PARADIGM BYTES
Newsletter for Paradigm 97
May 10, 2008
Notice: The Lady With the Lamp http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=113144
National Nurses Week is always May 6-12, ending on Florence Nightingale's birthday. Hope your Nurse's week was a good one.
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 Click here: PARADIGM97 chatroom fis always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends in for a little chat. Let me know if you want others involved.
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SNIPPETS
The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, today issued the first clinical guidelines in the United States for the diagnosis and management of von Willebrand Disease (VWD), the most common inherited bleeding disorder. The guidelines include recommendations on screening, diagnosis, disease management, and directions for future research. An extensive article on the guidelines is published online Feb. 29 in the journal Haemophilia.
In VWD, low or absent levels of a blood protein called von Willebrand factor affect the blood’s ability to clot. Von Willebrand factor also carries with it clotting factor VIII, another important protein that helps blood clot. VWD is typically milder but more common than another bleeding disorder, hemophilia. However, for some people with VWD, the condition can pose serious health risks, especially during surgery, following an injury, or during childbirth. VWD affects 1 out of every 100 to 1,000 people - both males and females. Hemophilia mainly affects males.
“These are the first guidelines on von Willebrand Disease published in the United States and we are pleased to offer clinicians science- based recommendations in the evaluation and treatment of patients,” said NHLBI Director Elizabeth G. Nabel, M.D. “The disease can be difficult to diagnose, especially in women of child-bearing age and in children, and the danger of excessive bleeding is often under- recognized.”
In consultation with the American Society of Hematology, the NHLBI convened an expert panel on VWD whose members were selected for their scientific and clinical knowledge and experience, including
specialists in hematology as well as family medicine, obstetrics and gynecology, pediatrics, internal medicine, and laboratory sciences. A draft of the guidelines was posted on the NHLBI Website
for a 30-day public comment period in September 2006.
Screening recommendations in the guidelines call for physicians to take a complete medical history and physical examination, and order a sequence of blood tests to evaluate persons whose history suggests VWD or any bleeding disorder.
The symptoms of VWD includefrequent large bruises from minor bumps or injuries, frequent or hard-to-stop nosebleeds, extended bleeding from the gums after a dental procedure, heavy bleeding after a cut or after surgery, and heavy or extended menstrual bleeding in women.
“The guidelines provide physicians with recommendations for diagnosing and treating the three major types of VWD,” said William L. Nichols, Jr., M.D., associate professor of medicine at the Mayo Clinic in Rochester, Minn., and chairman of the NHLBI expert panel that developed the guidelines. “While von Willebrand Disease cannot be cured, it can be treated. Proper diagnosis is important, and with the right treatment plan, even people with type 3 VWD, the most serious form, can live active lives.”
The guidelines address the three types of von Willebrand disease. In type 1 VWD, patients have a low level of the von Willebrand factor, and may have lower than normal levels of factor VIII. This is the mildest and most common form of VWD. About three out of every four people with VWD have type 1 VWD. In type 2 VWD, the von Willebrand factor does not work the way it's supposed to. Type 2 VWD is divided into subtypes 2A, 2B, 2M, and 2N. Each type is caused by different gene mutations and treated differently.
In type 3 VWD, patients usually have no von Willebrand factor and low levels of factor VIII. Type 3 is the most serious form of VWD, but is very rare.
People with type 1 or type 2 VWD may not have major bleeding problems, according to Nichols, and, as a result, they may not be diagnosed until they have heavy bleeding after surgery or some other trauma. On the other hand, type 3 VWD can cause major bleeding problems during infancy and childhood. As a result, children with type 3 VWD are usually diagnosed during their first year of life.
Since heavy menstrual bleeding is the most common symptom of VWD in women, the guidelines suggest that a full gynecological exam be performed before diagnosis of VWD is made. In addition, the guidelines address the challenges that pregnancy and childbirth present for women with VWD.
“Even before conception, VWD patients should consult with a hematologist and an obstetrician who specializes in high-risk pregnancies,” said Andra James, M.D., assistant professor of obstetrics and gynecology in the Division of Maternal-Fetal Medicine at Duke University and a member of the NHLBI expert panel. “Once pregnant, women with VWD should consider using a center that specializes in high-risk pregnancies.”
Treatment for VWD depends on its type and severity and this makes knowing the exact type of VWD a patient has very important. Most cases of VWD are mild, and may require treatment only for surgery,
tooth extraction, or injury. Medicines may be prescribed to replace von Willebrand factor, or increase the release of it into the bloodstream (desmopressin), to prevent the breakdown of clots (antifibrinolytics) or to control heavy menstrual bleeding in women (oral contraceptives).
According to the guidelines, it is important for people with VWD to avoid over-the-counter medicines that can affect blood clotting, including aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs). Those with VWD should talk to their dentist to determine if medicine is needed before dental work to reduce bleeding. Anyone over two years of age with VWD should be immunized against hepatitis A and B to decrease risks of complications from blood transfusions. It is important to exercise regularly and maintain a healthy weight. Safe exercises include swimming, biking, and walking. Football, hockey, wrestling and lifting heavy weights are not recommended for people with VWD. The NHLBI von Willebrand Disease Expert Panel was established in spring 2004 in response to a recommendation from the FY 2004 Congressional appropriations conference committee. The committee urged NHLBI to work with medical associations and experts in the field to develop a set of treatment guidelines for VWD.
In addition to the guidelines, the NHLBI has developed a pocket guide for physicians to provide concise information from the full guidelines report as well as a fact sheet for patients and the public. Resources:
Guidelines for the Diagnosis, Evaluation and Management of von Willebrand Disease
http://emall.nhlbihin.net/product2.asp?sku=08-5832
A Pocket Guide to the Diagnosis, Evaluation and Management of von Willebrand Disease
http://emall.nhlbihin.net/product2.asp?sku=08-5833
In Brief: Your Guide to von Willebrand Disease
http://emall.nhlbihin.net/product2.asp?sku=08-5849
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MEDICAL NEWS
Medical News Today, Fri, 25 Apr 2008 5:08 AM PDT Critical New Information Added To Nursing Home Compare Web Site Medicaid beneficiaries and families searching for top quality long-term care services can find critical new information added to the Centers for Medicare & Medicaid Services' (CMS) Web site "Nursing Home Compare." For the first time, information about nursing homes on the Compare Web site will list whether a home is or has been on CMS' special focus facility (SFF) list.... http://www.medicalnewstoday.com/articles/105377.php
Newsletter for Paradigm 97
May 10, 2008
Notice: The Lady With the Lamp http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=113144
National Nurses Week is always May 6-12, ending on Florence Nightingale's birthday. Hope your Nurse's week was a good one.
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.
~~**~~**~~**~~**~~**~~
Please drop in . the Click here: PARADIGM97 chatroom fis always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends in for a little chat. Let me know if you want others involved.
***~~~***~~~***~~~***
SNIPPETS
The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, today issued the first clinical guidelines in the United States for the diagnosis and management of von Willebrand Disease (VWD), the most common inherited bleeding disorder. The guidelines include recommendations on screening, diagnosis, disease management, and directions for future research. An extensive article on the guidelines is published online Feb. 29 in the journal Haemophilia.
In VWD, low or absent levels of a blood protein called von Willebrand factor affect the blood’s ability to clot. Von Willebrand factor also carries with it clotting factor VIII, another important protein that helps blood clot. VWD is typically milder but more common than another bleeding disorder, hemophilia. However, for some people with VWD, the condition can pose serious health risks, especially during surgery, following an injury, or during childbirth. VWD affects 1 out of every 100 to 1,000 people - both males and females. Hemophilia mainly affects males.
“These are the first guidelines on von Willebrand Disease published in the United States and we are pleased to offer clinicians science- based recommendations in the evaluation and treatment of patients,” said NHLBI Director Elizabeth G. Nabel, M.D. “The disease can be difficult to diagnose, especially in women of child-bearing age and in children, and the danger of excessive bleeding is often under- recognized.”
In consultation with the American Society of Hematology, the NHLBI convened an expert panel on VWD whose members were selected for their scientific and clinical knowledge and experience, including
specialists in hematology as well as family medicine, obstetrics and gynecology, pediatrics, internal medicine, and laboratory sciences. A draft of the guidelines was posted on the NHLBI Website
for a 30-day public comment period in September 2006.
