Newsletter for Paradigm 97
May 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
Pharmacist supervision is critical for proper preparation of CLINIMIX multi-chamber bags Clinimix E is a parenteral nutrition multi-chamber bag with one chamber containing dextrose and calcium and the other chamber containing amino acids and electrolytes. A seal that separates the two chambers must be broken to mix the contents of both chambers together prior to dispensing/ administration. Intravenous fat emulsion and additional electrolytes may be added as necessary in the pharmacy.
We received a report in which a physician ordered this product to be administered “if the patient does not eat at least 50% of breakfast.” Two pharmacists confirmed with the nurse that the patient had, in fact, eaten about 50% of breakfast. So, the product was not dispensed.
However, the patient ate almost no lunch or dinner, so a decision was made to start Clinimix E.
After the pharmacy was closed, two charge nurses entered the pharmacy to retrieve a bag of Clinimix E—a practice allowed at this hospital. The next day, another nurse discovered that the container had been hung without breaking the seal between the chambers. Since the access port for the IV admini- stration set on the Clinimix E bag leads into the chamber with electrolytes and amino acids, the patient received a concentrated dose of these products, including 30 mEq of potassium chloride, and no dextrose or calcium. Fortunately, the patient’s metabolic profile collected that morning revealed normal values of electrolytes, and the patient experienced no adverse effects.
ISMP has been steadfast in its opposition to allowing non-pharmacy staff access to the pharmacy after it is closed, primarily due to staff unfamiliarity with the many items in a typical hospital pharmacy’s inventory.
Many state laws explicitly prohibit non-pharmacists from entering a pharmacy after it is closed. The Joint Commission is also openly opposed to this practice.
In hospitals without 24-hour pharmacy service, it is safest to provide access to a preapproved formulary of medications via emergency kits, automated dispensing cabinets (ADCs), or other means chosen with safety in mind. The selection of drugs and processes for accessing them should be approved by a pharmacy and therapeutics committee. Nurses should seek assistance from an on-call pharmacist whenever there is a question about a medication. Having pharmacists in a remote location review all orders before any medication is administered, except in an emergency, when a pharmacist is not onsite is another option. However, a mechanism to transport or dispense medications only available in the pharmacy must be provided to avoid nonpharmacy personnel from entering the pharmacy for needed drugs.
Another strategy is to avoid starting the first infusion of parenteral nutrition when the pharmacy is closed. If the first infusion is prepared by the pharmacy, all subsequent solutions can be anticipated and dispensed by the pharmacy as needed.
Parenteral nutrition is a non-urgent medication; the physician can always order 10% dextrose to infuse until the pharmacist can prepare and dispense the first infusion of parenteral nutrition.
Parenteral nutrition is one of the most complex sterile preparations to prepare, relying on a specific order of mixture as well as method of preparation to assure sterility, compatibility, and stability. Clinimix E, CLINIMIX (a similar product without electrolytes), and other FDA-approved, commercially available parenteral nutrition products may reduce the risk of errors associated with mixing these complex solutions.
However, ISMP has published previous reports in which nurses or pharmacy staff have failed to activate or mix multi-chamber bags of parenteral nutrition solutions, antibiotics (e.g., ADD-Vantage), and other products that require manipulation by nurses prior to administration. Since the initial error cited above was reported to ISMP, we have received reports of three more instances of failing to mix Clinimix products prior to administration, all occurring at the same hospital.
The safest strategy is for pharmacy to dispense Clinimix products for each patient after proper mixing and labeling of the bag. The manufacturer of Clinimix products has documented in the prescribing information that, once removed from the overwrap, mixed or not, Clinimix solutions may be stored under refrigeration for up to 9 days. Information about storage at room temperature is not available.
If the product is available in its overwrap in ADCs or other areas outside the pharmacy, nurses should be taught to activate this product. Educational resources are freely available at: www.clinimix.com/popups/video.jsp. These resources illustrate the dualchamber bag technology and offer step-by-step bag activation training. Some hospitals report that errors have been reduced by applying a noticeable auxiliary label to the overwrap, advising that the product must be activated prior to hanging (e.g., Mix Contents of Both Chambers Prior to Administration). We have also contacted Baxter to request more visible labeling regarding the need to mix the product before use. (April 2011)
Report errors with parenteral or enteral nutrition to ISMP
While parenteral nutrition and enteral nutrition are not traditionally thought of as medications, they are therapies that are prescribed, dispensed, and administered similar to medications. Administration also involves infusion devices that may be used in error. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommends that errors such as the one described above be reported to the ISMP Medication Errors Reporting Program (MERP), accessed at:
https://www.ismp.org/orderForms/report
errortoISMP.asp
As with all reports received via the ISMP MERP, they will be forwarded, if appropriate, in confidence to FDA and the manufacturer. The reporter has the option of remaining anonymous and may direct us to contextually de-identify information in the report.
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Standard NICU drug infusion concentrations. Few would disagree that standardizing the concentrations of drug infusions has enormous potential for increasing safety, especially in neonatal care.
