Saturday, April 5, 2008


PARADIGM BYTES
Newsletter for Paradigm 97
April 6, 2008

NOTICE:
TRUE VIRUS WARNING !
Anyone-using Internet mail such as Yahoo, Hotmail, AOL and so on. This information arrived this morning direct from both Microsoft and Norton. Please send it to everybody you know who has access to the Internet. You may receive an apparently harmless e-mail titled "Mail Server Report." If you open either file, a message will appear on your screen saying: 'It is too late now, your life is no longer beautiful.'
Subsequently you will LOSE EVERYTHING IN YOUR PC, and the person who sent it to you will gain access to your name, e-mail and password. This is a new virus which started to circulate on Saturday afternoon. AOL has already confirmed the severity, and anti-virus software is not yet capable of destroying it. The virus has been created by a hacker who calls himself 'life owner'. PLEASE SEND A COPY OF THIS NOTICE TO ALL YOUR FRIENDS, And ask them to PASS IT ON IMMEDIATELY! THIS HAS BEEN CONFIRMED BY SNOPES: http://www.snopes.com/computer/virus/mailserver.asp

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
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
Paradigm97 chatroom is always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends in for a little chat.
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SNIPPETS
A Complex Crisis No SINGLE Cure for Nursing Shortage
The U.S. Department of Health and Human Services projects that by 2020 more than 1 million registered nurses will be needed in our nation's health care system to meet the demand for nursing care. Increased awareness has brought national attention to the nursing shortage with programs such as The Johnson & Johnson Campaign for Nursing's Future and other national and statewide initiatives. Health care professionals agree this has been a successful first step toward improving the deficit, but more needs to be done.
"Activism at federal and state government levels and local, grassroots efforts among hospitals and schools of nursing are required to develop innovative programs to attract competent, new recruits to the profession," explained Pamela Jamieson, RN, MSN, MBA, vice president of Patient Care Services and chief nursing officer at St. Joseph's Medical Center in Maryland. "These efforts also serve to provide a satisfying professional practice environment to retain staff." St. Joseph's initiated a program called LAUNCH (Leading A Unique Nurse to Career Happiness) to help preserve nurse faculty and nurse educators. Jamieson describes the LAUNCH program that supports nurse graduates with the transition to the clinical setting as, "A successful program that meets the needs of the newly oriented graduate nurse during their first, critical year in transition." "Our results show that nurses who have completed the LAUNCH program have outstanding scores in critical thinking, professional practice and interpersonal skills, as measured by a highly regarded, evidence-based tool. Nurse satisfaction with the education sessions has been consistently over 90 percent, and our retention rate at one year for those successfully completing the LAUNCH program is a strong 82 percent," Jamieson explained.Dina Faucher, RN, PhD, APRNBC, OCN, CHT - chief nursing officer and dean of nursing at Apollo College in Phoenix agrees that "the nationwide attention to the nursing shortage has assisted students with the financial burden of going to nursing school and progressing on for their BSN and advanced practice degrees." But now, retention is a primary concern for Faucher. She believes, "The focus needs to be on retaining current nurses in the hospital work atmosphere since there is a cap on how many students can enter the nursing program due to the lack of clinical sites available."Whether focusing on retaining nurses currently in the field or attracting new candidates to the nursing profession, health professionals and executives agree that a sustained, collaborative effort and multifaceted approach will work best to alleviate what remains one of the most important challenges in health care today.
http://www.discovernursing.com/home.

An easy way to make your voice heard about important policy issues. Sign up as an activist with the ANA Safe Staffing Campaign, and offer your opinion to decision makers on key issues. http://rnaction.org/staffingcampaign/join.html?rk=C1S%2dJO9q3Whb
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The following is a letter I wrote in response to a new website.... I addressed this to a new forum... Discover nursing.com .

Dear Colleagues:

I want to address the plight of Florida nurses as an example of misuse of nurses. One of the hospitals in West Palm Beach actually gives the nurse 8 patients ! These patients are not rehab.....they are straight from ICU, ER, cardiac bypass surgeries, etc. This is a very common practice, a practice with which I was not familiar until I moved to West Palm Beach and spoke with my daughter who is a cardiology nurse. She has worked many times with 7 patients... without a telemetry tech on her floor, no charge nurse (or a charge nurse in charge of two floors), and no secretary ! This is outrageous ! My daughter is an excellent caring, competent nurse and now is looking elsewhere for a position........and I am encouraging her to do so. She has been a nurse long before I became one ... in fact, she pinned me !

I believe that IF the nurse to patient ratio was upheld nationally as it is in California and Oregon.... these hospitals would not lose so many nurses. The nurses become "burned-out" ...at least the good ones do.

The hospitals have a mistaken impression that the nurses are overhead..... this is a very serious attitude ... and definitely is detrimental to nursing.

I do hope that eventually all of us are able to achieve a much safer, saner nurse to patient ratio....and this definitely will have a positive effect on the nursing shortage. I will continue advocating for safer nurse to patient ratios.

Sincerely,

Frances J. Jessup, RN, BSN
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INTERESTING READING

