PARADIGM BYTES September 10, 2011

PARADIGM BYTES
Newsletter for Paradigm 97
September 10, 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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SNIPPET

Why are those nurses hogging so much of the hospital budget? ! Thank you, Sandy for all you do ! (Please support her site)
March 25, 2011 -- Recent press reports have highlighted the continuing debate over adequate nurse staffing in U.S. hospitals. A fairly good March 16 piece in the St. Paul Pioneer Press was among those reporting that a new study published in the New England Journal of Medicine had found that nurse understaffing at the Mayo Clinic significantly increased the risk of patient mortality, and that high patient turnover had an even great effect. Christopher Snowbeck's report also provided helpful context, noting that nurse staffing levels have been critical factors in recent labor disputes between hospitals and nursing unions. And today, the Boston Globe ran business columnist Steven Syre's piece about the "conundrum" hospitals face in trying to balance costs with the growing awareness that having fewer nurses threatens patients. It seems that nursing payrolls are the biggest single "expense" hospitals have. This piece also provides a pretty balanced look at recent labor disputes in which nurse staffing has been a key issue. But the writer seems puzzled about why nursing salaries are such a part of hospital budgets. No one says: "Yes, nursing salaries are a big factor because hospitals exist to provide professional nursing care, not to house physicians or machines. And nurses are not just 'expenses'; they create most of the value that hospitals provide." That basic reality might have been helpful for readers to know. In any case, we thank those responsible for these two pieces. more... Christopher Snowbeck's report also provided helpful context, noting that nurse staffing levels have been critical factors in recent labor disputes between hospitals and nursing unions. And today, the Boston Globe ran business columnist Steven Syre's piece about the "conundrum" hospitals face in trying to balance costs with the growing awareness that having fewer nurses threatens patients. It seems that nursing payrolls are the biggest single "expense" hospitals have. This piece also provides a pretty balanced look at recent labor disputes in which nurse staffing has been a key issue. But the writer seems puzzled about why nursing salaries are such a part of hospital budgets. No one says: "Yes, nursing salaries are a big factor because hospitals exist to provide professional nursing care, not to house physicians or machines. And nurses are not just 'expenses'; they create most of the value that hospitals provide." That basic reality might have been helpful for readers to know. In any case, we thank those responsible for these two pieces. ( for more about nurse's salaries...and the need for nurses check out the website). ...
http://www.truthaboutnursing.org/news/2011/mar/25_hogging.html ; ( We all need to have this information...no telling when the opportunity will arise for put forth the argument for good nursing care and what that really means).
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FROM THE MEMBERS

(Received this note from COMBATVET, and wanted to wish him the best in this new endeavor!!!! He wrote:)

"Frankie:

I completed my BSN from the University of Colorado at Colorado Springs and accepted a job teaching there starting this fall.

Robert Weiner" (COMBATVET@AOL.com)

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Just released, Bob Hess's 17-year retrospective on the IPNG, Slicing and Dicing Shared Governance: In and Around the Numbers, in the July/September issue of Nursing Administrative Quarterly.

Hospitals seeking Magnet status must demonstrate empowering structures and processes that involve nurses in governance and decision-making about their practice. Shared governance—an organizational innovation that legitimizes health care professionals' decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers—can achieve this. However, evidence connecting shared governance with clinical, professional, and organizational outcomes has been sparse. Research using the Index of Professional Nursing Governance is changing that. Innovative uses of the Index of Professional Nursing Governance is strengthening new shared governance programs, rejuvenating old ones, and finally connecting innovative models to favorable outcomes. ...
http://journals.lww.com/naqjournal/Abstract/2011/07000/Slicing_and_Dicing_Shared_Governance__In_and.8.aspx


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MEDICAL NEWS
BIG NEWS !!! FDA Approves the Accreditation Bodies to Accredit the Siemens Mammomat Inspiration Pure Full-Field Digital Mammography (FFDM) Unit (8/23/11)

