PARADIGM BYTES Newsletter

PARADIGM BYTES Newsletter for Paradigm 97
March 12, 2011

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
New Monograph Aims to Increase Tdap Vaccination of Adults and Adolescents
OAKBROOK TERRACE, Ill. – February 1, 2011) Pertussis rates have increased over the last two decades, primarily in adolescents and adults who have waning immunity from previous pertussis vaccinations or infection; however, it is infants who are too young to be vaccinated that bear the burden of severe pertussis. Low vaccination rates against pertussis among adolescents and adults are a contributing factor to the rise of the highly contagious and sometimes deadly disease, commonly known as whooping cough.

A new monograph from The Joint Commission, “Tdap Vaccination Strategies for Adolescents and Adults, Including Health Care Personnel – Strategies from Research and Practice,” aims to help health care organizations implement or enhance tetanus, diphtheria and acellular pertussis (Tdap) vaccination programs for adolescents and adults, including health care workers who can both acquire pertussis from and spread it to patients, other staff and family members.

Pertussis is the most common vaccine-preventable childhood disease and can be more severe than often assumed. Most pertussis-related deaths occur in infants younger than 4 months. All infants less than 6 months of age, and any infant who has not yet received three doses of pertussis-containing vaccine, are especially vulnerable to pertussis infection and often require hospitalization for supportive care for coughing spasms and feeding difficulties. Adolescents and adults with pertussis generally have mild symptoms that do not require hospitalization.

The Tdap vaccine has been available only since 2005 and information from the Centers for Disease Control and Prevention (CDC) shows that vaccination rates for adults are very low. Tdap vaccination rates among health care workers stands at about 16 percent, according to the CDC, despite the evidence that Tdap improves patient outcomes and reduces staff illness and absenteeism.

The CDC reports that adults may not realize that some of the vaccines they received in childhood will not protect them throughout their lives or that newer vaccines have been developed since they were first immunized. In addition, some adults simply were never vaccinated. These adolescents and adults play a significant role in the transmission of pertussis to vulnerable infants at home, in the community, and in health care and day care settings.

The monograph, which was supported by an educational grant from sanofi pasteur, was produced and published in partnership with infection prevention and infectious disease leaders from the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA) and the National Foundation for Infectious Diseases (NFID).

“Recent pertussis outbreaks should be a reminder of how serious and contagious pertussis can be and the value of Tdap vaccination,” said Jerod M. Loeb, Ph.D., executive vice president, Division of Healthcare Quality Evaluation, The Joint Commission. “This monograph includes strategies that organizations can implement and provides a foundation to improve vaccination rates among key populations. It is also a timely reminder that vaccinations save lives.”

The monograph includes:

Information about pertussis and the Tdap vaccine;
Barriers to successful Tdap vaccination programs and strategies for overcoming them.
Evidence-based guidelines and literature that highlight practical Tdap vaccination strategies.
Examples of initiatives that organizations have used to establish or enhance their Tdap vaccination programs.
The Joint Commission solicited leading practices to incorporate into the monograph and received more than 80 submissions from health care organizations. A subset of submissions was evaluated by the project’s editorial review panel; ultimately, 17 submissions were included in the monograph.

Electronic copies of the monograph are available on The Joint Commission’s website and can be downloaded free of charge.

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Where's the Evidence?

Kennedy, Maureen Shawn AJN, American Journal of Nursing. 110(4):7, April 2010.

doi: 10.1097/01.NAJ.0000370131.78964.17

In my first job on a critical care unit at a busy urban hospital, RNs and nurse's aides coming on duty received shift reports during walking rounds with the charge nurse of the outgoing shift. On the medical–surgical floors, nurses going off duty gave report to their head nurse, who in turn reported to the incoming head nurse, who then reported to her staff. At another facility, all outgoing RNs gave report to all incoming RNs (aides weren't included) at the same time at the nurses' station. And on the units that practiced primary nursing, outgoing primary nurses audiotaped reports; their incoming counterparts listened to the tapes but rarely interacted with the nurses going off duty, although they had that option. These four methods for giving shift report shared two similarities. First, none was based on evidence demonstrating its effectiveness over any other. And second, none specified what patient information was to be included; that critical aspect was left up to the individual giving the report.

It's been well documented that poor communication during patient handoffs is a major contributor to medical errors. Indeed, since 2008, the Joint Commission has required that hospitals have a standardized approach to handoffs. But is there evidence supporting one approach over another?