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

Fixing an ACL Tear Helps, Even for Older Patients Are you a Baby Boomer with knee pain due to an ACL injury? If so, your doctors probably recommend over-the-counter pain relievers instead of surgery. This is largely due to questions about recovery for patients in their 50s and 60s. However, a new study shows that surgery to repair torn ACLs can be a good solution for some older patients. ... http://yourtotalhealth.ivillage.com/acl-tears-worth-fixing-in-seniors.html?nlcid=pa03-19-2008
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Analysis Of Clinical Trial Finds That Immunizing Children At School Reduces Influenza Incidence And Saves Money School-based immunization of students ages 5-18 can be a cost-effective way of fighting influenza. That¹s the conclusion of a study published today on the Health Affairs Web site. In one large multistate trial, school-based immunization saved an estimated $171.96 per student-household over the course of a flu season, say a team of researchers led by Jordana Schmier of Exponent, a research organization based in Menlo Park, CA. Indeed, the researchers found that reductions in direct and indirect flu-related costs during the peak week of flu season alone offset the incremental costs of school-based immunization. You can read the article by Schmier and coauthors
at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w96
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California Study Find Variations In Hospital Treatment Intensity in all Patient Groups Large hospital-by-hospital variations in the intensity with which hospitals treat their seriously ill patients is found not only for patients covered by fee-for-service Medicare, but also for those covered by Medicare HMOs and for non-elderly patients with private insurance. Moreover, hospitals that frequently hospitalize their fee-for-service Medicare patients are also often the same hospitals that have high levels of resource use for other types of patients as well, according to a study of treatment provided by California hospitals to patients with chronic illnesses in their last two years life. The study, supported by the California Health Care Foundation and published today on the Health Affairs Web site, suggests that important savings could be available from improving health care delivery for a range of populations. You can read the article by Laurence Baker, a professor of health researchand policy at Stanford University, and coauthors Elliot Fisher and John Wennberg athttp://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.2.w123
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The Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, recently released 17 new toolkits to help healthcare providers and patients prevent medical errors. The toolkits focus on identifying high-risk practices and promote interventions to prevent errors and enhance communication among caregivers and with patients. Several of the patient toolkits address medication safety. For more information on the toolkits, go to www.ahrq.gov/qual/pips . http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=493509
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ANA Releases New Guide to the Code of Ethics for Nurses: Interpretation and Application 02/22/08 This new 200 page publication is for everyone who currently refers to and utilizes the ANA Code of Ethics for Nurses with Interpretive Statements as a guideline for putting the core values expressed in the Code into everyday practice. This book explains the specific implications of the ANA Code of Ethics. Each chapter discusses a single Code Provision ... call 1-800-637-0323 or order www.nursesbooks.org $23.95 http://nursingworld.org/HomepageCategory/NursingInsider/ANAReleasesNewPublication.aspx
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Patient-Controlled Analgesia (PCA) Patients can be protected from adverse outcomes involving general-use and patient-controlled analgesia (PCA) pumps by requiring the pumps to have intrinsic free-flow protection. When an infusion pump is in use, the fluid should not be able to run into the patient without first going through a free-flow protection device/mechanism. The device/mechanism must be built-in (intrinsic) to one of the two pieces of equipment that must always be used to get the fluid from the supply reservoir into the patient—-the pump and the administration set that runs from the pump to the patient. If the free-flow protection device/mechanism is an add-on (that is, not intrinsic to either the pump or the administration set), it is possible to use the pump and administration set without the add-on protection, thereby creating a risk to the patient of accidental free-flow that could result in harm or death. To test whether an infusion pump has free-flow protection, turn off the power but keep the infusion set primed and loaded in the device. While all the tubing clamps are open and the fluid container is as high above the device as the tubing allows, verify that no fluid flows out of the set as it hangs down from the device. Then, remove the set from the device (with the tubing clamps still open) and check that no fluid flows out of the set. http://www.medinfonow.com/min/secure/safety/viewtip.aspx?qs=D354FBE9658076E7E208581FE1EA7BFA49732C4A924EB8B0B9D1D3CAC8A540DD45BA4FE
359C7799D5547009B61DE297573943101B522CBD92A1236FE64AF9010C51106BFBDF040829ECF
F1C42ED42FC0
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When calories do and don't count... Americans have a love-hate affair with calories. At any given moment, more than 4 out of 10 of us say we’re on a diet, yet we are gobbling 300 calories more each day, on average, than we did 20 years ago. And calorie counts sometimes dominate our lives: We choose workouts based on how many calories they burn, shop for calorie bargains at the grocery store, and blame holiday calories for our widening waistlines. But do we really understand when calories do -- and don’t -- put on pounds? Take this true/false test and see how you score.
1. True or False: Women trying to lose weight should eat no fewer than 1,200 calories a day. True. It’s the lowest, yet still safe, calorie level for weight loss, says Elizabeth Somer, RD, author of 10 Habits That Mess Up a Woman’s Diet. Take a multivitamin to fill in some of the nutritional gaps, since nobody eats perfectly. Extreme dieting on 1,000 calories or less is a recipe for failure: The weight won’t stay off. Plus, shedding pounds too quickly can throw your body chemistry off and increase the risk of heart problems and gallstones (ouch!). 2. True or False: Most people have a pretty accurate idea of how many calories they consume. False. People typically underestimate how much they eat -- sometimes by up to 700 calories a day. “But most of us tend to be off by about a third,” Somer says. 3. True or False: Excess calories go straight to your hips. False. They go straight to wherever your genes tell them to. Could be your waist, could be your chin(s), could be anywhere, including, yes, your hips. But the decision's genetic, not caloric. A calorie is simply a measure of energy, and if you don’t need that energy right away (to sprint for a bus or build new cells, for example), it’s stored -- as glycogen -- in the liver and muscles. When those storehouses are full, excess calories are warehoused as fat in whatever areas your genes favor: sweet cheeks or chubby knees. 4. True or False: Fat calories pack on pounds faster than carb calories. True, if the calories are excess calories -- that is, more than your body needs. What accounts for the difference? It’s really easy for your body to convert excess dietary fat into body fat -- the process burns as little as 3% of the calories involved. But converting the calories in carbs and protein to fat is far harder and burns up to 23% of the calories in the process. That’s why excess fat calories bulk you up faster than excess carb calories. 5. True or False: Calories eaten at night are more fattening than calories consumed during the day. False. Calories eaten at night aren’t any more fattening -- but they are more tempting. During a jam-packed day, you may barely think about food. But when you get home, you’re tired, you're hungry, you want to relax, your resistance is down, and suddenly, everything in sight looks good. Whether you’re contemplating a lovely meal or a quart of ice cream for dinner, it’s easy to overeat after dark.
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Study Sees Hazards in Baby Powder and Lotion....Parents who want to reduce their infants' exposure to phthalates, chemicals suspected of impairing male reproductive function, should not apply baby lotions or powders -- except for medical reasons. So concludes a study published in the journal Pediatrics.
Phthalates --man-made chemicals used in the manufacture of lubricants, cosmetics and plastic products including children's toys -- get into the air, liquids and the skin. Young children have been shown to have especially high concentrations. But although researchers have speculated that sucking and chewing on toys and playing on dusty floors may account for this, no study has looked at sources of children's exposure.
The Pediatrics study measured phthalates in the urine of 163 infants (2 to 28 months old) against their mothers' reports of the babies' behavior in the previous 24 hours. The mothers were asked about use of infant powders, diaper creams, wipes, shampoo and lotion. They were also asked how many hours their infants played with items such as teething rings and pacifiers.
All the infants' urine had phthalates. Use of powder, lotion and shampoo was tied to higher concentrations, especially in younger infants. No such link was found with use of pacifiers, plastic toys or diaper cream.
Lead author Sheela Sathyanarayana, an acting assistant professor of pediatrics at the University of Washington School of Medicine in Seattle, advised parents of newborns to buy phthalate-free baby products and "limit [phthalate] exposures to the lowest amount possible."
John Bailey, chief scientist at the Personal Care Products Council, representing makers of baby care products, called the advice unwarranted. Only one of the seven phthalates found in the babies' urine -- diethyl phthalate, or DEP -- is used in personal care products for children, and, he said, it has been shown safe. DEP, he said, "is not a public health concern. . . . This is not good advice to be giving to consumers, to mothers." http://www.washingtonpost.com/wp-dyn/content/article/2008/02/01/AR2008020103284.html
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What do broccoli, brown rice, and baked beans have in common? They're good sources of blood-pressure-friendly protein. Because not just any kind of protein will do when you're trying to keep blood pressure under control. A diet high in vegetable protein -- not animal protein -- is key.
Amino Acids: The Answer? Researchers aren't sure why veggie protein lowers blood pressure, but they suspect that the amino acids in veggies may simply be kinder, somehow, to blood pressure than the amino acids in animal protein. (Check out the top 10 most nutritious vegetables.) And the magnesium and other good-for-you nutrients found in veggies may enhance the blood-pressure-friendly effects by interacting synergistically with the amino acids. (Find more food sources of magnesium with this online tool). Think Plant ProteinsSome other ways to get more protein without reaching for a steak knife:
Grab a handful of nuts. (Read about their heart-friendly powers.)
Snack on seeds. (Here’s another condition sunflower seeds may help thwart.)
Go for whole grains. (Test your whole-grain savvy with this quick quiz.)
Say "yes!" to soy. (Read this article for the best sources.)
Reference: Association between protein intake and blood pressure: the INTERMAP Study. Elliott, P., Stamler, J., Dyer, A. R., Appel, L., Dennis, B., Kesteloot, H., Ueshima, H., Okayama, A., Chan, Q., Garside, D. B., Zhou, B., Archives of Internal Medicine 2006 Jan 9;166(1):79-87.
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Spouse's Sickness Bodes ill for Partners Health SUNDAY, Feb. 10 (HealthDay News) -- It's called the "widow" or "widower" effect, and doctors have long been familiar with this curious but very real phenomenon: When a husband or wife dies, there's a greater likelihood that the surviving spouse will pass soon afterward. Now, researchers are gaining a better understanding of the forces at work, realizing problems often start with the hospitalization of a spouse.
New findings suggest that having a husband or wife who needs to be admitted to a hospital with a serious illness poses health risks for the partner. The culprit: The stress and upheaval the partner experiences while enduring the hospitalization of an ailing husband or wife.... http://www.healthday.com/Article.asp?AID=606422
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Got this from the list serve.....Check this out weekly, on the weekend, as they update the site daily. It is a sampling of abstracts from reputable journals from all over the world. If you enjoy getting news about science, health, medicine, nursing, education, astronomy, geriatrics,psychiatry, nutrition, etc. before your newspaper gets it, you'll love this web site. _http://www.eurekalert.org/pubnews.php_(http://www.eurekalert.org/pubnews.php)
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Shelf Life: How long does fruit stay Nutritious? You've got a ripe banana and a juicy plum. Which one's antioxidants will hold up best after a couple of days in your fruit bowl? The answer: Eat the banana now. Turns out bananas may lose their antioxidant qualities quickly. Dark plums, on the other hand? They could actually get a tiny antioxidant boost with short storage. Here's how other fruit holds up.

