Another from Raconte....Genevieve.

Medical tourism is a hot—and I mean hot—topic these days. Its coverage in newspapers, magazines and on television continues to attract a great deal of attention not only from the medical community, but also corporate America, including insurance companies, and the public at large. In many ways this coverage is beneficial, bringing to light the pros and cons of seeking intricate and often life-saving surgery thousands of miles from home.
The rise in popularity of medical tourism forces nurses to consider what kind of influence it might have on the future of our field. In the long term, the outcomes could prove far-reaching on what hospitals, doctors, nurses and patients expect in the ways of healthcare services and outcomes.
Historically, the United States has been a destination for people from foreign countries coming in search of treatment that was unavailable or in limited access in their home countries. This continues to be the case for both medically necessary and elective procedures. For example, with the Euro gaining strength against the U.S. dollar, many Europeans are coming here for cosmetic surgery not covered by their national healthcare plans.
What we’re seeing now is that many Americans are traveling outside the U.S. in search of low-cost, quality care. As foreign countries have upgraded, expanded and improved their homegrown and imported talent, they have developed hospitals that appear poised and ready to compete with the American care model. For example, many foreign hospitals have assertively adopted JCI (Joint Commission International) accreditation, which is the nonprofit, international arm of the Joint Commission.
A Significant Cost Difference
There are many reasons why a person would choose to participate in medical tourism instead of seeking treatment stateside. The most common reasons are cost, convenience (believe it or not), quality of care, and the ability to combine the procedure with a vacation. Some of the more popular destinations for medical tourism are (in no particular order of importance) Mexico, Costa Rica, Brazil, Argentina, South Africa, India, Thailand, Malaysia and Singapore.
The cost difference can be significant. For example, a heart bypass is around $100,000 in the U.S., $33,100 in France and $7,000 in India; a hip replacement is around $40,000 in the United States, $15,000 in France, and $5,800 in India; and a knee replacement costs around $35,000 in the U.S., $17,000 in France and $6,700 in India. Thus one can see why many individuals may find it attractive and sensible to seek treatment outside the United States.
Some countries have gone one step beyond in supporting medical tourism, where a patient might expect to find hospitals that are like luxury hotels, bringing state-of-the-art medical equipment alongside a feeling of being cared for at a spa or resort. In some cases, the patient can schedule a pre- or post-surgery tour of the country, organized by the same concierge team that arranged their medical care. Many of these specialized hospitals have an entire team that is devoted to a specific patient, staffed by a doctor who is available nearly 24/7, and Registered Nurses (no LVNs, CNAs or techs) dressed in the traditional starched white uniforms of the old days.
The Thai Eye Doctor
Many of us who have been privileged to either serve in the U.S. military or be the spouse of an active-duty service person have required medically necessary care while stationed in a far-off land. In most of these cases, our care was provided on a U.S. military installation and thus it is very much like being cared for on U.S. soil.
Unfortunately, there are times when even our U.S.-based military hospitals are not able to provide treatment, as was the case when my husband and our family were stationed in Bangkok, Thailand in the late ’60s. At that time the doctors at the 4th Army Field Hospital were not equipped to provided the corrective surgery that two of my children needed. Both were born with the congenital eye defect strabismus. My daughter’s case was less severe than my son’s, who was so crossed-eyed that it impaired his ability to do many age-appropriate behaviors.
It was at the base doctor’s suggestion that we consult with a local Thai eye specialist who had succeeded at surgically correcting this eye defect and who trained at Tulane Medical School in Louisiana. The Thai doctor assured us that he could easily correct my daughter’s eye defect, but expressed some trepidation at performing surgery on my son since he was under a year in age. After taking into consideration the educational delays that might stem from waiting, and assessing my skills as a nurse, he agreed to perform the surgery on my baby. Both children came through with flying colors. To this day many ophthalmologists marvel that the surgeon in Thailand was able to perform each correction with just one surgery.When Asked for Advice
As healthcare professionals, we are no strangers to having friends, family and business associates ask our opinion on issues concerning health and medicine. They may seek our advice on whether or not to have knee-replacement surgery at a hospital in Singapore or India.
If you find yourself being asked to provide an opinion on medical tourism, consider and possibly share the following: Though seeking medically necessary treatment in a foreign country appears to have many benefits, there are also risks. As potential patients, they need to do their own research and weigh the risk/benefit ratio instead of basing their decision solely on the information from a medical tourism brochure. Some important questions to ask are:
• Does that hospital participate in the JCI?
• Are its physicians board-certified (or that nation’s equivalent) in the procedure?
• Do they have staff members who are competent in your native language?
• How many procedures of this type do they perform each month/year? (Remember that with surgery, practice, practice, practice greatly increases the proficiency of the surgeons and generally improves the outcome for the patient.)
• What type of follow-up can you expect once you return to your home country? (Some American physicians are uncomfortable following up on a medical tourism patient.)
• What is the stability of the government where you will be receiving your medical treatment? And so forth.Remember that traveling to a foreign land means there will be differences to being treated in the States. Make sure that you are up to date on all necessary immunizations, that all your travel papers and documents are in order, that you sign in with the local U.S. embassy, and that you have all your ducks in a row prior to leaving.

