: Techniques to Improve Patient Safety on CD-ROM, 3rd edition · Patients as Partners: How to Involve Patients and Families in Their Own Care · Infection Control Issues in the Environment of Care · 2007 Standards for Ambulatory Care · 2007 Standards for Ambulatory Surgical Centers · Getting Results: Reliably Communicating and Acting on Critical Test Results · Meeting JCAHO's Infection Control Requirements: A Priority Focus Area · 2005-2006 Accreditation Process Guide for Ambulatory CareTo order, call JCR Customer Service toll-free at 877.223.6866, 8 a.m. to 8 p.m. CT, weekdays, or visit www.jcrinc.com.
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Start a nursing agency (I owned one long ago...lots of work. Really helps if one is a Nurse)
Starting or establishing your own nurse agency or nurse staffing agency does not need one to be a nurse. All you need is our packages and the desire to be self employed. This is the only industry where there will always be a shortage. ... Medical School Chat - http://www.medschoolchat.com/
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Diabetics who need to switch from oral medications to insulin could reduce their annual healthcare costs up to $17,000 by using an insulin pen instead of a syringe to deliver their daily dose of medication. A new study found that using an insulin pen may result in fewer trips to the emergency department and to the doctor's office, resulting in substantial savings to diabetics and their insurers. "For one, there is less chance of getting the wrong dose of insulin," said Rajesh Balkrishnan, the study's senior author and the Merrell Dow professor of pharmacy at Ohio State University. "Diabetics who use syringes must carefully measure their insulin, so there is a risk of getting too much or too little." The pen contains a pre-measured dose of insulin in a disposable cartridge. Users simply push a button on the pen, and the proper dose of medication is injected through a needle. A syringe user must extract the exact dose of insulin from a vial. ...The findings appear in a recent issue of the journal Clinical Therapeutics. http://www.medicalnewstoday.com/articles/80275.php
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Diabetics who need to switch from oral medications to insulin could reduce their annual healthcare costs up to $17,000 by using an insulin pen instead of a syringe to deliver their daily dose of medication. A new study found that using an insulin pen may result in fewer trips to the emergency department and to the doctor's office, resulting in substantial savings to diabetics and their insurers. "For one, there is less chance of getting the wrong dose of insulin," said Rajesh Balkrishnan, the study's senior author and the Merrell Dow professor of pharmacy at Ohio State University. "Diabetics who use syringes must carefully measure their insulin, so there is a risk of getting too much or too little." The pen contains a pre-measured dose of insulin in a disposable cartridge. Users simply push a button on the pen, and the proper dose of medication is injected through a needle. A syringe user must extract the exact dose of insulin from a vial. ...The findings appear in a recent issue of the journal Clinical Therapeutics. http://www.medicalnewstoday.com/articles/80275.php
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MOUNT Alexander Hospital nurses protested yesterday what they claim are dangerous nurse-to-patient ratios. But management denied unsafe staffing levels. The Australian Nursing Federation's Victorian secretary Lisa Fitzpatrick told The Advertiser there were not enough nurses rostered on at one time to ensure resident safety.She said the ANF had been in negotiations with hospital management for five months, but said she did not think they would increase staff numbers."It's extremely important because the staffing levels, which are mandated minimums in Victoria in residential aged care, aren't being abided by the hospital management," Ms Fitzpatrick said.Yesterday's protest erupted as the hospital held the official opening of its new aged care home, Ellery House. Almost 50 nurses from the hospital's aged care division refused to help move elderly residents to their new home. http://bendigo.yourguide.com.au/detail.asp?class=news&subclass=general&story_id=1035574&categor
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Take the time to read this article......one of our members- Sandy Summers- is quoted. This is a very interesting topic..........................................................................................................................................................................................When I first chose nursing as a career, I remember thinking how great it would be not having to spend hours dressing for work. I could leave superficiality behind and focus on what was important - the patient.I was vain enough to buy fitted shirts, cross over tops, and hip cargo pants before accepting my first professional RN job. One of my nursing school friends told me her parents bought her a whole new nursing wardrobe as a graduation present.Unfortunately, both of us had to put our new clothes at the bottom of our drawers. The hospitals we chose as our employers had nursing uniform requirements. There are several reasons hospitals are moving toward standardized scrub tops and pants for nurses... http://nursing.advanceweb.com/common/Editorial/Editorial.aspx?CC=93996
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(Low income families are monitored for many things including child abuse....it is very bad that upper income families escape being monitored for abuse....because as we all know, abuse occurs in all socioeconomic levels...not just the poor.)
Last year, 1,650 children in Kitsap County were referred to Child Protective Services because they were abused or neglected.
A handful of Kitsap physicians and business leaders wanted to reduce the numbers, so they started a nonprofit group to do it — Healthy Start Kitsap.
After years of talking about what could be done, the group is ready to take action.
During the last session, the state Legislature allotted new money to fund evidence-based programs — meaning they're proven to work — targeted at preventing child abuse and neglect.
The Healthy Start Kitsap group hopes to get some of that money and use it to implement a program that would help first-time, low-income parents break the cycle of abuse....
http://www.kitsapsun.com/news/2007/aug/11/group-sees-nurses-as-an-antidote-to-child-abuse/
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Early treatment with the drug interferon slows the progression of multiple sclerosis (MS) in people with the first symptoms of the disease and reduces impairment, an international study shows.The study of 468 people found that 37 percent of those who got every-other-day injections of interferon beta-1b progressed to full-blown MS over three years, compared to 51 percent of those who got inactive injections, according to the report in the Aug. 4 issue of The Lancet.Interferon treatment also reduced the progression of disability by 40 percent, the report said... http://www.healthday.com/Article.asp?AID=607027
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Despite Botulism Recall, Potentially Contaminated Products Still Being Sold Across the U.S. (AP) - Stores across the United States are continuing to sell recalled canned chili, stew, hash and other foods potentially contaminated with poisonous bacteria even after repeated warnings that the products could kill.... http://news.lp.findlaw.com/ap/o/55/07-27-2007/e6c30017c0ccc08a.htmlRelated Resources . See more recent food and drug recalls on FindLawhttp://injury.findlaw.com/defective-dangerous-products/recall.feeds/archive/FDA/2000/
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Anesthesia Safety More than 40 million people receive anesthetics each year in the U.S. Getting your patients involved in pre- and post-anesthesia planning can help your organization improve anesthesia safety. Be sure to collect the patient’s complete medical history, including previous anesthesia experience, allergies, and any current medications (prescribed, over-the-counter, and herbal medications and supplements), so all potential interactions with anesthetics can be identified. Because patients often do not mention products they do not consider to be medicine, staff should specifically ask about over-the-counter medicines (such as cold medicine) and herbal supplements (such as ginkgo). Staff should also ask about chronic medications for diabetes, hypertension, and asthma that might impair responses to anesthetics, as well as their use of alcohol and illicit drugs, which can significantly affect their response to, and risk from, anesthetic agents. If patients do not have their complete medical information for the preoperative assessment, ask them to call back or bring the medications with them when the procedure is scheduled. http://www.medinfonow.com/min/ct/5/57144/fuwluz/KAAK/256/default.aspx
********************************
Nurse Anesthetist is a growing Specialty It's a nursing specialty that nurses are proud to say dates back to the battlefields of the Civil War. As the first professional group to administer anesthesia services in the United States, nurse anesthetists are considered the first clinical nursing specialty, according to the American Association of Nurse Anesthetists Web site. Today, more than 30,0000 certified registered nurse anesthetists, a certification that began in 1956, work on teams with medical doctors at hospitals across the country providing anesthesia services to 27 million patients each year, according an AANA report in 2005. Dr. Thomas Bladek, chairman of the department of anesthesiology at St. Vincent's Medical Center in Bridgeport, said the hospital employs 18 full-time CRNAs and 12 full-time board certified anesthesiologists."Certified registered nurse anesthetists have been around for quite some time," said Bladek, recalling how St. Vincent's had three CRNAs when he joined the hospital in the 1960s. "Virtually every hospital has them in operating rooms, some have more than others.http://www.connpost.com/ci_6621932?source=most_emailed
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Psychological distress, personality, and adjustment among nursing students Warbah, L., et al. - Psychological distress and poor adjustment among a significant number of nursing students is an important issue facing nursing education. The concerns need to be studied in detail and solutions need to be built into the nursing course in order to help students with such difficulty... Nurse Education Today, 08/17/07 http://www.mdlinx.com/NurseLinx/newsl-article.cfm/1942679/?user_id=157159&email=rnfrankie@bellsouth.net&news_id=399
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Driven by consumer demand, the convenient care clinic (CCC) tsunami seems unstoppable. With the growing wave of clinics across the country comes a spotlight on nurse practitioners (NPs). Despite resistance from many physicians to embrace the CCC concept, NPs push forward, illuminating their skills to a growing number of clinic patients along the way. Growth projections estimate that the number of CCCs will expand from about 300 nationwide into the thousands within the next few years, according to the Convenient Care Association. Walgreen Co., which acquired Take Care Health Systems in May, currently has 60 of the clinics in Chicago and other cities and expects to have more than 400 CCCs in its stores by the end of 2008."Word of mouth is definitely spreading," says Marjorie Kozlowski, RN, MSN, APN, a nurse practitioner at a Take Care Health center located in a Walgreens in Lake Zurich, Ill., and assistant lead NP of Take Care Health Systems in Chicago. "The most common comment I hear is 'This makes so much sense. Why didn't we think of this sooner?'" http://news.nurse.com/apps/pbcs.dll/article?AID=/20070812/CA09/308120012
**********************************
Evading prostate cancer could be a little easier if you'd put more of these on your plate: cruciferous vegetables. Turns out sulforaphane -- the compound that makes the veggies in this family taste a little bitter and smell a little funky -- can help disarm prostate cancer cells before they do any damage. Here's the cruciferous lineup.