Time on My Side The antioxidants in black grapes, apples, oranges, and tomatoes (yes, tomatoes are fruit!) also seem to hold up well during storage. But not so much when it comes to apricots and cherries. Check out the nutrition profile of all these fruits with this online tool. Fun with Polyphenols. Researchers are busy finding the best way to measure the antioxidant power of individual pieces of fruit. Not an easy task, because the content can vary from piece to piece within the same variety of fruit, depending on the fruit's genes, the environment in which it grew, when it was harvested, and how it was stored. But you don’t have to wait for the final results. Start boosting the colors in your diet right now with these tips.
We know how it is. Sometimes the fruit bowl is just picked clean. Or in serious need of replenishment. On weeks when you just couldn't make it to the farmers market, be prepared with an emergency stash of highly antioxidant-rich dried fruit in your pantry, preferably this Just Tomatoes Just Fruit Munchies, 8-Ounce Tubs (Pack of 2)

Reference: Evolution of antioxidant capacity during storage of selected fruits and vegetables. Kevers, C., Falkowski, M., Tabart, J., Defraigne, J. O., Dommes, J., Pincemail, J., Journal of Agricultural and Food Chemistry 2007 Oct 17;55(21):8596-8603.
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Reaching for the fruit bowl might keep your brain sharp as a tack when you get older. That's because big fruit-eaters -- besides getting boatloads of good-for-you nutrients -- score high when it comes to memory and reasoning skills.
Mind Your Flavonoids The reason for fruit's brain-boosting effect? It's all about the flavonoids, those amazing antioxidants that fight disease and might be one of your best defenses against cognitive decline. In a study, people who had the highest flavonoid intake performed best throughout a 10-year period on tests of verbal fluency, logical reasoning, and visual memory. (Flex your mental muscle with this sudoku puzzle.) How to Get Your Fill Sneaking more fruit into your diet is one way to load up on flavonoids, but vegetables like onions and broccoli provide some, too. You'll need a wide variety of fruit and veggies in your diet to get the RealAge-recommended 31 milligrams of flavonoids per day. You can also sip some with several cups of tea (here's why green is a good choice) or juices like cranberry every day. (Did you know ruby-red cranberry juice could help your heart stay strong?) Use this online tool to find other good flavonoid sources, as well as recipes chock-full of the super health boosters.
Flavonoid intake and cognitive decline over a 10-year period. Letenneur, L., Proust-Lima, C., Le Gouge, A., Dartigues, J. F., Barberger-Gateau, P., American Journal of Epidemiology 2007 Jun 15;165(12):1364-1371.
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WASHINGTON (Reuters 3/11) - People are living longer in the United States but those with no more than a high school education are not sharing in the trend, researchers said on Tuesday. The education gap in expected lifespan dramatically widened in the 1980s and 1990s, in part because of smoking, according to the study by Harvard University researchers. From 1990 to 2000, life expectancy for people with at least some college education rose 1.6 years while remaining static for less-educated people.... In 2000, those in the less-educated group could be expected at age 25 to live to about age 75 while those in the more-educated group could be expected to reach 82.
"Folks in this less-educated group you can think of as being disadvantaged on any number of dimensions," Ellen Meara, a health-care policy professor at Harvard Medical School who worked on the study, said in a telephone interview....
http://www.reuters.com/article/healthNews/idUSN1037766920080311?feedType=nl&feedName=ushealth1100
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This was sent in by Rozalfaro whose nephew is involved with the band:
The band, Five for Fighting, is generously donating $0.49 to Autism Speaks for *each time* the video is viewed. The funding goes toward research studies to help find a cure. When you have a moment, please visit the link below to watch this beautiful, informative video and pass it along to your friends and family. They are aiming for 10,000 hits, but hopefully we can help them to surpass this goal. Click, here: http://www.whatkindofworlddoyouwant.com/videos/view/id/408214
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(The following article just makes me feel really tired ) CHICAGO (Reuters 3/11) - More people can survive a cardiac arrest when emergency medical workers use a new resuscitation method that starts with a round of 200 chest compressions before a defibrillator shock, U.S. researchers said on Tuesday.
Rescue teams in Arizona who used the new approach on people who had a cardiac arrest outside the hospital tripled the survival rate of the standard approach. "Cardiac arrest is incredibly common and survival is poor," said Dr. Bentley Bobrow, medical director for emergency services for the state of Arizona and a researcher at the Mayo Clinic in Scottsdale.... http://www.reuters.com/article/healthNews/idUSN1162127120080311?feedType=nl&feedName=ushealth1100
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This is from the Newsletter published by ssummers@nursingadvocacy.org in which she suggests that nurses shadow medical students so that the students can realize just what nurses are capable of doing. EXCELLENT IDEA Here is the article: Good doctor-nurse relationships are essential for good health care. But such relationships—often forged in a hectic and stressful environment—have historically been a little rocky. DMS recently established a nurse shadowing program that aims to help medical students build strong relationships with nurses, so they can collaborate more effectively.... http://dartmed.dartmouth.edu/summer05/html/vs_mantra.php
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Japan clears Herceptin for breast cancer: Roche ZURICH (Reuters 2/29) - Japan's health authorities have approved Roche's cancer drug Herceptin for the treatment of HER2-positive breast cancer, the Swiss drugmaker said on Friday.
HER2-positive breast cancer affects approximately 20 to 30 percent of women with breast cancer, the most common cancer among women worldwide, Roche said. Each year more than 1 million new cases of breast cancer are diagnosed worldwide, and nearly 400,000 people will die of the disease annually, the firm said.
Herceptin, a humanized antibody, designed to target and block the function of HER2, a protein produced by a specific gene with cancer-causing potential, is marketed by Roche's subsidiary Chugai Pharmaceuticals in Japan.... http://www.reuters.com/article/healthNews/idUSL298113020080229?feedType=nl&feedName=ushealth1100
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Glaxo's Tykerb goes head -to- head with Herceptin LONDON (Reuters 2/29) - GlaxoSmithKline Plc's new breast cancer drug Tykerb is to go head-to-head with Genentech Inc's blockbuster Herceptin to see whether one is better or if patients should get both. The U.S. National Cancer Institute said 8,000 participants in 50 countries would be given either Herceptin or Tykerb, or Herceptin followed by Tykerb, or the two treatments in combination.
Glaxo is providing financial support for the trial. Both Herceptin and Tykerb, known generically as trastuzumab and lapatinib, have been approved for treating HER2-positive breast cancer, an aggressive form of the disease found in 20 to 30 percent of patients with a particular gene mutation.
The new study, expected to end in 2011, will provide oncologists with the first direct comparison of the drugs in the earliest, most treatable stages of cancer.... http://www.reuters.com/article/healthNews/idUSL2916683920080229?feedType=nl&feedName=ushealth1100&sp=true