Geneviève M. Clavreul, RN, PhD, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management.

PARADIGM BYTES

Newsletter for Paradigm97
October 8, 2008

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://www.blogger.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.

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SNIPPET

Physicians Warn Clostridium Difficile (C. Dif.) the Next MRSA? Dr. Ed Corboy had no idea what was afflicting his 80-year-old mother, Joan Corboy. All he knew for certain was that since being treated for what was a routine diarrheal infection, she seemed to be wasting away and none of her doctors or other health specialists could explain why."She lost almost 55 pounds between July Fourth and Christmas in 2006," said Corboy, a resident of Wilmette. "She was so sick, so weak and despite the best care of her doctors, she was getting weaker. It was clear she was in big trouble."Afraid that his mother was running out of time, Corboy called the Centers for Disease Control in Atlanta for advice. Dr. Clifford McDonald told him the infection his mother probably had was of the NAP1 type of the bacteria Clostridium difficile, a virulent strain of a common intestinal bacteria currently plaguing hospitals that now rivals the superbug Methicillin-resistant staphylococcus aureus (MRSA) as one of the top emerging disease threats to humans."Disease caused by Clostridium difficile can range from nuisance diarrhea to life-threatening colitis that could lead to the surgical removal of the colon, and even death," said Dr. Stuart Johnson, associate professor of medicine, division of infectious diseases, Loyola University Chicago Stritch School of Medicine. "It's a very hardy strain and it seems to persist."C-diff, as it is better known, is a bacterium that was discovered in 1978 to be the cause of antibiotic-associated diarrhea and colitis, said Johnson, one of the world's top C-diff researchers and physicians, and who successfully treated Joan Corboy's infection. Although C-diff sickens about 500,000 Americans a year and has reached epidemic proportions in 38 states including Illinois, most people have not yet heard of it."I don't think that people appreciate the urgency and severity of this disease," said Dr. Dale Gerding, professor of medicine, division of infectious diseases, Stritch School of Medicine, and associate chief of staff for Research, Hines VA Hospital. "In the past, it was thought to be a nuisance illness. Now it is a fatal illness and a lot of physicians have not figured that out as yet.""I don't think that people appreciate the urgency and severity of this disease," said Dr. Dale Gerding, professor of medicine, division of infectious diseases, Stritch School of Medicine, and associate chief of staff for Research, Hines VA Hospital. "In the past, it was thought to be a nuisance illness. Now it is a fatal illness and a lot of physicians have not figured that out as yet."Hospitals in Quebec have been particularly hard hit by C-diff. In the 12 hospitals affected, about 2,000 deaths were directly attributable to the antibiotic resistant strain between the 2003 and 2004. In the United Kingdom, deaths from C-diff leaped by 28% in 2007 to more than 8,000, according to the nation's Department of Health."What was surprising was not just the rates, but the number of severe cases," said Johnson, who helped treat Joan Corboy's illness.Similar to MRSA, C-diff is an infection that is mainly acquired in a hospital or nursing home, although like MRSA there is some evidence that a community-acquired strain may (?) be developing, according to the CDC."When a patient is in the hospital getting antibiotics for some type of infection, one of the potential complications is that the normal bacterium that lives in the colon is disturbed with that antibiotic. That makes you susceptible to an infection with Clostrium difficile," Johnson said. "The great majority of cases occur in people who have recently used antibiotics."When C-diff is not actively dividing, it forms very tough spores that can exist on surfaces for months and years, making it very difficult to kill, Johnson said. "Antibiotics are very effective against the growing form of the bacteria but it doesn't do anything to the spores," Johnson said. "If there are spores they can sit around like stealth bombs. Once the antibiotic is gone, these spores can germinate again and spread their toxins."Since its discovery, C-diff has grown increasingly resistant to antibiotics, according to Johnson and Gerding, who has been studying the bacteria since 1980. Though it is appearing more often in younger people, those 65 years and older face a greater risk of developing infection from C-diff and has more severe outcomes and higher death rates. Relapse is common with about 25 percent of patient experiencing a second bout of disease within two months after their first. Patients who have had two or more episodes of disease have a 30 percent to 65 percent risk of another bout.Symptoms of C-diff include profuse diarrhea and abdominal pain and distention of the abdomen. An infection is also frequently accompanied by fever, nausea and dehydration. In some rare cases blood may be present in the stool. The infection is spread by spores that contaminate the hospital environment and hands of healthcare workers who can transmit the spores to patients. The resistance of the spores to hospital cleaning agents and to alcohol hand disinfectants makes it extremely difficult to eradicate. http://www.newswise.com/articles/view/544346/?sc=rsmn http://www.cdc.gov/ncidod/dhqp/id_cdiff.htmlhttp://www.mayoclinic.com/health/c-difficile/DS00736 http://www.emedicine.com/med/TOPIC3412.HTMhttp://www.medscape.com/viewarticle/570064 http://content.nejm.org/cgi/content/short/353/23/2503 (New England Journal of Medicine NEJM)

