Newsletter for Paradigm 97
July 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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The following was written by MarGerlach (Marlene):
It is with great sadness that we must tell you of the death of one of our charter members, Melva Solon (MJSolon @aol.com) on July 8th. Those of you who have been with us since the birth of Paradigm97 in 1997 will no doubt remember her. In reference you may remember because we highlighted the birth of her granddaughter "Baby Angela" in our weekly e-mailed Newsletter at that time. Angela (dubbed, "Little Bit") was born October 20, 1999 at 25 weeks and weighed 1# 10 oz. We published photos and updates for seven months as this little girl struggled and won and is now a healthy 11 year old. Well, her grandma knew struggle also as she watched and helped this little miracle baby grow and become healthy. Melva had her own struggle as she had fought cancer for many years. The best of treatments and all our prayers were eventually not enough and she passed away on July 8th while in hospice care these last few weeks. She was a good friend, and a remarkable and caring person. Her great faith sustained her. Our thoughts and prayers go out to her husband, daughter, granddaughter and siblings and to all who loved her as we did. May she rest in peace.
(I also consider her one of my good online friends...and will really miss her).
Obituary at:
http://www.mywebtimes.com/archives/ottawa/display.php?id=436368
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SNIPPETS
Vitamin D Can Help Elderly Women Survive (must be D3)
Giving vitamin D3 (cholecalciferol) to predominantly elderly women, mainly in institutional care, seems to increase survival. These women are likely to be vitamin D deficient with a significant risk of falls and fractures. This is the key conclusion in a systematic review published in the latest edition of The Cochrane Library.
Up until now there has been no clear view on whether there is a real benefit of taking vitamin D. “A Cochrane meta-analysis published only a couple of years ago found that there was some evidence for benefit, but it could not find an effect on mortality. We were, however, aware that more trials had been published and wanted to assess the effects of vitamin D when you added all the data together,” said Dr Goran Bjelakovic, who works at Department of Internal Medicine - Gastroenterology and Hepatology, at the University of Nis, in Serbia and at The Cochrane Hepato-Biliary Group at The Copenhagen Trial Unit in Copenhagen, Denmark.
The eight-strong international team of researchers identified 50 randomised trials that together had 94,148 participants. They had a mean age of 74 years, and 79% were women. “Our analyses suggest that vitamin D3 reduces mortality by about 6%. This means that you need to give about 200 people vitamin D3 for around two years to save one additional life,” says Bjelakovic.
There were no significant benefits of taking other forms of vitamin D such as vitamin D2, and the active forms of the vitamin, alfacalcidol or calcitriol. However, the researchers point out that they could only find much less data relating to these types of vitamin D and so these conclusions should be taken with caution. “We need to have more randomised trials that look specifically to see whether these forms of vitamin D do or don’t have benefits,” says Bjelakovic. His team did conclude that alfacalcidol and calcitriol significantly increased the risk of hypercalcaemia, and vitamin D3 combined with calcium significantly increased the risk of kidney stones.
There have been reports and comments that taking vitamin D can reduce the risk of getting cancer, but this work showed no evidence that vitamin D reduced cancer-related mortality.
“Previous reviews of preventive trials of vitamin D have not included as much information and have not examined the separate influence of different forms of vitamin D on mortality. By taking data from a larger number of trials we have been able to shed much more light on this important issue,” says Bjelakovic.
Full citation: Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, Bjelakovic M, Gluud C. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD007470. DOI: 10.1002/14651858.CD007470.pub2.
URL Upon publication: http://doi.wiley.com/ 10.1002/14651858.CD007470.pub2
So What? An Invitation to Nurses To Tell Us How They’re Translating Research into Practice
by jm
By Inge B. Corless, PhD, RN, FAAN, professor at the MGH Institute of Health Professions, Boston, and Brian Goodroad, DNP, RN, AACRN, nurse practitioner and associate professor at Metropolitan State University in Minneapolis–St. Paul, Minnesota
Crossing the Quality Chasm, an Institute of Medicine report from 2001, bemoans the chasm between our current research knowledge and the current state of care. Back in 2003, Don Berwick, now the Administrator of the Centers for Medicare and Medicaid Services, provided the following pithy codification of the problem in a JAMA article called “Disseminating Innovations in Health Care” (subscription required; click here for the abstract): “Failing to use available science is costly and harmful; it leads to overuse of unhelpful care, underuse of effective care, and errors in execution.” Berwick pondered the slow pace of innovation adoption and attributed it to three factors:
the characteristics of the innovation
the characteristics of the potential adopters
contextual factors
Berwick also made this observation about innovations that do get adopted: “Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly—if at all.”
Given these obstacles, what can be done to facilitate the integration of research findings into practice? What can be done to change this situation, and what would this entail?
One step is to share our knowledge and our successes in making changes, along with the obstacles to doing so. We invite nurses to identify research that has changed or somehow influenced their practice and to share their experiences with us for potential publication on this blog. We’re not asking for formal academic work here; what’s we’d like is simple, brief (one to five paragraphs) summary description in your own voice. Briefly describe the study and its findings, as you understand them—and then describe how the findings were integrated into practice and any outcomes (whether they were formally measured or anecdotally reported).
These summaries will not be peer-reviewed like AJN‘s print articles, but they will be open to reader comments, which authors can choose to respond to if they wish. We also invite nurse researchers to describe their studies and amplify the implications for practice, discussing what might facilitate integration into practice as well as potential obstacles. (Editor’s note: please send all submissions or inquiries to Inge Corless at this e-mail address: icorless@mghihp.edu. She will review submissions and pass those that seem appropriate along to us here at the blog.)