Screening recommendations in the guidelines call for physicians to take a complete medical history and physical examination, and order a sequence of blood tests to evaluate persons whose history suggests VWD or any bleeding disorder.
The symptoms of VWD includefrequent large bruises from minor bumps or injuries, frequent or hard-to-stop nosebleeds, extended bleeding from the gums after a dental procedure, heavy bleeding after a cut or after surgery, and heavy or extended menstrual bleeding in women.
“The guidelines provide physicians with recommendations for diagnosing and treating the three major types of VWD,” said William L. Nichols, Jr., M.D., associate professor of medicine at the Mayo Clinic in Rochester, Minn., and chairman of the NHLBI expert panel that developed the guidelines. “While von Willebrand Disease cannot be cured, it can be treated. Proper diagnosis is important, and with the right treatment plan, even people with type 3 VWD, the most serious form, can live active lives.”
The guidelines address the three types of von Willebrand disease. In type 1 VWD, patients have a low level of the von Willebrand factor, and may have lower than normal levels of factor VIII. This is the mildest and most common form of VWD. About three out of every four people with VWD have type 1 VWD. In type 2 VWD, the von Willebrand factor does not work the way it's supposed to. Type 2 VWD is divided into subtypes 2A, 2B, 2M, and 2N. Each type is caused by different gene mutations and treated differently.
In type 3 VWD, patients usually have no von Willebrand factor and low levels of factor VIII. Type 3 is the most serious form of VWD, but is very rare.
People with type 1 or type 2 VWD may not have major bleeding problems, according to Nichols, and, as a result, they may not be diagnosed until they have heavy bleeding after surgery or some other trauma. On the other hand, type 3 VWD can cause major bleeding problems during infancy and childhood. As a result, children with type 3 VWD are usually diagnosed during their first year of life.
Since heavy menstrual bleeding is the most common symptom of VWD in women, the guidelines suggest that a full gynecological exam be performed before diagnosis of VWD is made. In addition, the guidelines address the challenges that pregnancy and childbirth present for women with VWD.
“Even before conception, VWD patients should consult with a hematologist and an obstetrician who specializes in high-risk pregnancies,” said Andra James, M.D., assistant professor of obstetrics and gynecology in the Division of Maternal-Fetal Medicine at Duke University and a member of the NHLBI expert panel. “Once pregnant, women with VWD should consider using a center that specializes in high-risk pregnancies.”
Treatment for VWD depends on its type and severity and this makes knowing the exact type of VWD a patient has very important. Most cases of VWD are mild, and may require treatment only for surgery,
tooth extraction, or injury. Medicines may be prescribed to replace von Willebrand factor, or increase the release of it into the bloodstream (desmopressin), to prevent the breakdown of clots (antifibrinolytics) or to control heavy menstrual bleeding in women (oral contraceptives).
According to the guidelines, it is important for people with VWD to avoid over-the-counter medicines that can affect blood clotting, including aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs). Those with VWD should talk to their dentist to determine if medicine is needed before dental work to reduce bleeding. Anyone over two years of age with VWD should be immunized against hepatitis A and B to decrease risks of complications from blood transfusions. It is important to exercise regularly and maintain a healthy weight. Safe exercises include swimming, biking, and walking. Football, hockey, wrestling and lifting heavy weights are not recommended for people with VWD. The NHLBI von Willebrand Disease Expert Panel was established in spring 2004 in response to a recommendation from the FY 2004 Congressional appropriations conference committee. The committee urged NHLBI to work with medical associations and experts in the field to develop a set of treatment guidelines for VWD.
In addition to the guidelines, the NHLBI has developed a pocket guide for physicians to provide concise information from the full guidelines report as well as a fact sheet for patients and the public. Resources:
Guidelines for the Diagnosis, Evaluation and Management of von Willebrand Disease
http://emall.nhlbihin.net/product2.asp?sku=08-5832
A Pocket Guide to the Diagnosis, Evaluation and Management of von Willebrand Disease
http://emall.nhlbihin.net/product2.asp?sku=08-5833
In Brief: Your Guide to von Willebrand Disease
http://emall.nhlbihin.net/product2.asp?sku=08-5849
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MEDICAL NEWS
Medical News Today, Fri, 25 Apr 2008 5:08 AM PDT Critical New Information Added To Nursing Home Compare Web Site Medicaid beneficiaries and families searching for top quality long-term care services can find critical new information added to the Centers for Medicare & Medicaid Services' (CMS) Web site "Nursing Home Compare." For the first time, information about nursing homes on the Compare Web site will list whether a home is or has been on CMS' special focus facility (SFF) list.... http://www.medicalnewstoday.com/articles/105377.php
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INTERESTING READING
Please remember that the REUTERS articles are often good for 30 days only
Dusting: Adolescents have died huffing from cans of Dust-Off brand compressed air..
Snopes states this is a true story.........Read more about this : http://www.snopes.com/medical/toxins/dustoff.asp
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Homocysteine, Folic Acid, and Cardiovascular Disease The American Heart Association has not yet called hyperhomocysteinemia (high homocysteine level in the blood) a major risk factor for cardiovascular disease. We don't recommend widespread use of folic acid and B vitamin supplements to reduce the risk of heart disease and stroke. We advise a healthy, balanced diet that's rich in fruits and vegetables, whole grains, and fat-free or low-fat dairy products. For folic acid, the recommended daily value is 400 micrograms (mcg). Citrus fruits, tomatoes, vegetables and grain products are good sources. Since January 1998, wheat flour has been fortified with folic acid to add an estimated 100 micrograms per day to the average diet. Supplements should only be used when the diet doesn't provide enough. What is homocysteine, and how is it related to cardiovascular risk? Homocysteine is an amino acid in the blood. Too much of it is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease (fatty deposits in peripheral arteries). Evidence suggests that homocysteine may promote atherosclerosis (fatty deposits in blood vessels) by damaging the inner lining of arteries and promoting blood clots. However, a causal link hasn't been established.... http://www.americanheart.org/presenter.jhtml?identifier=4677
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Donna’s Blog: Nursing a "Best Career" The March 24 issue of U.S. News & World Report lists registered nurse as one of 31 of the best careers for the future. This list was compiled based on job satisfaction, training difficulty, prestige, job market outlook, and pay. http://www.nurse-power.net/blog.
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The Animal Rescue Site is having trouble getting enough people to click on it daily to meet their quota of getting free food donated every day to abused and neglected animals.
It takes less than a minute to go to their site and click on the purple box "fund food for animals" for free. This doesn't cost you a thing. Their corporate sponsors/advertisers use the number of daily visits to donate food to abandoned/neglected animals in exchange for advertising. Here's the web site! Pass it along to people you know. http://www.theanimalrescuesite.com
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The Institute for Safe Medication Practices Nurse survey.Please visit www.fc4research.com/ME2008/ to complete a brief questionnaire to help ISMP identify problems in nursing practice that contribute to errors.
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Asthma-Related Medicine Use Common in US Children 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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Go ahead, celebrate this season's delicate asparagus spears by digging into a big pile. Why? Your pancreas will thank you. Seems that getting lots of folate -- specifically from food, not so much from supplements -- may help protect you from pancreatic cancer. And just half a cup of asparagus delivers 190 micrograms of the stuff, more than 25 percent of what you need.
Your Pancreas, and More
Folate is a member of the B-vitamin group, and it has long been touted as a heart helper. Some early research also links high folate intake to a lower risk of colon, breast, ovarian, and lung cancers. Pancreatic cancer prevention is just the newest member of the why-we-love-folate list. (Do you know what pancreatitis is? Read up on the symptoms.) http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/5761
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Older women should eat plenty of protein as their bodies find it much harder than men's to replace the muscle lost as they age, a study suggests. Differences in the way male and female bodies metabolise food means older women do not use protein as effectively to maintain muscle, the research found. Nottingham and Washington researchers studied 29 men and women aged 65 to 80 .... http://news.bbc.co.uk/2/hi/health/7312395.stm
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WASHINGTON (Reuters April 4) - A second oral vaccine to prevent a leading cause of severe diarrhea in infants won approval from U.S. health officials on Thursday. The GlaxoSmithKline Plc vaccine Rotarix fights infection with the rotavirus, which causes about 55,000 hospitalizations in U.S. children each year and kills more than 600,000 children worldwide, mostly in developing countries.
