Wednesday, September 9, 2009

September Paradigm Bytes


PARADIGM BYTES
Newsletter for Paradigm 97
September 10, 2009

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/
Please copy, paste, and bookmark it.
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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SNIPPETS

Patient ? Client ? Consumer ?

by Geneviève M. Clavreul RN, Ph.D

One day I came across “The Martha Stewart Show” as it aired a segment dedicated to nurses and Nurses Week. It began with a brief discussion of the history of nursing over the past century or so, and I recognized many of the instruments from my youth and my early career in nursing. But what caught my fancy was how the nursing school representative, a nurse herself, continually referred to the patient as the “client,” and how she seemed to struggle while using the term, as if it was a foreign concept.

I know that both nursing and healthcare in general have been undergoing a lot of changes these past several years. As nurses we’ve seen it in the push for mandated nurse/patient ratios, lift teams, the ”doctor-nurse,” and even a push to relabel those we care for — from “patient” to “consumer,” or even “client.”
I have often wondered what effect, if any, does changing how we refer to our charges have on how we provide care? Will this change in terminology cause us to perform our task better, more properly or more efficiently? Or is it just window-dressing?
Personally, I’m not convinced that referring to the patient as the “client” or the “consumer” makes me be a better nurse, causes me to perform my job function any differently, or even alters how I perceive my role in relation to those under my care every day. However, I’m always game to take a look at things.

Let’s start with a definition of all three terms, beginning with the one many nurses have operated with for years:• Patient: an individual awaiting or under medical care and treatment; the recipient of any of various personal services, or one that is acted upon.• Client: one that is under the protection of another, or a person who engages the professional advice or services of another, or a person served by or utilizing the services of a social agency.• Consumer: one that consumes; specifically, one that utilizes economic goods.Keeping the above definitions in mind (provided courtesy of the Merriam-Webster Dictionary), one can easily see why all three can appear applicable as labels for an individual that receives care from a nurse, doctor or other healthcare professional. The questions that we must ask ourselves are: Does using one term over the other truly alter how we perform our duties, thus allowing us to perform at a higher level of quality? Or does using one term over the other alter the public’s perception of the care they receive from the healthcare team?Are we treating a patient?
If we consider the definition for patient, I think we can all agree that the person a nurse provides care and services to fits it to the proverbial “T.” This individual is indeed awaiting medical care or treatment, and they are most definitely being “acted upon.” When we have to wake a patient to have them take their 3am pill, or to move them from their warm bed to one that will take them to cold and invasive procedure, those are most certainly not peer-to-peer experiences.Are we treating a client?
A person under our care could be seen as a client, but what image is conjured up when we think of that word? Generally, a client is someone seen as purchasing or contracting from another person or entity. Indeed, a person receiving care is in this role, but do they really contract with the nurse for the delivery of their care? Rarely. In the hospital, clinic and hospice environment, each nurse’s time is not billed separately, the “client” does not compensate the nurse directly for their care, and in most cases the “client” does not pick and choose which nurse will provide their care.
Of course they have the right to request a different nurse, but there are limits to how this can be completely honored. For example, the “client” can make a request for a specific nurse, but if he or she is not skilled in the area — say they are in need of a ICU nurse and the nurse they request is lacking that expertise — then the request cannot be honored. Or are we treating a consumer?
This patient re-identification seems to be making its way into nursing lingo primarily through publications, edicts from some advocacy groups, and groups that oversee and report on the hospital and healthcare industry. Though a person receiving care is most definitely “consuming” the care that is being provided, this designation seems more suited to reports, government agencies and panels. It's not uncommon to hear patients referred to as “consumers” when they are part of focus groups, committees and advisory boards, but, just like “client,” it has limits on the wants and desires that can be imposed on the nurse.
The “consumer” cannot just leave their hospital bed at hospital A to go down the road to hospital B because there’s a special on the procedure they are about to undergo, or because they prefer the ambience of the other hospital. Can a person leave a hospital and remove him or herself from care? Of course. Most of us at one time or another have experienced a patient that wants to leave against medical advice, for which the “consumer” has to sign a form detailing that they are aware that they are leaving AMA, and the liability involved, indemnifying the hospital and its staff. But when’s the last time your grocer demanded you to do that before leaving their store in search of better service or deals at the competing store down the road?So, which should it be? Patient, client or consumer? The terminology may or may not seem significant to some, but to others it can mean a world of difference. Doctors rarely, if ever, seem to have the need to refer to the person under their care as a “client” or a “consumer” and seem to firmly believe that they provide care to their patients. Are our nursing leaders succumbing to the ever-growing politically correct syndrome? I would hope not. Or perhaps this is once again a search for validation in all the wrong places?
As nurses it is our function to provide the best possible care, and this means that in most states we are also designated (as part of our nurse practice act) as the patient advocate. Regardless of the label, we must strive to provide the best possible care to that individual, so keep in mind to always follow the set protocol your hospital, clinic, hospice, etc. has put forth. If it has deemed that all patients are now and forever to be referred to as the client or the consumer, by all means comply. If an opportunity presents itself to be part of a discussion about how nurses, doctors and other health professionals will refer to the patient and you have an opinion or preference, be sure to participate and make it known to those asking for input.
In the end it matters not so much how the person under your care is labeled as much as how you perform your nursing function. So always remember to do your professional best and never forget to advocate for your patient whenever the need arises. As long as we hold our nursing tenets near and dear to our hearts and express this conviction through our actions, we’ll always remember that the person we care for is an individual, not some object to be acted upon. Geneviève M. Clavreul RN, Ph.D., is a healthcare management consultant who has experience as a director of nursing and as a lecturer of hospital and nursing management. This article is from workingnurse.com
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FROM THE MEMBERS