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MEDICAL NEWS
This article was sent in by : (Anne) anne@wingusa.org Legislative Update on Safe Patient Handling September 26, 2008 HR 378 Nurse and Patient Safety and Protection Act Remains in Committee The national bill HR 378 “Nurse and Patient Safety and Protection Act of 2007” remains in committee. The bill for safe patient handling was originally introduced two years ago on September 26, 2006, as HR 6182 “Nurse and Patient Safety and Protection Act of 2006,” by U.S. Representative John Conyers, Jr., Democrat, Michigan District 14, calling for an amendment of the Occupational Safety and Health Act of 1970 to reduce injuries to patients, nurses, and other health care providers with a safe patient handling standard.Representative John Conyers, Jr., re-introduced the bill as HR 378 “Nurse and Patient Safety and Protection Act of 2007” on January 10, 2007. HR 378 would "direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard."If HR 378 is successful, a Federal Safe Patient Handling Standard, calling for “all health care facilities” to comply, will be enacted “to prevent musculoskeletal disorders for direct-care registered nurses and other health care providers working in health care facilities. This standard shall require the elimination of manual lifting of patients by direct-care registered nurses and other health care providers, through the use of mechanical devices, except during a declared state of emergency.”The last action on HR 378 was over a year ago. HR 378 was referred on May 9, 2007, by two House Committees, the Committee on Education and Labor and the Committee on Workforce Protections, to the House Subcommittee on Workforce Protections. As of this date, September 26, 2008, HR 378 remains in the Subcommittee on Workforce Protections where it has not yet had a hearing, and no hearing is scheduled.There is one co-sponsor to date of the Nurse and Patient Safety and Protection Act. On June 3, 2008, U.S. Representative Joe Sestak, Democrat, Pennsylvania District 7, (202) 225-2011, joined Representative John Conyers, Jr., to co-sponsor HR 378 for the protection of healthcare workers and dependent persons in their care against devastating injuries directly caused by manual patient lifting..From a call this date, September 26, 2008, to the House Education and Labor Committee office, (202) 225-3725, the Subcommittee on Workforce Protections has not acted on HR 378. And, with Congress looking to adjourn for this session, the Nurse and Patient Safety and Protection Act is not likely to be acted on this year. The date for Congress to re-convene will be per call of the Chair.Legislators wanting to co-sponsor HR 378 Nurse and Patient Safety and Protection Act, or others wishing to express support, can contact Representative John Conyers, Jr., (202) 225-5126, John.Conyers@mail.house.gov, and Mr. Joel Segal, Legislative Assistant on Health Policy, (202) 225-5126, Joel.Segal@mail.house.gov. UPDATE: Gov. Schwarzenegger has just vetoed the Safe Handling bill (SB1151) for 5th time/year : SB1151 Links to wording and complete history. The veto message will be added soon through the "Veto Message" link: http://www.blogger.com/.
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INTERESTING READING
Please remember that the REUTERS articles are usually good for 30 days