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In reviewing Deborah Woods' recent article “Nurses Start a Free Clinic” http://www.nurseconnect.com/Resources/ArticleProfile.aspx?Id=289140 about the success of nurses in Florida recently, we were struck by the emphasis these inspiring nurses placed on prevention. In the piece, Lolita Massengill, ARNP, MN, GNP-BC, founder, director and president of the clinic, states, “This is a nurse run clinic, and we have to make a difference. We are not just here to treat patients. We are here for prevention.” By keeping a local focus “on taking care of one’s health and screening to find problems early, when they are more easily treated…” Massengill and her 20 nurse volunteers are seizing the opportunity “to build a healthier community.”Such altruistic goal-oriented activity is basic to nursing. This is why a key role of the Office of the National Nurse will be to guide nurses to be strong advocates for prevention. The role nurses play in prevention is often subtle, and less recognized by the public. Yet because nurses are in every community and are the profession “most trusted” by the public, nurses are the logical messengers to lead a cultural shift to focus on prevention.
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CDC Publishes Alarming Report Rapid assessment and treatment following a cardiac episode greatly improves the prognosis. However, a recent study reported in the Feb 22, 2008 MMWR http://health.msn.com/health-topics/heart-and-cardiovascular/articlepage.aspx?cp-documentid=100194884 a continued need to increase public understanding with regards to signs and symptoms of heart attacks. The survey found that although the awareness of certain individual warning signs was as high as 93% (i.e., for shortness of breath), awareness of all five key warning signs was only 31%. Only 16% of respondents:1) were aware of all five heart attack warning signs and symptoms2) knew sudden trouble seeing in one or both eyes was not a warning sign3) indicated they would call 9-1-1 if they thought someone was having a heart attack or stroke.These results underscore a real need to increase public awareness. In addition, disparities in awareness were observed by race/ethnicity, sex, and level of education, suggesting that new public health measures should target populations with the lowest levels of awareness. Data from such studies assessing low levels of knowledge of important health symptoms and recommended actions support the proposal to create an Office of the National Nurse. A key role of the Office will be to guide this nation's many nurses to play a major role in prevention efforts. Having a National Nurse will raise public awareness and recognition of the roles nurses fill to promote awareness with their clients and in their communities.
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BOSTON (Reuters 3/19) - People who got old, stale blood during surgery were 30 percent more likely to die than people who got fresh blood, U.S. researchers reported on Wednesday.
Two weeks seemed the be the cutoff, with older blood causing more complications, the researchers reported in the New England Journal of Medicine. "We report that the relative risk of postoperative death is increased by 30 percent in patients given blood that has been stored for more than two weeks," the researchers wrote. This can cause a dilemma, as many blood banks and hospitals cannot keep enough blood on hand that is so fresh.
The U.S. Food and Drug Administration allows blood to be held for as long as six weeks, and blood banks typically give out the oldest blood first. One solution may be to use the freshest blood first. Another is to use techniques to reduce the need for a transfusion in the first place, said Dr. Colleen G.Koch of the Cleveland Clinic Foundation, who led the study.... http://www.reuters.com/article/healthNews/idUSN1932551220080319?feedType=nl&feedName=ushealth1100
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Uric acid may provide early clues to diabetic kidney disease For patients with type 1 diabetes, increased levels of uric acid in the blood may be an early sign of diabetic kidney disease that appears before any significant change in urine albumin level, reported a study in the May 2008 issue of the Clinical Journal of the American Society of Nephrology. The results raise the possibility that treatments to reduce uric acid might slow the decline of renal function in patients with diabetes. "Thus we have the hope of having a means to thwart the loss of kidney function while function is still in a relatively preserved stage," said Dr. Elizabeth T. Rosolowsky of Joslin Diabetes Center, Boston.... For patients with type 1 diabetes, increased levels of uric acid in the blood may be an early sign of diabetic kidney disease that appears before any significant change in urine albumin level, reported a study in the May 2008 issue of the Clinical Journal of the American Society of Nephrology. The researchers measured serum uric acid concentration in 675 patients with type 1 diabetes. On screening tests, 311 patients had small amounts of the protein albumin in the urine. The other 364 patients had normal urine albumin levels. None of the patients had higher levels of albumin (albuminuria) representing more advanced diabetic nephropathy. Nevertheless, one in five had some impairment of kidney function on. "Our research showed that loss of kidney function takes place even in the absence of albuminuria in patients with type 1 diabetes," said Rosolowsky. In contrast, the serum uric acid level was consistently related to kidney function—the higher the uric acid, the lower the kidney function. "The serum concentration of uric acid in these patients varied in a manner consistent with its having played a role in this early loss of kidney function," said Rosolowsky.... http://www.nephronline.com/nephnews/index.php?option=com_content&task=view&id=2480&Itemid=135
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For amputees, an unlikely painkiller (phantom) : Mirrors (CNN) -- Army Sgt. Nick Paupore was in the lead Humvee in a convoy rolling through Kirkuk City, Iraq, when the vehicle was hit by a roadside bomb.
Paupore says it wasn't a very big explosion, more like a loud firecracker. He could feel the rush going through the vehicle, the change of pressure, smoke filling the cab. He felt a burning sensation in the back of his legs, but he wasn't in pain, and he could actually move his legs. He felt lucky. He was alive. He got out of the vehicle, intending to help the others, and passed out.
When he regained consciousness, medics were working on him. The blast had ripped out a chunk of his leg, including 6 to 8 inches of an artery, and he was bleeding out. By the time they had stanched the flow, he had less than two pints of blood left. The average person has 10 pints of blood. Paupore was flown to Germany, where doctors fought to save his life. He survived, but they couldn't save his leg.... http://www.cnn.com/2008/HEALTH/03/19/mirror.therapy/index.html
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Quick Test for MRSA Infections Ok'd FDA cleared for marketing BD Diagnostics' GeneOhm (tm) StaphSR assay that uses molecular methods to determine whether a blood sample contains Staphylococcus aureus bacterium. It's the first rapid blood test for the drug-resistant MRSA (methicillin-resistant Staphylococcus aureus), which can cause deadly infections.
The agency cleared the new assay based on results of a clinical trial at five locations in which the test identified 100% of the MRSA-positive specimens and more than 98% of the more common staph specimens. To preserve the integrity of positive test results, FDA says, the test should be used only in patients suspected of a staph infection. It should not be used to monitor treatment for staph infections because it cannot quantify a patient's response to treatment. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=504394
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Study: Physician-Owned Ambulatory Surgical Centers Siphon Off High-Paying Patients Physicians who refer the most patients to physician-owned ambulatory surgical centers disproportionately send privately insured patients to these ASCs while sending Medicaid enrollees to hospital outpatient departments, according to a new study of referral patterns in the Pittsburgh andPhiladelphia metropolitan areas, published today as a Health Affairs Web Exclusive.The study was designed to test whether having an ownership stake in an ASC would affect the types of patients a physician would refer to the facility. Because no public records identify physician-owners of ASCs, the study used high numbers of referrals to physician-owned ASCs as a proxy for ownership:Lead author Jon Gabel and colleagues analyzed the referral patterns of physicians who accounted for the top 50 percent of physician-referrers to each physician-owned ASC.You can read the article by Gabel, a senior fellow in the Washington, D.C., office of the National Opinion Research Center (NORC), which is affiliated with the University of Chicago, and colleagues at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.3.w165