This is Decubqueen's invention...which she is now selling. she is keeping the medical supplies section, tho. www.accu-ruler.com for pictures/ ordering, etc.
WASHINGTON D.C., June 8, 2009 -- Accu-Ruler has been selected for the 2009 Best of Macon Award in the Medical Apparatus & Supplies category by the U.S. Commerce Association (USCA).
The USCA "Best of Local Business" Award Program recognizes outstanding local businesses throughout the country. Each year, the USCA identifies companies that they believe have achieved exceptional marketing success in their local community and business category. These are local companies that enhance the positive image of small business through service to their customers and community.
Various sources of information were gathered and analyzed to choose the winners in each category. The 2009 USCA Award Program focused on quality, not quantity. Winners are determined based on the information gathered both internally by the USCA and data provided by third parties.
About U.S. Commerce Association (USCA)
U.S. Commerce Association (USCA) is a Washington D.C. based organization funded by local businesses operating in towns, large and small, across America. The purpose of USCA is to promote local business through public relations, marketing and advertising.
The USCA was established to recognize the best of local businesses in their community. Our organization works exclusively with local business owners, trade groups, professional associations, chambers of commerce and other business advertising and marketing groups. Our mission is to be an advocate for small and medium size businesses and business entrepreneurs across America.
SOURCE: U.S. Commerce Association CONTACT: U.S. Commerce Association Email: PublicRelations@us-ca.org URL: http://www.us-ca.org
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MEDICAL NEWS

Upcoming ISMP ( The Institute for Safe Medication Practices) teleconferences
October 6 - Beyond the 5 Rights: A Safety Bolus for Nursing Leadership
Are nurse leaders in your organization worried about the risk of drug administration errors? Are they concerned that the “5 Rights” alone will not keep patients safe? Don’t let a medication-related sentinel event be your wake-up call! Learn where risk is present but “hidden” in your drug administration system, and discover the error-reduction strategies that can reduce the risk of harmful errors. Speakers will also discuss common at-risk behaviors that lead to errors and the nurse leader’s role in establishing a learning culture.
October 15 - Preventing Errors with Insulin: A Multidisciplinary Approach
While the number of people with diabetes mellitus rises at alarming rates, insulin use and the risk of errors are also increasing. ISMP invites nurses to join us for this important presentation during which we will explore the current trends in insulin therapy (including use of insulin pens), barriers to optimal therapy and safety, common errors that occur with insulin, and error prevention strategies.
For details on both programs, visit: www.ismp.org/educational/teleconferences.asp.
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SILVER SPRING, MD – Texas Governor Rick Perry (R) is expected to sign into law by the end of August a bill that would prohibit mandatory overtime for nurses. A similar law banning mandatory OT for nurses in Pennsylvania went into effect July 1st of this year.
Many states have varying degrees of restriction on overtime, but the common denominator is some level of protection for nurses who refuse to work in excess of an agreed-upon, posted schedule, said Janet Haebler, RN, associate director of State Government Affairs for the American Nurses Association.
The state bills and state nurses associations are focusing on involuntary versus voluntary OT, and not on prescriptions on number of hours worked, Haebler stressed. For example, a 15-hour shift in one department may be acceptable and not as strenuous as a 15-hour shift in an ICU department.
Nursing licenses deem that nurses will provide safe and competent care. Mandatory OT may jeopardize a nurse’s ability to provide that care, Haebler said. With these new laws in place, nurses will be able to refuse OT and not have to endure retaliation from the hospital or face the state board of nursing for neglect or abandonment of care.... http://www.healthcarefinancenews.com/news/texas-pennsylvania-prohibit-mandatory-overtime-nurses
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DEA Releases Letter (At last, this is at least a start ) The following update is provided by the American Society of Consultant Pharmacists (ASCP):On August 7, the Drug Enforcement Administration (DEA) issued a "Dear Practitioner" letter in response to industry requests for specific guidance on its rules and policies governing the prescribing and dispensing of controlled drugs for nursing home residents and hospice patients.In recent investigations, the DEA has threatened long term care pharmacies with fines and enforcement actions based upon practices that have long been the accepted standard of care. The DEA's letter reiterates the rules that permit a pharmacist to dispense a CII drug upon a practitioner's verbal order, but does not address:
Who can be the agent of the practitioner
Whether chart orders constitute valid prescription drug orders
What constitutes compliance with DEA's interpretation of the "nurse as agent" for CIII-V controlled drugs
The DEA offers no guidance on how pharmacies, practitioners, and facilities can comply with the DEA's interpretations, given the needs of nursing home residents and hospice patients who must receive appropriate pain medication without delay. A copy of the DEA's letter, can be accessed at the ASCP website. http://www.ascp.com/advocacy/federal/upload/Dear%20Practitioner%20letter.pdf

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The Health and Human Services Department issued regulations last week concerning the HIPAA breach notifications requirements enacted as part of the stimulus bill earlier this year.The American Recovery and Reinvestment Act of 2009 included changes to the Health Information Portability and Accountability Act, or HIPAA.The changes require covered entities to notify affected individuals when a privacy breach occurs. Previously, an entity only needed to try to limit the negative effects of a breach.Under the Act, if a breach affects more than 500 people, the covered entity must report the incident to HHS and the media; any breaches that affect less than 500 individuals must be reported to the Department on an annual basis.Notification must be given no later than 60 days after discovery of the breach, and if the breach includes 10 or more individuals with insufficient contact information, the covered entity must make a conspicuous posting on its website or provide notice in print and broadcast media. http://tinyurl.com/mzmml2
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INGLEWOOD, California (Reuters 8/13) - Inside an aging sports arena, where rows of dental chairs and a hospital smell have replaced the former Los Angeles Lakers basketball court, thousands of Americans are seeking free healthcare. Hundreds were turned away just on Tuesday, the first day of a weeklong clinic run by the nonprofit Remote Area Medical Volunteer Corp as part of its mission to provide free health, dental and eye care in needy spots around the world.
It marks the first time in RAM's (Remote Area Medical Volunteer Corp) 25 years that it has gone to a major U.S. metropolitan area -- a reminder that even in Los Angeles, with world-class doctors and hospitals, many do not have access to affordable healthcare.
RAM is apolitical, but its mobile medical center has sprung up in the working-class LA suburb of Inglewood against the backdrop of an increasingly bitter public debate over President Barack Obama's proposed overhaul of the U.S. healthcare system... http://www.reuters.com/article/healthNews/idUSTRE57C0PE20090813?feedType=nl&feedName=ushealth1100
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INTERESTING READING