Needle-Length Guidlines for Thigh and Shoulder Vaccines May Need Revision — Because of substantial risk for overpenetration of the intramuscular layer when using current recommendations for vaccination needle lengths, a revision of these needle-length guidelines for thigh and shoulder injections may be needed, according to the results of a study reported in the August 11 issue of Pediatrics."The US Centers for Disease Control and Prevention [CDC] has needle-length recommendations for intramuscular vaccinations in the thigh and shoulder on the basis of the age of the child," write William C. Lippert, BA, from Tulane University in New Orleans, Louisiana, and Eric J. Wall, MD, from Cincinnati Children's Hospital Medical Center in Ohio. "Underpenetration of the intramuscular layer with short needles has been documented; however, few studies have focused on the risk for overpenetration of the intramuscular level with needles that are too long. The purpose of this study was to determine the optimal needle length for intramuscular vaccination of children of various ages and sizes at the shoulder and thigh levels by using MRI [magnetic resonance imaging] and computed tomography [CT] scan measurements." ... http://www.medscape.com/viewarticle/579120
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Technology is evolving all the time, and so are Internet threats. It can be hard to keep track of how to cope with these challenges when things change so quickly. That's why we've come up with a list of 5 basic principles to help you keep surfing safely—now and in the future.... http://cdn.rsys1.net/ig.rsys1.net/responsysimages/tne/RS_CP/trendsetter_sept08_top5.html