Rotarix already is approved in more than 100 other countries throughout the world. The vaccine competes with Merck & Co Inc's rotavirus vaccine called RotaTeq. Without vaccination, nearly every child in the United States likely would be infected at least once with rotavirus by age five, the Food and Drug Administration said.... http://www.reuters.com/article/healthNews/idUSN0331204820080404?feedType=nl&feedName=ushealth1100
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WASHINGTON (Reuters) - About one of every 43 U.S. infants is physically abused or neglected annually, and those babies are especially at risk in the first week of their lives, U.S. health officials said on Thursday.... http://www.reuters.com/article/healthNews/idUSN0327933820080404?feedType=nl&feedName=ushealth1100
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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
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Watchful Waiting May be Appropriate for Some Women With HPV U.S. cancer researchers say women with a normal cytologic and initial positive HPV results may be candidates for watchful waiting. The authors say infections with carcinogenic HPV types are common and the risk of cancer following a single-time HPV detection is low. Persistent infections with a carcinogenic HPV type, however, substantially increase the risk for cervical cancer.... http://www.medscape.com/viewarticle/572441
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Osteoporosis Monograph Now Available In the United States, an estimated 10 million people are living with osteoporosis, also called brittle bone disease. Although osteoporosis is responsible for the majority of hip fractures, and accounts for more than eighteen billion dollars in health care expenditures annually, on average only 20% of patients are ever screened or treated for the disease. The Joint Commission recognizes the urgent need for improvement in the care of these patients and now has available a monograph containing 10 voluntary measures of care... To request a complimentary copy of the monograph, or to download a PDF version of the document, go to www.jointcommission.org and follow the relevant links. You may also obtain a copy at the National Pharmaceutical Council website: http://www.npcnow.org/resources/disease/osteo.asp .
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Three rare mutations lower blood pressure: study WASHINGTON (Reuters April 7) - Up to 100 million people globally have genetic mutations that keep their blood pressure low and lower their risk of heart and kidney disease and stroke, U.S. researchers reported on Sunday.
Their findings, published in the journal Nature Genetics, could help scientists design new and better blood pressure drugs. They also shed light on how the kidneys handle salt and in turn regulate blood pressure.... http://www.reuters.com/article/healthNews/idUSN0644675020080407?feedType=nl&feedName=ushealth1100
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Stubborn High Blood Pressure May Need Special Care CHICAGO (Reuters April 7) - People who are taking three or more drugs and still have high blood pressure have a condition known as resistant hypertension that may require special treatment, the American Heart Association said on Monday.
The guidelines are intended to help doctors and patients identify and control resistant hypertension, which affects as many as 30 percent of people with high blood pressure.... http://www.reuters.com/article/healthNews/idUSN0728669020080407?feedType=nl&feedName=ushealth1100
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The Joint Commission Issues Sentinel Event Alert: Preventing pediatric medication errors Medication safety is a big problem for small children. Young patients are at greater risk for drug errors because most medications are formulated and packaged for adults and most health care settings are built around the needs of adults. A study in the April issue of Pediatrics says that medication mix-ups, accidental overdoses, and bad drug reactions harm roughly one out of 15 hospitalized children. This Alert covers the steps that are critical to reducing pediatric medication errors. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_39.htm
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New guidelines for pediatric influenza immunizations (thanks MJSolon (Melva) — The American Academy of Pediatrics (AAP) has issued its 2007-2008 recommendations for influenza immunization in children. The revised guidelines, developed by the 2007-2008 Committee on Infectious Diseases, are published in the April issue of Pediatrics.
"The purpose of this statement is to update the current recommendations for routine use of influenza vaccine in children, which were originally published in a condensed format in April 2007," write Joseph A. Bocchini, Jr, MD, and colleagues from the 2007-2008 Committee on Infectious Diseases. "Highlights include (1) harmonization of the recommendation of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) that children younger than 9 years receive 2 doses of influenza vaccine in their second season of immunization if they only received 1 dose in the previous season; and (2) additional detail on the recommended storage, dosage, and administration of live-attenuated influenza vaccine (LAIV), including the recent licensure of LAIV for children as young as 2 years." ... http://www.medscape.com/viewarticle/572661
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Children are not getting enough sleep. Yet inadequate sleep in childhood is an “invisible phenomenon that fails to receive attention from primary care providers until it interferes with the child’s behavior, mood, or performance,” says Arlene Smaldone, RN, DNSc, CPNP, CDE, assistant professor, Columbia University School of Nursing. In 2003, a national survey was commissioned by the National Sleep Foundation (with a follow-up survey in 2004), to poll adults regarding their children’s sleep habits and sleep problems. ...
The poll indicated —
• Infants (0-11 months) average 12.7 hours of sleep — experts recommend 14–15 hours
• Toddlers (1-3 yrs) average 11.7 hours — experts recommend 12–14 hours
• Preschoolers (3-5 yrs) average 10.4 hours — experts recommend 11–13 hours
• School-agers (1st through 5th grades) average 9.5 hours — experts recommend 10 – 11 hours
• Adolescents and teens average 7.9 hours — experts recommend 8.5 – 9.25 hours
(www.pediatrics.org/cgi/content/full/119/Supplement_1/S29 )
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Reducing Hospital-Acquired Pressure Ulcer Prevalence Through a Focused Prevention Program. FEATURES Advances in Skin & Wound Care. 21(2):75-78, February 2008. McInerney, Joan A. MSN, RN, BC, CWOCN
Abstract:
OBJECTIVE: To provide health care organizations with strategies for decreasing the prevalence of hospital-acquired pressure ulcers.
DESIGN: Hospital-acquired pressure ulcer prevalence was measured every 6 months for 4.5 years while multiple strategies were implemented.
SETTING: The study took place in a not-for-profit, 548-bed, 2-hospital system in Southwest Florida.
PATIENTS: All adult patients with the exception of those admitted for obstetric or mental health care.
INTERVENTIONS: An assortment of interventions were implemented, including electronic medical records, risk assessment tied to automatic consults, pressure relief measures including new equipment and personnel augmentation, and an interdisciplinary team to decide on protocols.
MAIN RESULTS: Hospital-acquired prevalence rate for all pressure ulcers was reduced by 81%. The rate for heel ulcers alone was reduced by 90%.
CONCLUSION: A pressure ulcer prevention program has been developed, which has shown a trend toward improved patient outcomes with a resultant cost savings.
From: http://www.aswcjournal.com/pt/re/advswc/abstract.00129334-200802000-00007.htm;jsessionid=H9gGKTJTHfXP30Tn2hnLJCnbGHj2G2kcCJqpMrp79LqNrfRxq6gN!-1428189930!181195629!8091!-1 (C) 2008 Lippincott Williams & Wilkins, Inc
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TODAY'S RANDOM FACT... The tongue is the fastest healing part of the body.
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OAKBROOK TERRACE, Ill. – April 21, 2008) As the face of America continues to change, a research report released today by The Joint Commission, entitled “One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations,” urges health care organizations to assess their capacity to meet patients’ unique cultural and language needs. In its 2001 report “Crossing the Quality Chasm,” the Institute of Medicine identified patient-centered and equitable care as important elements of quality. The report is based on successful practices now being used in hospitals, and underscores the need to move away from a “one size fits all” approach that negatively affects the quality and safety of care for diverse patients. The report includes a self-assessment tool that can help health care organizations tailor their initiatives to meet the needs of diverse populations. The tool addresses the main issues found in the report and provides a framework for discussing needs, resources and goals for providing the highest quality care to every patient served. The report is the result of a multi-year research study, Hospitals, Language, and Culture: A Snapshot of the Nation supported by funding from The California Endowment. This study provided the first comprehensive examination of how hospitals in the United States respond to the diverse cultural and language needs of their patients. The study explored how 60 hospitals across the country provide care to culturally and linguistically diverse patient populations.... http://www.jointcommission.org/NewsRoom/NewsReleases/nr_04_21_08.htm
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LOS ANGELES/LONDON (Reuters 4/28) - Gene therapy for a rare type of inherited blindness has improved the vision of four patients who tried it, boosting hopes for the troubled field of gene repair technology, scientists said on Sunday.