Nursing is responsible for advancing the state of the science and the integration of science into practice. Our goal in initiating this blog series is to speed the integration of important research findings into practice as well as help those findings already in limited practice to become more widely adopted.
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(PLEASE, read the entire article; keep in mind she is a major advocate for the nursing image in the media)
Lucky Charms
June 2011 -- Recently the drug company Johnson & Johnson (J&J) released a new batch of television advertisements as part of its
Campaign for Nursing's Future, which began in 2002 as an effort to address the nursing shortage. The three new 30-second ads, like those
released in 2005 and 2007, highlight different aspects of nursing practice and do a good job at promoting diversity. Each of the new ads also
conveys something helpful about nursing skill. Unfortunately, each ad focuses mainly on the emotional support nurses give patients, and each
concludes with the vaguely uplifting message "NURSES HEAL." One ad features an authoritative ED nurse reacting quickly to a trauma case,
but even that ad is dominated by the nurse's returning of a lucky charm to the patient. And the other two ads will strike viewers as being mostly
about hand-holding, by a hospice nurse and a pediatric nurse. Thus, despite some positive elements, each ad subtly reinforces the enduring
image of nurses as low-skilled angels. The nursing crisis did not happen because people forgot that nurses hold hands. What decision-makers
need to know is that nurses are autonomous life-saving professionals who need respect and resources, and in this regard the new ads are
actually a step backwards from the 2007 ones. The new ads do at least omit the baby-soft voiceover and sappy music, which undermined
the prior ads' good elements with vapid lyrics about how nurses "dare to care."
The new ads are also more subtle about promoting J&J itself, though that cuts both ways; it distracts viewers less from the good
and bad aspects of the ads. In any case, we thank J&J for its continued efforts to promote nursing, and we urge the company to focus
more closely on telling the public that nurses are health experts who save lives. more.... ( I, for one, find this ad exceedingly irritating
and frustrating....glad that Sandy is at the forefront in fighting this stuff. )
http://www.truthaboutnursing.org/media/commercials/jnj_2011.html
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MEDICAL NEWS
ISMP Webinar: On July 26, ISMP will present Exploring Medication Safety Off the Beaten Path: Unique Medication Safety Challenges in Diagnostic and Procedural Areas. Have medication safety improvements been made in areas such as invasive radiology, GI suites, perioperative areas, or ambulatory clinics? Take a tour of these distinct locations with ISMP consulting staff to learn what unique medication safety risks have been uncovered "off the beaten path." For details, visit: www.ismp.org/educational/webinars.asp.
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Buttock site still most popular despite known potential for sciatic nerve injury
Seven out of ten hospital nurses who took part in a Canadian study used the dorsogluteal (DG) buttock site to administer intramuscular injections - despite the potential risks of sciatic nerve injury - with only 14% using the ventrogluteal (VG) hip site recommended by the nursing literature.
The research, published in the May issue of the Journal of Advanced Nursing, found that younger, newer nurses were significantly more likely to follow the latest VG site advice than their older, experienced colleagues. It also discovered that more than one in four nurses using the DG site were unaware of the potential risk of nerve damage.
Just over 40% of the staff nurses surveyed responded to the postal questionnaire. Most of the 264 respondents were aged between 30 and 49 years and had been working in nursing for more than ten years.
"Recent nursing literature suggests that the VG site is preferable because it is located away from major nerves and muscles, can provide better access to muscle tissue and offers faster medication uptake" says lead author Lorna Walsh, a nurse educator at the Centre for Nursing Studies, St John's, Canada.
"It's estimated that more than twelve billion intramuscular injections are administered every year throughout the world and unsafe injection practices have a significant impact on patient ill health and death. Complications can include skin and tissue trauma, muscle fibrosis and contracture, nerve palsies and paralysis, abscesses and gangrene. ... http://www.eurekalert.org/pub_releases/2011-05/w-mnd050911.php
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Benefit of mammograms even greater than thought
CHICAGO (Reuters) - The longest-running breast cancer screening study ever conducted has shown that regular mammograms prevent deaths from breast cancer, and the number of lives saved increases over time, an international research team said on Tuesday.
The study of 130,000 women in two communities in Sweden showed 30 percent fewer women in the screening group died of breast cancer and that this effect persisted year after year. Now, 29 years after the study began, the researchers found that the number of women saved from breast cancer goes up with each year of screening. ...
http://www.reuters.com/article/2011/06/28/us-cancer-breast-mammograms-idUSTRE75R0NM20110628?feedType=nl&feedName=ushealth1100
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TODAY'S THRIFTY TIP: To determine your debt burden, add up all of your monthly consumer debt obligations and minimum required
payments (not counting your mortgage). Include car loans, college loans and credit cards. If the total consumes 15 to 20
percent or more of your paycheck, you need to take measures to reduce your debt, say financial planners.
Also, look for other signs of a high debt burden, such as borrowing to pay for necessities, missing payments or making
late payments, being turned down for credit or neglecting to save for retirement or other financial goals.
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RANDOM FACTS: (1) James Bond wasn't a successful book series in America until JFK included From Russia with Love on a list of
his favorite books in 1961. (2) Casino Royale is the first Bond film not to feature a female dancing silhouette in the opening titles.