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According to Lanette Anderson,( http://www.nursetogether.com/tabid/169/itemid/516/Lanette-L-Anderson-MSN-JD-BBA-RN.aspx) nurses can play an important role in the policies shaping the nursing profession today. She states "one of the easiest ways to get started with this endeavor is to seek out and become a member of the nursing association in your local area, the American Nurses Association, or both." Here is her three part series on the importance of the involvement of nurses, both individually and as a profession, in politics and policy development.Click here to read "The basic review of the lawmaking process"Click here to read, "Current laws and regulations affecting nurses today"Click here to read, "What individual nurses can do"
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Patient follow-up helps reduce suicide rate: report GENEVA (Reuters 9/1) - Health workers should follow up patients who try to commit suicide as an effective way to save lives, the World Health Organization (WHO) said in a study published on Monday.In its latest bulletin, the U.N. agency said 85 percent of suicide attempts took place in developing countries. Worldwide, it was among the top three causes of death among people aged between 15 and 34. New research showed telephone calls and other regular contact after patients were released from hospital dramatically reduced the likelihood of their attempting suicide again.... http://www.reuters.com/article/healthNews/idUSL142015020080901?feedType=nl&feedName=ushealth1100
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Everyone should have access to quality, evidenced-based mental health services — regardless of age, sex, religion, sexual preference, race, or ethnicity. Yet minority populations continue to have limited access to or underutilize mental health treatment and intervention. SAGE's CBMCS* Multicultural Training Program is the most powerful training tool available to help improve cultural competency among mental health practitioners. To review this revolutionary training program request your sample materials.
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Joint Commission Alert: Prevent Blood Thinner Deaths and Overdoses OAKBROOK TERRACE, Ill. – September 24, 2008) A number of recent high profile errors related to commonly used blood thinners highlight a safety issue that too frequently results in harm or even death to patients, according to a Joint Commission alert issued today that offers solutions to this medication safety issue.The Joint Commission’s new Sentinel Event Alert urges greater attention to the dangers associated with anticoagulants, life-saving medications that also present serious risks when administered incorrectly or in error. Patients being treated with these medications must be closely monitored and screened for drug and food interactions, given that commonly used anticoagulants such as heparin and warfarin have narrow therapeutic ranges and a high potential for complications. Adding to the problem is a lack of standardized naming, labeling and packaging of anticoagulants that create confusion and lead to devastating errors.Anticoagulant medication errors are such a serious patient safety issue that The Joint Commission addresses these types of errors in the 2008 National Patient Safety Goals, with full implementation of the requirements expected by January 1, 2009 for hospitals, outpatient clinics, home care and long term care organizations across the United States. In addition, The Joint Commission’s medication management standards require organizations to pay particular attention to high-risk drugs such as anticoagulants in order to improve safety.“Anticoagulants are vital to maximizing the effectiveness of many medical treatments and surgical procedures that benefit patients, but the systems necessary to ensure that these drugs are used safely are not adequate,” says Mark R. Chassin, M.D., M.P.P., M.P.H.., president, The Joint Commission. “The strategies contained in this Alert give health care organizations and caregivers the tools to make a difference in preventing anticoagulant medication errors.”The Joint Commission’s Alert highlights factors that contribute to anticoagulant medication errors, including lack of standardized labeling and packaging, failure to document and communicate patient instructions during hand-offs, and inappropriate dosing for pediatric patients. http://www.jointcommission.org/Library/WhatsNew/nr_09_24_08.htm
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RANDOM FACT... A duck's quack doesn't echo.
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This is a follow-up to the article in August Newsletter about prevention of AIDS ... Circumcision problems impair HIV prevention: study GENEVA (Reuters 9/1) - African health workers need more training and better tools to circumcise men and boys safely for HIV prevention, according to a World Health Organisation (WHO) study chronicling "shocking" rates of complications.As many as 35 percent of males circumcised by traditional practitioners in Kenya's Bungoma district suffered complications such as bleeding, infection, excessive pain and erectile dysfunction from the procedure, the WHO researchers found."Other common adverse effects reported were pain upon urination, incomplete circumcision requiring recircumcision, and laceration," they wrote, estimating 6 percent of patients had life-long problems as a result.... http://www.reuters.com/article/healthNews/idUSL140856520080901?feedType=nl&feedName=ushealth1100