Please remember that the REUTERS articles are usually good for only 30 days
Gold nanotech breath test may detect lung cancer early LONDON (Reuters 8/30) - A sensor made with gold nanoparticles can detect lung cancer in a patient's breath and may offer a diagnosis before tumors show up on an x-ray, Israeli scientists said on Sunday.
The device, which the developers say would be cheap enough for everyday use by family doctors, detected lung cancer with 86 percent accuracy and may offer a way to screen for a disease not usually diagnosed until it has spread and is no longer curable.
It uses sensors based on gold nanoparticles to detect specific compounds -- volatile organic compounds (VOC) -- that lung cancer patients have in high levels in exhaled breath.... http://www.reuters.com/article/healthNews/idUSTRE57T1MF20090830?feedType=nl&feedName=ushealth1100
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Not feeling like much of an athlete these days? Eat an onion. New research suggests that quercetin -- an antioxidant found in onions (and tea, and broccoli, and apples) -- may help your body work harder longer. Taking a Cue from Quercetin The small study in question compared healthy college students on stationary bikes. Those taking quercetin supplements pedaled 14 percent longer than the placebo group. Still, it’s not yet clear how this information translates into real-world use, because the supplement takers were getting really large doses -- about 500 milligrams twice a day. That is far more than a person gets in a regular diet. Still, the results are pretty impressive, especially considering how much fitter the students were able to get with little effort. http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/9173 (Think I will find the pill, instead.....lol )
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LOS ANGELES - A new generation of blood tests can quickly and reliably -up to 96 percent accurate- show if a person is having a heart attack soon after chest pains start — a time when current tests are not definitive, two studies found.
The newer, sensitive tests give a much better way to tell who needs help fast. Each year, 15 million people in the United States and Europe go to emergency rooms with symptoms of a heart attack, but most are not truly suffering one.... http://www.msnbc.msn.com/id/32570276/ns/health-heart_health/
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An experimental heart drug being developed by AstraZeneca PLC significantly outperformed the blockbuster pill Plavix in a big clinical trial, setting the stage for a potential three-way battle in a $9 billion market for anticlotting medicines.
The drug, Brilinta, reduced the combination of heart attacks, strokes and death from cardiovascular causes by 16% compared with Plavix, researchers said. In an unusual achievement, the benefit came without an increase in major bleeding complications. The study also found that Brilinta reduced deaths from any cause compared with Plavix, a first in a major study of agents that prevent blood platelets from clotting, researchers said.... http://online.wsj.com/article/SB125161205972369947.html (before you scan and leave this article....Plavix is the one for anyone with stents)
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RANDOM FACT The strongest muscle in the body is the tongue.
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NEW YORK (Reuters Aug 12) - During an outbreak of varicella in an elementary school in Arkansas, students who were vaccinated once or twice still came down with the illness, though their symptoms were mild.
Furthermore, vaccine effectiveness was no better among those who received two inoculations prior to the outbreak than those who received only one, researchers report in the Pediatric Infectious Disease Journal for August. The CDC study found vaccine efficacy was 85.4% for one dose and 89.1% for two doses, not significantly different. Researchers suggested the two-dose recommendation for children, which began in 2006, may need to be reassessed.... http://www.medscape.com/viewarticle/707373
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HANDY HINTS: Clean Glass - Rub glass with a cut lemon or soak in lemon juice and water to add sparkle back to dull glass. This is especially effective with cloudy coffee pots, pitchers, or decanters.
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The following is the complete abstract...the pdf is for sale. Interesting and true, right?
Health promotion in nurses: Is there a healthy nurse in the house Applied Nursing Research, 07/23/09 The purpose of this pilot study was to examine the health-promoting lifestyle behaviors of acute-care nurses using the Health Promotion Model. Statistical analysis of 149 returned Health-Promoting Lifestyle Profile II surveys indicates areas of weakness in stress management and physical activity. No significant difference is found between unit, demographic factors, and subscale scores at the p < .01 level, but medical–surgical nurses consistently scored better than the critical-care nurses in health promotion. Findings support the need for the development of holistic nursing interventions to promote self-care in the identified areas. Strategies include educational/experiential classes in holistic nursing; individualized unit-based activities fostering stress management, such as massage, reflexology, and imagery; and development of an employee wellness program. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WB4-4WSHDSJ-6&_user=10&_coverDate=08%2F31%2F2009&_rdoc=12&_fmt=high&_orig=browse&_srch=doc-info(%23toc%236700%232009%23999779996%231320073%23FLA%23display%23Volume)&_cdi=6700&_sort=d&_docanchor=&_ct=14&_acct=C000050221&_version=1&_urlVersion=0&_ userid=10&md5=cab9eed06ae27ee817fb7f05f98278bf
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HANDY HINTS Extend your vacuum's reach by flattening a paper towel tube and taping it to the end of the crevice tool. You'll gain extra reach and still have suction power.
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Nurses help invent High-tech gadgets Healthcare technology is no longer the domain of nursing informatics and IT specialists, according to Susan K. Newbold, RN-BC, PhD, FHIMSS, FAAN, founding member of the Capital Area Roundtable on Informatics in Nursing (CARING). Nurses in many areas and specialties are getting involved with developing and implementing cutting-edge technologies and tools that are revolutionizing the way they work while improving safety and quality of care for patients. ... http://news.nurse.com/article/20090810/FL01/308100029/
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Osteoporosis drugs effective in killing flu viruses HONG KONG (Reuters 8/14) - Two existing drugs used to treat osteoporosis may be effective in killing influenza viruses, including the new H1N1 swine flu and the H5N1 bird flu viruses, researchers in Hong Kong have found....
http://www.reuters.com/article/healthNews/idUSTRE57D1SJ20090814?feedType=nl&feedName=ushealth1100