Team Green (and White)There's no surefire way to prevent prostate cancer. But your risk is greatly affected by your diet and everyday habits. For example, how much broccoli you eat. And how much cauliflower. These veggies -- along with cabbage, kale, and bok choy -- belong to the cruciferous family, and research shows that this family may put the kibosh on prostate cancer like no other veggie group. More tools to add to your prostate protection squad:
Up your intake of fruits and veggies. Although cruciferous veggies seem to be particularly helpful in protecting your prostate, upping your intake of produce, in general, is good for it, too.
Cut back on this.
Do more of this. Symptom CheckerCould those frequent bathroom breaks be a prostate problem? This quick questionnaire can help you get to the bottom of things.
References:
Potent induction of phase 2 enzymes in human prostate cells by sulforaphane. Brooks, J. D., Paton, V. G., Vidanes, G., Cancer Epidemiology, Biomarkers & Prevention 2001 Sep;10(9):949-954.
**************************************
Found this on a list serve I belong to....the guy who sent it in is a responsible person.
Heads up everyone! Please, keep this circulating... You walk across the parking lot, unlock your car and get inside. You start the engine and shift into Reverse. When you look into the rearview mirror to back out of your parking space, you notice a piece of paper stuck to the middle of the rear window. So, you shift into Park, unlock your doors, and jump out of your car to remove that paper (or whatever it is) that is obstructing your view. When you reach the back of your car, that is when the car jackers appear out of nowhere, jump into your car and take off. They practically mow you down as they speed off in your car. And guess what, ladies? I bet your purse is still in the car.So now the carjacker has your car, your home address, your money, and your keys. Your home and your whole identity are now compromised!BEWARE OF THIS NEW SCHEME THAT IS NOW BEING USED....If you see a piece of paper stuck to your back window, just drive away. Remove the paper later, and. be thankful that you read this e-mail.
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Tablets, chews, fortified juices, dairy products -- where should you get your calcium? One recent study suggests dairy is best, with a calcium supplement thrown in for good measure. In the study, women who got at least 70 percent of their calcium from dairy -- and the rest from supplements -- had better bone mineral density than the supplement-only group.
Healthy Sources AboundIt's not clear why calcium from dairy beat the supplemental stuff in a study. It may be that dairy favorably affects estrogen balance, making for stronger bones. But more research is needed to confirm the study results. (Are your bones headed for a break? Answer these questions and find out.) Calcium Do's and Don'tsCalcium Do's and Don'ts And the study findings don't mean you should ditch your calcium chews. Just don’t forget to seek out calcium from foods, too, especially because a lot of food sources provide other good-for-the-body nutrients, like vitamin D and protein. Consider low-fat yogurt (415 mg calcium per cup), Parmesan cheese (390 mg per ounce), low-fat milk (290 mg per cup), and -- if you're not into dairy -- soymilk (300 mg per cup), canned pink salmon (215 mg per half cup), and cooked spinach (180 mg per cup). A balanced, nutritious diet can make a serious dent in your calcium needs. Look up more calcium sources with this online tool. Reference:
Effects of dietary calcium compared with calcium supplements on estrogen metabolism and bone mineral density. Napoli, N., Thompson, J., Civitelli, R., Armamento-Villareal, R. C., American Journal of Clinical Nutrition 2007 May;85(5):1428-1433.
********************************
Low nurse staffing levels in Intensive Care Units (ICUs) contribute to an increased incidence of Ventilator-Associated Pneumonia (VAP), according to a new study published in the journal Critical Care. VAP is associated with high mortality rates, and can easily add dozens of days and substantial additional costs to a typical hospital stay. Researchers believe that when understaffed, nurses become overwhelmed by their case load and their compliance with basic hygiene standards is compromised. The training level of the nurses in the study had no measurable bearing on infection rates. V.A.P is a bacterial infection, and is spread from patient to patient. Authors of the study say it adds to a growing body of evidence suggesting that staffing levels are of critical importance to patient safety and positive health outcomes.http://www.dcmedmalblog.com/patient-safety-low-nurse-staffing-levels-lead-to-pneumonia-in-icus-new-study.html
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GOTHENBURG, Sweden, Aug. 22 -- Two research groups have provided long-awaited evidence that bariatric surgery saves lives, up to 136 per 10,000 operations. Gastric bypass reduced all-cause mortality 40% in a study of severely obese American patients, and bariatric surgery of whatever type reduced morality 29% in a Swedish study. The results of both studies were reported in the Aug. 23 issue of the New England Journal of Medicine....
http://www.medpagetoday.com/PrimaryCare/WeightManagement/tb/6480
********************************
-- NEW INSTRUCTIONS RELEASED Transmittal 1317 of the Medicare Claims Processing Manual, entitled "2008 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing for the Common Working File, Medicare Carriers and Fiscal In," was released. This instruction affectsAll Providers. View the complete text of Transmittal 1317 (PDF, 150 KB) http://www.cms.hhs.gov/transmittals/downloads/R1317CP.pdf
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Study says bleeding, not inflammation, causes pneumonia deaths. Common pneumonia is so often deadly because it can release an antibiotic-resistant toxin that causes severe bleeding in the lungs in some patients, researchers report. They also said the toxin is resistant to antibiotics and that standard drug treatments may not be helpful. http://r.smartbrief.com/resp/hOuonilqnvzktvqvfH
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Take the time to read this article......one of our members- Sandy Summers- is quoted. This is a very interesting topic..........................................................................................................................................................................................When I first chose nursing as a career, I remember thinking how great it would be not having to spend hours dressing for work. I could leave superficiality behind and focus on what was important - the patient.I was vain enough to buy fitted shirts, cross over tops, and hip cargo pants before accepting my first professional RN job. One of my nursing school friends told me her parents bought her a whole new nursing wardrobe as a graduation present.Unfortunately, both of us had to put our new clothes at the bottom of our drawers. The hospitals we chose as our employers had nursing uniform requirements. There are several reasons hospitals are moving toward standardized scrub tops and pants for nurses... http://nursing.advanceweb.com/common/Editorial/Editorial.aspx?CC=93996
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(Low income families are monitored for many things including child abuse....it is very bad that upper income families escape being monitored for abuse....because as we all know, abuse occurs in all socioeconomic levels...not just the poor.)
Last year, 1,650 children in Kitsap County were referred to Child Protective Services because they were abused or neglected.
A handful of Kitsap physicians and business leaders wanted to reduce the numbers, so they started a nonprofit group to do it — Healthy Start Kitsap.
After years of talking about what could be done, the group is ready to take action.
During the last session, the state Legislature allotted new money to fund evidence-based programs — meaning they're proven to work — targeted at preventing child abuse and neglect.
The Healthy Start Kitsap group hopes to get some of that money and use it to implement a program that would help first-time, low-income parents break the cycle of abuse....