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RANDOM FACT...During the Gold Rush in 1849, some people paid as much as $100 for a glass of water!
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FRIDAY, Aug. 29 (HealthDay News) -- Eating plenty of antioxidant-rich food such as blueberries, artichokes and pecans may help protect against macular degeneration, the leading cause of age-related blindness in the United States and other developed countries.U.S. researchers found that antioxidants disrupt a link between two processes in the retina that, in combination, contribute to macular degeneration. Antioxidants also extend the lifetime of irreplaceable photoreceptors and other retinal cells.The "destructive synergy" that causes macular degeneration occurs when a buildup of a compound called A2E disrupts energy production in mitochondria, the "power plants" in cells, the researchers said. The lack of energy interferes with daily cleaning and maintenance of photoreceptors and another type of retinal cell. This leads to more buildup of A2E and a continuing cycle that results in the destruction of the vital visual cells that can't be replaced.... http://healthday.com/Article.asp?AID=618674
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RANDOM FACT... Months that begin on a Sunday will always have a 'Friday the 13th'.
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WASHINGTON (Reuters 9/3) - Men with elevated levels of calcium in their blood may have a much higher risk of getting fatal prostate cancer, U.S. researchers said on Wednesday. The findings indicate that a simple blood test may identify men at high risk for the most dangerous prostate tumors, and there already are drugs available that cut calcium levels in the bloodstream, the researchers said.They tracked 2,814 men in a government health survey in which they gave blood samples that revealed calcium levels. The men in the top third of blood calcium levels had 2.68 times the risk of developing fatal prostate cancer later in life compared to those in the bottom third, the study found.... http://www.reuters.com/article/healthNews/idUSN0242123420080903?feedType=nl&feedName=ushealth1100
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Sex bias seen in control of cancer pain NEW YORK (Reuters 9/26) - How well pain is managed in people with cancer apparently differs between men and women, new research hints.Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic.Men and women did not differ significantly in terms of worst pain scores, least pain scores, or pain interference. However, average pain in the last week and pain right now were significantly higher in women.In addition, the average total daily dose of pain-killers was significantly greater for men (130 versus 66 milligrams morphine equivalent value).Women were also significantly less likely than men to receive prescriptions for high potency opioids (33 percent versus 51 percent).... http://www.reuters.com/article/healthNews/idUSTRE48P70E20080926?feedType=nl&feedName=ushealth1100
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RANDOM TIDBITS - RAINFORESTS (just in case you want to go on Jeopardy) Rainforests once covered 14% of the earth's land surface; now they cover 6%. One hundred and thirty seven plant, animal and insect species are being lost every single day due to rainforest deforestation. The howler monkey is the loudest animal living in the rainforests of South America.More than half of the world's estimated 10 million species of plants, animals and insects live in the tropical rainforests. One hectare of lowland rainforest in South America can contain as many frog species as in all of North America. The biggest rainforest in the world is in South America, along the banks of the Amazon River.
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Glucosamine and chondroitin don't slow arthritis (Reuters 9/29) - Two hugely popular supplements used to fight arthritis and joint pain, glucosamine and chondroitin sulfate, do not seem to work any better than placebo to slow the loss of knee cartilage in osteoarthritis, researchers reported on Monday.But the researchers said some of their findings were confusing and said more study was needed."At two years, no treatment showed what we determined to be a clinically important reduction in joint space width loss," said Dr. Allen Sawitzke of the University of Utah School of Medicine, who helped lead the study.The study, funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, confirms other findings showing the supplements have few or no effects.... http://www.reuters.com/article/healthNews/idUSTRE48S82820080929?feedType=nl&feedName=ushealth1100
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FDA: No Lou Gehrig's disease risk with statins (Reuters 9/29) - An analysis of dozens of studies found the widely used statin cholesterol drugs do not increase the risk of Lou Gehrig's disease, U.S. health officials said on Monday.The U.S. Food and Drug Administration said it reviewed 41 long-term controlled clinical trials after receiving a higher- than-expected number of reports of Lou Gehrig's disease, or amyotrophic lateral sclerosis, in patients who were treated with the cholesterol-lowering drugs. Millions of people around the world take statins, including Pfizer Inc's Lipitor and AstraZeneca Plc's Crestor.FDA researchers found that nine out of about 64,000 patients treated with statins were diagnosed with ALS, a fatal neurodegenerative disease, during long-term clinical trials. That compared with 10 of 56,000 patients who got placebos.... http://www.reuters.com/article/healthNews/idUSTRE48S8HA20080930?feedType=nl&feedName=ushealth1100