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CHICAGO (Reuters 8/13) - Improvements in cancer screening and better treatments have resulted in steady declines in cancer death rates over the past three decades, U.S. researchers said on Thursday. They said younger adults -- those aged 35 to 45 years old -- have experienced the steepest declines in cancer death rates, but all age groups have shown some improvement.... http://www.reuters.com/article/healthNews/idUSTRE57C0LW20090813?feedType=nl&feedName=ushealth1100
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Brussels (AFP) 8/25/09– Give Flu Vaccines to Nurses, Chronic Sick First Pregnant women, health workers and people with underlying health problems should receive swine flu vaccines ahead of the rest of the population, EU experts recommended Tuesday.
There was no call for children to be prioritised. A previous idea to include young people in the list of those to be vaccinated first "was abandoned", an EU source said, without giving a reason.
"All persons from six months old with underlying chronic conditions (e.g. chronic respiratory diseases; chronic cardiovascular diseases and persons with congenital or acquired immunodeficiency)," should be vaccinated first, the experts from the 27 EU nations said in a written statement.... http://news.yahoo.com/s/afp/20090825/hl_afp/healthflueu_20090825173013
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CHICAGO (Reuters 8/27/09) - For women, feelings of hopelessness are not just unfortunate, they are a stroke risk, U.S. researchers said on Thursday. They said otherwise healthy women who are chronically hopeless are more likely to have a buildup of plaque in their neck arteries that can trigger a stroke.
"These findings suggest that women who experience feelings of hopelessness may have greater risk for future heart disease and stroke," said Susan Everson-Rose of the University of Minnesota Medical School, whose study appears in the journal Stroke.... http://www.reuters.com/article/healthNews/idUSTRE57Q66720090827?feedType=nl&feedName=ushealth1100
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New fat-fighting drug has anti-diabetes action, too WASHINGTON (Reuters 8/27/09) - Researchers searching for a cure for obesity said on Thursday they have developed a drug that not only makes mice lose weight, but reverses diabetes and lowers their cholesterol, too.
The drug, which they have dubbed fatostatin, stops the body from making fat, instead releasing the energy from food. They hope it may lead to a pill that would fight obesity, diabetes and cholesterol, all at once.
Writing in the journal Chemistry and Biology, Salih Wakil of Baylor College of Medicine in Texas, Motonari Uesugi of Kyoto University in Japan and colleagues said the drug interferes with a suite of genes turned on by overeating. http://www.reuters.com/article/healthNews/idUSTRE57Q62E20090827?feedType=nl&feedName=ushealth1100
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Cooke E et al. – Nurses desired training, particularly in practical approaches when working with young people who self–harm, however, analysis suggested that they also needed underpinning theoretical knowledge. Therefore, this study highlights the need for self–harm training for school nurses, incorporating both practical approaches and theoretical knowledge, to ensure that young people who self–harm receive an effective, high–standard service. Journal of Child Health Care, Vol. 13, No. 3, 260-274 (2009) DOI: 10.1177/1367493509337440
http://chc.sagepub.com/cgi/content/abstract/13/3/260
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As students head back to school this fall, more than 66,000 nurses are resuming their roles in school clinics across the country. Today nurses have assumed responsibility for most activities related to staff and student health "School nurses are on the cutting edge of the public health mission by detecting abnormal health patterns in schools and alerting local public health departments," said Martha Dewey Bergren, DNS, RN, NCSN, FNASN, FASHA, director of research, National Association of School Nurses (NASN). "Since a school nurse identified the first U.S. case of the H1N1 virus earlier this year, school nurses have been getting even more recognition as essential healthcare professionals." ...http://www.jjnursingnotes.com/AUGUST09/
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School RNs Plan to Reduce H1N1 Cases this Fall Although the media frenzy over H1N1 waned this summer, the virus has not finished its run. In July, the Centers for Disease Control and Prevention reported 263 Americans died from the virus, including 72 in New York and New Jersey. The area isn’t near the highest number of reported cases, but at 57 New York leads the nation in the highest number of deaths, with new cases continuing to rise. Because the virus has a strong presence in the Greater New York area, school nurses must be ready for what’s to come.“Just as they did this spring, our school nurses are working closely with school principals and teachers,” says Anna Chu, RN, MPH, NA-BC, director of clinical programs at Lutheran Family Health Centers School-based Health Programs in Brooklyn, N.Y. During the height of the outbreak, Chu says, three of LFHC’s participating schools closed. “They were closed for three days,” she says. “The custodians were able to clean the schools and install hand sanitizers.” ... http://news.nurse.com/article/20090824/NY01/108240028
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RANDOM FACT: Women blink nearly twice as much as men.
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As waistlines widen......the brain shrinks !! TUESDAY, Aug. 25 (HealthDay News) -- For every excess pound piled on the body, the brain gets a little bit smaller.
That's the message from new research that found that elderly individuals who were obese or overweight had significantly less brain tissue than individuals of normal weight.
"The brains of obese people looked 16 years older than their healthy counterparts while [those of] overweight people looked 8 years older," said UCLA neuroscientist Paul Thompson, senior author of a study published online in Human Brain Mapping.... http://www.healthday.com/Article.asp?AID=630364
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CMS' Five Star Nursing Home Rating System Called Into Question ... PR Newswire Fortunately, CMS' Nursing Home Compare System that was in place before Five Star remains available to consumers as a tool for nursing home selection during ... http://tinyurl.com/lv73qj
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(Multiplication) RANDOM FACT:
111,111,111 x 111,111,111 = 12,345,678,987,654,321
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Understanding Malpractice: A Guide for Nephrology NursesNephrology Nursing Journal, 08/27/09 Larson K et al. – Malpractice and disciplinary actions against nurses, physicians, and other healthcare providers demonstrate a gradual escalation in the number of cases involving both nonspecialized registered nurses and advanced practice nurses. In advocating for the nephrology nursing community, nurses must understand the process and impact of malpractice. This education begins with a familiarization of legal terms, demystifying the steps of litigation, and exploring the emotional aftermath of a lawsuit.... http://www.annanurse.org/download/reference/journal/JA2009/36375377.pdf