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Lawyers weigh in on consistent use of smart pump libraries. As noted in our April 19, 2007 article, “Smart pumps are not smart on their own” (www.ismp.org/Newsletters/acute care/articles/20070419.asp), clinicians should not view the dose-checking feature of smart pumps as an option that can be turned on or off. Nor should the alerts that arise from the system be bypassed without serious consideration. ...
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(The following is a repeat from March issue---but good info) 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 .
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Birth Defects caused by World's Top- Selling Weedkiller, Scientists Say
WASHINGTON -- The chemical at the heart of the planet’s most widely used herbicide -- Roundup weedkiller, used in farms and gardens across the U.S. -- is coming under more intense scrutiny following the release of a new report calling for a heightened regulatory response around its use.
Critics have argued for decades that glyphosate, the active ingredient in Roundup and other herbicides used around the globe, poses a serious threat to public health. Industry regulators, however, appear to have consistently overlooked their concerns.
A comprehensive review of existing data released this month by Earth Open Source, an organization that uses open-source collaboration to advance sustainable food production, suggests that industry regulators in Europe have known for years that glyphosate, originally introduced by American agricultural biotechnology giant Monsanto in 1976, causes birth defects in the embryos of laboratory animals. ... http://www.huffingtonpost.com/2011/06/24/roundup-scientists-birth-defects_n_883578.html?ncid=webmail2
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Secret number one: Turn down your thermostat a smidge. Sounds odd, right? Yet studies indicate that cozy indoor temps may inhibit calorie-burning because your body will burn extra calories to keep warm. But not if it's feeling toasty. Research suggests that keeping temps below 68 degrees Fahrenheit may help fire up your metabolism. (Here's how to set up your kitchen for weight loss success.)
Secret number two: Go to bed early. A lack of sleep throws appetite hormones into gimme-more mode. Poor sleep also affects blood sugar and insulin levels in a way that can increase the risk of excessive weight gain. Your goal: 7 to 8 hours of nightly shut-eye, day in and day out. (Find out how else sleep loss affects your health.)
Secret number three: Cut down your dinners out to once a month. In the study, eating just one restaurant meal per week upped the risk of obesity by 50 percent. Preparing meals at home allows you to control fat, sugar, and salt content -- and let's you know exactly what you're eating. (Check out our collection of low-fat recipes that taste as good as restaurant meals.) Reference: Contributors to the obesity and hyperglycemia epidemics. A prospective study in a population-based cohort. Bo, S. et al., International Journal of Obesity 2011 Feb 1.
http://www.realage.com/tips/how-to-get-slim-without-exercise?eid=1098938002&memberid=4687812
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(This was sent in by Kurt Ullman......Thank you, Kurt) The medical aspects of radiation incidents (Rev. ed.)
http://orise.orau.gov/files/reacts/medical-aspects-of-radiation- incidents.pdf
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Resident doctors still work too long: report First-year residents may soon get a reprieve from grueling hospital shifts that last more than 24 hours, but that is not enough to prevent an alarming number of medical errors, according to a report released on Friday.
Starting July 1, new rules will require first-year residents to work shifts no longer than 16 straight hours. But that will not spare more experienced residents from working as long as 28 hours at a stretch.
A group of 26 doctors and patient safety experts are calling for limiting all resident physician work to shifts of 12 to 16 hours. Their report was published on Friday in the journal Nature & Science of Sleep journal. ...
http://www.reuters.com/article/2011/06/24/us-doctors-idUSTRE75N0ND20110624?feedType=nl&feedName=ushealth1100
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RANDOM FACT: In the early 1900s, aspirin maker Bayer also commercially developed and sold heroin for medicinal uses.
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CANCER FACTS AND FIGURES:
Provides the estimated numbers of new cancer cases and deaths in 2011 as well as cancer incidence, mortality, and survival statistics and information on cancer symptoms, risk factors, early detection, and treatment. The topic of the special section is cancer disparities and avoidable premature cancer deaths. Also available, the most requested tables and figures.
DOWNLOAD Cancer Facts & Figures 2011 [PDF version, 1,400 KB] http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2011
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How to Outsmart the Obesity Gene: Not a lot of size 6's in your family? Well, then, here's the simple trick to outrunning your
obesity genes: movement.
In a study of people genetically predisposed to obesity, those who were the most active managed to seriously alter their body's predisposition to gain weight. They were far less likely to pack on pounds over time compared with the least active in the study.
Handling Heavy DNA
In the recent study, researchers found 12 genes that increased the risk of obesity. And every obesity gene people had correlated to extra weight gain. Still, although certain genes made them more susceptible to obesity, participants were not slaves to their DNA.... Reference: Physical activity attenuates the genetic predisposition to obesity in 20,000 men and women from EPIC-Norfolk prospective population study. Li, S. et al., PLoS Medicine 2010 Aug 31;7(8). pii: e1000332.
http://www.realage.com/tips/obesity-gene-exercise-to-lose-weight?eid=7236&memberid=4687812
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Rethinking what is edible....
When most people think of healthy foods, they think of choices like colorful kiwi fruit and pineapple, perfectly juicy oranges, and bright, fresh broccoli and squash. Of course, missing from that picture are the parts of those superfoods that you may often discard, such as the skin of the kiwi and the hard core of the pineapple. But before you toss out these food parts, dietitians say, it’s time to reconsider what you’re cutting away. Many of these pared-off parts of fruits and veggies are positively brimming with antioxidants, and eating them can boost your health. ... ( Page 1 of 8 )
http://www.everydayhealth.com/diet-and-nutrition-pictures/rethinking-whats-edible.aspx?xid=aol_eh-nutr_1-_20110613&aolcat=DFT&ncid=webmail5
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One in three multivitamins don't have claimed nutrients A new review of popular multivitamins found that almost a third did not contain the amount of nutrients claimed in their labels. After testing 60 multivitamins, researchers at ConsumerLab.com found many had either too much or too little of specific nutrients.