http://www.kitsapsun.com/news/2007/aug/11/group-sees-nurses-as-an-antidote-to-child-abuse/
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Early treatment with the drug interferon slows the progression of multiple sclerosis (MS) in people with the first symptoms of the disease and reduces impairment, an international study shows.The study of 468 people found that 37 percent of those who got every-other-day injections of interferon beta-1b progressed to full-blown MS over three years, compared to 51 percent of those who got inactive injections, according to the report in the Aug. 4 issue of The Lancet.Interferon treatment also reduced the progression of disability by 40 percent, the report said... http://www.healthday.com/Article.asp?AID=607027
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Despite Botulism Recall, Potentially Contaminated Products Still Being Sold Across the U.S. (AP) - Stores across the United States are continuing to sell recalled canned chili, stew, hash and other foods potentially contaminated with poisonous bacteria even after repeated warnings that the products could kill.... http://news.lp.findlaw.com/ap/o/55/07-27-2007/e6c30017c0ccc08a.htmlRelated Resources . See more recent food and drug recalls on FindLawhttp://injury.findlaw.com/defective-dangerous-products/recall.feeds/archive/FDA/2000/
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Anesthesia Safety More than 40 million people receive anesthetics each year in the U.S. Getting your patients involved in pre- and post-anesthesia planning can help your organization improve anesthesia safety. Be sure to collect the patient’s complete medical history, including previous anesthesia experience, allergies, and any current medications (prescribed, over-the-counter, and herbal medications and supplements), so all potential interactions with anesthetics can be identified. Because patients often do not mention products they do not consider to be medicine, staff should specifically ask about over-the-counter medicines (such as cold medicine) and herbal supplements (such as ginkgo). Staff should also ask about chronic medications for diabetes, hypertension, and asthma that might impair responses to anesthetics, as well as their use of alcohol and illicit drugs, which can significantly affect their response to, and risk from, anesthetic agents. If patients do not have their complete medical information for the preoperative assessment, ask them to call back or bring the medications with them when the procedure is scheduled. http://www.medinfonow.com/min/ct/5/57144/fuwluz/KAAK/256/default.aspx
********************************
Nurse Anesthetist is a growing Specialty It's a nursing specialty that nurses are proud to say dates back to the battlefields of the Civil War. As the first professional group to administer anesthesia services in the United States, nurse anesthetists are considered the first clinical nursing specialty, according to the American Association of Nurse Anesthetists Web site. Today, more than 30,0000 certified registered nurse anesthetists, a certification that began in 1956, work on teams with medical doctors at hospitals across the country providing anesthesia services to 27 million patients each year, according an AANA report in 2005. Dr. Thomas Bladek, chairman of the department of anesthesiology at St. Vincent's Medical Center in Bridgeport, said the hospital employs 18 full-time CRNAs and 12 full-time board certified anesthesiologists."Certified registered nurse anesthetists have been around for quite some time," said Bladek, recalling how St. Vincent's had three CRNAs when he joined the hospital in the 1960s. "Virtually every hospital has them in operating rooms, some have more than others.http://www.connpost.com/ci_6621932?source=most_emailed
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Psychological distress, personality, and adjustment among nursing students Warbah, L., et al. - Psychological distress and poor adjustment among a significant number of nursing students is an important issue facing nursing education. The concerns need to be studied in detail and solutions need to be built into the nursing course in order to help students with such difficulty... Nurse Education Today, 08/17/07 http://www.mdlinx.com/NurseLinx/newsl-article.cfm/1942679/?user_id=157159&email=rnfrankie@bellsouth.net&news_id=399
**********************************
Driven by consumer demand, the convenient care clinic (CCC) tsunami seems unstoppable. With the growing wave of clinics across the country comes a spotlight on nurse practitioners (NPs). Despite resistance from many physicians to embrace the CCC concept, NPs push forward, illuminating their skills to a growing number of clinic patients along the way. Growth projections estimate that the number of CCCs will expand from about 300 nationwide into the thousands within the next few years, according to the Convenient Care Association. Walgreen Co., which acquired Take Care Health Systems in May, currently has 60 of the clinics in Chicago and other cities and expects to have more than 400 CCCs in its stores by the end of 2008."Word of mouth is definitely spreading," says Marjorie Kozlowski, RN, MSN, APN, a nurse practitioner at a Take Care Health center located in a Walgreens in Lake Zurich, Ill., and assistant lead NP of Take Care Health Systems in Chicago. "The most common comment I hear is 'This makes so much sense. Why didn't we think of this sooner?'" http://news.nurse.com/apps/pbcs.dll/article?AID=/20070812/CA09/308120012
**********************************
Evading prostate cancer could be a little easier if you'd put more of these on your plate: cruciferous vegetables. Turns out sulforaphane -- the compound that makes the veggies in this family taste a little bitter and smell a little funky -- can help disarm prostate cancer cells before they do any damage. Here's the cruciferous lineup.
Team Green (and White)There's no surefire way to prevent prostate cancer. But your risk is greatly affected by your diet and everyday habits. For example, how much broccoli you eat. And how much cauliflower. These veggies -- along with cabbage, kale, and bok choy -- belong to the cruciferous family, and research shows that this family may put the kibosh on prostate cancer like no other veggie group. More tools to add to your prostate protection squad:
Up your intake of fruits and veggies. Although cruciferous veggies seem to be particularly helpful in protecting your prostate, upping your intake of produce, in general, is good for it, too.
Cut back on this.
Do more of this. Symptom CheckerCould those frequent bathroom breaks be a prostate problem? This quick questionnaire can help you get to the bottom of things.
References:
Potent induction of phase 2 enzymes in human prostate cells by sulforaphane. Brooks, J. D., Paton, V. G., Vidanes, G., Cancer Epidemiology, Biomarkers & Prevention 2001 Sep;10(9):949-954.
**************************************
Found this on a list serve I belong to....the guy who sent it in is a responsible person.
Heads up everyone! Please, keep this circulating... You walk across the parking lot, unlock your car and get inside. You start the engine and shift into Reverse. When you look into the rearview mirror to back out of your parking space, you notice a piece of paper stuck to the middle of the rear window. So, you shift into Park, unlock your doors, and jump out of your car to remove that paper (or whatever it is) that is obstructing your view. When you reach the back of your car, that is when the car jackers appear out of nowhere, jump into your car and take off. They practically mow you down as they speed off in your car. And guess what, ladies? I bet your purse is still in the car.So now the carjacker has your car, your home address, your money, and your keys. Your home and your whole identity are now compromised!BEWARE OF THIS NEW SCHEME THAT IS NOW BEING USED....If you see a piece of paper stuck to your back window, just drive away. Remove the paper later, and. be thankful that you read this e-mail.
*********************
Tablets, chews, fortified juices, dairy products -- where should you get your calcium? One recent study suggests dairy is best, with a calcium supplement thrown in for good measure. In the study, women who got at least 70 percent of their calcium from dairy -- and the rest from supplements -- had better bone mineral density than the supplement-only group.
Healthy Sources AboundIt's not clear why calcium from dairy beat the supplemental stuff in a study. It may be that dairy favorably affects estrogen balance, making for stronger bones. But more research is needed to confirm the study results. (Are your bones headed for a break? Answer these questions and find out.) Calcium Do's and Don'tsCalcium Do's and Don'ts And the study findings don't mean you should ditch your calcium chews. Just don’t forget to seek out calcium from foods, too, especially because a lot of food sources provide other good-for-the-body nutrients, like vitamin D and protein. Consider low-fat yogurt (415 mg calcium per cup), Parmesan cheese (390 mg per ounce), low-fat milk (290 mg per cup), and -- if you're not into dairy -- soymilk (300 mg per cup), canned pink salmon (215 mg per half cup), and cooked spinach (180 mg per cup). A balanced, nutritious diet can make a serious dent in your calcium needs. Look up more calcium sources with this online tool. Reference:
Effects of dietary calcium compared with calcium supplements on estrogen metabolism and bone mineral density. Napoli, N., Thompson, J., Civitelli, R., Armamento-Villareal, R. C., American Journal of Clinical Nutrition 2007 May;85(5):1428-1433.
********************************
Low nurse staffing levels in Intensive Care Units (ICUs) contribute to an increased incidence of Ventilator-Associated Pneumonia (VAP), according to a new study published in the journal Critical Care. VAP is associated with high mortality rates, and can easily add dozens of days and substantial additional costs to a typical hospital stay. Researchers believe that when understaffed, nurses become overwhelmed by their case load and their compliance with basic hygiene standards is compromised. The training level of the nurses in the study had no measurable bearing on infection rates. V.A.P is a bacterial infection, and is spread from patient to patient. Authors of the study say it adds to a growing body of evidence suggesting that staffing levels are of critical importance to patient safety and positive health outcomes.http://www.dcmedmalblog.com/patient-safety-low-nurse-staffing-levels-lead-to-pneumonia-in-icus-new-study.html
************************
GOTHENBURG, Sweden, Aug. 22 -- Two research groups have provided long-awaited evidence that bariatric surgery saves lives, up to 136 per 10,000 operations. Gastric bypass reduced all-cause mortality 40% in a study of severely obese American patients, and bariatric surgery of whatever type reduced morality 29% in a Swedish study. The results of both studies were reported in the Aug. 23 issue of the New England Journal of Medicine....