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Black, Latino Children More Than 12 Times As Likely As White Children To Both Be Poor And Live In Poor Neighborhoods, Say Researchers In Health Affairs Almost 17 percent of black children and 20.5 percent of Latino children in the United States live in ³double jeopardy,² meaning that they live in both poor families and poor neighborhoods, according to research released today in the March/April issue of the journal Health Affairs. In contrast, only 1.4 percent of white children live in double jeopardy. http://content.healthaffairs.org/cgi/content/abstract/27/2/321 In addition, poor white children are more likely than poor black or Latino children to live in better neighborhoods. A typical poor white child lives in a neighborhood where the poverty rate is 13.6 percent, while a typical poor black child lives in a neighborhood where the poverty level is nearly30 percent. A typical poor Latino child lives in a neighborhood where the poverty rate is 26 percent. According to researchers Dolores Acevedo-Garcia, an associate professor at the Harvard School of Public Health, and colleagues, the type of neighborhood one lives in plays a significant rolein racial and ethnic health disparities.The study is part of a thematic Health Affairs issue on disparities in health that examines the link between racial and ethnic disparities and health status and health care. http://content.healthaffairs.org/current.shtml
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Education Affects Life Expectancy. Despite increased attention during the 1980s and 1990s to reducing disparities in life expectancy among the educationally disadvantaged, the educational gap in life expectancy is rising. Between the 1980s and 2000, life expectancy increases occurred nearly exclusively among highly educated groups, according to research from Ellen Meara, an assistant professor of health economics at Harvard Medical School, and colleagues.http://content.healthaffairs.org/cgi/content/abstract/27/2/350 ***********************Policymakers Must View Oral Health As Essential. Oral health is not given the same priority as general health in health care policy, despite research that shows links between oral health and overall health, say researchers Susan Fisher-Owens, an assistant clinical professor of pediatrics at theUniversity of California, San Francisco, and colleagues. The researchers review disparities in oral health and call for more diversity within the dental workforce, incentives for providers to work in areas where there is a shortage of dentists, programs that address inequalities in dental services, and better public insurance coverage for dental care. http://content.healthaffairs.org/cgi/content/abstract/27/2/404
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CHICAGO (Reuters 3/6 still accessible ) - Estrogen predicts breast cancer recurrence: study Blood taken from women whose breast cancer returned showed high levels of strogen even though many had been treated with estrogen-blocking drugs, U.S. researchers said on Thursday.
They said the finding suggests women who have had breast cancer should take extra steps -- such as regular exercise and weight management -- to reduce their estrogen levels and minimize the risk that their cancer will return. Estrogen is strongly linked with the initial development of many breast cancers, but few studies have looked at the link between high estrogen levels and cancer recurrence, especially in women who are taking anti-estrogen drugs like tamoxifen....
http://www.reuters.com/article/healthNews/idUSN0530199120080306?feedType=nl&feedName=ushealth1100
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C-sections linked to cervix length: study BOSTON (Reuters 3/27) - Doctors who use age, weight and other factors to predict if a pregnant woman will need a Caesarean section to deliver her baby have a new gauge: the length of the cervix, researchers said on Wednesday.
Researchers in Britain say their study of more than 27,000 pregnancies found that women with the longest cervixes were more likely to need surgery to deliver their child.
The C-section rate was 25.7 percent for women with a cervix between 40 and 67 millimeters, 21.7 percent for 36 to 39 millimeters, 18.4 percent for 31 to 35 millimeters and 16 percent with a cervical length of 16 to 30 millimeters. An inch is about 25 millimeters.... http://www.reuters.com/article/healthNews/idUSN2643859020080327?feedType=nl&feedName=ushealth1100
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CHICAGO, Illinois (AP) --- At least one in four teenage girls nationwide has a sexually transmitted disease, or more than 3 million teens, according to the first study of its kind in this age group. A virus that causes cervical cancer is by far the most common sexually transmitted infection in teen girls aged 14 to 19, while the highest overall prevalence is among black girls -- nearly half the blacks studied had at least one STD. That rate compared with 20 percent among both whites and Mexican-American teens, the study from the federal Centers for Disease Control and Prevention found.
About half of the girls acknowledged having sex; among them, the rate was 40 percent. While some teens define sex as only intercourse, other types of intimate behavior including oral sex can spread some infections.
For many, the numbers most likely seem "overwhelming because you're talking about nearly half of the sexually experienced teens at any one time having evidence of an STD," said Dr. Margaret Blythe, an adolescent medicine specialist at Indiana University School of Medicine and head of the American Academy of Pediatrics' committee on adolescence. ... http://www.cnn.com/2008/HEALTH/conditions/03/11/teen.std.ap/index.html
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Chefs warn on side effects of sushi boom TOKYO (Reuters 3/28) - As Japanese sushi conquers restaurants and homes around the world, industry experts are fighting the side-effects of the raw fish boom: fake sushi bars, over-confident amateurs, poisoned consumers.
Once a rare and exotic treat, seaweed rolls and bites of raw tuna on vinegared rice are now familiar to most food fans. So familiar, in fact, that many hobby cooks in Europe and the United States like to make them in their own kitchens.
But chefs and sushi experts at an international restaurant summit in Tokyo warned of a lack of awareness in handling raw fish among amateurs and some restaurateurs who enter the profitable industry without sufficient training.... http://www.reuters.com/article/healthNews/idUST27409320080328?feedType=nl&feedName=ushealth1100
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Suppositories kill deadliest malaria parasites fast LONDON (Reuters 3/27) - Suppositories derived from sweet wormwood kill the deadliest malaria parasites quickly and offer a stop-gap treatment for people in remote areas until they can reach a hospital, researchers said on Friday.
Their study found that a single dose of any artemisinin derivative given rectally was better at clearing parasites after 24 hours than a conventional injection of the older drug quinine for people with severe malaria. The researchers published their findings in the journal BMC Infectious Diseases.... http://www.reuters.com/article/healthNews/idUSL2691094620080328?feedType=nl&feedName=ushealth1100
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This was sent in by MJSolon (Melva) THANKS New York (Reuters 3/25) - More than one in seven US children were dispensed an asthma-related medication during a 2-year period, according to findings from a large study, although many apparently did not have an asthma diagnosis.
In the March issue of the Annals of Allergy, Asthma and Immunology, Dr. James J. Korelitz of Westat, Rockville, Maryland and colleagues note that in order to refine goals for pediatric studies of asthma drugs, "information is needed on the percentage of children who receive asthma-related medications."
To provide such an estimate, the researchers retrospectively examined data on more than 4.25 million members of commercial insurance plans who were aged 17 years or less.... http://www.medscape.com/viewarticle/571963
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HUMOR SECTION