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World Bank Calls famine in the Horn of Africa Man Made... The famine in the Horn of Africa is man made - the result of artificially high prices for food and civil conflict, the World Bank's lead economist for Kenya Wolfgang Fengler told Reuters Tuesday.
"This crisis is man made," Fengler said in a telephone interview. "Droughts have occurred over and again, but you need bad policy making for that to lead to a famine."
Some 12.4 million people in the Horn of Africa - including Somalia, Kenya, Ethiopia and Djibouti - are affected by the worst drought in decades, according to the United Nations. Tens of thousands of people have already died. Fengler said the price of maize, or corn, was significantly higher in east Africa than in the rest of the world due to controls on local food markets. ...
http://www.reuters.com/article/2011/08/16/us-africa-famine-manmade-idUSTRE77F6QN20110816?feedType=nl&feedName=ushealth1100

NON-MEDICAL........just wanted to share !
U.S. Set To File Suits Against Big Banks Over Mortgages
WASHINGTON - The agency that oversees mortgage markets is preparing to file suit against more than a dozen big banks, accusing them of misrepresenting the quality of mortgages they packaged and sold during the housing bubble, The New York Times reported on Thursday.
The Federal Housing Finance Agency, which oversees mortgage giants Fannie Mae and Freddie Mac, is expected to file suit against Bank of America, JPMorgan Chase, Goldman Sachs and Deutsche Bank, among other banks, the Times reported, citing three unidentified individuals briefed on the matter.
The suits stem from subpoenas the finance agency issued to banks last year. They could be filed as early as Friday, the Times said, but if not filed Friday it said the suits would come on Tuesday.
The government will argue the banks, which pooled the mortgages and sold them as securities to investors, failed to perform due diligence required under securities law and missed evidence that borrowers' incomes were falsified or inflated, the Times reported.... http://www.huffingtonpost.com/2011/09/01/us-suits-big-banks-mortgages_n_946010.html?ncid=webmail1 ~~**~~**~~**~~**~~**~~
INTERESTING READING

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

Stem cell team aims for spare heart parts in five years (Reuters) Stem cell researchers in Hong Kong and the United States are trying to grow spare parts for the human heart that may be ready for tests on people within five years, they said on Thursday.
Scientists have already made basic heart muscle from stem cells, but the Hong Kong-led team wants to refine it so it can replace any part damaged in heart attacks, and to recreate the natural pacemaker, where the heartbeat originates. ...
http://www.reuters.com/article/2011/08/18/us-heart-stemcells-idUSTRE77H0ZM20110818?feedType=nl&feedName=ushealth1100
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Mosquito resistance to bednets fuels malaria worries (Reuters) - Mosquitoes can quickly develop resistance to insecticide-treated nets, a study from Senegal shows, raising fears that a leading method of preventing the disease may be less effective than previously thought.
Researchers who studied malaria infections in a village in the West African country found that growing resistance to a common type of insecticide by Anopheles gambiae mosquitoes -- the species responsible for transmitting malaria to humans in Africa -- is causing the disease to rebound. ...
http://www.reuters.com/article/2011/08/18/us-malaria-nets-resistance-idUSTRE77H3L120110818?feedType=nl&feedName=ushealth1100
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Experts find way to make mosquitoes dengue-free (Reuters) Injecting a bacteria into mosquitoes can block them from transmitting the dengue virus and help control the spread of a disease that kills 20,000 annually in more than 100 countries, scientists said.
In two papers published in the journal Nature on Thursday, researchers in Australia showed how female mosquitoes infected with the Wolbachia bacteria passed the bug easily to their offspring, making them all dengue-free. They said such infected mosquitoes should be released into the wild, so that the spread of dengue to people may be reduced.
"The main feature we saw was their ability to reduce dengue transmission," said Professor Scott O'Neill, lead author and science faculty dean at Monash University. "It almost completely abolished dengue virus in the body of the mosquito." ...