After testing 38 multivitamins for a new report published online this week, researchers at ConsumerLab.com discovered that eight contained too little of specific nutrients, two contained more nutrient than claimed and three improperly listed ingredients. The good news: some of the best vitamins were also the cheapest. (check out results for children's vitamins) ... http://www.msnbc.msn.com/id/43429680/ns/health-diet_and_nutrition/
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Donors pledge 4.3 Billion for Vaccines for the poor (Reuters) International donors led by Britain and Bill Gates pledged $4.3 billion on Monday to buy vaccines to protect children in poor countries against potential killers such as diarrheal diseases and pneumonia.
The funding should allow more than 250 million of the world's poorest children to be vaccinated by 2015, helping to prevent more than four million premature deaths, the Global Alliance for Vaccines and Immunisation (GAVI) said. ... http://www.reuters.com/article/2011/06/13/us-vaccines-donors-idUSTRE75C1FV20110613?feedType=nl&feedName=ushealth1100
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Breastfeeding linked to lower risk of SIDS Babies who are breastfed- especially those who are fed only breast milk, and not formula as well--are less likely to die of Sudden Infant Death Syndrome (SIDS) suggests a new analysis of past studies. While the findings can't prove that breastfeeding causes the lower risk of SIDS, the authors write in Pediatrics that other explanations seem unlikely. "Breastfeeding is the best method of feeding infants," said Dr. Fern Hauck, the study's lead author from the University of Virginia School of Medicine in Charlottesville. ...
http://www.reuters.com/article/2011/06/14/us-breastfeeding-sids-idUSTRE75C2V220110614?feedType=nl&feedName=ushealth1100
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RANDOM FACT: 84% of a raw apple and 96% of a raw cucumber is water.
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RANDOM FACT: The rose family of plants, in addition to flowers, gives us apples, pears, plums, cherries, almonds, peaches and apricots.
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Original Research: Tragedy into Policy: A Quantitative Study of Nurses' Attitudes Toward Patient Advocacy Activities.
Black, Lisa M. AJN The American Journal of Nursing, June 2011,111(6):26-35
Although the Centers for Disease Control and Prevention (CDC) reports that an estimated 3.2 million Americans are living with chronic hepatitis C, in southern Nevada fewer than four cases of acute hepatitis C are confirmed annually.1, 2 So when six people who had recently undergone endoscopic procedures were diagnosed with acute hepatitis C within a six-month period (July 2007 to December 2007), alarms were sounded.1 Ultimately, more than 62,000 patients who had undergone endoscopic procedures at either of two southern Nevada endoscopy clinics would be notified that they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices. ... ( I, for one, would have reported it no matter what the consequences would be. )
http://journals.lww.com/ajnonline/Fulltext/2011/06000/Original_Research__Tragedy_into_Policy__A.23.aspx?WT.mc_id=EMxALLx20100222xxFRIEND
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If the current actions contributing to a multifaceted degradation of the world's oceans aren't curbed, a mass extinction unlike anything human history has ever seen is coming, an expert panel of scientists warns in an alarming new report.
The preliminary report from the International Programme on the State of the Ocean (IPSO) is the result of the first-ever interdisciplinary international workshop examining the combined impact of all of the stressors currently affecting the oceans, including pollution, warming, acidification, overfishing and hypoxia.
“The findings are shocking," Dr. Alex Rogers, IPSO's scientific director, said in a statement released by the group. "This is a very serious situation demanding unequivocal action at every level. We are looking at consequences for humankind that will impact in our lifetime, and worse, our children's and generations beyond that."
The scientific panel concluded that degeneration in the oceans is happening much faster than has been predicted, and that the combination of factors currently distressing the marine environment is contributing to the precise conditions that have been associated with all major extinctions in the Earth's history. ...
http://www.huffingtonpost.com/2011/06/20/ipso-2011-ocean-report-mass-extinction_n_880656.html?icid=maing-grid7|main5|dl2|sec1_lnk2|71953
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Is this an END TO AIDS?
- For his doctors, Timothy Ray Brown was a shot in the dark. An HIV-positive American who was cured by a unique type of bone marrow transplant, the man known as "the Berlin patient" has become an icon of what scientists hope could be the next phase of the AIDS pandemic: its end.
Timothy Ray Brown was living in Berlin when besides being HIV-positive, he had a relapse of leukemia. He was dying. In 2007, his doctor, Gero Huetter, made a radical suggestion: a bone marrow transplant using cells from a donor with a rare genetic mutation, known as CCR5 delta 32. Scientists had known for a few years that people with this gene mutation had proved resistant to HIV.