In this issue, Lee Ann Riesenberg and colleagues from the Christiana Care Health System in Newark, Delaware, report the results of their systematic review of research regarding nursing handoffs, which seeks "to identify features of structured handoffs that have been shown to be effective." While the authors conclude that most of the studies they reviewed lacked rigor and call for higher quality research in this area, they did identify and categorize numerous barriers to and strategies for effective patient handoffs. These thought-provoking categories suggest several areas for further inquiry.

Patient handoffs are fundamental to the delivery of safe care. Surely it's within nursing's purview to study and improve the handoff process. Of course, this is just one of many areas being investigated by clinicians and institutions as part of evidence-based quality improvement (QI) efforts. AJN has published several reports on QI projects, notably in our Transforming Care at the Bedside series (September 2008 through August 2009) and more recently in our Cultivating Quality column. (We welcome manuscripts about QI projects, but require that they follow the Standards for Quality Improvement Reporting Excellence [SQUIRE] guidelines, available at www.squire-statement.org.)


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FROM THE MEMBERS

One of our members--Bob Hess--was at the White House two weeks ago (end of January). He had a session with Kathleen Sebelius. Check it out: http://www.whitehouse.gov/photos-and-video/video/2011/01/27/open-questions-state-union-and-health-care . Quite an honor, Bob!
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(In answer to this Random Fact, Wendie (WAHowland) wrote " I have a great recipe for dandelion pesto-- it's yummy and the major ingredient is FREE and pesticide-free in my yard.

If you are interested in getting the recipe, please write me, I have it . The Random Fact was: According to the U.S. Department of Agriculture, dandelions are more nutritious than broccoli or spinach, contain more cancer-fighting beta-carotene than carrots, and are a rich source of calcium, iron, magnesium, potassium, thiamine, riboflavin, lecithin, and dietary fiber!
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The Truth About Nursing will hold its first conference in the lively and historic city of New Orleans on April 15-17, 2011. Empowering Nurses and Improving Care Through Better Understanding of Nursing will help nursing leaders develop and focus their skills in interacting with others in ways that enhance respect for the profession. For a full agenda : http://www.truthaboutnursing.org/conferences/2011/events.html

To register: https://www.truthaboutnursing.org/sunshop/

To contact Sandy Summers for other info: ssummers@truthaboutnursing.org
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MEDICAL NEWS

Breast Implants: FDA Review Indicates Possible Association With A Rare Cancer FDA announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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Quadrivalent HPV Vaccine found effective in Males The quadrivalent human papillomavirus vaccine prevents the infection as well as the development of external anogenital lesions associated with the virus in boys and men, according to a report in the Feb. 3 issue of the New England Journal of Medicine.

It is likely that the vaccine will similarly cut down on human papillomavirus (HPV) transmission and prevent the anogenital cancer, intraepithelial neoplasia, recurrent respiratory papillomatosis, and cancer of the oropharynx that eventually arise from HPV infection, but "each of these potential outcomes must be directly demonstrated" in future studies, said Anna R. Giuliano, Ph.D., of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., and her associates.

Cause to Celebrate

This report "undoubtedly gives us cause to celebrate the extraordinary potential for HPV vaccination to improve health in both women and men," said Jane J. Kim, Ph.D.

The quadrivalent HPV vaccine prevented infections with the four strains covered by the vaccine and also prevented the development of external genital lesions, primarily genital warts. So not only can vaccination of boys and men bolster health benefits in girls and women by reducing transmission, "but there is now clear evidence that boys and men themselves can benefit directly," she said.

Vaccinating boys and men also is desirable because it distributes the burden of obtaining protection to people of both sexes, which is only fair, as both sexes are responsible for HPV transmission. And it would be particularly valuable for the high-risk subgroup of men who have sex with men, she noted.