http://www.reuters.com/article/2011/08/25/us-dengue-australia-idUSTRE77O00O20110825?feedType=nl&feedName=ushealth1100
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Scientists find weakness in deadly Ebola virus (Reuters)
Laboratory mice bred to produce low levels of this protein -- known Niemann-Pick C1 -- survived exposure to both Ebola, which causes a hemorrhagic fever, and its cousin, Marburg virus.
"This research identifies a critical cellular protein that the Ebola virus needs to cause infection and disease," said Sean Whelan of Harvard Medical School, who worked on one of two studies published on Wednesday in the journal Nature. A protein that helps transport cholesterol inside cells may be a key to developing drugs to treat Ebola, a rare but lethal virus for which there are no known treatments, U.S. researchers said.
"The discovery also improves chances that drugs can be developed that directly combat Ebola infections," Whelan said in a statement. Ebola is one of the most deadly infections known, killing 90 percent of people infected by it. ...

http://www.reuters.com/article/2011/08/24/us-science-ebola-idUSTRE77N5X520110824?feedType=nl&feedName=ushealth1100
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RANDOM FACT #1: Originally named "Baby Gays," Leo Gerstenzang invented the cotton swab in the 1920's.
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RANDOM FACT #2: Nearly 3 out of 4 Americans stick cotton swabs in their ears despite the package's instructions against it.
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Addiction is a brain disorder...
WASHINGTON (AP) — Addiction isn't just about willpower. It's a chronic brain disease, says a new definition aimed at helping families and their doctors better understand the challenges of treating it.
"Addiction is about a lot more than people behaving badly," says Dr. Michael M. Miller of the American Society for Addiction Medicine.
That's true whether it involves drugs and alcohol or gambling and compulsive eating, the doctors group said Monday. And like other chronic conditions such as heart disease or diabetes, treating addiction and preventing relapse is a long-term endeavor, the specialists concluded.
Addiction generally is described by its behavioral symptoms — the highs, the cravings, and the things people will do to achieve one and avoid the other. The new definition doesn't disagree with the standard guide for diagnosis based on those symptoms. http://www.aarp.org/health/conditions-treatments/news-08-2011/us-med-healthbeat-addiction.html?cmp=NLC-RSS-DAILY-BULLETIN
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29 New Genes Linked to MS........Report is part of a 12-month Clinical Context series

The genetic puzzle underlying multiple sclerosis is proving to be increasingly complex, with genome-wide analyses now having identified 29 new gene variants associated with the disease, an international team of researchers reported.
Many of the newly implicated genes play important roles in the immune system, particularly in T-cell activation and differentiation, according to Stephen Sawcer, PhD, of the University of Cambridge in England, and colleagues.
"The over representation of genes that influence T-cell maturation provides independent and compelling evidence that the critical disease mechanisms primarily involve immune dysregulation," the researchers wrote in the August 11 issue of Nature.
These findings emerged from genome-wide association studies of DNA samples fom 9,772 patients in 15 countries and 17,376 controls. ...
New Genes Linked to MS CME

http://www.medpagetoday.com/clinical-context/MultipleSclerosis/28011?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=379846
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PCI for blocked arteries of Lasting Benefit in Diabetes Long-term outcomes for patients with diabetes were significantly improved following successful percutaneous coronary intervention (PCI) for chronic total occlusions, researchers found.
Through a median of three years of follow-up, the mortality rate following a successful procedure was significantly lower than an unsuccessful one (10.4% versus 13%, P<0.05), according to Roxana Mehran, MD, of the Cardiovascular Research Foundation in New York City, and colleagues.
There was also a substantial reduction in the need for CABG during follow-up after a successful PCI (2.4% versus 15.7%, P<0.01), the researchers reported online in the American Journal of Cardiology. ...

http://www.medpagetoday.com/Cardiology/PCI/28018?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=379846
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15 minutes of exercise a day can extend life by three years
(Reuters) - Doing just 15 minutes of moderate exercise a day may add three years to your life, a large study in Taiwan has found.
Most people struggle to stick to the standard guideline of 30 minutes a day of exercise, five days a week, and experts hope that by identifying a lower dose, more people will be motivated to get off the couch.
Lead researcher Chi Pang Wen of Taiwan's National Health Research Institutes said dedicating 15 minutes a day to a moderate form of exercise, like brisk walking, would benefit anyone. ... http://www.reuters.com/article/2011/08/16/us-exercise-taiwan-idUSTRE77E69L20110816?feedType=nl&feedName=ushealth1100
100 Ways to get slim... Don't have time or money for the gym? No sweat. Check out these 100 ways to get slim without the gym and watch your inches shrink while your wallet grows fat. Win-win! http://www.ivillage.com/100-ways-get-slim-without-gym/4-b-365413?nlcid=wh|08-16-2011|