"We really didn't know when we started this project what would happen," Huetter, an oncologist and haematologist who now works at the University of Heidelberg in southern Germany, told Reuters. The treatment could well have finished Brown off. Instead he remains the only human ever to be cured of AIDS. "He has no replicating virus and he isn't taking any medication. And he will now probably never have any problems with HIV," says Huetter. Brown has since moved to San Francisco. ... http://www.reuters.com/article/2011/06/01/us-aids-idUSTRE75030I20110601?feedType=nl&feedName=ushealth1100
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Alzheimer's diagnostic guidelines updated for first time in decades
NIH-supported revision also proposes staging of disease, potential use of biomarkers
For the first time in 27 years, clinical diagnostic criteria for Alzheimer's disease dementia have been revised, and research guidelines for earlier stages of the disease have been characterized to reflect a deeper understanding of the disorder. The National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease outline some new approaches for clinicians and provides scientists with more advanced guidelines for moving forward with research on diagnosis and treatments. They mark a major change in how experts think about and study Alzheimer's disease. Development of the new guidelines was led by the National Institutes of Health and the Alzheimer’s Association.
The original criteria were the first to address the disease and described only later stages, when symptoms of dementia are already evident. The updated guidelines announced today cover the full spectrum of the disease as it gradually changes over many years. They describe the earliest preclinical stages of the disease, mild cognitive impairment, and dementia due to Alzheimer's pathology. Importantly, the guidelines now address the use of imaging and biomarkers in blood and spinal fluid that may help determine whether changes in the brain and those in body fluids are due to Alzheimer's disease. Biomarkers are increasingly employed in the research setting to detect onset of the disease and to track progression, but cannot yet be used routinely in clinical diagnosis without further testing and validation. ...
http://www.nih.gov/news/health/apr2011/nia-19.htm
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[Thank you, Barbara (BAcello)] FDA approves rapid MRSA/MSSA test The U.S. Food and Drug Administration has approved a blood culture test
that can determine if Staphylococcus aureus bacteria infections are methicillin resistant (MRSA) or methicillin susceptible (MSSA).
http://haymarket.puresendmail.com/hmiclick/4x0i9x5Rbc4q36Rg7a2RtsqrgoRd3m2R9ygzwf/1/35468?DCMP=EMC-MCK_Daily
(I have not found free full text yet. This link is to an abstract--and you
can purchase the complete article for $12..........BA)
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Workplace bullying hurts morale -- and patients
Though most doctors act with respect for other hospital staff, bullying is not unheard of, and it can be passed down to the rest of the
organization, oncology nurse Theresa Brown writes. Being insulted by a fellow provider reinforces a false stereotype of nurses and
creates a negative workplace environment that in turn affects patient care, she writes. The New York Times (tiered subscription model) (5/7) ...
http://www.nytimes.com/2011/05/08/opinion/08Brown.html?_r=1
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Sleep Strategy Commonly Used by Night Nurses Throws Off Their Circadian Clocks
ScienceDaily (Apr. 14, 2011) — As many as 25 percent of hospital nurses go without sleep for up to 24 hours in order to adjust
to working on the night shift, which is the least effective strategy for adapting their internal, circadian clocks to a night-time schedule.
http://www.sciencedaily.com/releases/2011/04/110414131933.htm
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CDC updates guidelines on preventing catheter-related infections The CDC has released new guidelines for preventing bloodstream infections
among patients using intravenous catheters. The guidelines, which update the 2002 guidelines, touch on various strategies for prevention
such as more training for health care staff and the use of maximum sterile barrier measures during central venous catheter insertion.
Modern Healthcare (free registration) (4/1)
This Medscape article provides a more thorough overview: http://www.medscape.com/viewarticle/740137
The complete guideline may be downloaded from: http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
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ELDER JUSTICE ACT – REPORTING OF CRIMES IN FEDERALLY FUNDED LONG TERM CARE
FACILITIES Benesch Friedlander Coplan & Aronoff LLP
Sections §6701 to §6703 of the Patient Protection and Affordable Care Act of 2010, H.R. 3590 ("PPACA") include requirements
for reporting of crimes in federally funded long term care facilities.
Long term care facilities or nursing homes have heard very little about the reporting obligations because it has not been clear which federal
agency was responsible for implementation and guidance relating to the provisions. In recent private correspondence, the Centers for
Medicare and Medicaid Services ("CMS") has commented that it will take the lead on implementation and will have some guidance
out in the coming months.
The statutory obligations provide that "covered individuals" in long-term care facilities that receive a minimum of $10,000 in federal
funding must report to the Secretary of DHHS and one or more local law enforcement entities - any reasonable suspicion of a crime (as
defined by local law) against any individual who is a resident of, or is receiving care from, the facility.
http://www.lexology.com/r.ashx?i=2733977&l=7F6WNJ4
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Medicare releases report on preventable errors at hospitals
Medicare has released data on eight serious and preventable medical errors that occurred at more than 4,700 U.S. hospitals,based on
billing reports for Medicare patients from 2008 to 2010. Falls were the most common preventable error at hospitals, occurring at a rate of
one for every 2,000 patient stays, followed by severe bedsores or skin ulcers, according to the report. St. Louis Post-Dispatch (4/7)
http://www.stltoday.com/lifestyles/health-med-fit/fitness/article_9a03e00b-8ae7-5bd4-8b9d-b4b7bc85b3d7.html
http://tinyurl.com/3kolpen
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Some tools may underestimate hospital adverse events: Researchers looking at data on about 800 inpatients from three hospitals
in 2004 found 393 adverse events. The Institute for Healthcare Improvement's Global Trigger Tool found 354 of the events, while the
tool used by the Agency for Healthcare Research and Quality only detected 35 events and voluntary reporting from the hospitals
only found four events. Researchers cautioned that hospitals "may be seriously misjudging actual performance" in their
voluntary reports. Modern Healthcare (free registration) (4/7)
https://home.modernhealthcare.com/clickshare/authenticateUserSubscription.do?