http://www.medpagetoday.com/PrimaryCare/WeightManagement/tb/6480
********************************
-- NEW INSTRUCTIONS RELEASED Transmittal 1317 of the Medicare Claims Processing Manual, entitled "2008 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing for the Common Working File, Medicare Carriers and Fiscal In," was released. This instruction affectsAll Providers. View the complete text of Transmittal 1317 (PDF, 150 KB) http://www.cms.hhs.gov/transmittals/downloads/R1317CP.pdf
********************************
Study says bleeding, not inflammation, causes pneumonia deaths. Common pneumonia is so often deadly because it can release an antibiotic-resistant toxin that causes severe bleeding in the lungs in some patients, researchers report. They also said the toxin is resistant to antibiotics and that standard drug treatments may not be helpful. http://r.smartbrief.com/resp/hOuonilqnvzktvqvfH
*************************************
Innovative New Book Shows Families How To Keep Seniors Home For Life It is possible to keep seniors home for life. Families across the nation struggle with health care decisions for aging loved ones every day. Many seniors and families are faced with premature institutionalization when they are left to rely on the government (Medicaid) to pay for their long-term care needs. Today families are learning that there are other solutions.. http://www.longtermcareprovider.com/nl/506122/1763927
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Hospitals move to ’smart beds’ to increase patient safety More hospitals are purchasing so-called smart beds, which feature alarms and turning technology to increase patient safety, according to the New York Sun. The beds come equipped with alarms that help staff members determine whether a patient is trying to get out of bed or needs to be turned. It can also weigh a patient and determine a proper turning schedule to prevent pressure sores. The beds cost between $10,000 and $35,000, but are credited with increasing patient safety by hospital officials, according to the Sun. http://www.nysun.com/article/60620
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Hospitals move to ’smart beds’ to increase patient safety More hospitals are purchasing so-called smart beds, which feature alarms and turning technology to increase patient safety, according to the New York Sun. The beds come equipped with alarms that help staff members determine whether a patient is trying to get out of bed or needs to be turned. It can also weigh a patient and determine a proper turning schedule to prevent pressure sores. The beds cost between $10,000 and $35,000, but are credited with increasing patient safety by hospital officials, according to the Sun. http://www.nysun.com/article/60620
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Nurses group puts the spotlight on assaults The Massachusetts Nurses Association (MNA) has gone on the offensive against workplace violence, using an OSHA inspection of a hospital to point to the dangers healthcare workers face. The MNA posted a report detailing OSHA's visit to Brockton (MA) Hospital in March. In a July 13 letter from OSHA to the hospital--which the MNA posted online--the agency urges the facility to take further steps to prevent assaults on staff members. "The majority of the cases involved patient care givers who were assaulted while assisting and/or caring for patients in the emergency department and psychiatric unit," OSHA wrote. Brockton Hospital has adopted some of OSHA's recommendations and will also monitor violence in the facility, a hospital spokesperson told The Boston Globe this week.There is no OSHA standard for workplace violence, though the agency can cite hospitals for problems under the general duty clause, which requires workplaces to be free of hazards to employees. http://www.massnurses.org/
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Web site provides information on coverage eligibility A new Web site and toll-free hotline from the Foundation for Health Coverage Education provides personalized health insurance information for people in all 50 states and Washington, D.C. The goal of the site, created by the Foundation for Health Coverage Education, is to inform people about insurance programs for which they didn't know they were qualified. The Washington Post http://r.smartbrief.com/resp/hNsInilqnvzbmzZmDH
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Nursing Negligence In the not too distant past, our lawyers' experience had been that medical malpractice encompassed almost exclusively the negligent wrongs of physicians. However, as nursing has evolved into a sophisticated, technical, and specialized profession, nurses regularly assume roles previously in the exclusive domain of physicians. These include examinations, diagnosis, post-surgical monitoring, and treatments of patients. Sometimes this is done without any direct supervision from physicians. The nurse's expanded role in patient care, the continual development of specialized and sophisticated medical technology, and the heightened emphasis on independent nursing practice have placed nurses into positions of increased accountability. Generally, when the nurse's negligence occurs in the scope of the nurse's employment at a hospital or clinic, the nurse's conduct can be imputed to the facility or the hospital. In certain cases, the nurse's conduct may be imputed to the physician.... http://www.georgiainjurylawyerblog.com/2007/08/nursing_negligence.html
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New Detection for Dry Eye Syndrome Does lissamine green sound like something you'd want to get in your eyes? The name might be a turnoff, but a few properly placed drops can reveal staining patterns that are key to diagnosing dry eye syndrome earlier than other methods, providing doctors more options for treating the potentially sight-stealing disease, new research at UT Southwestern Medical Center confirms.Lissamine green is an eye-drop stain used by ophthalmologists to detect damaged cells on the eye's surface, flagging them green under special lighting.Dry eye syndrome is one of the most common eye ailments. According to various estimates, it affects 10-30 percent of the world's population, including 10-14 million Americans, mostly older women. Symptoms include eyes that burn or sting, blurred vision, frequent blinking, light sensitivity or a sandy or gritty feeling.In a study appearing in the July issue of Eye and Contact Lens, James McCulley, MD, FACS, chairman of ophthalmology at UT Southwestern, and colleagues found that the severity of the dry eye condition in patients correlates with where the stain patterns show up.Stains in the cornea indicate a break in the surface cells. Most bacteria require such a break in order to penetrate the eye, where the bacteria can cause an ulcer. http://NW.advanceweb.com/Newsletter.htm
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Too much exercise may speed heart failure NEW YORK (Reuters Health) 8/16/07 - Though exercise can be a key part of managing high blood pressure and heart disease, new animal research suggests there can be too much of a good thing.In experiments with rats, researchers found that excessive exercise worsened high blood pressure and progression to heart failure in rats with high blood pressure. Dr. Rebecca L. Schultz and colleagues at the University of South Dakota, Sioux Falls, report the results in the journal Hypertension.Regular physical activity has been linked to a lower risk of heart disease in numerous studies. Moreover, exercise therapy has been shown to improve both blood pressure and symptoms of heart failure -- a chronic condition in which the heart loses its ability to pump blood efficiently, causing symptoms like breathlessness and fatigue.The new findings in rats are, therefore, unexpected, according to an editorial published with the study.The implications for humans are not yet certain, according to the editorialists Dr. Paul Christian Schulze, of Boston University Medical Center, and Satyam Sarma, of Brown University Medical Center in Providence, Rhode Island. However, the findings "should raise our awareness" of the potential harm intense exercise might do to people with untreated high blood pressure. http://www.reutershealth.com/archive/2007/08/16/eline/links/20070816elin002.html
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The value of specialty nursing certification Bonnie Niebuhr, MS, RN, CAE, Melissa Biel, DPA, RN
The American Board of Nursing Specialties (ABNS) undertook a national study to validate nurses’ perceptions, values, and behaviors related to certification. A Web-based survey was developed and disseminated to certified nurses, noncertified nurses, and nurse managers. Of the 11 427 respondents, 8615 (75%) identified themselves as certified nurses, and 2812 (25%) were noncertified nurses. Of these, 1608 respondents (14%) held the position of Nurse Manager. Using the Perceived Value of Certification Tool© (PVCT©), certified and noncertified nurses showed a high level of agreement with the value statements on certified practice. Nurse Managers bolstered these perceptions with their correspondingly high rate of agreement on the certification value statements. Additionally, the study examined barriers and challenges to certification, incentives to certification, the impact of certification on lost workdays and nurse retention. This study took an important step in furthering understanding of nursing certification and the implications for health care organizations, nursing certification boards, and certified and noncertified nurses.
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Risk factors for clinical fractures among postmenopausal women van Geel, T.A.C.M., et al. - Only scarce data are available on the long-term absolute risk (AR) of all clinical fractures, taking into account the time when they occurred. Therefore, we assessed during a 10-year follow-up the risk factors associated with the occurrence of any first or second clinical fracture...Conclusion: In postmenopausal women, over a 10-year follow-up, the AR of a second clinical fracture is highest in the five years after any first clinical fracture. The AR for a first clinical fracture is lower and depends on osteoporosis and age [more...] Menopause International, 08/29/07 http://www.mdlinx.com/NurseLinx/newsl-article.cfm/1960482/?user_id=157159&email=rnfrankie@aol.com&news_id=410
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I love the following Letter to the Editor....... what do you think of it?