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HHS Awards $71.3 Million to Strengthen Nursing Workforce 08/02/11
Nursing workforce development programs, reauthorized by the Affordable Care Act and administered by Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA), are the primary source of federal funding for nursing education and workforce development. These programs bolster nursing education at all levels, from entry-level preparation through the development of advanced practice nurses. They also prepare faculty to teach the nation’s future nursing workforce.
http://nursingworld.org/HomepageCategory/NursingInsider/HHS-Strengthen-Nursing-Workforce.aspx ;
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Dismantling Nursing's Catch-22 The potential positives of med-error reporting often are overshadowed by the repercussions to nurses
Victoria L. Rich, RN, PhD, FAAN, chief nurse executive at the University of Pennsylvania Medical Center and an associate professor at the school of nursing there, recalls working at a hospital in the 1980s where a nurse who made three medication errors in one year automatically was fired. In such a fearful environment, few nurses wanted to report errors, Rich said, referring to those days as "the dark ages."

In the past 15 years, as a preponderance of evidence shows the harm to patients from medical errors and the need to shed light on how and why such errors occur, more hospitals are trying to shift from punishing individuals for honest mistakes to using error reports as evidence to change systems, making it harder for clinicians to make errors and easier to catch mistakes before they cause harm. But the process of creating trust and a true culture of safety is not easy, said Ronda Hughes, RN, PhD, MHS, FAAN, associate professor at Marquette University College of Nursing in Milwaukee, Wis. It requires long-term hospital wide commitment, strong leadership and a lot of time.

"It's something you have to do for years on end," said Hughes, who was a senior health scientist administrator for the Agency for Healthcare Research and Quality and works as a consultant for the Labor Management Institute in Minnesota. "It's not something you can do for weeks or even a year." ... http://news.nurse.com/article/20110808/NATIONAL01/108080059
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Interdisciplinary Pilot Study Suggests Nurses Can Help Chronically Ill Patients Properly Manage Medication after Being Discharged from Hospital Medicare will soon release new rules requiring hospitals to focus more attention on patients after they are discharged. Readmissions have cost Medicare $26 billion a decade and the program plans to cut payments to hospitals that have high readmission rates. Nonadherence to medication regimens may be one factor in high readmission rates. After leaving the hospital, patients are not always likely or able to adhere to the medication regimens they were prescribed, sometimes with disastrous results. Without supervision from a health care provider, some patients either never take the prescribed medication, or take the wrong dosage. One study found that more than seven in ten (72 percent) of adverse events after a patient left the hospital were related to medication. ...
http://inqri.blogspot.com/2011/08/interdisciplinary-pilot-study-suggests.html
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Details Crucial When Reporting Adverse Events Due to Medical Devices
Rapid identification of adverse events associated with medical devices is essential to prevent injury or death. Unfortunately, many adverse events reported to the Food and Drug Administration (FDA) do not include vital information such as the patient’s age, which may delay identification of problems in the pediatric population and result in under-reporting of serious adverse events in children. The American Academy of Pediatrics (AAP) Newsmagazine http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/news/newsletter.cfm?news=64#8
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Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book’s recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives. The National Academies Press. Health Care Comes Home: The Human Factors. 2011.
http://www.nap.edu/catalog.php?record_id=13149
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/news/newsletter.cfm?news=64#7

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RANDOM FACT: An estimated 1,000,000 dogs in the U.S. have been named as the primary beneficiaries in their owner's will.
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(In my opinion, the individual vaccine is probably safe, but question what happens when double or triple vaccines are given in one dose. )