But imagine the benefits if drug concentrations could be standardized for neonates beyond just one hospital’s four walls. Some regional efforts have accomplished standardizing drug concentrations in adult medicine (Eastham JH, Rizos A, Gama JA, et al.) Reduction in variation of intravenous drug administration in seventeen San Diego hospitals with standardized drug concentrations and dosage units. Hosp Pharm. 2009;44: 150–158).
For neonates, standardization would help reduce risk when critically-ill babies are transferred from one facility to another. It would also stimulate the development of standardized infusion device drug
libraries and could even provide the level of demand necessary for manufacturers to offer commercially-prepared solutions, thus reducing the risk of extemporaneous compounding errors within hospitals. Such an effort to standardize neonatal drug infusion concentrations nationally is well underway through a joint effort between ISMP and the Vermont Oxford Network (VON), a non-profit voluntary collaboration of healthcare professionals dedicated to improving the quality and safety of medical care for newborn infants. ISMP and VON collaborated with representatives from NICUs across the country during
the past 2 years to develop standard concentrations to be used as default concentrations to cover at least 80% of the needs in neonatal patients. The list is now available on the ISMP website at: www.ismp.org/
Tools/PediatricConcentrations.
We urge all NICU staff to review the list and consider full adoption if possible. Your efforts can help reduce the risk of medication errors when treating our tiniest patients. (April 2011)
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MEDICAL NEWS
Americans need to be aware of six major changes that are occurring or will occur in the U.S. health system, including the greater role of nurse practitioners and physician assistants in primary care practices. Other changes include increased transparency on provider and hospital performance and the rise of accountable care organizations to improve care coordination and quality. http://money.cnn.com/2011/04/20/pf/future_of_healthcare.moneymag/?section=money_latest
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Two U.S. senators on Thursday asked the federal Food and Drug Administration to answer for its handling of investigations into millions of recalled medical prep products tied to serious infections and death. Sen. Michael F. Bennet, D-Colo., and Sen. Lamar Alexander, R-Tenn., sent a letter to FDA Commissioner Margaret Hamburg asking her to explain the agency's actions regarding H&P Industries Inc. and the Triad Group of Hartland, Wis., whose products have been blamed for serious illnesses in the senators' states.
As msnbc.com reported this week , the FDA on Monday asked H&P Industries and its sister company, the Triad group, to voluntarily shut down production of its drug products. So far, Christy Maginn, a spokeswoman for the firm, will not say whether the company intends to comply, stating only that officials are in discussions with FDA and plan to meet next week.
http://www.msnbc.msn.com/id/42349575/ns/health-infectious_diseases/
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
On May 12, ISMP will present 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 medication administration system, and discover the high-leverage error reduction strategies that can reduce the risk of harmful errors. For details, visit: www.ismp.org/educational/webinars.asp.
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Step It UP
Despite its real-world applications, many RNs are just as leery of EBP as Smailes was about nursing research. They often cite lack of time, resources or support from administration as barriers. And because it’s relatively new to nursing, having gained popularity over the past five years along with the push for Magnet designation, many RNs find it intimidating.
However, by breaking EBP down into five simple steps, it can be a manageable, even enjoyable, process. ... http://news.nurse.com/article/20110418/NATIONAL01/104180019/-1/frontpage
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The following was sent in by BAcello (Barbara) who writes: "I am sharing this information with selected colleagues to ensure everyone knows about the free resources available online through Ebsco. No database has everything, but Ebsco is pretty darn good. This is where I do much of the research for my books".
State Electronic Libraries
Ebsco is part of the state library database, which (for reasons that are a mystery to me) seems to be a deep, dark secret. Your tax dollars pay for it in all 50 states and few of my colleagues seem to know about it. The Ebsco/state library systems have quite a few databases. Many are full text. This is the health database:
HEALTH AND MEDICINE
Alt Health Watch
Ebsco Consumer Health Complete SP
Ebsco Natural and Alternative Treatments
Health and Wellness Resource Center
Health Reference Center Academic
Health Source: Consumer Edition
Health Source: Nursing/Academic Edition (**This is the one I use most of
the time)
MedicLatina SP
Medline
netLibrary
Salud en Espanol SP
If you have a library card, go to your public library and ask for the url, user name, and password for the Ebsco state electronic database. It is awesome. And it is free. You can pull up full text articles immediately, or email them to yourself or others, such as when you are collaborating
with others when researching.
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Here are more sites: if you are looking for reliable, trustworthy places to get up-to-date, accurate information, try these sites:
www.ncbi.nim.nih.gov/pubmed (Pubmed) the database houses more than 19 million citations for biomedical articles. Just type in a few keywords and find the latest published research.
www.cdc.gov (Centers for Disease Control and Prevention) wealth of credible, reliable info on diseases and conditions, statistics, emergencies and disasters, etc.
www.emedicine.com (eMedicine) Filled with evidence-based content updated regularly.
From: Nursing2010 Cynthia Laufenberg, senior editor.
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RANDOM FACTS: #1 Almost 99 percent of imported food is never inspected by the FDA or the USDA. (think of all the imports from China) ; #2 One pound of peanut butter can contain up to 150 bug fragments and 5 rodent hairs. I am opting to take a pass on this !!!