Dr. Kim is in the department of health policy and management at Harvard School of Public Health, Boston. She reported no financial conflicts of interest. These comments were taken from her Perspective piece that accompanied Dr. Giuliano’s report (N. Engl. J. Med. 2011;364:393-5).

http://www.internalmedicinenews.com/newsletter/internal-medicine-news-e-newsletter/singleview40577/quadrivalent-hpv-vaccine-found-effective-in-males/fdc16c27dd.html

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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days


Sent in by Kurt Ullman ( kurtullman@SPRINTMAIL.COM ) Thanks !
After three years of exhaustive analysis led by a University of Alberta researcher, the list of known compounds in human blood has exploded from just a handful to more than 4,000. Right now a medical doctor analyzing the blood of an ailing patient looks at something like 10 to 20 chemicals," said University of Alberta biochemist David Wishart. "We've identified 4,229 blood chemicals that doctors can potentially look at to diagnose and treat health problems." ...
http://www.sciencedaily.com/releases/2011/02/110224145609.htm

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Heart failure therapy twice as effective in women (Reuters) Women derive twice the benefit from a device to treat heart failure in men, U.S. researchers said, underscoring the different ways in which men and women experience heart disease.
Women treated with a combination pacemaker and defibrillator device had a 70 percent reduction in heart failure compared with a 35 percent decline in men, they said. ... http://www.reuters.com/article/2011/02/07/us-heart-failure-device-idUSTRE71660R20110207?feedType=nl&feedName=ushealth1100
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RANDOM FACT: New York taxi drivers collectively speak 60 languages.
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FDA Approves First Drug to Prevent Premature Births - the drug is a reissue of an earlier drug and received accelerated approval, the agency says. (HealthDay News) -- The U.S. Food and Drug Administration has approved the first drug to help prevent premature birth in women who have had at least one previous preterm delivery.
The drug -- called Makena (hydroxyprogesterone caproate) -- is expected to reduce the risk of premature delivery, which experts say raises the risk of infant complications at birth, lifelong disabilities such as cerebral palsy, and even death. ... http://consumer.healthday.com/Article.asp?AID=649631

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Harsh Medicine Protective gear is a must for oncology nurses. It's the treacherous irony of oncology: the things that kill cancer can also cause it. One example is radiation. Given at too high a dose in CT scans in an attempt to find cancer, or beamed off-target at healthy tissue in an attempt to treat it, radiation can precipitate the very disease it is intended to diagnose and eradicate. ... http://nursing.advanceweb.com/Features/Articles/Harsh-Medicine.aspx

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Preventing Ventilator Alarm Fatigue Ventilator alarm fatigue continues to be a serious problem that directly affects patient safety. Frequent ventilator alarms often desensitize healthcare providers, or the alarms can blend in with other accustomed sounds in the ICU. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death.
The ICU can be a stressful and noisy environment that can distract healthcare providers because of the many different monitoring systems because of the many different monitoring systems. For example, a typical ICU may have more than 40 alarm sources such as ventilators, electrocardiograms, arterial pressure, pulse oximetry, perfusion pumps, nutrition pumps, automatic syringes, dialysis systems and bed monitoring alert systems. One ventilator on the market has 111 different alarm features listed in the operator's manual. ... http://nursing.advanceweb.com/Regional-Content/Articles/Preventing-Ventilator-Alarm-Fatigue.aspx

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RANDOM FACT: The strike note of The Liberty Bell is E flat.
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Nurse: Patients' needs go beyond what can be charted Oncology nurse Theresa Brown says a nurse's task to keep records on everything from fall prevention efforts to conversations with lab techs and doctors to medication details can result in "a mishmash of confusing and oppressive paperwork." She says the principle of "if it isn't charted, it isn't done" may lead to a neglect of patient needs that can't be recorded in a chart, such as empathy. NYTimes.com/Well blog http://well.blogs.nytimes.com/2011/02/02/caring-for-the-chart-or-the-patient/?ref=health
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Academic skills: using literature to support your discussion Kerri Wright , Paul Street, Mamood Gousy British Journal of Nursing, Vol. 20, Iss. 2, 25 Jan 2011, pp 101 - 106 A good academic piece of work aims to locate itself within the available body of knowledge on the subject area. Knowledge can come from a range of different sources, each contributing to the body of knowledge on the subject. The final article in this three-part series discusses the importance of appraising and making sense of literature when considering the knowledge relating to a particular subject area. Guidelines and methods are described to help organize, collate and make sense of the knowledge obtained, so that a logical plan can be created to structure academic work. The academic requirements of different levels are then briefly explained to give guidance on how best to use the literature to support and inform discussions. ... http://www.britishjournalofnursing.com/cgi-bin/go.pl/library/article.html?uid=81534;article=BJN_020_2_101
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Shoveling snow bad for your heart? For blizzard vets, checking in with your doctor before shoveling the sidewalk may seem like overkill. But consider this: According to an ABC News study, the heart attack rate jumps by 20 percent the week after a snowstorm!