Vaccines largely safe, U.S. expert panel finds (Reuters) - After a close review of more than 1,000 research studies, a federal panel of experts has concluded that vaccines cause very few side effects, and found no evidence that vaccines cause autism or type 1 diabetes.
The report, issued on Thursday by the Institute of Medicine, part of the National Academies of Sciences, is the first comprehensive report on vaccine side effects since 1994.
Fears that vaccines might cause autism or other health problems have led some parents to skip vaccinating their children, despite repeated reassurances from health authorities. The concerns have also forced costly reformulations of many vaccines. ...
http://www.reuters.com/article/2011/08/25/us-vaccines-idUSTRE77O4ZE20110825?feedType=nl&feedName=ushealth1100

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(As nurses, we could have a patient with quadriplegia; Definitely, there is a chance that we could encounter Autonomic Dysreflexia-- which is life threatening for the quad. It behooves us to know what to do in this emergency.)

Headache attributed to autonomic dysreflexia : An under -recognized clinical entity
Objective: The recognition and the management of headache attributed to autonomic dysreflexia after spinal cord injury (SCI) are challenging issues. Given this, I systematically reviewed the literature to establish the features of the headache attributed to autonomic dysreflexia after SCI.
Methods: This review included all articles that addressed any feature of headache attributed to autonomic dysreflexia after SCI. The literature search addressed publications from 1950 until April 2010. The literature search was conducted using MEDLINE, CINAHL, EMBASE, and PsycINFO® databases. The literature search was limited to only articles written in English.
Results: Of the 273 publications captured in all 4 databases, 45 articles fulfilled our inclusion and exclusion criteria. Typically, the headache attributed to autonomic dysreflexia is a sudden-onset, severe headache accompanied by several signs and symptoms including increased blood pressure, altered heart rate, and diaphoresis cranial to the level of SCI, which is triggered by different noxious and nonnoxious stimuli. However, clinicians need to be aware of other headache features and the variety of potential triggers associated with the headache attributed to autonomic dysreflexia.
Conclusions: The greater awareness of this clinical entity among clinicians, in particular neurologists, is crucial for early recognition and proper management of episodes of autonomic dysreflexia to prevent its complications. Neurology® 2011;77:792–798

http://www.neurology.org/content/77/8/792.abstract
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Mob RANDOM FACTS: Benjamin "Bugsy" Seigel built the Flamingo hotel and casino in 1945, with a mob loan; however due to mismanagement it soon went over budget. Unable to get their money back, the top gangsters including Luciano and Lansky agreed to have him killed. On June 20, 1947, "Bugsy" Seigel was killed in his Los Angeles house.

Bonus Fact: Donnie Brasco, in reality Joe Pistone, spent five years undercover for the FBI between 1976 and 1981. His evidence resulted in more than 100 convictions and the near collapse of the Bonanno family in New York.
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Obesity to worsen, weigh heavily on healthcare costs (Reuters) - Obesity is most widespread in Britain and the United States among the world's leading economies and if present trends continue, about half of both men and women in the United States will be obese by 2030, health experts warned on Friday.
Obesity is fast replacing tobacco as the single most important preventable cause of chronic non-communicable diseases, and will add an extra 7.8 million cases of diabetes, 6.8 million cases of heart disease and stroke, and 539,000 cases of cancer in the United States by 2030.
Some 32 percent of men and 35 percent of women are now obese in the United States, according to a research team led by Claire Wang at the Mailman School of Public Health in Columbia University in New York. They published their findings in a special series of four papers on obesity in The Lancet.
In Britain, obesity rates will balloon to between 41-48 percent for men and 35-43 percent for women by 2030 from what is now 26 percent for both sexes, they warned. ... http://www.reuters.com/article/2011/08/26/us-obesity-health-idUSTRE77P17020110826?feedType=nl&feedName=ushealth1100
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RANDOM FACT: A cat's heart beats twice as fast as a human heart, at 110 to 140 beats per minute.
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Four Signs of Elder abuse:

Physical and sexual abuse
Suspicious bruises or other injuries. Rope burns or other signs of restraints. Sudden change in behavior. Caregiver's refusal to allow visitors.
Emotional or psychological abuse
(Insults, threats, social isolation) Elder is extremely upset, withdrawn, unresponsive; other unusual behavior.
Neglect
Dehydration, malnutrition, untreated bed sores, weight loss. Unattended health problems or lack of necessary aids, such as eyeglasses or dentures. Unsanitary living conditions (lice, soiled bedding). Inadequate clothing; no heat or running water.
Financial exploitation
Unexplained bank withdrawals, unauthorized use of a credit or ATM card, stolen or "misplaced" cards or checkbook. Checks written as a "loan" or "gift." Abrupt changes in a will or other documents. Unexplained transfer of assets to a family member or someone outside the family. Disappearance of valuables. Ill-advised investments. Sudden appearance of a previously uninvolved relative claiming a right to an elder's affairs or possessions.
http://www.aarp.org/politics-society/advocacy/info-2007/protecting_the_vulnerable_sb.html
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#15 Prepay... Adding a bit to your monthly payment can dramatically shorten the life of your mortgage and ultimately save you thousands of dollars in interest. Every extra dollar is applied to the loan's principal. Adding $10 per payment can prune 14 months from a 30-year, 5 percent mortgage for $100,000, and save you $4,500 in interest.
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FDA Okays Late-Stage Melanoma Drug
WASHINGTON -- The FDA has approved vemurafenib (Zelboraf) for the treatment of metastatic and unresectable melanoma along with a companion genetic mutation test. Vemurafenib is specifically indicated for patients whose tumors express a BRAF V600E mutation, the FDA said in a statement. The companion diagnostic tool, known as the cobas 4800 BRAF V600 Mutation Test, can help determine if the melanoma cells contain the indicated mutation.
Vemurafenib is a BRAF inhibitor that blocks the function of the V600E-mutated BRAF protein. The drug has not been studied in patients who test negative for the BRAF V600E mutation, the FDA stated.
Vemurafenib is the second drug approved for late-stage melanoma this year; ipilimumab (Yervoy) was approved by the FDA in March. ...
http://www.medpagetoday.com/PublicHealthPolicy/FDAGeneral/28083?utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news
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Blacks at Higher Risk for Resistant Breast Disease
TUESDAY, Aug. 16 (HealthDay News) -- Black women are more likely to have two or more children and are less likely to breast-feed, putting them at greater risk of developing a difficult-to-treat type of breast cancer, according to a new study.
The study, published in the current issue of Cancer Epidemiology, Biomarkers & Prevention, found the risk for hormone receptor-negative breast cancer was 50 percent greater among women who gave birth to at least two children. The researchers noted, however, that breast-feeding reduced that risk. ... http://consumer.healthday.com/Article.asp?AID=655782
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HPV Vaccination Rates Lagging for Teens
Coverage rates for all three recommended adolescent vaccines have risen, although vaccination against human papillomavirus (HPV) is lagging, the CDC reported.
A national survey showed that overall coverage with the meningococcal conjugate vaccine (MenACWY) and the tetanus, diphtheria, acellular pertussis (Tdap) vaccine each rose by about 10 percentage points in 2010 compared with 2009, the agency reported in the Aug. 26 issue of Morbidity and Mortality Weekly Report.
In contrast, the CDC reported, coverage with at least one dose of the HPV vaccine rose by slightly more than four percentage points, while coverage with the complete three-dose regimen increased by just over five percentage points.
The findings parallel what has been happening since 2006, the agency said: coverage rates for all three vaccines have been rising, but the average annual rate increase for MenACWY and Tdap has been significantly higher than for HPV. ...
http://www.medpagetoday.com/Pediatrics/Vaccines/28197?utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news
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Genome Region Tied to Risk of Second Cancers after RadiationTherapy A new study may provide an important clue about the long-term risk of second primary cancers in children with Hodgkin lymphoma who receive radiation therapy as part of their treatment. In the study, researchers identified two genetic variants, called single nucleotide polymorphisms (SNPs), in a region of chromosome 6 that were strongly associated with an increased risk of a second cancer in this group of cancer survivors.
Published July 24 in Nature Medicine, the study is among the first genome-wide association studies focused on second cancer risk, and one of the few such studies to date that limited the study population to a group that received a specific therapeutic intervention.
Approximately 90 percent of children and adolescents diagnosed with Hodgkin lymphoma are cured. But that cure can come at a price: Nearly 20 percent of survivors will develop a second cancer, which is the second leading cause of death in this population. ...
http://www.cancer.gov/ncicancerbulletin/080911/page2