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A Current Look at Vitamin D Supplementation THE use of oral vitamin D supplementation in the chronic kidney disease (CKD) population has gained popularity recently. In fact, vitamin D supplementation is now widely recommended for all populations ranging from children to the elderly population, including those with chronic disease.1, 2 Vitamin D deficiency has been linked to autoimmune diseases, diabetes mellitus, low bone density, cardiovascular disease, hyperparathyroidism, and certain forms of cancer.1, 3
Vitamin D has been touted as being more of a hormone than a vitamin. This may be because of its multiple functions in the body. Research shows that there are vitamin D receptors in the heart, prostate, breast, colon, brain, and immune system cells.1, 2 Vitamin D works as an immunomodulator, in that it aids in the regulation of the immune system without suppressing it. This function of vitamin D may rationalize why taking additional oral vitamin D is associated with a decreased risk for autoimmune diseases such as type 1 diabetes mellitus, lupus, rheumatoid arthritis, and multiple sclerosis.2 Vitamin D also seems to manipulate genes that control cellular proliferation, possibly clarifying why lower risks for certain cancers seem to be associated with higher serum levels of 25-hydroxyvitamin D (25(OH)D).2 ... http://www.jrnjournal.org/article/S1051-2276(11)00041-0/fulltext
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Study: Mechanical lifts improve injury rates in long-term care facilities Making safe-lift programs a priority at long-term care facilities could be the key to reducing injuries and worker compensation costs, according to a new report.
http://haymarket.puresendmail.com/hmiclick/723dzowWqrj5ilWyenhW8756v3W4uzhWpdvebu/1/33423?DCMP=EMC-MCK_Daily (If Hoyer lifts were available, there would be fewer back injuries...why aren't they available??? )
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Implantable Device May Lower Tough-to-Treat Hypertension April 5 (HealthDay News) -- For people with hard-to-control blood pressure, a new implantable device shows promise, researchers report.
The device, surgically placed just below the collarbone, sends a four- to six-volt electrical jolt to the carotid arteries. This is said to lower blood pressure through a process known as baroreflex activation therapy.
The researchers were scheduled to present their findings Tuesday at the annual meeting of the American College of Cardiology in New Orleans.
"People with resistant hypertension -- high blood pressure that doesn't respond to multi-drug therapy and lifestyle changes -- are a growing group, and they're in desperate need of additional treatments," study lead author Dr. John D. Bisognano, professor of medicine in the cardiology division of the University of Rochester, said in a meeting news release. ... http://consumer.healthday.com/Article.asp?AID=651640
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The FDS approved AstraZeneca Plc's medullary thyroid cancer drug, vandetanib, the first treatment to be approved for the rare form of cancer (Reuters) The drug had faced a three-month delay after U.S. regulators, in January, extended the time needed to complete a review.
The decision, which was supposed to come by January 7, was pushed to April 7 after the company submitted a risk evaluation and mitigation strategy to the regulators. The drug has been approved to treat patients with non-operable advanced medullary thyroid cancer, which accounts for 3 to 5 percent of thyroid cancers. ... http://www.reuters.com/article/2011/04/06/us-astrazeneca-idUSTRE7356XT20110406?feedType=nl&feedName=ushealth1100
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RANDOM FACT: If you sneeze too hard, you can fracture a rib. If you try to suppress a sneeze, you can rupture a blood vessel in your head or neck, which is/or could be fatal.
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Pulse pressure measured by a physician may help discriminate between patients with "white coat" hypertension and true hypertension, according to a study presented April 4 at the annual scientific sessions of the American College of Cardiology.
About a third of the more than 1,000 patients in the study who were receiving ongoing anti-hypertensive treatment actually had white coat hypertension (WCH), suggesting that the costs and potential side effects from drug therapy could have been avoided in these patients, said Dr. Young Keun Ahn of the Chonnam National University Hospital, Gwangju, South Korea, and associates. ...
(Major Finding: Pulse pressure was positively correlated with a systolic white coat effect (r=.063, P<.001) and diastolic white coat effect (r=.037, p<.001).
Data Source: The study enrolled 1,087 patients undergoing treatment for chronic hypertension in outpatient academic hospital settings. Disclosures: The study was funded by the Korean Institute of Medicine; the Korea Healthcare Technology R& D Project; Korean Ministry of Health, Welfare, & Family Affairs; and the Republic of Korea.). http://www.internalmedicinenews.com/newsletter/internal-medicine-news-e-newsletter/singleview40640/pulse-pressure-may-help-distinguish-white-coat-from-true-hypertension/f274b3d542.html
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Study Examines link between nurse staffing, patient outcomes Better working conditions and better staffing of nurses can significantly improve the care of patients with serious conditions, according to the latest nurse labor study by the University of Maryland School of Nursing.
Several noteworthy trends surfaced as researchers analyzed survey data concerning patient outcomes from 633 nurses in 71 hospitals in North Carolina and Illinois, said lead investigator Alison Trinkoff, RN, ScD, FAAN. For example, pneumonia deaths were significantly more likely in hospitals where nurses reported increased psychological demands and more adverse work schedules.