Theoretical Laws:
Law of Mechanical Repair: After your hands become coated with grease,your nose will begin to itch or you'll have to pee.
Law of the Workshop: Any tool, when dropped, will roll to the least accessible corner.
Law of Probability: The probability of being watched is directly proportional to the stupidity of your act.
Law of the Telephone: If you dial a wrong number, you never get a busy signal.
Law of the Alibi: If you tell the boss you were late for work because you had a flat tire, the very next morning you will have a flat tire.
Law of Variation: If you change lines (or traffic lanes), the one you were in will start to move faster than the one you are in now.
Law of the Bath: When the body is fully immersed in water, the telephone rings.
Law of Close Encounters: The probability of meeting someone you know increases when you are with someone you don't want to be seen with.
Law of the Result: When you try to prove to someone that a machine won't work, it will.
Law of Biomechanics: The severity of the itch is inversely proportional to the reach.
Law of the Theatre: At any event, the people whose seats are furthest from the aisle arrive last.
Law of Coffee: As soon as you sit down to a cup of hot coffee, your boss will ask you to do something which will last until the coffee is cold.
Murphy's Law of Lockers: If there are only two people in a locker room, they will have adjacent lockers.
Law of Carpets: The chances of an open-faced jelly sandwich landing face down on a floor covering are directly correlated to the newness and cost of the carpet/rug.
Law of Location: No matter where you go, there you are.
Law of Politics: Communicating logic to a liberal/ conservative is only a little more difficult than communicating with the dead.
Law of Logical Argument: Anything is possible if you don't know what you are talking about.
Brown's Law: If the shoe fits, it's ugly.
Oliver's Law: A closed mouth gathers no feet.
Wilson's Law: As soon as you find a product that you really like, they will stop making it..
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