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RANDOM FACT: Tomatoes first grew as wild, cherry-size berries in the South American Andes, but the fruit, as we know it today,
was developed in Mexico where it was known as tomatil and traveled to Europe by boat with the returning conquistadors.
Bonus Fact: A tomato is 94% water.
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Are skin disorders related to work strain in hospital workers? A cross-sectional study. To evauluate whether occupational stress factors (high demands, low control, low social support, strain, and iso-strain) are associated with skin disorders in hospital workers and whether psychological problems, such as anxiety and depression, act as potential mechanisms through which occupations stress factors are associated with skin disorders. ...

http://www.biomedcentral.com/1471-2458/11/600
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Cervical Screening Guidelines Ignored Many physicians recommend the HPV and Papanicolaou co-tests for cervical cancer screening on an annual basis, despite guidelines that call for re-screening every three years, researchers said.
National survey data show that about 51% of providers ordered the co-test, but in clinical vignettes, only about 14% recommended re-screening in three years for women with normal results, Katherine Roland, MPH, of the Centers for Disease Control and Prevention in Atlanta, and colleagues reported online in the American Journal of Obstetrics & Gynecology.
"Annual cervical cancer screening continues to be a common recommendation, regardless of whether a screening history has been established or an HPV test has been ordered," the researchers wrote. ...

http://www.medpagetoday.com/OBGYN/GeneralOBGYN/28098?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=379846
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#17 Compare costs BillShrink.com analyzes your everyday costs for services like cell-phones and cable TV and financial accounts. FindABetterBank.com compares checking account plans at banks and credit unions. BrightScope.com compares 401 (k) plans and financial advisers.
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Nearly one in 10 children in the United States is being diagnosed with attention deficit hyperactivity disorder, according to a new government study. That’s an increase of more than 2 percent in ADHD diagnoses compared to a decade ago, researchers from the Centers for Disease Control and Prevention reported today.
The new findings don’t necessarily mean that more kids are developing ADHD, said the study’s lead author Dr. Lara Akinbami, a medical officer at the CDC’s National Center for Health Statistics. “This change is reflected in numerous national data sets,” Akinbami explained. “It’s robust and real. But we can’t say whether it’s a true increase in prevalence or just better detection.” ...

http://www.msnbc.msn.com/id/44190936/ns/health-childrens_health/
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A review of educational strategies to improve nurses roles in recognizing and responding to deteriorating patients
International Nursing Review, 07/19/2011
Liaw SY et al. – The review has highlighted important aspects of patient safety in clinical deterioration that could be further addressed by educational strategies targeting the role of ward nurses. These strategies include: utilizing clinical decision–making models to develop nurses' decision making skills; developing a standardized tool for systematic nursing assessment and management of clinical deterioration; incorporating training in clinical deterioration as a core competence of pre–registered nursing education; providing vital signs training to nursing assistants; and conducting more rigorous studies to evaluate the effectiveness of the educational programmes. ... (You will need to register in order to view entire article, unfortunately. Registration is simple)
http://www.mdlinx.com/nursing/newsl-article.cfm/3670043/ZZ5603146585149290157159/?news_id=399&newsdt=081911&subspec_id=44
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The Newest Way to Detect Cancer They're man's best friend, but dogs, it turns out, may also be a doctor's newest secret weapon for detecting cancer.German researchers report in the European Respiratory Journal that dogs can be trained to detect lung cancer by sniffing human breath. The scientists worked with an admittedly small number of canines — just four, including two German shepherds, a Lab and an Australian shepherd — but the dogs had good success. They were able to suss out cancer in 71 out of 100 breath samples from lung cancer patients, and were able to correctly identify 93% of cancer-free samples, giving them an impressively low rate of false positives.
That's better than the imaging tests that most physicians currently use to detect lung cancer. WebMD reports that in a recent study, longtime smokers who went in for annual CT scans of their lungs cut their risk of dying from lung cancer by only 20%. ...
http://healthland.time.com/2011/08/18/a-new-way-to-detect-lung-cancer-dogs-can-sniff-it-out/#ixzz1Vh6cRqaB