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Obesity epidemic risks heart disease "tsunami" CHICAGO/LONDON (Reuters) - More than half a billion people, or one in 10 adults worldwide, are obese -- more than double the number in 1980 -- as the obesity epidemic spills over from wealthy into poorer nations, researchers said on Thursday. ... http://www.reuters.com/article/2011/02/04/us-heart-obesity-idUSTRE71300Y20110204?feedType=nl&feedName=ushealth1100
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Simple life changes could stop millions of cancers LONDON (Reuters) - About a third of all common cancers in the United States, China and Britain could be prevented each year if people ate healthier food, drank less alcohol and exercised more, health experts said on Friday. ... http://www.reuters.com/article/2011/02/04/us-cancer-prevention-idUSTRE71300S20110204?feedType=nl&feedName=ushealth1100
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Thank you, Barbara (BAcello) The IOM below is a free download. See the bottom right corner of the page.
Clinical Data as the Basic Staple for Health Learning - Workshop Summary Successful development of clinical data as an engine for knowledge generation has the potential to transform health and health care in America. As part of its Learning Health System Series , the Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss expanding the access to and use of clinical data as a foundation for care improvement.
http://www.iom.edu/Reports/2011/Clinical-Data-as-the-Basic-Staple-for-Health-Learning.aspx
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RANDOM FACT: Camel's milk does not curdle.
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U.S. stroke belt also hit by heart failure (Reuters Health) - People who live in the southeastern U.S., already dubbed the nation's "stroke belt," may have a higher-than-average rate of death from heart failure as well, a new study finds.
Researchers found that across the six contiguous southeastern states -- Alabama, Arkansas, Georgia, Louisiana, Mississippi and Oklahoma -- the rate of death from heart failure was 31 per 100,000 people.

That was 69 percent higher than the national average of 18 heart-failure deaths per 100,000 people, the researchers report in the American Journal of Cardiology. And the regional disparity was seen among both whites and African Americans. The southeastern U.S. has long been known as the nation's "stroke belt" because stroke death rates are about 50 percent higher there compared with the rest of the country.

But the current study appears to be the first to I.D. the southeast as the nation's "heart failure belt," according to Marjan Mujib and colleagues at the University of Alabama at Birmingham. ... http://www.reuters.com/article/2011/02/02/us-stroke-belt-idUSTRE7119DO20110202?feedType=nl&feedName=ushealth1100

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Psychotropic Drugs and Falls in the Elderly People: Updated Literature Review and Meta-Analysis. To carry out meta-analyses on psychotropic drugs and to provide an update of the risk of falling in the elderly people related to psychotropic drugs. Design: Meta-analyses of studies on psychotropic drugs. Results: 177 studies are included, of which 71 have data on risk factors associated with psychotropic drugs. The odds ratio and 95% Cl for associations between use of psychotropic drugs and fall are 1.78 and 1.57-2.01, respectively. This result is statistically heterogeneous. This heterogeneity disappears in the group of very old participants for each class. Conclusion: Our study confirms the association between falls in the elderly people and psychotropic drugs. These results are similar to those of former meta-analyses but with different methods. It shows that these meta-analyses on psychotropic drugs have a small impact on prescribing habits. They only give evidence to support the association between psychotropic drugs and falls even if there is no proven link.
Published online before print October 14, 2010, doi: 10.1177/0898264310381277 J Aging Health March 2011 vol. 23 no. 2 329-346 (Full Text PDF)
http://jah.sagepub.com/content/23/2/329.abstract
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The Implants Loophole New York Times (12/16/2010) Barry Meier While new drugs must undergo rigorous clinical trials before receiving Food and Drug Administration (FDA) marketing approval, new implants that are substantially similar to devices already approved may be sold without such testing. The process allows manufacturers to make small improvements rapidly. Many experts say it also creates a loophole by allowing producers to include aspects of unapproved devices into existing designs.

"You are basically testing these devices in an uncontrolled way on a large number of people," said Dr. Sidney M. Wolfe, director of Public Citizen's Health Research Group.