This site contains a huge number of CME/CE offerings....check it out. http://www.medscape.com/nurses/ce

www.nurse.com ( formerly nursiing spectrum.com )
Pay Only $34.99 for a full year of CONTACT HOURS
www.sharedgovernance.org both of these from Bobhess@voicenet.com

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Sign up for 12 months of unlimited CE from RN for a flat rate of $29.95!
Cardiac care: Managing postoperative bleeding (1 contact hour)Nicole Zarra, RN, BSN, CCRN, EMT-P, and Suzy Asani, RN, CCRN Your thorough assessment, early detection, and quick intervention can mean the difference between life and death for patients who suffer from excessive bleeding after open-heart surgery.

Beyond preeclampsia: HELLP syndrome (1 contact hour)Dianna J. Hagl-Fenton, RN, BSN Your ability to recognize this critical condition could spare your pregnant patients and their babies a host of complications-and in some cases, save their lives.

VRE: How you can stop the spread of this drug-resistant organism (1 contact hour)Elizabeth Cooper, RN, MSN The options are limited for treating vancomycin-resistant enterococci, so infection prevention is the best way to protect your patients.

Understanding the world of children with autism (1 contact hour) Melissa Beard-Pfueffer, LPNOne day soon, in the ED or a pediatrics unit, you likely will care for a child with an autistic spectrum disorder (ASD). Here's what you should know to provide the services these special patients need.
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com.
http://www.snopes.com/

http://www.blogged.com/directory/health/nursing

Check out your neighborhood for Offenders: http://www.felonspy.com/

This is an excellent website.....check it out
JournalsOnlineSupport-usa@elsevier.com

Here are some links re. the microfiber cleaning products:
http://www.epa.gov/region09/waste/p2/projects/hospital/mops.pdf

You may receive an apparently harmless e-mail titled "Mail Server Report."If you open either file, a message will appear on your screen saying: 'It is too late now, your life is no longer beautiful.' Subsequently you will LOSE EVERYTHING IN YOUR PC, ...
http://www.snopes.com/computer/virus/mailserver.asp

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MEDICAL RECALLS
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Singulair (montelukast) FDA informed healthcare professionals and patients of the Agency's investigation of the possible association between the use of Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide. Singulair is a leukotriene receptor antagonist used to treat asthma and the symptoms of allergic rhinitis, and to prevent exercise-induced asthma. Patients should not stop taking Singulair before talking to their doctor if they have questions about the new information. Healthcare professionals and caregivers should monitor patients taking Singulair for suicidality (suicidal thinking and behavior) and changes in behavior and mood. This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. Due to the complexity of the analyses, FDA anticipates that it may take up to 9 months to complete the ongoing evaluations. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Singulair
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The following three articles are on the same "page" at http://www.fda.gov/medwatch/safety/2008/safety08.htm#Singulair