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RANDOM FACT... Scratch-and-sniff works by taking the aroma-generating chemical and encapsulating it in gelatin or plastic spheres that are a few microns in diameter. When you scratch the sticker, you rupture some of these spheres and release the smell.
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Omega-6 fatty acid intake tied to breast cancer NEW YORK (Reuters 9/26) - Substances called heterocyclic amines (HAs) found in cooked meat and fish don't appear to boost a woman's risk of developing breast cancer after menopause, Swedish researchers report.However, low intake of these substances combined with high consumption of omega-6 polyunsaturated fatty acids (PUFAs), which are found in most types of vegetable oil, may indeed increase the likelihood that postmenopausal women will develop breast cancer, Dr. Emily Sonestedt, of Lund University, Malmo, and her colleagues found."The interaction in the present study between omega-6 PUFAs and HAs is not easily explained, and points toward the importance of examining the impact of food patterns rather than the influence of single dietary factors," Sonestedt and her team state in the October 1 issue of the International Journal of Cancer.... http://www.reutershealth.com/archive/2008/09/26/eline/links/20080926elin003.html
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On-site nurse practitioners help with health of nursing home residents EUGENE, Ore. - With America growing older, concern is mounting over health care. But in Eugene, a program between some nursing homes and a local health plan is showing promise.Collaboration and thinking outside the box are the forces behind this idea. Here's the problem: doctors are hard pressed to visit patients in nursing homes locally, and patients are making trips too often to the hospital or the emergency room.Trillium Community Health Plans and the rehab center have teamed up to place on-site nurse practitioners in the center. http://www.kval.com/news/local/29434039.html
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WASHINGTON (Reuters 10/2) - .A CDC report, based on 2006 data, said about 1.1 million people in the U.S. are living with HIV/AIDS, a figure that is increasing as more people become infected and as patients survive longer. The report also estimated about 20% of that group were not aware they have the disease. http://www.reuters.com/article/healthNews/idUSTRE49166C20081002
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In an effort to reduce the student-to-school nurse ratio in public secondary schools and elementary schools, United States Representative Carolyn McCarthy, D-NY, and fellow Congress member Lois Capps, D-CA, introduced the Student-to-School Nurse Ratio Improvement Bill-H.R. 6201 in June 2008.If enacted, the first-of-its-kind bill would direct funding to district schools with substandard nurse-to-student ratios to help improve them, providing grants through the Centers for Disease Control and Prevention (CDC) to eligible states to help reduce the student-to-school nurse ratios. A report to Congress on the effectiveness of the grant program will also be required.... http://sdm3.rm04.net/ctt?kn=12&m=2201373&r=MTEzODI2Mjk5NTAS1&b=0&j=NTgzNjYzMTQS1&mt=1&rt=0.
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HUMOR SECTION
I was walking past the mental hospital the other day,and all the patients were shouting,'13....13....13' The fence was too high to see over, but I saw a little gap in the planks and looked through to see what was going on.Some bastard poked me in the eye with a stick.Then they all started shouting '14....14....14'...
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Ralph and Edna were both patients in a mental hospital. One day while they were walking past the hospital swimming pool. Ralph suddenly jumped into the deep end. He sank to the bottom of the pool and stayed there. Edna promptly jumped in to save him. She swam to the bottom and pulled him out. When the Head Nurse Director became aware of Edna's heroic act she immediately ordered her to be discharged from the hospital, as she now considered her to be mentally stable. When she went to tell Edna the news she said, 'Edna, I have good news and bad news. The good news is you're being discharged, since you were able to rationally respond to a crisis by jumping in and saving the life of the person you love. I have concluded that your act displays sound mindedness. The bad news is, Ralph hung himself in the bathroom with his bathrobe belt right after you saved him. I am so sorry, but he's dead.' Edna replied, 'He didn't hang himself, I put him there to dry. How soon can I go home?'
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
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Can either pay $8 / course OR pay $26.99 for a year for all the CE courses you want to take
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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%20/This site has passed the Snopes.com test