Two separate teams of doctors reported successes in using gene therapy to treat Leber congenital amaurosis, or LCA damages light receptors in the retina. It usually begins affecting sight in early childhood and causes total blindness by the time a patient is 30. There is no treatment..... http://www.reuters.com/article/healthNews/idUSN2739550520080428?feedType=nl&feedName=ushealth1100
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Volunteers needed for research: Must eat one chocolate bar daily ! LONDON (Reuters 4/28) - Calling all chocoholics: British researchers recruiting volunteers willing to eat a bar of chocolate daily for a year, guilt-free and all in the name of science.
The trial starting in June will explore whether compounds called flavonoids found in chocolate and other foods can reduce the risk of heart disease for menopausal women with type 2 diabetes, the researchers said on Monday.... http://www.reuters.com/article/healthNews/idUSL2838269320080428?feedType=nl&feedName=ushealth1100
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Racial And Ethnic Health Disparities Linked To Physician Practice Resources Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance
payments than their counterparts treating fewer such patients, according to a national study published today as a Health Affairs Web Exclusive. These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care. In addition, the Commonwealth Fund-sponsored study examined how higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities.
The study by James D. Reschovsky and Ann S. O'Malley, senior researchers at the Center for Studying Health System Change : http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.3.w222
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World map of metabolism finds blood pressure clues WASHINGTON (Reuters 4/20) - Researchers creating a map of human metabolism around the world have found compounds in urine that point to some surprising differences affecting blood pressure, based not on genes but on what people eat and their gut bacteria.
They hope their findings, published in the journal Nature on Sunday, can help lead to the development of new drugs to fight high blood pressure or perhaps even non-drug therapy.... http://www.reuters.com/article/healthNews/idUSN1826242120080420?feedType=nl&feedName=ushealth1100
INTERESTING READING
Please remember that the REUTERS articles are often good for 30 days only
Dusting: Adolescents have died huffing from cans of Dust-Off brand compressed air..
Snopes states this is a true story.........Read more about this : http://www.snopes.com/medical/toxins/dustoff.asp
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Homocysteine, Folic Acid, and Cardiovascular Disease The American Heart Association has not yet called hyperhomocysteinemia (high homocysteine level in the blood) a major risk factor for cardiovascular disease. We don't recommend widespread use of folic acid and B vitamin supplements to reduce the risk of heart disease and stroke. We advise a healthy, balanced diet that's rich in fruits and vegetables, whole grains, and fat-free or low-fat dairy products. For folic acid, the recommended daily value is 400 micrograms (mcg). Citrus fruits, tomatoes, vegetables and grain products are good sources. Since January 1998, wheat flour has been fortified with folic acid to add an estimated 100 micrograms per day to the average diet. Supplements should only be used when the diet doesn't provide enough. What is homocysteine, and how is it related to cardiovascular risk? Homocysteine is an amino acid in the blood. Too much of it is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease (fatty deposits in peripheral arteries). Evidence suggests that homocysteine may promote atherosclerosis (fatty deposits in blood vessels) by damaging the inner lining of arteries and promoting blood clots. However, a causal link hasn't been established.... http://www.americanheart.org/presenter.jhtml?identifier=4677
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Donna’s Blog: Nursing a "Best Career" The March 24 issue of U.S. News & World Report lists registered nurse as one of 31 of the best careers for the future. This list was compiled based on job satisfaction, training difficulty, prestige, job market outlook, and pay. http://www.nurse-power.net/blog.
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The Animal Rescue Site is having trouble getting enough people to click on it daily to meet their quota of getting free food donated every day to abused and neglected animals.
It takes less than a minute to go to their site and click on the purple box "fund food for animals" for free. This doesn't cost you a thing. Their corporate sponsors/advertisers use the number of daily visits to donate food to abandoned/neglected animals in exchange for advertising. Here's the web site! Pass it along to people you know. http://www.theanimalrescuesite.com
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The Institute for Safe Medication Practices Nurse survey.Please visit www.fc4research.com/ME2008/ to complete a brief questionnaire to help ISMP identify problems in nursing practice that contribute to errors.
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Asthma-Related Medicine Use Common in US Children 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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Go ahead, celebrate this season's delicate asparagus spears by digging into a big pile. Why? Your pancreas will thank you. Seems that getting lots of folate -- specifically from food, not so much from supplements -- may help protect you from pancreatic cancer. And just half a cup of asparagus delivers 190 micrograms of the stuff, more than 25 percent of what you need.
Your Pancreas, and More
Folate is a member of the B-vitamin group, and it has long been touted as a heart helper. Some early research also links high folate intake to a lower risk of colon, breast, ovarian, and lung cancers. Pancreatic cancer prevention is just the newest member of the why-we-love-folate list. (Do you know what pancreatitis is? Read up on the symptoms.) http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/5761
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Older women should eat plenty of protein as their bodies find it much harder than men's to replace the muscle lost as they age, a study suggests. Differences in the way male and female bodies metabolise food means older women do not use protein as effectively to maintain muscle, the research found. Nottingham and Washington researchers studied 29 men and women aged 65 to 80 .... http://news.bbc.co.uk/2/hi/health/7312395.stm
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WASHINGTON (Reuters April 4) - A second oral vaccine to prevent a leading cause of severe diarrhea in infants won approval from U.S. health officials on Thursday. The GlaxoSmithKline Plc vaccine Rotarix fights infection with the rotavirus, which causes about 55,000 hospitalizations in U.S. children each year and kills more than 600,000 children worldwide, mostly in developing countries.
Rotarix already is approved in more than 100 other countries throughout the world. The vaccine competes with Merck & Co Inc's rotavirus vaccine called RotaTeq. Without vaccination, nearly every child in the United States likely would be infected at least once with rotavirus by age five, the Food and Drug Administration said.... http://www.reuters.com/article/healthNews/idUSN0331204820080404?feedType=nl&feedName=ushealth1100
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WASHINGTON (Reuters) - About one of every 43 U.S. infants is physically abused or neglected annually, and those babies are especially at risk in the first week of their lives, U.S. health officials said on Thursday.... http://www.reuters.com/article/healthNews/idUSN0327933820080404?feedType=nl&feedName=ushealth1100
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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
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Watchful Waiting May be Appropriate for Some Women With HPV U.S. cancer researchers say women with a normal cytologic and initial positive HPV results may be candidates for watchful waiting. The authors say infections with carcinogenic HPV types are common and the risk of cancer following a single-time HPV detection is low. Persistent infections with a carcinogenic HPV type, however, substantially increase the risk for cervical cancer.... http://www.medscape.com/viewarticle/572441
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Osteoporosis Monograph Now Available In the United States, an estimated 10 million people are living with osteoporosis, also called brittle bone disease. Although osteoporosis is responsible for the majority of hip fractures, and accounts for more than eighteen billion dollars in health care expenditures annually, on average only 20% of patients are ever screened or treated for the disease. The Joint Commission recognizes the urgent need for improvement in the care of these patients and now has available a monograph containing 10 voluntary measures of care
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Three rare mutations lower blood pressure: study WASHINGTON (Reuters April 7) - Up to 100 million people globally have genetic mutations that keep their blood pressure low and lower their risk of heart and kidney disease and stroke, U.S. researchers reported on Sunday.
Their findings, published in the journal Nature Genetics, could help scientists design new and better blood pressure drugs. They also shed light on how the kidneys handle salt and in turn regulate blood pressure.... http://www.reuters.com/article/healthNews/idUSN0644675020080407?feedType=nl&feedName=ushealth1100
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Stubborn High Blood Pressure May Need Special Care CHICAGO (Reuters April 7) - People who are taking three or more drugs and still have high blood pressure have a condition known as resistant hypertension that may require special treatment, the American Heart Association said on Monday.
The guidelines are intended to help doctors and patients identify and control resistant hypertension, which affects as many as 30 percent of people with high blood pressure.... http://www.reuters.com/article/healthNews/idUSN0728669020080407?feedType=nl&feedName=ushealth1100
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The Joint Commission Issues Sentinel Event Alert: Preventing pediatric medication errors Medication safety is a big problem for small children. Young patients are at greater risk for drug errors because most medications are formulated and packaged for adults and most health care settings are built around the needs of adults. A study in the April issue of Pediatrics says that medication mix-ups, accidental overdoses, and bad drug reactions harm roughly one out of 15 hospitalized children. This Alert covers the steps that are critical to reducing pediatric medication errors. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_39.htm
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New guidelines for pediatric influenza immunizations (thanks MJSolon (Melva) — The American Academy of Pediatrics (AAP) has issued its 2007-2008 recommendations for influenza immunization in children. The revised guidelines, developed by the 2007-2008 Committee on Infectious Diseases, are published in the April issue of Pediatrics.