Trinkoff said researchers measured high psychological demands by very fast pace of work, lack of time to complete work, excessive required work, being delayed by other workers and frequent interruptions.
http://news.nurse.com/article/20110427/ALL01/105090007/-1/frontpage
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RANDOM FACTS: In 2006 about 4,935 people were killed riding motorcycles of different kinds. Most motorcycle accidents involve a short trip associated with shopping, errands, friends, entertainment or recreation, and the accident is likely to happen in a very short time close to the trip origin. (and the rider ends up in ICU)
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Boating accidents claim an average 700 lives each year.
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New legislation will allow a resident that is held in "observation" to have this time counted toward their required Medicare 3 day stay. The Improving Access to Medicare Act would allow beneficiaries kept in a hospital for "observation" to qualify for Medicare Part A coverage of a subsequent stay in a skilled nursing facility (SNF). The bill would count any time spent in observation toward the 3-day stay requirement. Increasing numbers of beneficiaries are disqualified from Part A coverage of their SNF stay because they were held for observation rather than admitted as an inpatient. Please Contact Congress and ask your legislators to support this important legislation so it can move to the floors of the U.S. Senate and House of Representatives. Please follow the link to tell your legislators how important that this legislation is. http://capwiz.com/leadingage/issues/alert/?alertid=42264501
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Which hospitals have more problems after surgery? (Reuters) Teaching hospitals have more deaths after emergency surgery than non-teaching hospitals, while both types of hospitals have similar risks of dying after elective surgeries, according to research published in the May issue of the Annals of Surgery.
The researchers analyzed a nationwide database of hospitalizations from 2000 to 2006 that included one out of every five hospitals in the United States.
According to the Association of American Medical Colleges, there are more than 1,000 teaching hospitals in the United States, comprising a little more than a fifth of the country's hospitals. ... http://www.reuters.com/article/2011/04/27/us-hospitals-surgery-idUSTRE73Q80720110427?feedType=nl&feedName=ushealth1100 (I, for one, am disappointed with the results of this study. I very much prefer working in teaching hospitals)
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FRIDAY, April 22 (HealthDay News) -- Brain cancer patients live longer if neurological side effects from chemoradiation can be minimized, a new study says.
U.S. researchers analyzed the records of 2,761 patients with high-grade gliomas -- the most common primary brain tumor -- who were enrolled in 14 Radiation Therapy Oncology Group studies between 1983 and 2003.
Patients who didn't experience neurological side effects, such as fatigue and memory loss, during chemoradiation lived an average of four months longer than those who had such effects, said the team at the Kimmel Cancer Center at Thomas Jefferson University in Philadelphia. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_111303.html **************
Risk factors for geriatric patient falls in rehabilitation hospital setting: a systematic review. Clinical Rehabilitation, 04/22/2011 Evidence Based Medicine
Vieira ER et al. –
Objective: To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings.
Data sources: Eligible studies were systematically searched on 16 databases from inception to December 2010.
Review methods: The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ≥65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded.
Results: A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified.
Conclusion: Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings. http://cre.sagepub.com/content/early/2011/04/15/0269215511400639.abstract?rss=1
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RANDOM FACT: Each year in the United States, 3 billion pizzas are sold. Americans eat around 350 slices of pizza each second, or 100 acres per day.
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CDC finds high obesity prevalence among arthritis sufferers Rising rates of obesity among the 50 million Americans with arthritis are cause for concern because excess weight is associated with increased problems for arthritis patients, a new study says.
CDC researchers looking at data from 2003 to 2009 said obesity was 54% more prevalent among adults with arthritis compared with those without the condition. The study in the Morbidity and Mortality Weekly Report also found that the number of states with more than 40% of adult arthritis patients who were obese rose from zero in 2005 to 12 in 2009. ... http://consumer.healthday.com/Article.asp?AID=652380
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(I heard on NPR that the ratio is now 1 in 48 !!) Simple test helps spot autism in infants: study CHICAGO (Reuters) - A five-minute screening test could help detect autism in babies at 12 months of age, giving parents and doctors far more time to intervene, U.S. researchers said Thursday
The study is the first to show that a simple screening tool could be used to detect autism in infants, said Dr. Lisa Gilotty, who heads the autism program at the National Institute of Mental Health, which funded the study.
"The benefit of this study is children get into treatment much earlier than they would otherwise," Karen Pierce of the University of California, San Diego, whose study appears in the Journal of Pediatrics, said in a telephone interview. ... http://www.reuters.com/article/2011/04/28/us-autism-test-idUSTRE73R3D620110428?feedType=nl&feedName=ushealth1100
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Customers advised not to use Prep Pads in black starter kits for Forteo [teriparatide (rDNA origin) injection] . Recall Due to Potential Microbial Contamination. March 23, 2011.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm239319.htm
Two U.S. senators on Thursday asked the federal Food and Drug Administration to answer for its handling of investigations into millions of recalled medical prep products tied to serious infections and death. http://www.msnbc.msn.com/id/42349575/ns/health-infectious_diseases/
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HIV kids growing up well, Study finds FRIDAY, April 22 (HealthDay News) -- Most children born with HIV infection now survive into adulthood, a markedly different prognosis from the near-certain death that awaited HIV-infected babies years ago, researchers report.
Researchers are tracking children with HIV, the AIDS-causing virus, to better understand the effects of treatment and identify possible complications.