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Thanks to Barbara (BAcello@spamcop.net ), who is a constant contributor, of the following:
Hospitals more proactive about medical errors Hospitals are being more open with patients and families about medical errors, apologizing and implementing systemic changes to help prevent similar mistakes in the future. There is evidence showing patients involved in this new, more open process are less likely to sue, but hospital officials say the long-term solution is to improve hospital safety records....
http://online.wsj.com/article/SB10001424052970204884404574363043088675838.html ***************
Virus blamed for Half of Penile Cancers LONDON (Reuters 8/24) - A sexually transmitted virus that causes cervical cancer is also to blame for half of all cases of cancer of the penis, Spanish researchers said on Tuesday.
The finding suggests already available human papillomavirus (HPV) vaccines for cervical cancer are also likely to be effective in the fight against penile cancer, doctors from the Catalan Institute of Oncology in Barcelona said.... http://www.reuters.com/article/healthNews/idUSTRE57N5MD20090824?feedType=nl&feedName=ushealth1100
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RANDOM FACT Dolphins sleep with one eye open
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Weight Lifting Can Ease Arm Swelling in Breast Cancer Survivors WEDNESDAY, Aug. 12 (HealthDay News) -- Lifting weights can help prevent flare-ups of lymphedema, a painful swelling of the arm that often occurs after breast cancer surgery, new research shows.
The finding runs counter to what women have been told for years -- that they should avoid stressing the arm during strength training or other exercise because muscle strain can cause lymphedema to worsen. The study is published in the Aug. 13 issue of the New England Journal of Medicine. http://www.healthday.com/Article.asp?AID=629968
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RANDOM TIDBITS Monarch butterflies journey from the Great Lakes to the Gulf of Mexico, a distance of about 2,000 miles, and return to the north again in the spring.
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Butterflies cannot fly if their body temperature is less than 86 degrees.
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Many butterflies can taste with their feet to find out whether the leaf they sit on is good to lay eggs on to be their caterpillars' food or not.
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(This article is kinda long...but looks interesting) What can an RN do to keep from falling prey to an overload of stressors? Plenty! Lachman offers some relevant coping strategies:
Reframe - Change your perceptions. "Instead of thinking, 'Oh no, three patients,' reframe the thought to, 'Wow, three admissions! That's job security!" While you can't always change what happens, you can change how you react.
Avoid catastrophizing. Don't invent problems that may never occur. In our opening scenario, the RN took three admissions and turned them into her husband missing an interview. She was crossing imaginary bridges. "I have a sign over my desk," said Lachman. "It says: 'When you change the way you look at things, the things you look at change.'"
Avoid personalizing. "Don't think everything people say or do is a reaction to you. It's not," said Lachman. "If a patient screams at you, it's because he's stressed, or scared or feeling discomfort. It's not about you."
Catch stress early. .... http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=204287
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Juice for your bladder On the next hot summer afternoon, forgo the lemonade stand and choose an icy glass of cranberry juice instead. Your bladder will thank you. A review of research shows that cranberry juice helps to protect bladders from infection.Beat Bladder Blues In two studies, daily intake of cranberry products significantly reduced the incidence of urinary tract infections over the course of 12 months. How much is enough? Women in one study drank about 250 milliliters of juice daily. That’s about 1 liquid cup....
http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/9152
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RANDOM TIDBITS If you are right handed, you will tend to chew your food on your right side. If you are left handed, you will tend to chew your food on your left side.
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The pupil of the eye expands as much as 45 percent when a person looks at something pleasing.
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Noninvasive Ventilation Cuts Risk of Repiratory Failure Early, noninvasive mechanical ventilation may help prevent complications in patients with chronic respiratory conditions who experience hypercapnia when they first try to breathe on their own after intubation, a small study found. http://www.medpagetoday.com/Pulmonary/SmokingCOPD/15506
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Give your blood pressure this daily treat........chocolate. Just 30 calories per day of chocolate may be enough to help reduce your blood pressure. As far as serving sizes go, that’s about a Hershey’s Kiss worth. But you have to eat the right kind of chocolate, according to Joseph Maroon, MD, author of The Longevity Factor. He recommends nonsweetened or minimally sweetened dark chocolate that’s at least 70 percent cocoa.
Crazy for Cocoa Dark chocolate can also help reduce atherosclerosis and blood clotting, aid blood flow, contribute to an overall reduction in heart attacks, and improve cholesterol levels, according to Maroon. And it’s all thanks to the powerful antioxidants found in the cocoa bean.
http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/9061
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First Wi-Fi pacemaker in US NEW YORK (Reuters 8/10) - After relying on a pacemaker for 20 years, Carol Kasyjanski has become the first American recipient of a wireless pacemaker that allows her doctor to monitor her health from afar -- over the Internet. When Kasyjanski heads to St. Francis Hospital in Roslyn, New York, for a routine check-up, about 90 percent of the work has already been done because her doctor logged into his computer and learned most of what he needed to know about his patient.... ttp://www.reuters.com/article/healthNews/idUSTRE5790AK20090810?feedType=nl&feedName=ushealth1100
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Eat these treats and live longer Getting older is inevitable. But how fast you get there is almost completely in your hands. So start putting on the brakes by eating more of these: nuts and berries. Research shows that foods high in vitamin E (like almonds) and vitamin C (like strawberries) may help slow aging on a cellular level. How Long Are Your Telomeres? In a study, a vitamin C- and E-rich diet was associated with having longer telomeres....... http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/9203
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Make Low-Carb Healthier with this Switch Here's what worked with the low-carb Atkins diet: Lots of people lost loads of pounds. And here's what didn't work . . : It gave cardiologists the shivers. But new research suggests you can peel off pounds and improve your heart health on an Atkins-esque diet . . . you just have to get your protein from plants instead of animals.... (I have bought the book, intend to try it) http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/9181