For patients receiving untested augmented devices, the consequences of device failure can be grave. Betty Jane Haak, 74, received a hip with a redesigned hip cup that had been approved because of the similar design, the A.S.R. cup designed by DePuy Orthopaedics, a division of Johnson and Johnson, but the hip is faulty and many recipients need replacements. Though her hip cup is painful and has highly elevated her blood colbalt levels, Ms. Haak is medically unable to receive a replacement due to a heart attack she suffered after the initial implant. Ms. Haak summarized her situation, "Do I risk a heart attack, or do I risk
poisoning myself?"

Current rules do not require FDA notification when producers bundle together components from approved and unapproved devices, said Mark Melkerson, an agency official. An internal agency review recently
released, however, found problems with the process and the FDA is proposing changes.
http://www.nytimes.com/2010/12/17/business/17hip.html?_r=1
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Before dialing, check out DialAHuman.com or GetHuman.com, which list customer service numbers and give instructions on how to bypass automated prompts to reach a LIVE representative. With another free service, LucyPhone.com, you can avoid being placed on hold. You enter the company's name of phone number and your number and hit "start". Lucy-phone connects you to the company's line, where you pick an option for getting a live rep. You hang up and get a callback when a person is actually on the line. I checked out DialAHuman.com ( http://dialahuman.com/ ) ---- looks to be very good. I did not try the Lucy suggestion. I hate the automated recordings......they take forever . ****************

This is from Sandy Summers (news_alerts@truthaboutnursing.org) October 11, 2010 -- Today The Washington Post ran an excellent op-ed by Veneta Masson, the Washington, D.C. nurse practitioner and writer, based on an article she wrote for this month's Health Affairs . Explaining why she no longer gets annual mammograms, Masson discusses the research about the flawed test, finding no evidence that it actually saves lives. And she points to downsides including the severe harm many suffer from unnecessary treatment following false positives. The Post rightly describes Masson as a "nurse practitioner," even though she no longer practices, because nursing is a profession. But a story on the mammogram debate that aired today on National Public Radio's Morning Edition was not so good for nursing. Richard Knox's piece includes a brief statement by Masson, but it refers to her as a "former nurse practitioner." ... http://www.truthaboutnursing.org/news/2010/oct/11_masson.html
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Posted: Mar 2, 11 - CMS Recognizes The Joint Commission’s Accreditation of Psychiatric Hospitals - The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has granted The Joint Commission deeming authority for psychiatric hospitals. The four-year CMS designation means that psychiatric hospitals accredited by The Joint Commission will be “deemed” as meeting Medicare and Medicaid’s health and safety requirements.
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RANDOM FACT: Your thumb is the same length as your nose (eek).
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Pregnancy in women who have corrected tetralogy of Fallot: Occurrence and predictors of adverse events Background: In women with corrected tetralogy of Fallot (ToF), pregnancy is associated with maternal cardiac, obstetric, and offspring complications. Our aim is to investigate the magnitude and determinants of pregnancy outcome in women with corrected ToF. ... http://www.ahjonline.com/article/PIIS0002870310009270/abstract?rss=yes

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Survey: NPs salaries increased in 2010 Full-time nurse practitioners earned an average of $90,770 last year, up from $81,397 in 2007 and $89,579 in 2009, according to the National Salary Survey of Nurse Practitioners. The average annual pay for full-time NPs has increased by more than $25,000 since 2001, the survey found. http://www.beckershospitalreview.com/compensation-issues/nurse-practitioner-physician-assistant-average-salaries-jump-25k-since-2001.html
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Half of Adults have Hypertension or High Cholesterol: CDC Despite some improvements, far too many Americans have out-of-control blood pressure and cholesterol levels -- both primary risk factors for heart disease, federal health officials warn.
According to the latest report from the U.S. Centers for Disease Control and Prevention, one-third of U.S. adults have hypertension (high blood pressure), about the same proportion as 10 years ago.

Perhaps more distressing, only 46 percent had the condition controlled, despite the fact that the majority have some form of health insurance -- meaning they could be accessing care -- and 70 percent were actually being treated with blood pressure-lowering drugs. ... http://consumer.healthday.com/Article.asp?AID=649499 **************



More doubts about acupuncture for labor pain (Reuters) While many women may want a drug-free way to ease the pain of childbirth, a new study suggests that acupuncture is not the answer.
The findings, published in the obstetrics journal BJOG, add to evidence that acupuncture is not effective for relieving labor pain. Researchers found that among 105 first-time moms having a labor induction, those given acupuncture before their contractions started showed no benefit when it came to pain. ... http://www.reuters.com/article/2011/02/01/us-acupuncture-labor-idUSTRE71098S20110201?feedType=nl&feedName=ushealth1100

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RANDOM FACT: Tourists visiting Iceland should know that tipping at a restaurant is considered an insult!
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Study finds way to predict when cancer will spread (Reuters)
Researchers have found a compound that tumors make when they are likely to spread, and said they hope to use to it predict which patients are most at risk of dying from their cancers.
And experiments in mice show there may be a way to block the protein, preventing cancer from spreading and becoming deadly.