"The purpose of this statement is to update the current recommendations for routine use of influenza vaccine in children, which were originally published in a condensed format in April 2007," write Joseph A. Bocchini, Jr, MD, and colleagues from the 2007-2008 Committee on Infectious Diseases. "Highlights include (1) harmonization of the recommendation of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) that children younger than 9 years receive 2 doses of influenza vaccine in their second season of immunization if they only received 1 dose in the previous season; and (2) additional detail on the recommended storage, dosage, and administration of live-attenuated influenza vaccine (LAIV), including the recent licensure of LAIV for children as young as 2 years." ... http://www.medscape.com/viewarticle/572661
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Children are not getting enough sleep. Yet inadequate sleep in childhood is an “invisible phenomenon that fails to receive attention from primary care providers until it interferes with the child’s behavior, mood, or performance,” says Arlene Smaldone, RN, DNSc, CPNP, CDE, assistant professor, Columbia University School of Nursing. In 2003, a national survey was commissioned by the National Sleep Foundation (with a follow-up survey in 2004), to poll adults regarding their children’s sleep habits and sleep problems. ...
The poll indicated —
• Infants (0-11 months) average 12.7 hours of sleep — experts recommend 14–15 hours
• Toddlers (1-3 yrs) average 11.7 hours — experts recommend 12–14 hours
• Preschoolers (3-5 yrs) average 10.4 hours — experts recommend 11–13 hours
• School-agers (1st through 5th grades) average 9.5 hours — experts recommend 10 – 11 hours
• Adolescents and teens average 7.9 hours — experts recommend 8.5 – 9.25 hours
(www.pediatrics.org/cgi/content/full/119/Supplement_1/S29 )
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Reducing Hospital-Acquired Pressure Ulcer Prevalence Through a Focused Prevention Program. FEATURES Advances in Skin & Wound Care. 21(2):75-78, February 2008. McInerney, Joan A. MSN, RN, BC, CWOCN
Abstract:
OBJECTIVE: To provide health care organizations with strategies for decreasing the prevalence of hospital-acquired pressure ulcers.
DESIGN: Hospital-acquired pressure ulcer prevalence was measured every 6 months for 4.5 years while multiple strategies were implemented.
SETTING: The study took place in a not-for-profit, 548-bed, 2-hospital system in Southwest Florida.
PATIENTS: All adult patients with the exception of those admitted for obstetric or mental health care.
INTERVENTIONS: An assortment of interventions were implemented, including electronic medical records, risk assessment tied to automatic consults, pressure relief measures including new equipment and personnel augmentation, and an interdisciplinary team to decide on protocols.
MAIN RESULTS: Hospital-acquired prevalence rate for all pressure ulcers was reduced by 81%. The rate for heel ulcers alone was reduced by 90%.
CONCLUSION: A pressure ulcer prevention program has been developed, which has shown a trend toward improved patient outcomes with a resultant cost savings.
From: http://www.aswcjournal.com/pt/re/advswc/abstract.00129334-200802000-00007.htm;jsessionid=H9gGKTJTHfXP30Tn2hnLJCnbGHj2G2kcCJqpMrp79LqNrfRxq6gN!-1428189930!181195629!8091!-1 (C) 2008 Lippincott Williams & Wilkins, Inc
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TODAY'S RANDOM FACT... The tongue is the fastest healing part of the body.
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OAKBROOK TERRACE, Ill. – April 21, 2008) As the face of America continues to change, a research report released today by The Joint Commission, entitled “One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations,” urges health care organizations to assess their capacity to meet patients’ unique cultural and language needs. In its 2001 report “Crossing the Quality Chasm,” the Institute of Medicine identified patient-centered and equitable care as important elements of quality. The report is based on successful practices now being used in hospitals, and underscores the need to move away from a “one size fits all” approach that negatively affects the quality and safety of care for diverse patients. The report includes a self-assessment tool that can help health care organizations tailor their initiatives to meet the needs of diverse populations. The tool addresses the main issues found in the report and provides a framework for discussing needs, resources and goals for providing the highest quality care to every patient served. The report is the result of a multi-year research study, Hospitals, Language, and Culture: A Snapshot of the Nation supported by funding from The California Endowment. This study provided the first comprehensive examination of how hospitals in the United States respond to the diverse cultural and language needs of their patients. The study explored how 60 hospitals across the country provide care to culturally and linguistically diverse patient populations.... http://www.jointcommission.org/NewsRoom/NewsReleases/nr_04_21_08.htm
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LOS ANGELES/LONDON (Reuters 4/28) - Gene therapy for a rare type of inherited blindness has improved the vision of four patients who tried it, boosting hopes for the troubled field of gene repair technology, scientists said on Sunday.
Two separate teams of doctors reported successes in using gene therapy to treat Leber congenital amaurosis, or LCA damages light receptors in the retina. It usually begins affecting sight in early childhood and causes total blindness by the time a patient is 30. There is no treatment..... http://www.reuters.com/article/healthNews/idUSN2739550520080428?feedType=nl&feedName=ushealth1100
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Volunteers needed for research: Must eat one chocolate bar daily ! LONDON (Reuters 4/28) - Calling all chocoholics: British researchers recruiting volunteers willing to eat a bar of chocolate daily for a year, guilt-free and all in the name of science.
The trial starting in June will explore whether compounds called flavonoids found in chocolate and other foods can reduce the risk of heart disease for menopausal women with type 2 diabetes, the researchers said on Monday.... http://www.reuters.com/article/healthNews/idUSL2838269320080428?feedType=nl&feedName=ushealth1100
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Racial And Ethnic Health Disparities Linked To Physician Practice Resources Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance
payments than their counterparts treating fewer such patients, according to a national study published today as a Health Affairs Web Exclusive. These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care. In addition, the Commonwealth Fund-sponsored study examined how higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities.
The study by James D. Reschovsky and Ann S. O'Malley, senior researchers at the Center for Studying Health System Change : http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.3.w222
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World map of metabolism finds blood pressure clues WASHINGTON (Reuters 4/20) - Researchers creating a map of human metabolism around the world have found compounds in urine that point to some surprising differences affecting blood pressure, based not on genes but on what people eat and their gut bacteria.
They hope their findings, published in the journal Nature on Sunday, can help lead to the development of new drugs to fight high blood pressure or perhaps even non-drug therapy.... http://www.reuters.com/article/healthNews/idUSN1826242120080420?feedType=nl&feedName=ushealth1100
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This was sent in by a friend.... Not a medical interesting reading...but wanted to share the info.
I've been using aluminum foil for more years than I care to remember. Great stuff, but sometimes it can be a pain. You know, like when you are in the middle of doing something and you try to pull some foil out and the roll comes out of the box. Then you have to put the roll back in the box and start over. The darn roll always comes out at the wrong time. Well, I would like to share this with you. Yesterday I went to throw out an empty Reynolds foil box and for some reason I turned it and looked at the end of the box. And written on the end it said, "Press here to lock." Right there on the end of the box is a tab to lock the roll in place. How long has this little locking tab been there? I then looked at a generic brand of aluminum foil and it had one, too. I then looked at a box of Saran wrap and it had one too! I can't count the number of times the Saran warp roll has jumped out when I was trying to cover something up.
(glad wrap has the locks, also )
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HUMOR SECTION
Subject: Children's Science Exam
Q: Name the four seasons.
A: Salt, pepper, mustard and vinegar.
Q: Explain one of the processes by which water can be made safe to drink.
A: Flirtation makes water safe to drink because it removes large pollutants like grit, sand, dead sheep and canoeists.
Q: How is dew formed?
A: The sun shines down on the leaves and makes them perspire.
Q: How can you delay milk turning sour? (brilliant, love this)!
A: Keep it in the cow.
Q: What causes the tides in the oceans?
A: The tides are a fight between the Earth and the Moon. All water tends to flow towards the moon, because there is no water on the moon, and nature hates a vacuum. I forget where the sun joins in this fight.