CSProduct=modernhealthcare&CSAuthReq=1:373432962137841:AID|IDAID=20110407/NEWS/
304079961|ID=:54339D7D08CE4B670E16AA58C49D5B96&AID=20110407/NEWS/304079961&title=
Adverse-event%20figures%20could%20be%20far%20higher%3A%20study&ID=&CSTargetURL=
http%3A%2F%2Fwww.modernhealthcare.com%2Fapps%2Fpbcs.dll%2Flogin%3FAssignSessionID%
3D373432962137841%26AID%3D20110407%2FNEWS%2F304079961
http://tinyurl.com/3swtxy5
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The HHS Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis In response to the IOM report released last year, Assistant Secretary for Health Dr. Howard Koh created a workgroup made up of U.S. Department of Health and Human Services (HHS) experts and charged them with developing a comprehensive strategic plan for viral hepatitis prevention and control. The resulting action plan is entitled, Combating the Silent Epidemic: U.S. Department of Health and Human Services Action Plan for the Prevention, Care and Treatment of Viral Hepatitis, and was released on May 12th.
The Action Plan covers six broad topics: ... http://www.cdc.gov/hepatitis/HHS-ActionPlan.htm
Combating the Silent Epidemic of Viral Hepatitis - 84 page pdf report: http://www.hhs.gov/ash/initiatives/hepatitis/actionplan_viralhepatitis2011.pdf
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US approves second new Hepatitis C drug WASHINGTON (AFP) - The US Food and Drug Administration on Monday approved Incivek to treat hepatitis C when taken along with the current two-drug regimen, marking the second such drug approval this month.
"The sustained virologic response for patients treated with Incivek across all studies, and across all patient groups, was between 20 and 45 percent higher than current standard of care," the FDA said. Incivek is a pill that should be taken three times a day with food, and is added to therapy made up of peginterferon alfa and ribavirin. ... http://ca.topmodel.yahoo.com/s/afp/110523/health/health_us_medicine_disease_pharma_company_vertex
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Advancing Oral Health in America Though it is highly preventable, tooth decay is a common chronic disease in the United States and one of the most common diseases worldwide. Individuals and many health care professionals remain unaware of the risk factors and preventive approaches for this and many other oral diseases, and they do not fully appreciate how oral health affects overall health and well-being. In this report, the IOM highlights the vital role that HHS can play in improving oral health and oral health care in the United States if HHS's efforts have clearly articulated goals; are coordinated effectively and adequately funded; and have high-level accountability. Barbara writes: "Please note: Although there is a charge for ordering copies of IOM reports, you can read them online for free. There are also links on the pages that enable you to download all or part of each report. IOM is an excellent source of high quality, well-researched, peer reviewed information.............BA".
(This was sent in by Barbara (BAcello) Thank you...for all you do.)
http://tinyurl.com/3hc7gud
************************ FALL ASSESSMENTS
This is from a list serve to which I belong....Thought it was worth sending on just in case you missed it. The question was "What does one do in assessing a person who fell?" My question is: Why isn't this addressed in detail in school?
I paraphrased the following): Ask if he/she is okay....this is part of the assessment.
"We do a lot of assessments just by saying "how are you?". You want to look for LOC changes, pain level, location and
intensity. In older people you might have to take to hospital any way for xray since they lose their ability to feel
pain at the same intensity young people do. If Fx is suspected then stabilize the location of suspected Fx
location and do as minimal movement as possible especially when you are the only one. Wait for paramedic to arrive.
If you were in the hospital and this happens to one of your pt's then call on your team.
A lot of times you are looking for a possible hip fracture, shortening of the leg and external rotation of the lower extremity.
Usually the foot ankle is rotated out (facing away from the body). Hope this helps, especially in the elderly."
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Perrycare@comcast.net (Sarah) writes:
Also think about neck trauma -- Arthritic spines, narrowed spaces where the cord and peripheral nerves pass -- kinda scary, eh?
depending on the mechanism of the fall you might have to think about stabilizing the neck before you do too much moving around.
Granted, this is not the case in most instances, but when I trip over a rug in a small space, like the bathroom, you might want to pay
particular attention to how I landed.
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Slow brain bleeds going unnoticed due to the fact that the elders brains can handle more blood not because they have larger ventricles but because it's due to the fact that the brain (gray matter) shrinks with age which leaves more space to handle
the excess blood. (sorry, not sure the author of this one).
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"Yes that is one possibility. Many of the elderly are on anticoags due to atrial fib. They fall (one loses muscle mass as they get older so they
become naturally weaker). Atrial fib is the natural way for older hearts too. I recall a cardiologist used to say if you live long enough you will
develop atrial fib. Anywho, so when they fall, they bleed into their brains; their large ventricles are sometimes a life-saver for them b/c they
won't herniate- the brain has more space to accommodate the extra blood without pushing on itself and endangering vital functions. Having
said all of this, when they are on anticoags they bleed into their brains more and faster therefore many die or become disabled which quickly
lead to a whole host of new problems i.e. pressure ulcers, infections, vent dependent....... basically waiting to die.
Also falling and breaking a bone which lead them to become disable or bedridden for months to heal from the fall will open the same host
of risks that I mentioned above as they don't heal as quickly and efficiently as young people do."