"Blue Steel" and "Hero" Dietary Supplement Products The U.S. Food and Drug Administration is advising consumers not to purchase or use "Blue Steel" or "Hero" products, marketed nationally as dietary supplements, because these products contain undeclared ingredients, which may dangerously affect a person’s blood pressure level. They are considered unapproved drugs and have not been proven to be safe or effective. These products are promoted and sold over the Internet for the treatment of erectile dysfunction [ED] and for sexual enhancement. They contain undeclared and unapproved substances similar in chemical structure to sildenafil, the active ingredient in an FDA-approved prescription drug for ED. The undeclared ingredients in these products may interact with nitrates found in some prescription drugs (such as nitroglycerin), and can lower blood pressure to dangerous levels.
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Medtronic Neuromodulation SynchroMed EL, SynchroMed II and IsoMed Implantable Infusion Pumps FDA and Medtronic notified healthcare professionals of the Class 1 recall of Medtronic Neuromodulation Implantable Infusion Pumps, implantable devices for administering drugs to a specific site in the body to treat pain, spasticity and cancer. The company updated the labeling for the devices to include current patient management and treatment recommendations. The company received reports of inflammatory mass formations at or near the distal tip of intrathecal catheters which infuse opioids, baclofen, or chemotherapy drugs into patients. On January 16, 2008, Medtronic sent a letter to doctors who implant these devices and/or provide care to patients with the implanted device. The letter described the problem, patient risks, patient management, recommendations and next steps. Medtronic’s representatives will complete a reply card to document their communication with each doctor regarding this recall, as well as asking the doctors to sign and return a reply card.
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Erythropoiesis Stimulating Agents: Aranesp (darbepoetin alfa), Epogen (epoetin alfa), and Procrit (epoetin alfa) Amgen and FDA notified healthcare professionals of changes to the Boxed Warnings/WARNINGS: Increased Mortality and/or Tumor Progression section of the Aranesp and EPOGEN/PROCRIT labeling to update information describing the results of two additional studies showing increased mortality and more rapid tumor progression in patients with cancer receiving ESAs. Based on the results of these studies, the prescribing information has been revised as follows: ESAs shortened overall survival and/or time to tumor progression in clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers when dosed to target a hemoglobin of ≥ 12 g/dL.
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The FDA issued an Early Communication about recent findings of The Data Collection on Adverse Events of Anti-HIV Drugs Study. Data analyses from this study indicate a higher risk of heart attack in patients infected with HIV-1 who were taking Ziagen (abacavir) or Videx (didanosine) as part of their drug therapy. The study is a large observational study of 33,347 HIV-1 infected patients living in North America, Europe and Australia. Patients in this study are being followed to evaluate the short and long term adverse effects of treatment with anti-HIV drugs. FDA continues to evaluate the overall risks and benefits of abacavir and didanosine. This evaluation may result in the need to revise labeling for the products. Until the FDA’s review is complete, health care professionals should evaluate the potential risks and benefits of each HIV-1 antiretroviral drug their patients are taking. This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.
http://www.fda.gov/medwatch/safety/2008/safety08.htm#abacavir
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The FDA is conducting a safety review based on study data suggesting there may be an increased risk of death from cancer in diabetic patients using Regranex (becaplermin) Gel, a skin product used to heal leg and foot ulcers. While the review is ongoing, the FDA recommends health care professionals discuss the potential risks and benefits of using Regranex with their patients. This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Regranex
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B. Braun Medical Inc. was notified by its supplier, Scientific Protein Laboratories LLC (SPL) of a nationwide recall of Heparin Sodium USP active pharmaceutical ingredient (API). The voluntary recall affects 23 Finished Product lots manufactured and distributed by B. Braun Medical Inc. nationwide and to Canada. This product recall was initiated due to a notification received from SPL, disclosing that one lot of Heparin Sodium, USP API acquired by B. Braun has a heparin-like contaminant. FDA has received reports of serious injuries and/or deaths in patients who have been administered Heparin injectable products of other companies containing this contaminant. http://www.fda.gov/medwatch/safety/2008/safety08.htm#BBraun
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FDA and Medtronic notified healthcare professionals of the Class 1 recall of Medtronic Neuromodulation Implantable Infusion Pumps, implantable devices for administering drugs to a specific site in the body to treat pain, spasticity and cancer. The company updated the labeling for the devices to include current patient management and treatment recommendations. The company received reports of inflammatory mass formations at or near the distal tip of intrathecal catheters which infuse opioids, baclofen, or chemotherapy drugs into patients. On January 28, 2008, Medtronic sent a letter to doctors who implant these devices and/or provide care to patients with the implanted device.... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Neuromodulation
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Total Body Formula, Total Body Mega Formula The FDA notified consumers of a recall of, and advised them not to purchase or consume, the liquid dietary supplement products Total Body Formula in the flavors of Tropical Orange and Peach Nectar, or Total Body Mega Formula in the Orange/Tangerine flavor. The Florida Department of Health recently provided reports to the FDA on 23 individuals who experienced serious reactions to these products seven to 10 days after ingestion. In all cases, the reactions included significant hair loss, muscle cramps, diarrhea, joint pain and fatigue. FDA laboratories are analyzing samples of the products to identify the cause of the reactions. http://www.fda.gov/medwatch/safety/2008/safety08.htm#TotalBody
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FDA modified the prescribing information for the Ortho Evra Contraceptive Transdermal (Skin) Patch to include the results of a new epidemiology study that found that users of the birth control patch were at higher risk of developing serious blood clots, also known as venous thromboembolism (VTE), than women using birth control pills. VTE can lead to pulmonary embolism. The label changes are based on a study conducted by the Boston Collaborative Drug Surveillance Program on behalf of Johnson and Johnson. The patch was studied in women aged 15-44. These findings support an earlier study that also said women in this group were at higher risk for VTE. FDA believes that Ortho Evra is a safe and effective method of contraception when used according to the labeling, which recommends that women with concerns or risk factors for serious blood clots talk with their health care provider about using Ortho Evra versus other contraceptive options. http://www.fda.gov/medwatch/safety/2008/safety08.htm#orthoevrapatch

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NURSING HINTS CORNER

Fast Access to Vacutainers Because we draw our own blood specimens in the emergency department, we keep all the necessary equipment on a phlebotomy tray. But we used to misplace our Vacutainers. here is how we solved the problem: We taped several tongue blades onto the tray's center handle, leaving about 4" of each blade sticking up from the top of the handle. The tongue blades hold the Vacutainers. So now we don't have to waste time looking for them--they're quickly and easily accessible. Polly Zimmermann, RN, BSN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 144 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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This ad is from Wendie (The Inservice guru)
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508-564-9556 (office) 915-990-1367 (fax)
whowland1@mac.com www.thefoundationnetwork.com
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NEW MEMBERS

Welcome to: felecia.brockington@SGMC.ORG (Felecia) 4/3/08
and
leslie.evans@SGMC.ORG Leslie (4/5/08)

Please send the prospective members' screen names with their 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
No address changes this issue

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EDITORIAL STAFF:
GALLO RN @AOL.com (Sue), GingerMyst @AOL.com (Anne), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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PARADIGM 97 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
(submitted by JuliaCR)

A rich person is not one who has the most
but who needs the least."
(author unknown)

Hope to see you online..... Frankie
(RNFrankie@AOL.com)