Q: What are steroids?
A: Things for keeping carpets still on the stairs.
Q: What happens to your body as you age?
A: When you get old, so do your bowels and you get intercontinental.
Q: What happens to a boy when he reaches puberty?
A: He says good-bye to his boyhood and looks forward to his adultery.
Q: Name a major disease associated with cigarettes
A: Premature death.
Q: How are the main parts of the body categorized? (e.g., abdomen).
A: The body is consisted into three parts -- the brainium, the borax and the abdominal cavity. The brainium contains the brain; the borax contains the heart and lungs, and the abdominal cavity contains the five bowels, A, E, I, O, and U.
Q: What is the fibula?
A: A small lie.
Q: What does 'varicose' mean? (I do love this one...)
A: Nearby.
Q: Give the meaning of the term 'Caesarean Section'
A: The Caesarean Section is a district in Rome
Q: What does the word 'benign' mean?'
A: Benign is what you will be after you be eight
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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
CME Case Study 1: Options for Patients With Newly Diagnosed Rheumatoid Arthritis Who Do Not Adequately Respond to Methotrexate http://www.medscape.com/viewprogram/12442
CME/CE Psychiatric Issues Related to the Diagnosis and Treatment of Restless Legs Syndrome http://www.medscape.com/viewprogram/12523
I've been using aluminum foil for more years than I care to remember. Great stuff, but sometimes it can be a pain. You know, like when you are in the middle of doing something and you try to pull some foil out and the roll comes out of the box. Then you have to put the roll back in the box and start over. The darn roll always comes out at the wrong time. Well, I would like to share this with you. Yesterday I went to throw out an empty Reynolds foil box and for some reason I turned it and looked at the end of the box. And written on the end it said, "Press here to lock." Right there on the end of the box is a tab to lock the roll in place. How long has this little locking tab been there? I then looked at a generic brand of aluminum foil and it had one, too. I then looked at a box of Saran wrap and it had one too! I can't count the number of times the Saran warp roll has jumped out when I was trying to cover something up.
(glad wrap has the locks, also )
~~**~~**~~**~~**~~**~~
HUMOR SECTION
Subject: Children's Science Exam
Q: Name the four seasons.
A: Salt, pepper, mustard and vinegar.
Q: Explain one of the processes by which water can be made safe to drink.
A: Flirtation makes water safe to drink because it removes large pollutants like grit, sand, dead sheep and canoeists.
Q: How is dew formed?
A: The sun shines down on the leaves and makes them perspire.
Q: How can you delay milk turning sour? (brilliant, love this)!
A: Keep it in the cow.
Q: What causes the tides in the oceans?
A: The tides are a fight between the Earth and the Moon. All water tends to flow towards the moon, because there is no water on the moon, and nature hates a vacuum. I forget where the sun joins in this fight.
Q: What are steroids?
A: Things for keeping carpets still on the stairs.
Q: What happens to your body as you age?
A: When you get old, so do your bowels and you get intercontinental.
Q: What happens to a boy when he reaches puberty?
A: He says good-bye to his boyhood and looks forward to his adultery.
Q: Name a major disease associated with cigarettes
A: Premature death.
Q: How are the main parts of the body categorized? (e.g., abdomen).
A: The body is consisted into three parts -- the brainium, the borax and the abdominal cavity. The brainium contains the brain; the borax contains the heart and lungs, and the abdominal cavity contains the five bowels, A, E, I, O, and U.
Q: What is the fibula?
A: A small lie.
Q: What does 'varicose' mean? (I do love this one...)
A: Nearby.
Q: Give the meaning of the term 'Caesarean Section'
A: The Caesarean Section is a district in Rome
Q: What does the word 'benign' mean?'
A: Benign is what you will be after you be eight
~~**~~**~~**~~**~~**~~
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
CME Case Study 1: Options for Patients With Newly Diagnosed Rheumatoid Arthritis Who Do Not Adequately Respond to Methotrexate http://www.medscape.com/viewprogram/12442
CME/CE Psychiatric Issues Related to the Diagnosis and Treatment of Restless Legs Syndrome http://www.medscape.com/viewprogram/12523
CME Recognizing At-Risk Patients and Managing CKD-Related Anemia http://www.medscape.com/viewprogram/12488
www.sharedgovernance.org
www.nurse.com Pay Only $34.99 for a full year of CONTACT HOURS
Managing spasticity with intrathecal drug delivery (1 contact hour) Ellen Barker, RN, MSN, APN, CNRN Patients with severe spasticity may be candidates for intrathecal baclofen therapy, a treatment that may significantly improve their quality of life. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=508958
Improving quality of life for patients with kidney failure (1 contact hour) Deborah Martchev, RN
When kidneys fail, hemodialysis may be the only way to prolong life. Nurses can help patients cope with this arduous intervention and maintain compliance. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=508959
www.sharedgovernance.org
www.nurse.com Pay Only $34.99 for a full year of CONTACT HOURS
Managing spasticity with intrathecal drug delivery (1 contact hour) Ellen Barker, RN, MSN, APN, CNRN Patients with severe spasticity may be candidates for intrathecal baclofen therapy, a treatment that may significantly improve their quality of life. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=508958
Improving quality of life for patients with kidney failure (1 contact hour) Deborah Martchev, RN
When kidneys fail, hemodialysis may be the only way to prolong life. Nurses can help patients cope with this arduous intervention and maintain compliance. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=508959
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. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=502760
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. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=502761
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WEBSITES/ LINKS
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. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=502760
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. http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=502761
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com
http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.snopes.com/
the National Nurse's new website: http://nationalnurse.org/
Leaky gut is increased intestinal permeability. Here are a couple sites with
complete explanations.
http://www.mdheal.org/leakygut.htm
http://altmedicine.about.com/od/healthconditionsdisease/a/TestLeakyGut.htm
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MEDICAL RECALLS
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Herbal Science International, Inc. and FDA informed consumers and healthcare professionals of a nationwide recall of twelve dietary supplements that contain ephedra, aristolochic acid or human placenta because they may present a serious health hazard to consumers. FDA has long regarded dietary supplements containing ephedra, a botanical that contains ephedrine alkaloids, as a potential health hazards because the alkaloid raises blood pressure and otherwise stress the circulatory system. These effects are linked to adverse health effects like heart attacks and stroke. FDA issued a rule in February 2004 prohibiting the sale of dietary supplements containing ephedrine alkaloids because they present an unreasonable risk of illness or injury. Two of the recalled products contain aristolochic acid which is a potent carcinogen and nephrotoxin. This chemical can cause serious kidney damage and has been associated with several occurrences of kidney failure. The twelfth recalled product contains human placenta, an ingredient which may transmit disease. Dietary supplements that contain human placenta may not be lawfully marketed in the United States. No illnesses have been reported in connection with the recalled products and distribution of all of the products has ceased. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Herbal
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Actavis Totowa LLC notified healthcare professionals of a Class I nationwide recall of all strengths of Digitek, a drug used to treat heart failure and abnormal heart rhythms. The products are distributed by Mylan Pharmaceuticals Inc., under a “Bertek” label and by UDL Laboratories, Inc. under a “UDL” label. The product is being recalled due to the possibility that tablets with double the appropriate thickness may contain twice the approved level of active ingredient. The existence of double strength tablets poses a risk of digitalis toxicity in patents with renal failure. Digitalis toxicity can cause nausea, vomiting, dizziness, low blood pressure, cardiac instability and bradycardia. Several reports of illnesses and injuries have been reported. Patients should contact their healthcare professional with questions.... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Digitek
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Cubist Pharmaceuticals, Inc. informed healthcare professionals that a potentially significant impurity, 2-mercaptobenzothiazole (MBT), has been isolated from reconstituted Cubicin stored in with ReadyMED elastomeric infusion pumps manufactured by Cardinal Health, Inc. MBT is used in the manufacture of rubber and has been reported to leach from rubber stoppers and syringe components into medicinal products in the past. Cutaneous exposure to MBT has been associated with dermal sensitization, and chronic administration of MBT to laboratory rodents has been associated with an increased risk of certain tumors. No MBT has been identified in reconstituted Cubicin in other standard types of infusion systems that have been tested. Healthcare professionals are advised to discontinue using ReadyMED elastomeric infusion pumps with Cubicin until the issue has been addressed. http://www.fda.gov/medwatch/safety/2008/safety08.htm#cubicin
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Amgen and Wyeth Pharmaceuticals informed healthcare professionals of revisions to prescribing information for Enbrel. The revisions include a BOXED WARNING about infections, including serious infections leading to hospitalization or death that have been observed in patients treated with Enbrel. Infections have included bacterial sepsis and tuberculosis. The ADVERSE REACTIONS section of the label was updated to include information regarding global clinical studies and the rate of occurrence of tuberculosis in patients treated with Enbrel. Healthcare professionals should screen patients for latent tuberculosis infection before beginning Enbrel. Patients should be educated about the symptoms of infection and closely monitored for signs and symptoms of infection during and after treatment with the drug. Patients who develop an infection should be evaluated for appropriate antimicrobial treatment and, in patients who develop a serious infection, Enbrel should be discontinued. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Enbrel
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Pfizer informed healthcare professionals and patients of updated safety information in the WARNINGS section of prescribing information for Exubera, a short-acting insulin you breathe in through your mouth using the Exubera inhaler that helps to control high blood sugar in adults with diabetes. There have been 6 newly diagnosed cases of primary lung malignancies in clinical trials among Exubera-treated patients, and 1 newly diagnosed case among comparator treated patients. There has also been 1 post-marketing report of a primary lung malignancy in an Exubera-treated patient. There were too few cases to determine whether the emergence of these events is related to Exubera. All patients who were diagnosed with lung cancer had a prior history of cigarette smoking. Because of limited availability of Exubera, healthcare professionals should seek alternative treatment options to maintain patients' glycemic control.