Hayat Barron, ICU-RN, CCRN, BSN
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(last, but not least--- will leave you with this Int read)
Probiotics Shorten Diarrhoea Episodes submitted by KurtUllman@Sprintmail.com
Probiotic bacteria given as therapies for diarrhoea reduce the length of time sufferers are affected and lessen the chance of episodes continuing for more than four days. These are the findings of a new systematic review by Cochrane researchers. Every year, diarrhoeal diseases kill nearly two million people in developing countries, mostly young children. The main treatment is rehydration
fluids, but these do not tend to reduce the length of illness, which is crucial in reducing the risk of persistent diarrhoea. Probiotics, so-called “good bacteria”, may help in a variety of different ways including eliminating the bacteria, viruses or parasites responsible,
for example, by competing for the same nutrients. A previous Cochrane review showed benefits with probiotics in diarrhoeal disease, but the
current report reviews data from a far larger evidence base. The researchers reviewed data from 63 trials involving a total of 8,014 patients, over four times the number involved in the previous study. 56 trials focused on infants and young children. Giving probiotics in conjunction with rehydration fluids reduced the duration of diarrhoea by around a day and reduced the risk of diarrhoea lasting four or more days by 59%. No serious adverse effects were reported
in the trials and although vomiting was quite common it also occurred with placebos. “A striking finding of this review is that most trials reported that probiotics reduced diarrhoea,” said lead researcher Stephen Allen of the School of Medicine at Swansea University, UK. “The beneficial effect was consistent and significant across many different types of trials.” “There were no adverse effects, so these therapies can be used safely in addition to rehydration fluids. However, more research needs to be carried out on the specific strains of bacteria that are effective in treating diarrhoea and on preventing the progression from short-term to persistent diarrhoea,” Allen said. A second review, by a separate group of Cochrane researchers, examined the use of probiotics for treating persistent diarrhoea reviewing
data from trials undertaken exclusively in children. The review found that probiotics can reduce the length of an episode of persistent diarrhoea,
however, the authors stress that the review was based on just four trials involving 464 patients and therefore provides only limited evidence of benefit. Full citations: Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for reating acute infectious diarrhoea. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD003048. DOI: 10.1002/14651858.CD003048.pub3 Upon publication, this link will take you to the paper: http://doi.wiley.com/10.1002/14651858.CD003048.pub3. Bernaola Aponte G, Bada Mancilla CA, Carreazo Pariasca NY, Rojas Galarza RA. Probiotics for treating persistent diarrhoea in children. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD007401. DOI: 10.1002/14651858.CD007401.pub2 Upon publication, this link will take you to the paper: http://doi.wiley.com/10.1002/14651858.CD007401.pub2.
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HUMOR SECTION
Two women were sitting in the doctor's waiting room comparing notes on their various disorders.
"I want a baby more than anything in the world," said the first, "But I guess it is impossible."
"I used to feel just the same way," said the second. "But then everything changed. That's why I'm here. I'm going to have a baby in three months."
"You must tell me what you did."
"I went to a faith healer."
"But I've tried that. My husband and I went to one for nearly a year and it didn't help a bit."
The other woman smiled and whispered, "Try going alone, next time, dearie."
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /
Free CEs http://www.myfreece.com/welcome.asp
https://nursing.advanceweb.com/CE/TestCenter/Main.aspx
This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
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/12-lead-ekg-interpretation-part-2
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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Defibtech Lifeline and ReviveR Automated External Defibrillators (AEDs): Recall - Software Defect May Cancel Shock
Devices subject to this recall include Model DDU-100 series with software version 2.004 or earlier, sold under the brand names Lifeline and ReviveR. AEDs using software version 2.004 or earlier may cause the device to cancel shock during the charging process. Failure to provide appropriate therapy may result in failure to resuscitate the patient. Defibtech will provide customers with a free software upgrade. Because the conditions that may lead to a canceled shock occur rarely, it is recommended that customers keep their AEDs in service during the software upgrade process. Full instructions and recommendations are being mailed to affected customers. Defibtech is responsible for contacting all end users unless a distributor has agreed to contact their accounts directly regarding this field correction
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm254929.htm
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Weck Hem-o-Lok Ligating Clips: Contraindicated for Ligation of Renal Artery During Laparoscopic Living-Donor Nephrectomy The Weck Hem-o-Lok Ligating Clip is a V-shaped clip made from a non-absorbable material that comes in various sizes. It is used to permanently close bleeding vessels or tissue structures.
FDA notified health care providers that Weck Hem-o-Lok Ligating Clips should not be used for the ligation of the renal artery during a laparoscopic living-donor nephrectomy because of serious risks to the donor. The clips may become dislodged, which can lead to uncontrolled bleeding, additional surgery, or death of the donor. In 2006, the manufacturer added this contraindication to the Instructions for Use after receiving 15 reports of 12 injuries and three deaths which occurred between 2001 and 2005. Since the contraindication issued in 2006, there have been three more kidney donor deaths, all associated with the contraindicated use.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm254363.htm
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List of Medical Device Recalls....
http://www.fda.gov/MedicalDevices/Safety/RecallsCorrectionsRemovals/ListofRecalls/default.htm
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Revlimid (lenalidomide): Ongoing Safety Review - increased risk of developing new malignancies ISSUE: FDA is informing the public that we are aware of results from clinical trials conducted inside and outside the United States that found that patients treated with Revlimid (lenalidomide) may be at an increased risk of developing new types of cancer compared to patients who did not take the drug.FDA is currently reviewing all available information on this potential risk and will communicate any new recommendations once it has completed its review. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm250606.htm
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Greenstone LLC announced a recall of medicines with lot number FI0510058-A on the label. Bottles labeled as Citalopram (used to treat depression) may contain Finasteride (used for the treatment of benign prostatic hyperplasia). Women who are, or may become pregnant, should not take or handle Finasteride due to the possible risk of side effects which may cause abnormalities to the external genitalia of a developing male fetus. Citalopram is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or pimozide; it is also contraindicated in patients with a hypersensitivity to Citalopram or any of the inactive ingredients in the tablet. Patients who discontinue Citalopram abruptly by inadvertently taking the mislabeled product may experience discontinuation symptoms and/or worsening of depression.