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Nursing Negligence In the not too distant past, our lawyers' experience had been that medical malpractice encompassed almost exclusively the negligent wrongs of physicians. However, as nursing has evolved into a sophisticated, technical, and specialized profession, nurses regularly assume roles previously in the exclusive domain of physicians. These include examinations, diagnosis, post-surgical monitoring, and treatments of patients. Sometimes this is done without any direct supervision from physicians. The nurse's expanded role in patient care, the continual development of specialized and sophisticated medical technology, and the heightened emphasis on independent nursing practice have placed nurses into positions of increased accountability. Generally, when the nurse's negligence occurs in the scope of the nurse's employment at a hospital or clinic, the nurse's conduct can be imputed to the facility or the hospital. In certain cases, the nurse's conduct may be imputed to the physician.... http://www.georgiainjurylawyerblog.com/2007/08/nursing_negligence.html
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New Detection for Dry Eye Syndrome Does lissamine green sound like something you'd want to get in your eyes? The name might be a turnoff, but a few properly placed drops can reveal staining patterns that are key to diagnosing dry eye syndrome earlier than other methods, providing doctors more options for treating the potentially sight-stealing disease, new research at UT Southwestern Medical Center confirms.Lissamine green is an eye-drop stain used by ophthalmologists to detect damaged cells on the eye's surface, flagging them green under special lighting.Dry eye syndrome is one of the most common eye ailments. According to various estimates, it affects 10-30 percent of the world's population, including 10-14 million Americans, mostly older women. Symptoms include eyes that burn or sting, blurred vision, frequent blinking, light sensitivity or a sandy or gritty feeling.In a study appearing in the July issue of Eye and Contact Lens, James McCulley, MD, FACS, chairman of ophthalmology at UT Southwestern, and colleagues found that the severity of the dry eye condition in patients correlates with where the stain patterns show up.Stains in the cornea indicate a break in the surface cells. Most bacteria require such a break in order to penetrate the eye, where the bacteria can cause an ulcer. http://NW.advanceweb.com/Newsletter.htm
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Too much exercise may speed heart failure NEW YORK (Reuters Health) 8/16/07 - Though exercise can be a key part of managing high blood pressure and heart disease, new animal research suggests there can be too much of a good thing.In experiments with rats, researchers found that excessive exercise worsened high blood pressure and progression to heart failure in rats with high blood pressure. Dr. Rebecca L. Schultz and colleagues at the University of South Dakota, Sioux Falls, report the results in the journal Hypertension.Regular physical activity has been linked to a lower risk of heart disease in numerous studies. Moreover, exercise therapy has been shown to improve both blood pressure and symptoms of heart failure -- a chronic condition in which the heart loses its ability to pump blood efficiently, causing symptoms like breathlessness and fatigue.The new findings in rats are, therefore, unexpected, according to an editorial published with the study.The implications for humans are not yet certain, according to the editorialists Dr. Paul Christian Schulze, of Boston University Medical Center, and Satyam Sarma, of Brown University Medical Center in Providence, Rhode Island. However, the findings "should raise our awareness" of the potential harm intense exercise might do to people with untreated high blood pressure. http://www.reutershealth.com/archive/2007/08/16/eline/links/20070816elin002.html
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The value of specialty nursing certification Bonnie Niebuhr, MS, RN, CAE, Melissa Biel, DPA, RN
The American Board of Nursing Specialties (ABNS) undertook a national study to validate nurses’ perceptions, values, and behaviors related to certification. A Web-based survey was developed and disseminated to certified nurses, noncertified nurses, and nurse managers. Of the 11 427 respondents, 8615 (75%) identified themselves as certified nurses, and 2812 (25%) were noncertified nurses. Of these, 1608 respondents (14%) held the position of Nurse Manager. Using the Perceived Value of Certification Tool© (PVCT©), certified and noncertified nurses showed a high level of agreement with the value statements on certified practice. Nurse Managers bolstered these perceptions with their correspondingly high rate of agreement on the certification value statements. Additionally, the study examined barriers and challenges to certification, incentives to certification, the impact of certification on lost workdays and nurse retention. This study took an important step in furthering understanding of nursing certification and the implications for health care organizations, nursing certification boards, and certified and noncertified nurses.
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Risk factors for clinical fractures among postmenopausal women van Geel, T.A.C.M., et al. - Only scarce data are available on the long-term absolute risk (AR) of all clinical fractures, taking into account the time when they occurred. Therefore, we assessed during a 10-year follow-up the risk factors associated with the occurrence of any first or second clinical fracture...Conclusion: In postmenopausal women, over a 10-year follow-up, the AR of a second clinical fracture is highest in the five years after any first clinical fracture. The AR for a first clinical fracture is lower and depends on osteoporosis and age [more...] Menopause International, 08/29/07 http://www.mdlinx.com/NurseLinx/newsl-article.cfm/1960482/?user_id=157159&email=rnfrankie@aol.com&news_id=410
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I love the following Letter to the Editor....... what do you think of it?
Published: Aug 27, 2007 - Page: 4B The Aug. 19 issue of The Advocate spoke of the shortage of nurses and the increased cost of hiring and keeping nurses.I have been a registered nurse in one of our local hospitals for 12 years. I have loved being a nurse taking care of patients, but I recently resigned my position and am now teaching and working in home health.Over the past two years I have seen our census at the hospital double and triple. Patients are sicker than ever before, taking more time and more skill for nurses to take care of them.I seldom worked less than 13 hours of a 12-hour shift. I seldom stopped for lunch. My patients were acutely ill, yet I was assigned more patients to take care of in that 12-hour shift.I mentored new nursing graduates who would come to me in tears of frustration, fear and fatigue. This was not what they bargained for when they became nurses.I have seen nurses work 16 hours, go home for eight hours and return to work for 16 hours the next day.And I have seen people in administration turn their respective heads or shrug their shoulders, saying there was nothing that could be done.Airline pilots are limited in the amount of hours they can fly and are required to rest periodically. It makes sense; people's lives are in their hands. A pilot needs to be alert and able to think clearly in routine and in crisis situations.Nurses have no such limits - they are working indefinite numbers of days straight in eight-, 12- and 16-hour increments. They are paid overtime, incentives and bonuses - but at what cost to the patients?Our hospitals are opening new facilities with state-of-the-art operating rooms and expanded patient-care areas. They name wings and departments after famous people, but who is going to take care of the increased number of patients?Will the nurse-to-patient ratio go even higher? Will nurses be asked to work longer hours, taking care of more patients who are sicker than ever before?I miss working as an acute-care nurse in the hospital. I miss working with the physicians, the staff and with my patients. But at least I sleep better at night. I don't wake up with my heart pounding, wondering if I forgot to do something vital for one of my patients.If I saw an ad in the classifieds calling for nurses to work in a hospital with a lower nurse-to-patient ratio, competitive salary, no incentives or bonuses, I would apply in a minute. And I have a hunch I wouldn't be alone.Please, hospital administrators, are you listening?
Diana Norton, RNC registered nurse, Baton Rouge http://www.2theadvocate.com/opinion/9385651.html
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EDUCATION NOTES Dallas Morning News (subscription) - TX, USATWU offers online nursing program: Texas Woman's University's College of Nursing is offering a new online master of science in nursing education degree for ...http://www.dallasnews.com/sharedcontent/dws/dn/education/stories/DN-ednotes_27met.ART.State.Edition1.4225c56.html
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New diabetes mellitus clinical practice guidelines The American Association of Clinical Endocrinologists (AACE) has announced the release of its medical guidelines for the diagnosis and management of diabetes mellitus. http://www.news-medical.net/?id=29034
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A side of sliced strawberries with your steel-cut oatmeal may make for one heck of a smart breakfast combo. That's because oats are rich in heart-healthy compounds called phenols. And it seems that adding some vitamin C (from the berries) is like adding water to a Chia Pet: It causes the heart-helping powers of the oats to grow Working in Synergy When oat phenols and vitamin C were combined in a study, they worked synergistically to reinforce LDL cholesterol and make it more stable -- even better than the oat phenols alone could do. (How low should your LDL be? Check here.) And you want your LDL to be stable, because that means it’s less likely to break down and stick to the walls of your arteries. You know, that process that can lead to heart attacks, strokes, and other nasty business. Why Steel-Cut Oats? They take a little longer to make, but they’re worth it. Steel-cut oats -- also called coarse-cut oats -- are lightly processed. And that means they probably still have most of their good stuff intact (fiber, nutrients, etc.). Quiz yourself on your knowledge of whole grains.
References :
Avenanthramides and phenolic acids from oats are bioavailable and act synergistically with vitamin C to enhance hamster and human LDL resistance to oxidation. Chen, C. Y., Milbury, P. E., Kwak, H. K., Collins, F. W., Samuel, P., Blumberg, J. B., Journal of Nutrition 2004 June;134(6):1459-1466.
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Doctors urged to curb reliance on beta-blockers For decades, beta-blockers and diuretics, also known as water pills, constituted the cornerstone of treatment for the 50 million Americans with high blood pressure. But a growing body of medical evidence shows that diuretics and newer blood-pressure medications are superior to beta-blockers at reducing high blood pressure, which can lead to heart attacks and strokes, said researchers whose report appeared yesterday in the Journal of the American College of Cardiology.
"We in medicine like to say that we practice evidence-based medicine," said Dr. Franz H. Messerli, an author of the study and a cardiologist at St. Luke's-Roosevelt Hospital in New York. "What's the evidence here" for continued use of beta-blockers to treat hypertension, Messerli asked. "Zero. To my way of thinking, this is pretty alarming."
Heart specialists not involved with the study predicted that it is likely to accelerate a shift in hypertension treatment from beta-blockers, which can cause side effects such as fatigue and sexual dysfunction.
Still, those doctors as well as the authors of the study emphasized that there is strong evidence to support prescribing beta-blockers for patients who have suffered a heart attack or those with a progressive weakening condition called heart failure.
Data from IMS Health, a healthcare information company, show that from January through June of this year, more than 75 million prescriptions were written for various beta-blockers, widely available in generic form. The statistics do not indicate which conditions the doctors were treating.
European medical societies have already begun urging physicians to abandon beta-blockers as a high blood-pressure medication, specialists said. "I think this paper is going to be fairly influential, although I think the trend had already started before this of moving away from beta-blockers as a first-line treatment of hypertension," said Dr. Joseph Carrozza, chief of interventional cardiology at Beth Israel Deaconess Medical Center. "The side effects are probably the worst" of any medication used to treat high blood pressure, he said.