http://www.fda.gov/medwatch/safety/2008/safety08.htm#exubera
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Schwarz Pharma informed healthcare professionals and patients of the recall of Neupro, a transdermal delivery system worn on the skin and used to treat early stage Parkinson’s disease, at the end of April 2008, because of the formation of rotigotine crystals in the patches. When the drug crystallizes, less drug is available to be absorbed through the skin and the efficacy of the product may vary. Healthcare professionals should not initiate any new patients on Neupro and should begin to down-titrate all patients currently using the product per the guidelines in the product labeling. Patients should NOT abruptly discontinue therapy. Abrupt withdrawal of dopamine agonists has been associated with a syndrome resembling neuroleptic malignant syndrome or akinetic crises. http://www.fda.gov/medwatch/safety/2008/safety08.htm#neupro
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FDA informed healthcare professionals that the Agency is investigating a potential association between the use of CellCept (mycophenolate mofetil) and Myfortic (mycophenolate acid) , medicines used to prevent organ rejection, and the development of progressive multifocal leukoencephalopathy (PML), a life-threatening disease. PML is a rare disorder that affects the central nervous system usually occurring in patients with immune systems suppressed by disease or medicines. FDA is reviewing data submitted by Roche, including postmarketing reports it has received of PML in patients who took CellCept or Myfortic, and the proposed revisions to the CellCept prescribing information. FDA has asked Novartis, the maker of Myfortic, for data on PML cases and to revise the Myfortic prescribing information to include the same information about PML included in the CellCept prescribing information. FDA anticipates it may take about 2 months to complete its review of the postmarketing reports and the proposed revisions to the prescribing information. As soon as the review is completed, FDA will communicate the conclusions and recommendations to the public. Until further information is available, patients and healthcare professionals should be aware of the possibility of PML, such as localized neurologic signs and symptoms in the setting of a suppressed immune system, including during therapy with CellCept and Myfortic. http://www.fda.gov/medwatch/safety/2008/safety08.htm#mycophenolate
******************
"Total Body Formula" and "Total Body Mega Formula" detected hazardous amounts of chromium in addition to selenium. Excessive consumption of chromium can cause fatigue, muscle cramps, hyperactivity, hypoglycemia, renal failure and liver toxicity. Excessive chromium intake can also interfere with certain medications. FDA continues to investigate how excessive amounts of selenium and chromium got into the products.
[UPDATE 04/10/2008] The FDA notified healthcare professionals and patients that it has found hazardous levels of selenium in samples of certain flavors of the dietary supplement products "Total Body Formula" and "Total Body Mega Formula." Analyses of samples by FDA have found most of the samples contain extremely high levels of selenium -- up to 200 times the amount of selenium indicated on the labels of the products. The FDA has received 43 reports of persons from nine states who experienced serious adverse reactions using these products. The adverse reactions generally occurred after five to 10 days of daily ingestion of the product, and included significant hair loss, muscle cramps, diarrhea, joint pain, deformed fingernails, and fatigue. Consumers should stop taking the products and consult their healthcare professional if they experience any adverse events associated with the use of the products.
[Posted 03/28/2008] 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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NURSING HINTS CORNER
Keeping a catheter in place The skin cement (Skin Prep) or bond that is used with colostomy supplies also keeps external catheters in place. It is more effective than tape of tincture of benzoin, and it doesn't irritate the patient's skin . Laurie Ellsworth, RN
http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.snopes.com/
the National Nurse's new website: http://nationalnurse.org/
Leaky gut is increased intestinal permeability. Here are a couple sites with
complete explanations.
http://www.mdheal.org/leakygut.htm
http://altmedicine.about.com/od/healthconditionsdisease/a/TestLeakyGut.htm
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*
MEDICAL RECALLS
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Herbal Science International, Inc. and FDA informed consumers and healthcare professionals of a nationwide recall of twelve dietary supplements that contain ephedra, aristolochic acid or human placenta because they may present a serious health hazard to consumers. FDA has long regarded dietary supplements containing ephedra, a botanical that contains ephedrine alkaloids, as a potential health hazards because the alkaloid raises blood pressure and otherwise stress the circulatory system. These effects are linked to adverse health effects like heart attacks and stroke. FDA issued a rule in February 2004 prohibiting the sale of dietary supplements containing ephedrine alkaloids because they present an unreasonable risk of illness or injury. Two of the recalled products contain aristolochic acid which is a potent carcinogen and nephrotoxin. This chemical can cause serious kidney damage and has been associated with several occurrences of kidney failure. The twelfth recalled product contains human placenta, an ingredient which may transmit disease. Dietary supplements that contain human placenta may not be lawfully marketed in the United States. No illnesses have been reported in connection with the recalled products and distribution of all of the products has ceased. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Herbal
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Actavis Totowa LLC notified healthcare professionals of a Class I nationwide recall of all strengths of Digitek, a drug used to treat heart failure and abnormal heart rhythms. The products are distributed by Mylan Pharmaceuticals Inc., under a “Bertek” label and by UDL Laboratories, Inc. under a “UDL” label. The product is being recalled due to the possibility that tablets with double the appropriate thickness may contain twice the approved level of active ingredient. The existence of double strength tablets poses a risk of digitalis toxicity in patents with renal failure. Digitalis toxicity can cause nausea, vomiting, dizziness, low blood pressure, cardiac instability and bradycardia. Several reports of illnesses and injuries have been reported. Patients should contact their healthcare professional with questions.... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Digitek
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Cubist Pharmaceuticals, Inc. informed healthcare professionals that a potentially significant impurity, 2-mercaptobenzothiazole (MBT), has been isolated from reconstituted Cubicin stored in with ReadyMED elastomeric infusion pumps manufactured by Cardinal Health, Inc. MBT is used in the manufacture of rubber and has been reported to leach from rubber stoppers and syringe components into medicinal products in the past. Cutaneous exposure to MBT has been associated with dermal sensitization, and chronic administration of MBT to laboratory rodents has been associated with an increased risk of certain tumors. No MBT has been identified in reconstituted Cubicin in other standard types of infusion systems that have been tested. Healthcare professionals are advised to discontinue using ReadyMED elastomeric infusion pumps with Cubicin until the issue has been addressed. http://www.fda.gov/medwatch/safety/2008/safety08.htm#cubicin
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Amgen and Wyeth Pharmaceuticals informed healthcare professionals of revisions to prescribing information for Enbrel. The revisions include a BOXED WARNING about infections, including serious infections leading to hospitalization or death that have been observed in patients treated with Enbrel. Infections have included bacterial sepsis and tuberculosis. The ADVERSE REACTIONS section of the label was updated to include information regarding global clinical studies and the rate of occurrence of tuberculosis in patients treated with Enbrel. Healthcare professionals should screen patients for latent tuberculosis infection before beginning Enbrel. Patients should be educated about the symptoms of infection and closely monitored for signs and symptoms of infection during and after treatment with the drug. Patients who develop an infection should be evaluated for appropriate antimicrobial treatment and, in patients who develop a serious infection, Enbrel should be discontinued. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Enbrel
******************
Pfizer informed healthcare professionals and patients of updated safety information in the WARNINGS section of prescribing information for Exubera, a short-acting insulin you breathe in through your mouth using the Exubera inhaler that helps to control high blood sugar in adults with diabetes. There have been 6 newly diagnosed cases of primary lung malignancies in clinical trials among Exubera-treated patients, and 1 newly diagnosed case among comparator treated patients. There has also been 1 post-marketing report of a primary lung malignancy in an Exubera-treated patient. There were too few cases to determine whether the emergence of these events is related to Exubera. All patients who were diagnosed with lung cancer had a prior history of cigarette smoking. Because of limited availability of Exubera, healthcare professionals should seek alternative treatment options to maintain patients' glycemic control.