BACKGROUND: This includes Citalopram 10mg Tablets (100-count bottle) and Finasteride 5mg Tablets (90-count bottle), both distributed in the U.S. market. The recall is due to the possibility that incorrect labels have been placed on the bottles by a third-party manufacturer. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm248595.htm
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APP Pharmaceuticals, Inc. issued a voluntary recall of five lots of Irinotecan Hydrochloride Injection due to the discovery of foreign material and non-sterility in one lot of Irinotecan injection. Non-sterility of a chemotherapeutic product administered via the intravenous route has the potential to result in infections, which could be fatal, especially in patients who are immunocompromised.
BACKGROUND: Irinotecan Hydrochloride Injection is used for recurrent or progressive metastatic colorectal cancer. Three customers reported that they discovered a particulate in the product solution in lot 870DE00301. Investigation of the returned vials confirmed that the particulate was a fungal microbial contaminant. See the Firm Press Release for a listing of recalled lot numbers. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm248598.htm
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Erythropoiesis-Stimulating Agents (ESAs) In Chronic Kidney Disease: Drug Safety Communication - Modified Dosing Recommendations
Epoetin alfa (marketed as Epogen and Procrit) and darbepoetin alfa (marketed as Aranesp)
FDA notified healthcare professionals that new, modified recommendations for more conservative dosing of Erythropoiesis-Stimulating Agents (ESAs) in patients with chronic kidney disease (CKD) have been approved to improve the safe use of these drugs. FDA has made these recommendations because of data showing increased risks of cardiovascular events with ESAs in this patient population. The new dosing recommendations are based on clinical trials showing that using ESAs to target a hemoglobin level of greater than 11 g/dL in patients with CKD provides no additional benefit than lower target levels, and increases the risk of experiencing serious adverse cardiovascular events, such as heart attack or stroke.
ESAs treat certain types of anemia by stimulating the bone marrow to produce red blood cells and by decreasing the need for blood transfusions.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm260641.htm
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Oridion Medical and Philips Healthcare Microstream CO2 Filterline (FilterLine H Set Infant/Neonate, VitaLine H Set Infant/Neonate: Recall - Plastic Strands on the Adapter May Become Dislodged, Inhaled by Patient
Fine plastic strands on the inner surface of the infant/neonatal airway adapter may become dislodged and inhaled by the patient. Inhalation of the plastic strands on the defective devices may cause respiratory compromise, which could result in serious illness or death.
BACKGROUND: The Microstream CO2 Filterline is a medical device used by emergency medical services, hospitals, and other health care providers to measure exhaled carbon dioxide (CO2) during ventilation of newborn and infant patients. See the recall notice for affected models and lots. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm258133.htm
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This is a Class I Notice: Boston Scientific iCross and Atlantis SR Pro 2 Coronary Imaging Catheters: Recall – Catheter Tip Can Break Inside of the Patient
The catheter tip can break inside of the patient and embolize causing tissue and blood vessel injury, heart attack or other serious events requiring additional unplanned surgery.
BACKGROUND: The Boston Scientific iCross and Atlantis A SR Pro2 coronary imaging catheters are intended for ultrasound examination of coronary intravascular pathology only. Intravascular ultrasound imaging is used on patients who are candidates for transluminal coronary interventional procedures. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm259097.htm
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Boston Scientific Innova Self-Expanding Stent System: Recall - Failure to Deploy
Boston Scientific sent an urgent medical device recall letter to OUS customers on May 13, 2011. The recall notice explained the issue, identified the affected products, required distributors to cease further distribution and use of the product, and requested the return of unused product to Boston Scientific. See the Recall Notice for a complete list of affected lot numbers.
Complaints of no deployment and partial deployment have been received. This type of failure may result in vessel wall injury, increased procedure time and/or emergency surgery to remove the partially deployed stent. This recall does not affect stents that have already been implanted as the issue occurs during delivery of the stent http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm259764.htm
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NURSING HINTS CORNER
Body cast dilemma
When my 2-year old son was in a body cast for 2 months, i ket the perineal area of his cast clean and dry with disposable diapers for newborns. I tucked the diaper tightly into the cast;s perineal opening to prevent wetness from soaking into the cast. After two months, the cast had no odor or stains. Sheryl Knoedler, RN, BSN (I think this would be a great patient/parent teaching tool).
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 85, 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:
joy2unu@yahoo.com (Jeanne) June 12, 2011
sabessonette@gmail.com (Sally) June 18, 2011
Tamibihl@yahoo.com (Tami) June 18, 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, okay? RNFrankie@AOL.com
New Address: aznitern@Q.com (Roxie) Old Address: aznitern @msn.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
Children are the living messages we send to a time we
will not see.
--Neil Postman
Hope to see you online..... Frankie
RNFrankie@AOL.com