Cardiologists said there is no clear culprit for the heavy use of beta-blockers. Early research suggested that the drugs had promise in treating high blood pressure, though they were often used with diuretics, which turned out to provide much of the benefit.
Also, beta-blockers have been around for decades and in recent years, their patents had expired, so they were relatively inexpensive, doctors said. "This is just another example of why we need to do continuing follow-up research on classes of medicine," said Alan Goldhammer, deputy vice president for regulatory affairs at PhRMA, a leading pharmaceutical industry association.... http://www.boston.com/news/nation/articles/2007/08/07/doctors_urged_to_
curb_reliance_on_beta_blockers/?page=2 )
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EDUCATION NOTES Dallas Morning News (subscription) - TX, USATWU offers online nursing program: Texas Woman's University's College of Nursing is offering a new online master of science in nursing education degree for ...http://www.dallasnews.com/sharedcontent/dws/dn/education/stories/DN-ednotes_27met.ART.State.Edition1.4225c56.html
*****************************
New diabetes mellitus clinical practice guidelines The American Association of Clinical Endocrinologists (AACE) has announced the release of its medical guidelines for the diagnosis and management of diabetes mellitus. http://www.news-medical.net/?id=29034
**********************
A side of sliced strawberries with your steel-cut oatmeal may make for one heck of a smart breakfast combo. That's because oats are rich in heart-healthy compounds called phenols. And it seems that adding some vitamin C (from the berries) is like adding water to a Chia Pet: It causes the heart-helping powers of the oats to grow Working in Synergy When oat phenols and vitamin C were combined in a study, they worked synergistically to reinforce LDL cholesterol and make it more stable -- even better than the oat phenols alone could do. (How low should your LDL be? Check here.) And you want your LDL to be stable, because that means it’s less likely to break down and stick to the walls of your arteries. You know, that process that can lead to heart attacks, strokes, and other nasty business. Why Steel-Cut Oats? They take a little longer to make, but they’re worth it. Steel-cut oats -- also called coarse-cut oats -- are lightly processed. And that means they probably still have most of their good stuff intact (fiber, nutrients, etc.). Quiz yourself on your knowledge of whole grains.
References :
Avenanthramides and phenolic acids from oats are bioavailable and act synergistically with vitamin C to enhance hamster and human LDL resistance to oxidation. Chen, C. Y., Milbury, P. E., Kwak, H. K., Collins, F. W., Samuel, P., Blumberg, J. B., Journal of Nutrition 2004 June;134(6):1459-1466.
**********************
Doctors urged to curb reliance on beta-blockers For decades, beta-blockers and diuretics, also known as water pills, constituted the cornerstone of treatment for the 50 million Americans with high blood pressure. But a growing body of medical evidence shows that diuretics and newer blood-pressure medications are superior to beta-blockers at reducing high blood pressure, which can lead to heart attacks and strokes, said researchers whose report appeared yesterday in the Journal of the American College of Cardiology.
"We in medicine like to say that we practice evidence-based medicine," said Dr. Franz H. Messerli, an author of the study and a cardiologist at St. Luke's-Roosevelt Hospital in New York. "What's the evidence here" for continued use of beta-blockers to treat hypertension, Messerli asked. "Zero. To my way of thinking, this is pretty alarming."
Heart specialists not involved with the study predicted that it is likely to accelerate a shift in hypertension treatment from beta-blockers, which can cause side effects such as fatigue and sexual dysfunction.
Still, those doctors as well as the authors of the study emphasized that there is strong evidence to support prescribing beta-blockers for patients who have suffered a heart attack or those with a progressive weakening condition called heart failure.
Data from IMS Health, a healthcare information company, show that from January through June of this year, more than 75 million prescriptions were written for various beta-blockers, widely available in generic form. The statistics do not indicate which conditions the doctors were treating.
European medical societies have already begun urging physicians to abandon beta-blockers as a high blood-pressure medication, specialists said. "I think this paper is going to be fairly influential, although I think the trend had already started before this of moving away from beta-blockers as a first-line treatment of hypertension," said Dr. Joseph Carrozza, chief of interventional cardiology at Beth Israel Deaconess Medical Center. "The side effects are probably the worst" of any medication used to treat high blood pressure, he said.
Cardiologists said there is no clear culprit for the heavy use of beta-blockers. Early research suggested that the drugs had promise in treating high blood pressure, though they were often used with diuretics, which turned out to provide much of the benefit.
Also, beta-blockers have been around for decades and in recent years, their patents had expired, so they were relatively inexpensive, doctors said. "This is just another example of why we need to do continuing follow-up research on classes of medicine," said Alan Goldhammer, deputy vice president for regulatory affairs at PhRMA, a leading pharmaceutical industry association.... http://www.boston.com/news/nation/articles/2007/08/07/doctors_urged_to_
curb_reliance_on_beta_blockers/?page=2 )
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HUMOR SECTION
The current scandals over how large companies have been cooking the books reminds me of a basic accounting course I took years ago. The professor was explaining an accounting method called
First In Last Out, which is useful for industries that accumulate large inventories of stuff. It explains why the oil industry, for example, reported huge profits during the 1970's when the oil shortage occurred. They stopped buying oil, so they had to use oil that, on paper, had been purchased in the 1930's at 20¢ a barrel. They of course sold it at current market prices, which accounted for their huge profits.One of the students put up his hand and said, "Excuse me, sir, but that doesn't sound veryethical to me."To which the professor replied, "You're in the wrong class, son, this is Accounting 101. Ethics 101 is down the hall."
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The current scandals over how large companies have been cooking the books reminds me of a basic accounting course I took years ago. The professor was explaining an accounting method called
First In Last Out, which is useful for industries that accumulate large inventories of stuff. It explains why the oil industry, for example, reported huge profits during the 1970's when the oil shortage occurred. They stopped buying oil, so they had to use oil that, on paper, had been purchased in the 1930's at 20¢ a barrel. They of course sold it at current market prices, which accounted for their huge profits.One of the students put up his hand and said, "Excuse me, sir, but that doesn't sound veryethical to me."To which the professor replied, "You're in the wrong class, son, this is Accounting 101. Ethics 101 is down the hall."
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........A website offering free CEU s: http://www.medscape.com/cmecenterdirectory/nurses
CME/CE Zinc and Its Uses
Clinical Case, August 2007
CME/CE Genital Herpes and HIV: Disease Interactions in 2 Intersecting Epidemics
Slide/Lecture Presentation, August 2007
CME/CE Expert Insights: All You Need to Know on Acid-Related Disorders ... and Beyond!
Slide/Lecture Presentation, August 2007
CME/CE Companion Animals and Human Health Risk: Animal Bites and Rabies
Journal Article, August 2007
CME/CE Cases From AHRQ WebM&M: Production Pressures
Clinical Case, August 2007
CME/CE Management of PMDD in a Woman Planning Pregnancy
Clinical Case, August 2007 More Nurses CE »
Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /
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CME/CE Zinc and Its Uses
Clinical Case, August 2007
CME/CE Genital Herpes and HIV: Disease Interactions in 2 Intersecting Epidemics
Slide/Lecture Presentation, August 2007
CME/CE Expert Insights: All You Need to Know on Acid-Related Disorders ... and Beyond!
Slide/Lecture Presentation, August 2007
CME/CE Companion Animals and Human Health Risk: Animal Bites and Rabies
Journal Article, August 2007
CME/CE Cases From AHRQ WebM&M: Production Pressures
Clinical Case, August 2007
CME/CE Management of PMDD in a Woman Planning Pregnancy
Clinical Case, August 2007 More Nurses CE »
Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com.
This is a most excellent website for those of us involved in assessing pressure ulcer staging.............
This is a most excellent website for those of us involved in assessing pressure ulcer staging.............