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Eat this for Damage Control As if broccoli didn't already have enough going for it, it just picked up another honor. Sulforaphane, a compound in broccoli, was given the Golden Green award for helping to protect your organs against blood sugar damage. (Just kidding. There is no such award, but read on and you'll find out why we think it deserves one.)When your blood sugar (glucose) is chronically high, the cells of your heart, eyes, kidneys, and nerves take a big hit. Hit after hit leads to permanent damage. When researchers looked at what glucose would do to blood vessel cells in a petri dish, they saw that sulforaphane muzzled damage -- or oxidation -- by as much as 73%.... http://realage.typepad.com/youdocsdaily/2009/04/eat-this-for-damage-control.html
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RANDOM FACT As part of a charity event, 500 cats were spayed and neutered in the cafeteria of an elementary school. School was cancelled for days and $10,000 was spent on cleaning and sterilizing the room. (Why there, among other questions)?
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Handy Hint: Make ironing go faster with aluminum foil. You can make ironing go faster by placing a sheet of aluminum foil under your ironing board cover as it will help transfer the heat to the items you are ironing and quicken your work.
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Worst Dollar Store Deals (by Unit Cost)-- Wallet Pop 10 Dollar Store Deals to Skip
Dollar stores are great places to find bargains on dozens of household needs but sometimes you're being duped into less of a bargain than you're expecting! Comparison shopping is always a good idea, no matter where you shop so, notepad in hand, WalletPop's dollar store diva, Marlene Alexander, set out to compare the prices of ten items from the dollar store with prices at other discount stores....
http://www.walletpop.com/economizer/worst-dollar-store-deals?icid=mainhtmlws-maindl7link5http%3A%2F%2Fwww.walletpop.com%2Feconomizer%2Fworst-dollar-store-deals
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RANDOM FACT A shark can detect one part of blood in 100 million parts of water.
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Aspirin cuts colon cancer death risk: U.S. study CHICAGO (Reuters 8/11) - Taking aspirin not only can help keep colon cancer from coming back, but it also can lower the risk of dying from the disease, U.S. researchers said on Tuesday....
http://www.reuters.com/article/healthNews/idUSTRE57A6F120090811?feedType=nl&feedName=ushealth1100
************************ HANDY HINT: If you get a cut that bleeds, just take some pepper and sprinkle it lightly on the cut. It will stop bleeding immediately and does not burn. (Rationale????)
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Preschool thinking skills linked to weight (Reuters 8/12) Smarter youngsters may be less apt to be overweight, a new study hints. In the study, researchers from Spain found that preschool kids with above average language, number, and puzzle solving skills were less likely to be overweight two years later when they were old enough to enter school....... http://www.reutershealth.com/archive/2009/08/12/eline/links/20090812elin003.html
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RANDOM TIDBITS Pi is the most recognized mathematical constant in the world. Scholars often consider Pi the most important and intriguing number in all of mathematics. The symbol for pi (TT) has been used regularly in its mathematical sense only for the past 250 years.
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In the Greek alphabet, TT (piwas) is the sixteenth letter. In the English alphabet, p is also the sixteenth letter.
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Low Choline Level in Pregnancy Tied to Birth Defects A study found the risk of anencephaly and spina bifida increased in newborns when their mothers had low levels of choline during pregnancy. Researchers said women with the lowest blood choline levels were 2.4 times more likely to have infants with neural tube defects than those with average levels.... http://news.yahoo.com/s/hsn/20090815/hl_hsn/lowcholinelevelinpregnancytiedtobirthdefects
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Screening Could Lead to More Potent Cancer Drugs Researchers have discovered a way to identify drugs that can specifically attack and kill cancer stem cells, a finding that could lead to a new generation of anticancer medicines and a new strategy of treatment.
Many researchers believe that tumor growth is driven by cancerous stem cells that, for reasons not understood, are highly resistant to standard treatments. Chemotherapy agents may kill off 99 percent of cells in a tumor, but the stem cells that remain can make the cancer recur, the theory holds, or spread to other tissues to cause new cancers. Stem cells, unlike mature cells, can constantly renew themselves and are thought to be the source of cancers when, through mutations in their DNA, they throw off their natural restraints.... http://www.nytimes.com/2009/08/14/health/research/14cancer.html?th&emc=th
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More evidence that fish is brain food NEW YORK (Reuters 8/14) - Older adults in developing countries who regularly eat fish seem to have a lower risk of dementia, a new study suggests.
Researchers found that among nearly 15,000 older adults living in China, India or one of five Latin American countries, the odds of having dementia generally declined as fish consumption rose.
For each increase in participants' reported fish intake -- from never, to some days of the week, to most or all days of the week -- the prevalence of dementia dipped by 19 percent.... http://www.reuters.com/article/healthNews/idUSTRE57D39Z20090814?feedType=nl&feedName=ushealth1100
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HUMOR SECTION
A doctor in Duluth wanted to get off work and go hunting, so he approached his assistant. 'Ole, I am goin' huntin' tomorrow and don't want to close the clinic. I want you to take care of the clinic and take care of all my patients.'
'Yes, sir!' answers Ole.
The doctor goes hunting and returns the following day and asks: 'So, Ole, how was your day?'
Ole told him that he took care of three patients. 'The first one had a headache so I gave him TYLENOL.'
'Bravo, Mate, and the second one?' asks the doctor.
'The second one had stomach burning and I gave him MAALOX, sir,' says Ole.
Bravo, bravo! You're good at this and what about the third one?' asks the doctor.
'Sir, I was sitting here and suddenly the door opens and a woman enters.Like a flash, she undresses herself, taking off everything including her underware and lies down on the table and shouts: HELP ME - I haven't seen a man in over two years!!
'Tunderin' Yehosaphat, Ole, what did you do?' asks the doctor..
'I put drops in her eyes!!
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !

This is new as of 8/9/09, and although it contains many resources, it is not fully up & running yet. It is multidisciplinary, but some disciplines have no content yet. You may want to bookmark it and check back in a few weeks.http://www.medlineuniversity.com/DesktopShell.aspx
Holistic & Complementary Therapies 18 Contact Hours Item #:N1110Half Price - $29.95 (Savings $30.00) In the last 20 years there has been a shift in the concept of healing in Western healthcare, and the support of complementary and alternative medicine has never been greater. This course is designed to facilitate and inspire experience with alternative and complementary therapies, while appreciating the role of holism in healing and stress management.

West Nile Virus Course 1 Contact Hours Item #:N1165Free Course with Purchase - $9.95 (Savings $5.00) The CDC estimates that about one million people in the U.S. have been infected with the West Nile Virus (WNV). This course provides an overview of WNV including history, diagnosis, treatment and prevention. Discover new options for protection against mosquito bites. get details >>

Orthopedic Nursing 30 Contact Hours Item #:N1086Super Saver - $29.95 (Save $40.00)Keep up on current orthopedic nursing practice and the nursing management of patients with common musculoskeletal disorders. A must-have course for any nurse engaged in orthopedic nursing practice. Includes bonus case studies! get details >>

Psychiatric Nursing 30 Contact Hours Item #:N1074Sale - $29.95 (Save $40.00)
Update your mental health skills and knowledge of current psychiatric nursing care. Chapters place a clinical emphasis on the nursing process utilizing case studies to help you develop expertise in writing care plans. Case studies and care plans are included throughout as bonus material! get details >>

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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.

www.accu-ruler.com (decubqueen@aol.com website)

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.nationalnurse3.blogspot.com/

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263
National Do Not Call Registry

If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

Master the Scholarship Game by Donna Cardillo, RN, MA
http://www.dcardillo.com/articles/scholargame.html

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Critical Thinking is More Than Problem Solving
Critical Thinking: Not Usually Rapid Fire
Should Clinical Courses Get a Letter Grade?
Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/

Emerging Infectious Diseases Journal Homepage CDC EID This is in the expedited release section of EIN: Nurses' Contacts and Potential for Infectious Disease Transmission http://www.cdc.gov/ncidod/EID/index.htm The 15 page download is at: http://www.cdc.gov/eid/content/15/9/pdfs/08-1475.pdf


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MEDICAL RECALLS
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Tumor Necrosis Factor (TNF) Blockers (marketed as Remicade, Enbrel, Humira, Cimz

UPDATED 08/31/2009] Supplemental Q&As added. [Original Posting 08/04/2009]

FDA notified healthcare professionals that it has completed its analysis of tumor necrosis factor (TNF) blockers and has concluded that there is an increased risk of lymphoma and other cancers associated with the use of these drugs in children and adolescents. This new safety information is now being added to the Boxed Warning for these products. FDA has also identified new safety information related to the occurrence of leukemia and new-onset psoriasis in patients treated with TNF blockers. The current prescribing information for TNF blockers does contain a warning for malignancies, but does not specifically mention leukemia. FDA is also requiring updates to the current Medication Guide to help patients understand the risks associated with TNF blocker therapy. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm175843.htm
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Intelence (etravirine) Tibotec Therapeutics and FDA notified healthcare professionals of revisions to the WARNINGS AND PRECAUTIONS section of the prescribing information for Intelence (etravirine). There have been postmarketing reports of cases of Stevens-Johnson syndrome, toxic epidermal necrolysis and erythema multiforme, as well as hypersensitivity reactions characterized by rash, constitutional findings, and sometimes organ dysfunction, including hepatic failure. Intelence therapy should be immediately discontinued when signs and symptoms of severe skin or hypersensitivity reactions develop. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm180579.htm
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FDA notified healthcare professionals and patients that it is reviewing new safety information regarding reports of liver-related adverse events in patients taking orlistat. Orlistat is marketed in the United States as a prescription product, Xenical, and as an over-the-counter (OTC) product, Alli. Between 1999 and October 2008, 32 reports of serious liver injury, including 6 cases of liver failure, in patients using orlistat were submitted to FDA’s Adverse Event Reporting System. The most commonly reported adverse events described in the 32 reports of serious liver injury were jaundice, weakness, and abdominal pain. FDA is reviewing other data on suspected cases of liver injury submitted by the manufacturers of orlistat, analysis of these data is ongoing and no definite association between liver injury and orlistat has been established at this time. FDA is not advising healthcare professionals to change their prescribing practices with orlistat. Consumers currently taking Xenical should continue to take it as prescribed and those using over-the-counter Alli should continue to use the product as directed. FDA urges both healthcare professionals and consumers to report side effects from the use of orlistat (Alli and Xenical) to FDA's MedWatch Adverse Event Reporting program. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm180025.htm
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WASHINGTON (Reuters) - Stolen vials of Novo Nordisk insulin for diabetics may still be on the market and may be harmful, U.S. regulators warned on Wednesday.
"Evidence gathered to date suggests that the stolen insulin was not stored and handled properly and may be dangerous for people to use," a Food and Drug Administration statement said.
The FDA warned in June that 129,000 vials of Novo's long-acting Levemir insulin had been stolen in North Carolina. Only about 2 percent has been recovered, the agency said... http://www.reuters.com/article/healthNews/idUSTRE57P4EG20090826?feedType=nl&feedName=ushealth1100
Follow up:

Levemir Insulin (Novo Nordisk) [UPDATED 08/26/2009] FDA is reminding the public that stolen vials of the long-acting insulin Levemir made by Novo Nordisk Inc. still may be on the market. Evidence gathered to date suggests that the stolen insulin was not stored and handled properly and may be dangerous for people to use. FDA has received multiple reports of patients who suffered an adverse event due to poor control of glucose levels after using a vial from one of the stolen lots. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm166359.htm
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Stabilet Infant Warmer models 200, 300, 1250, 1500, 200/3000, 2000, 2200/3200, 3 [UPDATED 08/25/2009; original alert 07/22/2009] FDA notified healthcare professionals of a Class 1 recall of these models of the Stabilet infant warmer because these out-of-date devices may cause serious injury to infants and caregivers due to the possibility that the warmer might be the ignition source for a fire. On July 20, 2009, Draeger sent a recall letter to all known customers, requested customers remove the affected devices from service, remove the heating element and the power cord to make the device unusable once removed from service and emphasized these devices are not to be used, donated or sold for any other purpose. Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious injury or death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm173239.htm
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Accusure Insulin Syringes [31G, 1/2 cc and 1 cc] Qualitest Pharmaceuticals and FDA notified patients and healthcare professionals of a voluntary nationwide recall of two lots of Accusure Insulin Syringes. The syringes in these lots have been found to have needles which can detach from the syringe. When the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into the syringe, or remain in the skin after an injection. Consumers who have any recalled Accusure Insulin Syringes (31 G –Short Needle-either 1/2 cc or 1 cc, lot number 6JCB1 or lot number 7CPT1) should stop using them and contact Qualitest at 1-800-444-4011 for product replacement instructions. The lot number can be found on the white paper backing of each individual syringe. These recalled products were distributed from January 2007 through June 2008 to wholesalers and retail pharmacies nationwide (including Puerto Rico). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm179955.htm
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FDA notified healthcare professionals of the possibility of falsely elevated blood glucose results when using GDH-PQQ glucose test strips on patients who are receiving therapeutic products containing certain non-glucose sugars. These sugars can falsely elevate glucose results, which may mask significant hypoglycemia or prompt excessive insulin administration, leading to serious injury or death.
GDH-PQQ glucose monitoring measures a patient’s blood glucose value using methodology that cannot distinguish between glucose and other sugars. Certain non-glucose sugars, including maltose, xylose, and galactose, are found in certain drug and biologic formulations, or can result from the metabolism of a drug or therapeutic product. for the FDA Public Health Notificationl's a list of GDH-PQQ Glucose Test Strips : http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm177295.htm
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Barr Laboratories, Inc. issued a voluntary recall of Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate (Mixed Salts of a Single Entity Amphetamine Product) 20mg Tablets, 100 count bottles, lot number 311756. The product is being recalled because the affected lot may contain some tablets exceeding weight requirements which may lead to super-potent tablets.
Clinically significant adverse reactions to a supratherapeutic dose could include cardiovascular, neurologic, psychiatric and gastrointestinal reactions. Customers who have this lot in their possession are instructed to cease using the product and return it to their pharmacy/distributor. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm177434.htm
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Hospira, Inc. Device Recall Hospira and FDA notified healthcare professionals and patients of a nationwide recall of devices that have defective AC power cords in response to customer reports of sparking, charring and fires on the plug of the power cord. Hospira's investigation of these reports determined that the power cord's prongs may crack and fail at or inside the plug. The potential risks from this power cord failure include electrical shock, delay in setup and therapy, interruption of therapy, device failure, and fires which may also occur in an oxygen-rich environment. Depending on the device and therapy, these failures may lead to potential serious injury or death.
Users with affected power cords that have bent or cracked prongs, burnt plastic or excessive wear and tear should discontinue use immediately and contact their Hospira sales representative or Hospira Technical Support Operations at 1-800-241-4002 (available from 6 a.m. to 4 p.m., Pacific time) for instructions on receiving replacement parts or devices.
For a list of the recalled devices http://www.fda.gov/Safety/Recalls/ucm178158.htm

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm179004.htm

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NURSING HINTS CORNER
Let your V be your guide Recently I was teaching a blind diabetic patient how to administer her insulin . When practicing, she would often miss the injection site and stick her fingers (which were holding the skin taut), instead.
So I made an injection guide by taping two tongue blades together at one end to form a V. Then, just before she was ready to inject herself, she placed the tongue blades on her thigh, felt the outline of the blades, and inserted the needle--right on target-- inside the V. Theresa Gilliland, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.25, Springhouse Corporation/www.springnetcom.
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
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NOTICE:
I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.......lol So please send me your new name/address, ok? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~

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.
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THOUGHT FOR THE DAY

"The budget should be balanced , the treasury should be refilled, public debt should be reduced, the arrogance of officialdom should be tempered and controlled, and the assistance to foreign lands should be curtailed lest we become bankrupt. People must again learn to work, instead of living on public assistance

Cicero, 55 BC (Rome)

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