The findings, published in the Journal of Clinical Investigation, are at a very early stage. But a team at the National Institutes of Health, the University of Hong Kong and elsewhere said on Tuesday they will work to develop both a test and, perhaps, a treatment. ... http://www.reuters.com/article/2011/02/01/us-cancer-spread-idUSTRE71065D20110201?feedType=nl&feedName=ushealth1100
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HINT: Wipe the leaves of your plants with the soft inside of a banana skin to bring shine and remove dust.
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HINT: To clean paint off your hands, use olive oil--it softens the paint and makes it easy to remove.
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Plague Kills U.S. Lab Worker THURSDAY, Feb. 24 (HealthDay News) -- While experts stress that epidemics of plague will probably remain a scourge of centuries past, isolated cases still appear, even in the United States.

In fact, according to a just-released government report, an American lab worker died from plague in 2009 -- the first case of plague from a laboratory-acquired infection since 1959 and the first known death from a weakened form of the germ.

The report appears in the February 25 issue of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Not only are cases of the plague "unusual," said Dr. Steven Hinrichs, chairman of the department of pathology and microbiology at the University of Nebraska Medical Center in Omaha, but "it's unusual to have laboratory accidents. I would say there are less than 10 cases of laboratory accidents involving infectious diseases per year."

Yersinia pestis, the cause of plague, is the microbe that was harbored by fleas-on-rats in the Middle Ages and created the Black Plague, which wiped out a third of Europe's population. The case of the lab worker is particularly intriguing because he was working with a weakened strain of Y. pestis, one that has not been known to cause harm to humans. ... http://consumer.healthday.com/Article.asp?AID=650281

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Study: Gender doesn't affect survival after severe heart attack Women who had in-hospital procedures for ST-elevation myocardial infarction had a higher risk of dying compared with men, a study in the American Heart Journal found. But researchers found the disparity was not because of gender but to the fact women generally were older and had more comorbidities when they were treated. U.S. News & World Report/HealthDay News http://tinyurl.com/5rwwtng
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HealthGrades names 50 best U.S. hospitals HealthGrades' annual list of the 50 top-performing U.S. hospitals found they had a 28.59% lower mortality rate and a 3.45% lower risk of complications than those that didn't make the cut. Researchers said if all hospitals had achieved the quality of care seen in hospitals on the list, more than 500,000 Medicare deaths could have been prevented over the past
decade. Modern Healthcare (free registration) http://tinyurl.com/5rleaym
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More errors result of physicians not listening: study Great effort goes into stopping preventable errors such as wrong-site surgeries, but authors of a study on unwanted variation in elective
procedures say that many more errors are taking place Advertisement | View Media Kit because physicians are not listening to their patients. Modern Healthcare (free reg.) http://tinyurl.com/65xtcd3
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Gallup: Nurses Top Honesty and Ethics List for 11th year
http://www.gallup.com/poll/145043/Nurses-Top-Honesty-Ethics-List-11- Year.asp ************
HINT: Spray the bottom of your shoes with hairspray and they will have more grip on slippery floors.
Not sure about this hint...don't want spray build-up. : )
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7 tips to improve your professional etiquette By Kathleen D. Pagana, PhD, RN
Etiquette is more than just please and thank-you. Knowing how to present yourself in a professional manner helps you stand out and increases your chance for career success. ... http://www.nursingcenter.com//upload/static/403753/NMIEeNews_Bonus_Dec09.htm


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HUMOR SECTION
QUESTION: A black dog is sleeping in the middle of a black road that has no streetlights and there is no moon. A car coming down the road with its lights off steers around the dog. How did
the driver know the dog was there?

ANSWER: It was daytime.
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The graveside service just barely finished, when there was massive clap of thunder, followed by a tremendous bolt of lightning, accompanied by even more thunder rumbling in the distance...

The little old man looked at the pastor and calmly said, 'Well, she's There.'