Please check it out http://www.npuap.org/pr2.htm
Differentiating nursing leadership and management competencies Bonnie Mowinski Jennings, Cynthia C. Scalzi, James D. Rodgers, Anne Keanepages 169-175.e4 http://www.nursingoutlook.org/article/PIIS0029655406002843/abstract
The value of specialty nursing certification Bonnie Niebuhr, Melissa Bielpages 176-181 http://www.nursingoutlook.org/article/PIIS0029655407000590/abstract
The image of the nurse on the internet Beatrice J. Kalisch, Suzanne Begeny, Sue Neumannpages 182-188 http://www.nursingoutlook.org/article/PIIS0029655406002478/abstract
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Differentiating nursing leadership and management competencies Bonnie Mowinski Jennings, Cynthia C. Scalzi, James D. Rodgers, Anne Keanepages 169-175.e4 http://www.nursingoutlook.org/article/PIIS0029655406002843/abstract
The value of specialty nursing certification Bonnie Niebuhr, Melissa Bielpages 176-181 http://www.nursingoutlook.org/article/PIIS0029655407000590/abstract
The image of the nurse on the internet Beatrice J. Kalisch, Suzanne Begeny, Sue Neumannpages 182-188 http://www.nursingoutlook.org/article/PIIS0029655406002478/abstract
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MEDICAL RECALLS/Information
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After a review of postmarketing adverse event reports, FDA determined that an updated label with a boxed warning on the risks of heart failure was needed for the entire thiazolidinedione class of antidiabetic drugs. These drugs are used in conjunction with diet and exercise to improve blood sugar control in adults with type 2 (non-insulin-dependent) diabetes. Manufacturers of certain drugs have agreed to the upgraded warning. The strengthened warning advises healthcare professionals to observe patients carefully for the signs and symptoms of heart failure, including excessive, rapid weight gain, shortness of breath, and edema after starting drug therapy. Patients with these symptoms who then develop heart failure should receive appropriate management of the heart failure and use of the drug should be reconsidered. People who have questions should contact their healthcare providers to discuss alternative treatments. http://www.fda.gov/medwatch/safety/2007/safety07.htm#rosi_pio
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FDA warns consumers and healthcare professionals to avoid using Red Yeast Rice and Red Yeast Rice/Policosonal Complex, sold by Swanson Healthcare Products, Inc. and manufactured by Nature's Value Inc. and Kabco Inc., respectively; and Cholestrix, sold by Sunburst Biorganics because the products may contain an unauthorized drug that could be harmful to their health. The products, promoted and sold over the internet as treatments for high cholesterol, contain lovastatin, the active pharmaceutical ingredient in Mevacor, a prescription drug approved for high cholesterol.Lovastatin can cause severe muscle problems leading to kidney impairment. The risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions such as nefazodone (an antidepressant), certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol lowering agents. Consumers who use any red yeast rice products should consult their healthcare provider if they experience any problems that may be due to these products. http://www.fda.gov/medwatch/safety/2007/safety07.htm#redyeast.
*************************
FDA issued an early communication about the ongoing review of new safety data for the proton pump inhibitors, Prilosec and Nexium. The new safety data was from two small long-term clinical studies in patients with severe GERD. In both studies, patients were randomly assigned to receive treatment with a drug (either omeprazole or esomeprazole) or to have surgery to control their gastroesophageal reflux disease (GERD).The results from the study of Prilosec and analyses from an ongoing study of Nexium raised concerns that long-term use of Prilosec or Nexium may have increased the risk of heart attacks, heart failure, andheart-related sudden death in those patients taking either one of the drugs compared to patients who received surgery. After reviewing these and other data submitted by the company, FDA's preliminary conclusion at this time, is that collectively, these data do not suggest an increased risk of heart problems for patients treated with omeprazole or esomeprazole. Healthcare providers should not change their prescribing practices and patients should not change their use of these products at this time.Both drugs are used for the treatment of GERD, esophageal erosions and for maintenance of healing erosions of the esophagus. They are also used for the treatment of ulcers. Prilosec is also sold over the counter for frequent heartburn. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Omeprazole
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FDA issued a Public Health Advisory with important new information about a very rare, but serious, side effect in nursing infants whose mothers are taking codeine and are ultra-rapid metabolizers of codeine. When codeine enters the body and is metabolized, it changes to morphine, which relieves pain. Many factors affect codeine metabolism, including a person's genetic make-up. Some people have a variation in a liver enzyme and may change codeine to morphine more rapidly and completely than other people. Nursing mothers taking codeine may also have higher morphine levels in their breast milk. These higher levels of morphine in breast milk may lead to life-threatening or fatal side effects in nursing babies. In most cases, it is unknown if someone is an ultra-rapid codeine metabolizer.When prescribing codeine-containing drugs to nursing mothers, physicians should choose the lowest effective dose for the shortest period of time and should closely monitor mother-infant pairs. There is an FDA cleared test for determining a patient's CYP2D6 genotype. The test is not routinely used in clinical practice but is available through a number of different laboratories. The results of this test predict that a person can convert codeine to morphine at a faster rate than average, resulting in higher morphine levels in the blood. When levels of morphine are too high, patients have an increased risk of adverse events.http://www.fda.gov/medwatch/safety/2007/safety07.htm#Codeine
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FDA announced that on October 18 - 19, 2007, the Nonprescription Drugs Advisory Committee will discuss the safety and effectiveness of cough and cold drug product use in children. Questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under two years of age. In preparation for the meeting, FDA is reviewing safety and efficacy data for the ingredients of these products.Some reports of serious adverse events associated with the use of these products appear to be the result of giving too much of these medicines to children. An over-the-counter cough and cold medicine can be harmful if more than the recommended amount is used, if it is given too often, or if more than one cough and cold medicine containing the same active ingredient are being used. To avoid giving a child too much medicine, parents must carefully follow the directions for use of the product in the "Drug Facts" box on the package label. The Public Health Advisory offers parents and caregivers of children recommendations when using cough and cold products in children. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Cough
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FDA and Bristol-Myers Squibb notified healthcare professionals of revisions to the following sections of the Baraclude prescribing information: BOXED WARNINGS, MICROBIOLOGY/Antiviral Activity against HIV (human immunodeficiency virus), WARNINGS/Co-infection with HIV, PRECAUTIONS/Information for Patients, and Patient Package Insert. Baraclude therapy is not recommended for HIV/hepatitis B virus (HBV) co-infected patients who are not also receiving highly active antiretroviral therapy (HAART) due to the potential for the development of HIV resistance. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Baraclude ****************************
After a review of postmarketing adverse event reports, FDA determined that an updated label with a boxed warning on the risks of heart failure was needed for the entire thiazolidinedione class of antidiabetic drugs. These drugs are used in conjunction with diet and exercise to improve blood sugar control in adults with type 2 (non-insulin-dependent) diabetes. Manufacturers of certain drugs have agreed to the upgraded warning. The strengthened warning advises healthcare professionals to observe patients carefully for the signs and symptoms of heart failure, including excessive, rapid weight gain, shortness of breath, and edema after starting drug therapy. Patients with these symptoms who then develop heart failure should receive appropriate management of the heart failure and use of the drug should be reconsidered. People who have questions should contact their healthcare providers to discuss alternative treatments. http://www.fda.gov/medwatch/safety/2007/safety07.htm#rosi_pio
************************
FDA warns consumers and healthcare professionals to avoid using Red Yeast Rice and Red Yeast Rice/Policosonal Complex, sold by Swanson Healthcare Products, Inc. and manufactured by Nature's Value Inc. and Kabco Inc., respectively; and Cholestrix, sold by Sunburst Biorganics because the products may contain an unauthorized drug that could be harmful to their health. The products, promoted and sold over the internet as treatments for high cholesterol, contain lovastatin, the active pharmaceutical ingredient in Mevacor, a prescription drug approved for high cholesterol.Lovastatin can cause severe muscle problems leading to kidney impairment. The risk is greater in patients who take higher doses of lovastatin or who take lovastatin and other medicines that increase the risk of muscle adverse reactions such as nefazodone (an antidepressant), certain antibiotics, drugs used to treat fungal infections and HIV infections, and other cholesterol lowering agents. Consumers who use any red yeast rice products should consult their healthcare provider if they experience any problems that may be due to these products. http://www.fda.gov/medwatch/safety/2007/safety07.htm#redyeast.