"About two thirds of these kids, at this point, don't have virus detectable in the blood," Tulane University infectious diseases expert Dr. Russell Van Dyke said in a university news release. "While they are still infected and they are not cured, it's surprising how well they're doing, considering what they've been through." ... http://www.businessweek.com/lifestyle/content/healthday/652179.html
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RANDOM FACT: Vincent van Gogh is known to have only sold one painting.
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Scientists Spot Key Gene Mutations in Melanoma FRIDAY, April 15 (HealthDay News) -- U.S. scientists who completed the world's first "whole-exome sequencing" of melanoma say their accomplishment will improve the ability to diagnose and treat the deadliest form of skin cancer. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_111045.html
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Doctors are overusing thyroid cancer treatment NEW YORK (Reuters Health) - Too many patients are getting a thyroid cancer treatment that kills thyroid tissue but can also harm other tissues in the process, according to a new study.
The research, published in Cancer, finds that doctors are treating patients with early-stage, low-risk thyroid cancer using radioactive iodine, which doesn't increase their chances of surviving but may put them at risk for a secondary cancer.
"Our study shows that these low-risk patients do not need" radioactive iodine, Dr. Ian Ganly, one of the study's authors from Memorial Sloan-Kettering Cancer Center in New York, told Reuters Health.http://www.nlm.nih.gov/medlineplus/news/fullstory_111060.html
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Abbott absorbable stent shows good results Abbott Laboratories Inc's experimental Absorb heart stent, designed to dissolve and thereby restore the blood vessel's natural flexibility, has proven safe and effective a year after being implanted in patients, researchers said.
The findings, which follow similarly promising 6-month and 9-month data on the plastic device, were described at the annual scientific sessions of the American College of Cardiology in New Orleans. ... http://www.reuters.com/article/2011/04/03/us-heart-abbott-stent-id USTRE7322OG20110403?feedType=nl&feedName=ushealth1100
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SOCIAL SECURITY FACTS:
Since 1936, more than 420 million different Social Security numbers have been issued. More than 5.5 million new numbers are assigned every year.
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The first three digits of a Social Security number are known as the "area number." Area numbers assigned before 1972 reflect the state where you applied for your number; otherwise, they are based upon the Social Security card application mailing address ZIP code. Area numbers are assigned geographically, with the lowest numbers in the Northeast and the highest in the Northwest. That practice will no longer apply, however, after a new randomized assignment methodology officially goes into effect on June 25.
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Some people believe the next two digits, called the "group number," helps identify a persons race. It doesn't. The two-digit group number was actually created as a way to organize Social Security Administration filing cabinets into subgroups to make them more manageable. The last four digits on a Social Security card are serial numbers that are issued consecutively within a group from 0001 to 9999.
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In 1938 a sample Social Security card with the number 078-05-1120 was inserted into new wallets manufactured by the E.H. Ferree company in Lockport, N.Y. Unfortunately, that number belonged to Hilda Schrader Whitcher, the secretary of an E.H. Ferree vice president who decided to use her official number on the sample cards. Whitcher was eventually issued a new number, but not before being questioned by the FBI. They wanted to know why so many people had her number.
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Even though numbers aren't reused, the Social Security Administration says the current numbering system is capable of providing enough new numbers for "several generations into the future." That means Social Security numbers will still be available well past 2030.
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Based upon the original assignment criterion, one would naturally expect a Maine resident to have the lowest Social Security number ever issued. However, New Hampshire was ultimately given the 001 area number so that Social Security number 001-01-0001 could be assigned to Social Security board chairman John G. Winant, who was a three-time governor of the state. Winant eventually declined the honor of having the lowest Social Security number. As a result, it eventually found its way to Grace D. Owen of Concord, N.H.
Source: MSN Money
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Poverty Can Hinder a Child's Cognitive Development, Study says WEDNESDAY, April 20 (HealthDay News) -- Persistent poverty harms the cognitive development of children, but family instability has no effect, a new study suggests.
Researchers analyzed data collected from almost 19,000 British children and their families when the children were 9 months, 3 years and 5 years old. The data provided insight into family poverty, family transitions, family demographics and housing conditions.
Most of the families (62.1 percent) were not poor at any of the three assessment points, but 13 percent did experience persistent poverty. Most parents (56.6 percent) were in a stable marriage, 12.7 percent were continuously cohabitating with the same partner, and 7.8 percent were continuously single. ... http://health.yahoo.net/news/s/hsn/povertycanhinderachildscognitivedevelopmentstudysays
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Patients with do-not-resuscitate orders fare worse Reuters – A new study could help people with a do-not-resuscitate order make better decisions about what surgeries they are willing to undergo.
About seven in 10 Americans die with such an order, which instructs healthcare workers not to use life-prolonging treatment if a patient's heart or breathing stops. But other situations that aren't necessarily covered in the do-not-resuscitate, or DNR, orders may also be worth considering, researchers say.
The new report, out Monday in the Archives of Surgery, shows DNR patients have a higher chance of dying following surgery, although not with all kinds of procedures. ... http://news.yahoo.com/s/nm/20110418/hl_nm/us_do_not_resuscitate
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People who donate Organs for Transplants can have Difficulty Getting Insurance Kaiser Health Most people would agree that donating an organ to someone in need is a selfless act. There's no medical upside in giving up one of your kidneys or part of your liver, lung or pancreas. It's a risk people take so that someone else -- often but not always a loved one in desperate need -- may live a better, longer life.