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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

Over 400 hours of Nursing CEs Available with NetCE
CME Resource provides NetCE as a continuing education resource for nurse professionals. We are an ANCC-Accredited provider of continuing nursing education and have additional approvals through many state boards of nursing. With over 400 hours available online, completing your required continuing education couldn’t be easier.

http://www.netce.com/search.php?type=courses
This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/

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

Just pass your cursor over the area of the map to learn about that area's weather. http://www.wrh.noaa.gov/zoa/mwmap3.php?

Sent in by Kurt Ullman....thanks
Ready or not? Protecting the public's health from diseases,
disasters, and bioterrorism - 2010
http://healthyamericans.org/assets/files/TFAH2010ReadyorNot%20FINAL.pdf
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Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)

Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org

Decubqueen's website: www.accu-ruler.com

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

The Nursing Site http://thenursingsite.com .

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

http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website


http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

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

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/

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MEDICAL RECALLS
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Hydrocodone Bitartrate And Acetaminophen Tablets, Phenobarbital Tablets by Qualitest: Recall - Incorrect Package Labeling An individual bottle of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10mg / 500mg, NDC 0603-3888-20, 60 count was found incorrectly labeled with a Phenobarbital Tablets, USP 32.4 mg, NDC 0603-5166-32, 1000 count label, printed with Lot Number T150G10B. Both products are manufactured by Qualitest Pharmaceuticals.
The recall includes:
Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10mg / 500mg, NDC 0603-3888-20, 60 count, Lot Numbers T150G10B, T120J10E and T023M10A
Phenobarbital Tablets, USP 32.4 mg, NDC 0603-5166-32, 1000 count, Lot Numbers T150G10B, T120J10E and T023M10A
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm242527.htm

*************************** American Regent Injectable Products: Recall - Visible Particulates in Products Recall initiated because some vials exhibit translucent visible particles consistent with glass delamination. Potential adverse events after intravenous administration include damage to blood vessels in the lung, localized swelling, and granuloma formation. (Sodium Thiosulfate Injection USP 10% ; Potassium Phosphates Injection, USP ) http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm242365.htm

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Merit Prelude Short Sheath Catheter Introducer: Class I Recall - Tip May Detach Introducer tip may detach during use, causing arterial injury, hemorrhaging, or other serious events, while introducer tip material may enter into the bloodstream, causing blood clots (thrombosis). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm242343.htm
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B. Braun Outlook 400ES Safety Infusion System, Model Number 621-400ES: Class I Recall - Hardware May Become Unresponsive Infusion systems upgraded with the Motorola compact flash hardware and supporting software, when used in a network environment that utilizes Temporal Key Integrity Protocol (TKIP) authentication, can potentially induce a memory leak that can cause the Management Processor to become non-responsive. This causes normal operation to stop, which is signaled by an audible backup alarm indicating that the pump is not delivering the medicine. There is no visual error warning to alert the user that the pump is not working. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm241637.htm
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Morphine Sulfate Oral Solution 100 mg per 5 mL. (20 mg/mL): Medication use Error Reports of accidental overdose Roxane Laboratories and FDA notified healthcare professionals of serious adverse events and deaths resulting from accidental overdose of morphine sulfate oral solutions, especially when using the high potency 100 mg/5mL product. In most of these cases, morphine sulfate oral solutions ordered in milligrams (mg) were mistakenly interchanged for milliliters (mL) of the product. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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NURSING HINTS CORNER

Lung Assessment: I've found a good way to demonstrate the sound of rales (crackles) to new staff nurses (also student nurses). I pour a carbonated soft drink into a paper cup and tell the nurses to listen to the soft drink as it fizzes. They will hear a good imitation of rales (crackles). Joe Niemczura, RN, MS

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.119, 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

WELCOME TO:


ellenjoykramer@gmail.com (Ellen) February 14, 2011

clydecg6@msn.com (Clyde) February 14, 2011

lauren_hagins@yahoo.com (Lauren) February 15, 2011


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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com
OLD ADDRESS:
ozrn@hotkey.net.au

NEW ADDRESS:
ozrn2@bigpond.com (Janine)


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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 views.

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THOUGHT FOR THE DAY


“No person was ever honored for what he received. He
was honored for what he gave.”

Calvin Coolidge.



Would really like to hear from you...suggestions, criticism (preferably constructive-- lol) Frankie
RNFrankie@AOL.com