*************************
FDA issued an early communication about the ongoing review of new safety data for the proton pump inhibitors, Prilosec and Nexium. The new safety data was from two small long-term clinical studies in patients with severe GERD. In both studies, patients were randomly assigned to receive treatment with a drug (either omeprazole or esomeprazole) or to have surgery to control their gastroesophageal reflux disease (GERD).The results from the study of Prilosec and analyses from an ongoing study of Nexium raised concerns that long-term use of Prilosec or Nexium may have increased the risk of heart attacks, heart failure, andheart-related sudden death in those patients taking either one of the drugs compared to patients who received surgery. After reviewing these and other data submitted by the company, FDA's preliminary conclusion at this time, is that collectively, these data do not suggest an increased risk of heart problems for patients treated with omeprazole or esomeprazole. Healthcare providers should not change their prescribing practices and patients should not change their use of these products at this time.Both drugs are used for the treatment of GERD, esophageal erosions and for maintenance of healing erosions of the esophagus. They are also used for the treatment of ulcers. Prilosec is also sold over the counter for frequent heartburn. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Omeprazole
*********************************
FDA issued a Public Health Advisory with important new information about a very rare, but serious, side effect in nursing infants whose mothers are taking codeine and are ultra-rapid metabolizers of codeine. When codeine enters the body and is metabolized, it changes to morphine, which relieves pain. Many factors affect codeine metabolism, including a person's genetic make-up. Some people have a variation in a liver enzyme and may change codeine to morphine more rapidly and completely than other people. Nursing mothers taking codeine may also have higher morphine levels in their breast milk. These higher levels of morphine in breast milk may lead to life-threatening or fatal side effects in nursing babies. In most cases, it is unknown if someone is an ultra-rapid codeine metabolizer.When prescribing codeine-containing drugs to nursing mothers, physicians should choose the lowest effective dose for the shortest period of time and should closely monitor mother-infant pairs. There is an FDA cleared test for determining a patient's CYP2D6 genotype. The test is not routinely used in clinical practice but is available through a number of different laboratories. The results of this test predict that a person can convert codeine to morphine at a faster rate than average, resulting in higher morphine levels in the blood. When levels of morphine are too high, patients have an increased risk of adverse events.http://www.fda.gov/medwatch/safety/2007/safety07.htm#Codeine
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FDA announced that on October 18 - 19, 2007, the Nonprescription Drugs Advisory Committee will discuss the safety and effectiveness of cough and cold drug product use in children. Questions have been raised about the safety of these products and whether the benefits justify any potential risks from the use of these products in children, especially in children under two years of age. In preparation for the meeting, FDA is reviewing safety and efficacy data for the ingredients of these products.Some reports of serious adverse events associated with the use of these products appear to be the result of giving too much of these medicines to children. An over-the-counter cough and cold medicine can be harmful if more than the recommended amount is used, if it is given too often, or if more than one cough and cold medicine containing the same active ingredient are being used. To avoid giving a child too much medicine, parents must carefully follow the directions for use of the product in the "Drug Facts" box on the package label. The Public Health Advisory offers parents and caregivers of children recommendations when using cough and cold products in children. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Cough
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FDA and Bristol-Myers Squibb notified healthcare professionals of revisions to the following sections of the Baraclude prescribing information: BOXED WARNINGS, MICROBIOLOGY/Antiviral Activity against HIV (human immunodeficiency virus), WARNINGS/Co-infection with HIV, PRECAUTIONS/Information for Patients, and Patient Package Insert. Baraclude therapy is not recommended for HIV/hepatitis B virus (HBV) co-infected patients who are not also receiving highly active antiretroviral therapy (HAART) due to the potential for the development of HIV resistance. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Baraclude ****************************
FDA approved updated labeling to include pharmacogenomics information to the CLINICAL PHARMACOLOGY, PRECAUTIONS, and DOSAGE AND ADMINISTRATION sections of the prescribing information for the widely used blood-thinning drug, Coumadin. This new information explains that people's genetic makeup may influence how they respond to the drug. Specifically, people with variations in two genes may need lower warfarin doses than people without these genetic variations. The two genes are called CYP2C9 and VKORC1. The CYP2C9 gene is involved in the breakdown (metabolism) of warfarin and the VKORC1 gene helps regulate the ability of warfarin to prevent blood from clotting.The dosage and administration of warfarin must be individualized for each patient according to the particular patient's prothrombin time (PT) / International Normalized Ratio (INR) response to the drug. The specific dose recommendations are described in the warfarin product labeling, along with the new information regarding the impact of genetic information upon the initial dose and the response to warfarin.Ongoing warfarin therapy should be guided by continued INR monitoring. http://www.fda.gov/medwatch/safety/2007/safety07.htm#Warfarin
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Abbott Laboratories disseminated a Dear Healthcare Provider Letter throughout the world to physicians and pharmacists that prescribe/distribute Kaletra Oral Solution. The letter informed healthcare professionals of an accidental overdose that occurred with a pediatric patient taking Kaletra Oral Solution. The infant received a significantly large dose of Kaletra and subsequently died. Healthcare professionals should pay special attention to accurate calculation of the dose of Kaletra, transcription of the medication order, dispensing information and dosing instructions to minimize the risk for medication errors. http://www.fda.gov/medwatch/safety/2007/safety07.htm#kaletra
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Abbott Laboratories disseminated a Dear Healthcare Provider Letter throughout the world to physicians and pharmacists that prescribe/distribute Kaletra Oral Solution. The letter informed healthcare professionals of an accidental overdose that occurred with a pediatric patient taking Kaletra Oral Solution. The infant received a significantly large dose of Kaletra and subsequently died. Healthcare professionals should pay special attention to accurate calculation of the dose of Kaletra, transcription of the medication order, dispensing information and dosing instructions to minimize the risk for medication errors. http://www.fda.gov/medwatch/safety/2007/safety07.htm#kaletra
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NURSING HINTS CORNER
Keeping Ice packs in place
After oral or facial surgery, many of the patients on our postanesthesia care unit need ice packs. ... We had trouble keeping those packs in place. Here's how I solved the problem:
I cut a 3' piece of by 3 inch wide orthopedic stockinette (netting). After tying a knot in the center, I insert an ice pack in one or both ends, depending on the type of surgery the patient had. Then I tie the stockinette at the top of the patient's head, with the knot under his chin.
The ice pack remains in place without slipping, and the patient is comfortable. Mark Peplow, RN
(using the netting to hold a dressing in place works beautifully, also, Frankie)
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 50 Springhouse Corporation/www.springnetcom.
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
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 : no new members this issue
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
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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 email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.......lol So please send me your new name/address, ok? RNFrankie@AOL.com
OLD ADDRESS: sldavenpo@aol.com (Sandy)
NEW ADDRESS: sldavenpo@sbcglobal.net (Sandy)
OLD ADDRESS: Raconte@AOL.com
NEW ADDRESS: raconte@att.net (Genevieve)
OLD ADDRESS: ehough29@earthlink.net
NEW ADDRESS: ehough29@embarqmail.com
OLD ADDRESS: ThreeCansandHome@comcast.net (Shellie)
NEW ADDRESS: SmileyGE@bellsouth.net
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OLD ADDRESS: sldavenpo@aol.com (Sandy)
NEW ADDRESS: sldavenpo@sbcglobal.net (Sandy)
OLD ADDRESS: Raconte@AOL.com
NEW ADDRESS: raconte@att.net (Genevieve)
OLD ADDRESS: ehough29@earthlink.net
NEW ADDRESS: ehough29@embarqmail.com
OLD ADDRESS: ThreeCansandHome@comcast.net (Shellie)
NEW ADDRESS: SmileyGE@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.........
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 @AOL.com (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.
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PARADIGM97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (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 hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY
This was sent in by Nin45 (Linda) It is worth a repeat... Thank you !
When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was believed that she had nothing left of any value. Later, when the nurses were going through her meager possessions, they found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital. One nurse took her copy to Ireland. The old lady's sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the North Ireland Association for Mental Health. A slide presentation has also been made based on her simple, but eloquent poem. And this little old Scottish lady, with nothing left to give to the world, is now the author of this "anonymous" poem winging across the Internet:
Crabby Old Woman
This was sent in by Nin45 (Linda) It is worth a repeat... Thank you !
When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was believed that she had nothing left of any value. Later, when the nurses were going through her meager possessions, they found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital. One nurse took her copy to Ireland. The old lady's sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the North Ireland Association for Mental Health. A slide presentation has also been made based on her simple, but eloquent poem. And this little old Scottish lady, with nothing left to give to the world, is now the author of this "anonymous" poem winging across the Internet:
Crabby Old Woman
What do you see, nurses?
What do you see?
What are you thinking
When you're looking at me?
A crabby old woman,
Not very wise,
Uncertain of habit,
With faraway eyes?
Who dribbles her food
And makes no reply
When you say in a loud voice,
"I do wish you'd try!"
Who seems not to notice
The things that you do,
And forever is losing
A stocking or shoe?
Who, resisting or not,
Lets you do as you will,
With bathing and feeding,
The long day to fill?
Is that what you're thinking?
Is that what you see?
Then open your eyes, nurse,
You're not looking at me.
I'll tell you who I am
As I sit here so still,
As I do at your bidding,
As I eat at your will.
I'm a small child of ten
With a father and mother,
Brothers and sisters,
Who love one another.
A young girl of sixteen
With wings on her feet
Dreaming that soon now
A lover she'll meet.
A bride soon at twenty,
My heart gives a leap,
Remembering the vows
That I promised to keep.
At twenty-five now,
I have young of my own,
Who need me to guide
And a secure happy home
A woman of thirty,
My young now grown fast,
Bound to each other
With ties that should last.
At forty, my young sons
Have grown and are gone,
But my man's beside me
To see I don't mourn.
At fifty once more,
Babies play round my knee,
Again we know children,
My loved one and me.
Dark days are upon me,
My husband is dead,
I look at the future,
I shudder with dread.
For my young are all rearing
Young of their own,
And I think of the years
And the love that I've known.
I'm now an old woman
And nature is cruel;
'Tis jest to make old age
Look like a fool.
The body, it crumbles,
Grace and vigor depart,
There is now a stone
Where I once had a heart.
But inside this old carcass
A young girl still dwells,
And now and again,
My battered heart swells.
I remember the joys,
I remember the pain,
And I'm loving and living
Life over again.
I think of the years
All too few, gone too fast,
And accept the stark fact
That nothing can last.
So open your eyes, people,
Open and see,
Not a crabby old woman;
Look closer . . . see ME !!
Remember this poem when you next meet an old person who you might brush aside without looking at the young soul within . .. . we will all, one day, be there, too!
Remember this poem when you next meet an old person who you might brush aside without looking at the young soul within . .. . we will all, one day, be there, too!
Hope to see you online..... Frankie
( RNFrankie@ AOLcom )