http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3
the National Nurse's new website: http://nationalnurse.org/

Nurse's TV........check out your city and the time of broadcast
http://www.nursetv.com/tv-showtimes/

Click here: Safe Staffing Saves Lives http://safestaffingsaveslives.org/

How ethical are you? Take this quiz....http://jobs.aol.com/quiz/ethics?ncid=AOLCOMMjobsDYNLprim0001&icid=200100397x1207917944x1200447018

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Title of "nurse" protection from individuals who profess to be nurses. Look for your state--- MINE ISN"T THERE!!! Therefore anyone can claim they are a nurse and getaway with it...ie. medical assistants, etc. http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/State/StateLegislativeAgenda/TitleNurse_1.aspxClick here to print out the list of CEU requirement for each of the 50 states.

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MEDICAL RECALLS
FDA notified healthcare professionals of a Class I Recall of the Nebion HLX-8 Magnetic Resonance Device. The manufacturer of the device made unsupported claims that the product could be used to treat many different medical conditions and diseases such as cancer (including breast, bone, lung, and pancreatic), carpel tunnel syndrome, migraines, premenstrual syndrome, rheumatoid arthritis, ruptured disks, shingles, and sports injuries and sprains. The device was not approved by FDA, lacked safety and effectiveness data, and was not manufactured under current good manufacturing practices. Individuals with the device should stop using it immediately and contact the manufacturer to make arrangements to return the device. Read the entire 2008 MedWatch Safety Summaries, including a link to the FDA Class I Recall notice regarding the above issue at:http://www.fda.gov/medwatch/safety/2008/safety08.htm#Nebion
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Medtronic and FDA notified healthcare professionals of the Class I Recall of several Medtronic intrathecal catheters and intrathecal catheter revision kits used with the implanted Medtronic SyncroMed II, SynchroMed EL, and IsoMed infusion pumps that store and deliver parenteral drugs to the intrathecal space. The products were recalled because of potential misconnections of the Medtronic Sutureless Connector Catheters from the catheter port on the pump. These misconnections have resulted in a blockage between the sutureless pump connector and the catheter port on the pump and disconnection from the pump connector. See the FDA Recall Notice for recommendations for healthcare professionals. Read the entire 2008 MedWatch Safety Summary, including a link to the FDA Class I Recall Notice regarding the above issue at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#INDURA
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Statin drugs and amyotrophic lateral sclerosis (ALS) An FDA analysis provides new evidence that the use of statins does not increase incidence of amyotrophic lateral sclerosis (ALS), a neurodegenerative disease often referred to as "Lou Gehrig's Disease." The FDA analysis, undertaken after the agency received a higher than expected number of reports of ALS in patients on statins, is based on data from 41 long-term controlled clinical trials. The results showed no increased incidence of the disease in patients treated with a statin compared with placebo. The FDA is anticipating the completion of a case-control or epidemiological study of ALS and statin use. Results from this study should be available within 6-9 months. FDA is also examining the feasibility of conducting additional epidemiologic studies to examine the incidence and clinical course of ALS in patients taking statins. Based on currently available information, health care professionals should not change their prescribing practices for statins and patients should not change their use of statins. Read the entire 2008 MedWatch Safety Summary, including a link to the FDA New Release, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Statin
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FDA has been made aware of preliminary safety findings from a clinical trial conducted in Germany investigating the use of epoetin alfa to treat acute ischemic stroke. The clinical trial utilized doses of epoetin alfa that were considerably higher than the doses recommended for the treatment of anemia as described in the FDA-approved labeling for the product. Over a period of ninety days after the start of the trial, there were more deaths in the group of patients who received epoetin alfa compared to patients who received the placebo (16% versus 9%). Roughly half of all deaths in both groups occurred within the first seven days after starting the drug, with death from intracranial hemorrhage (bleeding within the brain) occurring among approximately 4% of patients who received epoetin alfa compared to 1% of patients in the placebo group. FDA anticipates the receipt of additional data within the next several weeks. As soon as the review of these data is complete, FDA will communicate our conclusions and recommendations to the public. The finding of increased mortality in patients receiving epoetin alfa in the German trial suggests the need to closely monitor patients enrolled in other ongoing trials for adverse outcomes and to evaluate whether the potential benefits for enrolled patients outweigh the risks in these trials. Read the entire 2008 MedWatch Safety Summary, including a link to the FDA's Early Communication About An Ongoing Safety Review regarding this issue. http://www.fda.gov/medwatch/safety/2008/safety08.htm#ESA3
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Ammonul (sodium phenylacetate and sodium benzoate) Injection 10%/10% Ucyclyd Pharma, Inc. informed healthcare professionals of the detection of particulate matter in the Ammonul Injection product. This particulate matter may impact the safe use of Ammonul. To ensure optimal patient care, healthcare providers are being instructed to use a MilIex Durapore GV 33 mm Sterile Syringe Filter (0.22 µm ) during the admixture process when injecting Ammonul into the 10% Dextrose IV bag. Since this particulate matter may not be readily seen on visual inspection, a filter must be employed in all cases regardless of whether particulate matter is seen in the vial. Testing has confirmed the removal of this specific particulate when using this filter to admix Ammonul. Contact Ucyclyd Pharma, 1-888-829-2593, or 1-800-900-6389 -- a representative is available 24 hours, seven days a week. Read the entire 2008 MedWatch Safety Summary, including a link to the manufacturer's Dear Healthcare Provider Letter, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Ammonul.
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Tarceva (erlotinib) Tablets OSI and Genentech notified healthcare professionals that cases of hepatic failure and hepatorenal syndrome, including fatalities, have been reported during use of Tarceva, particularly in patients with baseline hepatic impairment. Patients with hepatic impairment receiving Tarceva should be closely monitored during therapy and the product should be used with extra caution in patients with total bilirubin >3x ULN. Dosing should be interrupted or discontinued if changes in liver function are severe, such as doubling of total bilirubin and/or tripling of transaminases in the setting of pretreatment values outside the normal range. New information from a pharmacokinetic study in patients with moderate hepatic impairment associated with significant liver tumor burden has been provided in the revised prescribing information, and other recommendations are included Read the entire 2008 MedWatch Safety Summary, including links to the manufacturer's Dear Healthcare Provider Letter and the revised prescribing information for Tarceva, http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tarceva.
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Covidien and Mallinckrodt Inc. informed healthcare professionals of important new safety information in prescribing Phosphocol P 32. Phosphocol P 32 is approved for the intracavitary instillation for the treatment of peritoneal or pleural effusions caused by metastatic disease. Phosphocol P 32 may increase the risk for leukemia in certain situations. Two children (ages 9 and 14) with hemophilia developed acute lymphocytic leukemia approximately 10 months after intra-articular injections of Phosphocol P 32 (0.6 and 1.5 mCi total dose). This drug is not indicated in the intra-articular treatment of hemarthroses. Additionally, post marketing experience identified radiation injury (necrosis and fibrosis) to the small bowel, cecum, and bladder following administration of P 32 into the peritoneal cavity. Healthcare professionals should refer to the product's revised prescribing information for updated information regarding the appropriate use of Phosphocol P 32. Read the entire 2008 MedWatch Safety Summaries, including a link to the manufacturer's Dear Healthcare Provider Letter and the revised prescribing information for Phosphocol P 32. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Phospho

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NURSING HINTS CORNER
This one is from the ListServe.........

If you have a patient who "finger paints" or just has fecal matter under the nails.......the best way to clean them is with shaving cream. Leaves skin soft.....and very definitely clean.

Here's another one: For patients with contractures the skin in the folds of their contractures can get very smelly and is difficult to clean. Try using toothpaste- rub on your hands with a little water then gently rub into the contracture. It cleans out the dead skin, leaves a fresh minty smell and is comforting and less painful than trying to get a wash cloth in there to clean it. (Thanks to Kristi pd3rn@oh.rr.com for this hint)

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ADVERTISEMENTS
from the members

This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.
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This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php

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NEW MEMBERS
Please send the prospective members' screen names and 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

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

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THOUGHTS FOR THE DAY

Fear defeats more people than any

other one thing in the world

.--Ralph Waldo Emerson*

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Until we stop harming all other living things,

we are still savages.

"Thomas A. Edison (1847-1931)

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