http://www.fda.gov/medwatch/safety/2008/safety08.htm#exubera
*************************
Schwarz Pharma informed healthcare professionals and patients of the recall of Neupro, a transdermal delivery system worn on the skin and used to treat early stage Parkinson’s disease, at the end of April 2008, because of the formation of rotigotine crystals in the patches. When the drug crystallizes, less drug is available to be absorbed through the skin and the efficacy of the product may vary. Healthcare professionals should not initiate any new patients on Neupro and should begin to down-titrate all patients currently using the product per the guidelines in the product labeling. Patients should NOT abruptly discontinue therapy. Abrupt withdrawal of dopamine agonists has been associated with a syndrome resembling neuroleptic malignant syndrome or akinetic crises. http://www.fda.gov/medwatch/safety/2008/safety08.htm#neupro
********************
FDA informed healthcare professionals that the Agency is investigating a potential association between the use of CellCept (mycophenolate mofetil) and Myfortic (mycophenolate acid) , medicines used to prevent organ rejection, and the development of progressive multifocal leukoencephalopathy (PML), a life-threatening disease. PML is a rare disorder that affects the central nervous system usually occurring in patients with immune systems suppressed by disease or medicines. FDA is reviewing data submitted by Roche, including postmarketing reports it has received of PML in patients who took CellCept or Myfortic, and the proposed revisions to the CellCept prescribing information. FDA has asked Novartis, the maker of Myfortic, for data on PML cases and to revise the Myfortic prescribing information to include the same information about PML included in the CellCept prescribing information. FDA anticipates it may take about 2 months to complete its review of the postmarketing reports and the proposed revisions to the prescribing information. As soon as the review is completed, FDA will communicate the conclusions and recommendations to the public. Until further information is available, patients and healthcare professionals should be aware of the possibility of PML, such as localized neurologic signs and symptoms in the setting of a suppressed immune system, including during therapy with CellCept and Myfortic. http://www.fda.gov/medwatch/safety/2008/safety08.htm#mycophenolate
******************
"Total Body Formula" and "Total Body Mega Formula" detected hazardous amounts of chromium in addition to selenium. Excessive consumption of chromium can cause fatigue, muscle cramps, hyperactivity, hypoglycemia, renal failure and liver toxicity. Excessive chromium intake can also interfere with certain medications. FDA continues to investigate how excessive amounts of selenium and chromium got into the products.
[UPDATE 04/10/2008] The FDA notified healthcare professionals and patients that it has found hazardous levels of selenium in samples of certain flavors of the dietary supplement products "Total Body Formula" and "Total Body Mega Formula." Analyses of samples by FDA have found most of the samples contain extremely high levels of selenium -- up to 200 times the amount of selenium indicated on the labels of the products. The FDA has received 43 reports of persons from nine states who experienced serious adverse reactions using these products. The adverse reactions generally occurred after five to 10 days of daily ingestion of the product, and included significant hair loss, muscle cramps, diarrhea, joint pain, deformed fingernails, and fatigue. Consumers should stop taking the products and consult their healthcare professional if they experience any adverse events associated with the use of the products.
[Posted 03/28/2008] 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
~~**~~**~~**~~**~~**~~
NURSING HINTS CORNER
Keeping a catheter in place The skin cement (Skin Prep) or bond that is used with colostomy supplies also keeps external catheters in place. It is more effective than tape of tincture of benzoin, and it doesn't irritate the patient's skin . Laurie Ellsworth, RN
NOTE: (I also ALWAYS use it under any adhesive...tape, wound VAC layer, etc. It is superior in "bonding" and it is easy to remove...and is painless. On elderly patients , I consider it essential when taping a dressing on their fragile skin).
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.49 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/ .
~~**~~**~~**~~**~~**~~
This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php
This ad is from Wendie (The Inservice guru)
The eLifeCard can save your life when seconds count! Carry this life-saving card in your wallet in case of emergency at home, at work, at school, traveling, or on vacation! NEW online estate planning system membership makes it possible for you to buy, upload, change and securely store your health care directive, allergies and medication lists, emergency contacts, and more. Exceptional package of other benefits. Give yourself and your family the gift of peace of mind. For FREE information, email name & phone number. All responses kept confidential and answered promptly. Wendie Howland, CEO Miracle Group TFN Affiliate #10136
508-564-9556 (office) 915-990-1367 (fax)
whowland1@mac.com www.thefoundationnetwork.com
~~**~~**~~**~~**~~**~~
NEW MEMBERS
Welcome To:
felecia.brockington@SGMC.ORG Felecia 4/3/08
leslie.evans@SGMC.ORG Leslie 4/5/08
jrbaisden@accessatc.net Jennifer 4/23/08
macysaunt@hotmail.com Stacey 4/23/08
tammy.chandler@sgmc.org Tammy 4/29/08
donna.crawford@sgmc.org Donna 5/7/08
Returning Members:
RNGCS@AOL.com Gamze
and
ozrn@hotkey.net.au (Janine)
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
~~**~~**~~**~~**~~**~~
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: dantenspot1@aol.com
New Address: dantenspot@AOL.com
~~**~~**~~**~~**~~**~~
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)
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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.
~~**~~**~~**~~**~~**~~
THOUGHT FOR THE DAY
'Be kinder than necessary, for everyone you meet is fighting some kind of battle.'
Anonymous
Hope to see you online..... Frankie
RNFrankie@AOL.com
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.49 Springhouse Corporation/www.springnetcom .
~~**~~**~~**~~**~~**~~
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/ .
~~**~~**~~**~~**~~**~~
This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php
This ad is from Wendie (The Inservice guru)
The eLifeCard can save your life when seconds count! Carry this life-saving card in your wallet in case of emergency at home, at work, at school, traveling, or on vacation! NEW online estate planning system membership makes it possible for you to buy, upload, change and securely store your health care directive, allergies and medication lists, emergency contacts, and more. Exceptional package of other benefits. Give yourself and your family the gift of peace of mind. For FREE information, email name & phone number. All responses kept confidential and answered promptly. Wendie Howland, CEO Miracle Group TFN Affiliate #10136
508-564-9556 (office) 915-990-1367 (fax)
whowland1@mac.com www.thefoundationnetwork.com
~~**~~**~~**~~**~~**~~
NEW MEMBERS
Welcome To:
felecia.brockington@SGMC.ORG Felecia 4/3/08
leslie.evans@SGMC.ORG Leslie 4/5/08
jrbaisden@accessatc.net Jennifer 4/23/08
macysaunt@hotmail.com Stacey 4/23/08
tammy.chandler@sgmc.org Tammy 4/29/08
donna.crawford@sgmc.org Donna 5/7/08
Returning Members:
RNGCS@AOL.com Gamze
and
ozrn@hotkey.net.au (Janine)
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
~~**~~**~~**~~**~~**~~
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: dantenspot1@aol.com
New Address: dantenspot@AOL.com
~~**~~**~~**~~**~~**~~
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)
~~**~~**~~**~~**~~**~~
PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)
~~**~~**~~**~~**~~**~~
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.
~~**~~**~~**~~**~~**~~
THOUGHT FOR THE DAY
'Be kinder than necessary, for everyone you meet is fighting some kind of battle.'
Anonymous
Hope to see you online..... Frankie
RNFrankie@AOL.com