It's said that no good deed goes unpunished, however, and living donors sometimes find themselves unable to find affordable -- or any -- health insurance after the fact. Insurers sometimes claim that the donation is equivalent to a preexisting medical condition and either reject an application outright or offer coverage with a very steep premium. ... http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/Michelle-Andrews-on-insurance-for-living-organ-donors.aspx
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NIH obesity plan focuses on real-world research/ Reuters Health officials Thursday announced a new effort to curb America's obesity epidemic by moving science from the lab into clinical trials to find practical ways for prevention and treatment.
"This plan is a bold blueprint that will encourage the research community to examine the epidemic of obesity from diverse perspectives," National Institutes of Health (NIH) Director Dr. Francis Collins said in a statement.
More than a third of adults and nearly 17 percent of children in the United States are obese, increasing their chances of developing health problems including type 2 diabetes, heart disease, high blood pressure, fatty liver disease and some cancers. ... http://www.reuters.com/article/2011/04/01/us-nih-obesity-plan-idUSTRE72U6W720110401?feedType=nl&feedName=ushealth1100
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Burn off Belly fat with this condiment It's perfect on potatoes, very good on veggies, and divine in salad dressings. And the best news yet? It may help with fat burning. The magic condiment in question: vinegar.
Obese people who took in 1 to 2 tablespoons of apple cider vinegar daily in a study melted significantly more body fat and belly fat than a group taking a placebo -- despite being on the same diet and exercise plan. ...
Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Kondo, T. et al., Bioscience, Biotechnology, and Biochemistry 2009 Aug;73(8):1837-1843.
http://www.realage.com/tips/burn-off-belly-fat-with-this-condiment?eid=1098941006&memberid=4687812
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Slow Down Aging by Cooking with This Juice Whatever you put in your pan for dinner tonight, make sure you add a few squeezes of this: lemon juice.
A new study shows that marinating meats in lemon juice -- or vinegar -- can help greatly reduce the production of harmful compounds linked to aging and chronic disease. ...
Reference: Advanced glycation end products in foods and a practical guide to their reduction in the diet. Uribarri, J. et al., Journal of the American Dietetic Association 2010 Jun;110(6):911-916.e12.
http://www.realage.com/tips/slow-aging-by-cooking-meat-slowly?eid=1098941006&memberid=4687812
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Hemophilia drug often used in other patients: study (Reuters)
A drug approved only to treat the rare bleeding disorder hemophilia is being used much more often in other patients, such as those having cardiac surgery or a liver transplant, according to new research.
While such "off-label" prescribing is allowed by the U.S. Food and Drug Administration, the researchers found there is little evidence that the drug, called NovoSeven and marketed by the company Novo Nordisk, actually helps prevent death in people who have conditions other than hemophilia.
Dr. Veronica Yank, a member of the research team from Stanford University, said that she and her colleagues were "surprised by the amount of off-label use that we saw."
Based on the findings, doctors "need to temper their enthusiasm and be more cautious" with the use of this drug, Yank told Reuters Health. ... (apparently, the drug causes side effects for non-hemophiliac patients, according to what I heard on NPR)
http://www.reuters.com/article/2011/04/18/us-hemophilia-drug-idUSTRE73H6VW20110418?
feedType=nl&feedName=ushealth1100
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New Alzheimer's guidelines view disease in stages (Reuters) - The first new U.S. diagnostic guidelines for Alzheimer's disease released in 27 years paint the disorder as a disease that occurs gradually over many years, starting with changes in the brain, then mild memory problems and finally progressing to full-blown dementia.
Released on Tuesday by the National Institute on Aging and the Alzheimer's Association, the guidelines officially recognize mild cognitive impairment or MCI -- first described more than a decade ago -- as a precursor to the disease.
And they add a new research category known as preclinical Alzheimer's, the earliest stage of the disease when clumps of a protein called amyloid are just beginning to form in the brains of people who are otherwise healthy. ... http://www.reuters.com/article/2011/04/19/us-alzheimers-guidelines-id USTRE73I0NA20110419?feedType=nl&feedName=ushealth1100
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Better Your Brain with These Tips Are you neglecting your gray matter? You know that you have to exercise your noggin to help keep it sharp and nimble. But sometimes your brain gets stuck in a rut, thinking about the same things and doing the same projects over and over.
http://www.realage.com/look-young-stay-sharp/aging-well/?src=nl&dom=realage&list= aw&link=text&ad=aging-well-awareness&eid=1010634657&memberid=4687812&cbr=pru_os
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The Spine Academy Learning Series
It's no longer necessary to travel to a classroom in order to stay abreast of changes in the industry. Now it's possible to go online and learn about the latest developments in the business of spine care, coding changes, regulations, and documentation requirements because Medtronic provides live interactive programs free of charge throughout the year.
http://www.medicalproductguide.com/bguide/User/Resource/brief/426/The-Spine-Academy-Learning-Series
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Three ways to know if your auto insurer is ripping you off (ARA) - With the economy still tight, it's smart to look at your budget and see where you can save some money. One of the easiest and best places to shave a couple hundred dollars off your bills is to evaluate your car insurance policy.
If you've been working with an insurance carrier for a while, you're probably comfortable and don't want to move. The problem is you have no idea how much money you're wasting needlessly on insurance. You could save hundreds of dollars per year rather than continuing to give it away. Here's what you need to know to make sure you're getting the best deal:
http://www.aralifestyle.com/article.aspx?UserFeedGuid=c8327e5a-7294-409a-a33d-2b79220c17d2&ArticleId=3115&ComboId=21516&title=3-ways-to-know-if-your-auto-insurer-is-ripping-you&origin=168069-APP5&subid=0000721127&segments=
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RANDOM TIDBITS:
The only letter not appearing on the Periodic Table is the letter “J”.
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If you stretch a standard Slinky out flat it measures 87 feet long.
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The leg muscles of a locust are about 1,000 times more powerful than an equal weight of human muscle.
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Armadillos, opossums, and sloths spend about 80% of their lives sleeping.
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Human jaw muscles can generate a force of 200 pounds on the molars.
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The ears of a cricket are located on the front legs, just below the knee.
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Study Examines link between nurse staffing, patient outcomes Better working conditions and better staffing of nurses can significantly improve the care of patients with serious conditions, according to the latest nurse labor study by the University of Maryland School of Nursing. ...
http://news.nurse.com/article/20110427/ALL01/105090007/-1/frontpage
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Electronic Nursing Documentation as a Strategy to Improve Quality of Patient Care-- Kelley 2011
Journal of Nursing Scholarship Published 20-Apr-2011 by Brian Stever in Latest News (the full article is available PDF -- use the link)
ABTRACT:
Purpose: Electronic health records are expected to improve the quality of care provided to hospitalized patients. For nurses, use of electronic documentation sources becomes highly relevant because this is where they obtain the majority of necessary patient information.
Methods: An integrative review of the literature examined the relationship between electronic nursing documentation and the quality of care provided to hospitalized patients. Donabedian's quality framework was used to organize empirical literature for review.
Results: To date, the use of electronic nursing documentation to improve patient outcomes remains unclear.
Conclusions and Implications: Future research should investigate the day-to-day interactions between nurses and electronic nursing documentation for the provision of quality care to hospitalized patients.
Clinical Relevance: The majority of U.S. hospital care units currently use paper-based nursing documentation to exchange patient information for quality care. However, by 2014, all U.S. hospitals are expected to use electronic nursing documentation on patient care units, with the anticipated benefit of improved quality. However, the extent to which electronic nursing documentation improves the quality of care to hospitalized patients remains unknown, in part due to the lack of effective comparisons with paper-based nursing documentation.
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HUMOR SECTION
While making rounds, a doctor points out an X-ray to a group of medical students.
"As you can see," she says, "the patient limps because his left fibula and tibia are radically arched. Michael, what would you do in a case like this?"
"Well," ponders the student, "I suppose I'd limp too."
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Mary was married to a something of a chauvinist. They both worked full time, but he never did anything around the house and certainly....not any housework. That, he declared, was 'woman's work.'
One evening Mary arrived home from work to find the children bathed, a load of wash in the washing machine and another in the dryer, dinner on the stove and a beautifully set table, complete with flowers. She was astonished, and she immediately wanted to know what was going on.
It turned out that her husband Charley had read a magazine article that suggested working wives would be more romantically inclined if they weren't so tired from having to do all the housework in addition to holding down a full-time job. The next day, she couldn't wait to tell her friends in the office. "How did it work out?" they asked.
"Well, it was a great dinner," Mary said. "Charley even cleaned up, helped the kids with their homework, folded the laundry and put everything away."
"But what about afterward?" her friends wanted to know.
"Oh, that part didn't work out," Mary said. "Charley was too tired."
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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
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
https://nursing.advanceweb.com/CE/TestCenter/Main.aspx
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.
If you are looking for reliable, trustworthy places to get up-to-date, accurate information, try these sites:
www.ncbi.nim.nih.gov/pubmed (Pubmed) the database houses more than 19 million citations for biomedical articles. Just type in a few keywords and find the latest published research.
www.cdc.gov (Centers for Disease Control and Prevention) wealth of credible, reliable info on diseases and conditions, statistics, emergencies and disasters, etc.
www.emedicine.com (eMedicine) Filled with evidence-based content updated regularly.
From: Nursing2010 Cynthia Laufenberg, senior editor.
This is an excellent nursing site, check it out: http://nursingpub.com/
Back issues of the ISMP 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
12 lead EKG Interpretation Part #1
http://nursingpub.com/12-lead-ekg-explained-part-1
12 Lead EKG Interpretation Part #2 http://nursingpub.com t
12 Lead EKG Interpretation Part #3
http://nursingpub.com/12-lead-ekg-interpretation-part-3
This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/
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MEDICAL RECALLS
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FDA notified healthcare professionals and patients that FDA continues to receive reports of methemoglobinemia, a serious condition in which the amount of oxygen carried through the blood stream is greatly reduced and whose signs and symptoms such as pale, gray or blue colored skin, lips, and nail beds; headache; lightheadedness; shortness of breath; fatigue; and rapid heart rate. It is a serious and potentially fatal adverse effect, associated with benzocaine products both as a spray, used during medical procedures to numb the mucous membranes of the mouth and throat, and benzocaine gels and liquids sold over-the-counter and used to relieve pain from a variety of conditions, such as teething, canker sores, and irritation of the mouth and gums. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm250264.htm
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Heartstring II Proximal Seal System (HS-1045) by Maquet Cardiovascular, LLC: Recall - Insufficient Adhesive The deployment tube may detach during use due to insufficient adhesive and may result in the failure of the product to operate. This may cause serious injury and/or death.
BACKGROUND: This device is used by cardiac surgeons during coronary artery bypass procedures (CABG). It helps to control the flow of blood in the aorta during surgery. This allows the surgeon to create an important connection between blood vessels (proximal anastomosis) without the use of an aortic clamp. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm249395.htm
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Mikro-Tip Angiographic Catheter, Model SPC-454D and SPC-454F by Millar Instruments Inc.: Class 1 Recall Millar Instruments, Inc, and FDA issued a recall of Human Use High Injection Angiographic Catheter, Models SPC-454D and SPC-454F. There is a possibility that small particles (debris) may be found inside the catheter. This foreign debris can potentially travel (embolize) from the catheter to tissues, blood vessels, limbs and organs. This could lead to a decreased blood supply to these structures which can result in serious injury and /or death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm249387.htm
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Ortho-McNeil Neurologics Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., is recalling two lots of Topamax (topiramate) 100mg Tablets. The recall stems from four consumer reports of an uncharacteristic odor thought to be caused by trace amounts of TBA (2,4,6 tribromoanisole). While not considered to be toxic, TBA can generate an offensive odor and a small number of patients have reported temporary gastrointestinal symptoms. There have been no reported serious adverse events caused by the presence of TBA in Topamax. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm251556.htm
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Lansoprazole Delayed-Release Orally Disintegrating Tablets by Teva Pharmaceuticals: Letter to Healthcare Professionals - Clogged, Blocked Oral Syringes and Feeding Tubes The FDA has received reports that Teva’s lansoprazole delayed-release orally disintegrating tablet has clogged and blocked oral syringes and feeding tubes, including both gastric and jejunostomy types, when the drug is administered as a suspension through these devices. The tablets may not fully disintegrate when water is added to them and/or they may disintegrate but later form clumps. These clumps can adhere to the inside walls of oral syringes and feeding tubes. In some cases, patients have had to seek emergency medical assistance and their feeding tubes have had to be unclogged or removed and replaced. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm251575.htm
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Tumor Necrosis Factor (TNF) blockers, Azathioprine and/or Mercaptopurine: Update on Reports of Hepatosplenic T-Cell on Reports of Hepatosplenic T-Cell FDA continues to receive reports of a rare cancer of white blood cells (known as Hepatosplenic T-Cell Lymphoma or HSTCL, primarily in adolescents and young adults being treated for Crohn’s disease and ulcerative colitis with medicines known as tumor necrosis factors (TNF) blockers, as well as with azathioprine, and/or mercaptopurine. TNF blockers include Remicade (infliximab), Enbrel (etancercept), Humira (adalimumab), Cimzia (certolizumab pegol) and Simponi (golimumab).
Educate patients and caregivers about the signs and symptoms of malignancies such as HSTCL so that they are aware of and can seek evaluation and treatment of any signs or symptoms. These may include splenomegaly, hepatomegaly, abdominal pain, persistent fever, night sweats, and weight loss.
Monitor for the emergence of malignancies when a patient has been treated with TNF blockers, azathioprine, and/or mercaptopurine.
Know that people with rheumatoid arthritis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis may be more likely to develop lymphoma than the general U.S. population. Therefore, it may be difficult to measure the added risk of TNF blockers, azathioprine, and/or meracaptopurine. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm251443.htm
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NURSING HINTS CORNER
Tracheostomy care: Flow of facts To save charting time when caring for a tracheostomy patient, we've developed an interdisciplinary tracheostomy flow sheet. In eight one-line entries, we can document the type and amount of secretions and aspirate, frequency of suctioning and basic care, and presence of a cough.
Each sheet has three identical sections, one to be filled out at the end of each nursing shift.
The flow sheet not only saves time, but also organizes information about the patient's care. Nurses and respiratory therapists can glance at the sheet for a quick assessment of the patient's condition and care during the previous 24 hours. Mary Hartz, RN, BSN (Has computer charting totally replaced this type of charting?--- let me know, please. Frankie)
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.228, 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:
VickyKayeWard@yahoo.com (Vicky) April 18, 2011
alk8200@aim.com (Adrienne) April 20, 2011
mwts@bellsouth.net (Ginny) April 28, 2011
m.morrisrn@gmail.com ( Matt ) May 5, 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 your new name/address to: RNFrankie@AOL.com
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)
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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY
"If you have health, you probably will be happy,
and if you have health and happiness, you have all the
wealth you need, even if it is not all you want."
Elbert Hubbard. (1856-1915), American writer, publisher, artist, and
philosopher, was an influential exponent of the Arts and
Crafts Movement.
Your e-mails are very welcome.... Frankie RNFrankie@AOL.com