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Check for leaks in the toilet tank: The Environmental Protection Association estimates American homes waste an average of 10,000 gallons of water each year. (Wow! That's a lot of water.) Much of this waste is due to "minor" water leaks. While some toilet leaks are easy to find (think water puddle on the floor), others like a leaky tank can be difficult to spot. To identify these hidden leaks, drop food coloring into your tank. If after 30 minutes, the food coloring is in the bowl, then you have a leak around your toilet flapper. If that's the case, you need to either find a plumber or get a new toilet.
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Study Links Brain Stents to More Deaths and Strokes Aggressive medical therapy was more than twice as effective in lowering the risk of recurrent stroke or death than was stenting of narrowed intracranial arteries, a randomized trial found.

In the SAMMPRIS trial, 14.7% of patients randomized to percutaneous transluminal angioplasty and stenting (PTAS) developed fatal or nonfatal strokes at 30 days compared with 5.8% of patients in the aggressive medical management group (P=0.002), reported Marc I. Chimowitz, MB, ChB, from the Medical University of South Carolina, and colleagues in the study, which was published online by the New England Journal of Medicine. ...
( CE involved, also) . http://www.medpagetoday.com/Cardiology/Strokes/28385
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( Have I missed something? When did corporations have the right to "free speech as warranted by the constitution"?)
Cigarette makers sue FDA over new labeling rules

NEW YORK (Reuters) - Four big cigarette makers sued the Food and Drug Administration, seeking to void as unconstitutional new graphic labels and advertising that warn consumers about the risks of smoking and induce them to quit.

The lawsuit by Reynolds American Inc's R.J. Reynolds unit, Lorillard Inc, Liggett Group LLC and Commonwealth Brands Inc, owned by Britain's Imperial Tobacco Group Plc, said the warnings required no later than September 22, 2012 would force cigarette makers to "engage in anti-smoking advocacy" on the government's behalf.
They said this violates their free speech rights under the First Amendment, according to a complaint filed Tuesday with the U.S. District Court in Washington, D.C. ...
http://www.reuters.com/article/2011/08/17/us-cigarettes-advertising-lawsuit-idUSTRE77G05V20110817?feedType=nl&feedName=ushealth1100
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FDA approves Roche skin cancer drug Zelboraf U.S. drug regulators on Wednesday approved a targeted skin cancer drug from Roche Holding along with its diagnostic test, an advance in personalized health care.
The Food and Drug Administration was two months ahead of schedule in approving the drug, under the brand name Zelboraf, along with a companion diagnostic that identifies which patients have a specific genetic mutation that means they will benefit from the treatment.
Zelboraf offers a treatment for patients who had few options in the past. In March, the FDA approved the first treatment to help patients with advanced melanoma live longer. The drug Yervoy, or ipilimumab, is sold by Bristol-Myers Squibb. ...
http://www.reuters.com/article/2011/08/17/us-roche-zelboraf-idUSTRE77G2SE20110817?feedType=nl&feedName=ushealth1100
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J&J, Lilly drugs found among best for manic episodes (Reuters) - Antipsychotics are far more effective than mood stabilizers in tackling acute manic episodes, researchers found, and Eli Lilly's Zyprexa, Johnson & Johnson's Risperdal and generic haloperidol outperform the rest.
In a study published in the Lancet medical journal on Wednesday, researchers from Britain and Italy ranked antipsychotic drugs according to their effectiveness and said that since current treatment guidelines don't differentiate between the drugs, their findings could offer useful guidance for doctors. ...
http://www.reuters.com/article/2011/08/16/us-mania-antipsychotics-idUSTRE77F72S20110816?feedType=nl&feedName=ushealth1100
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Scouring food labels on processed foods like pasta sauce, cereal, and ice cream has become de rigueur during food shopping, but fresh, unpackaged produce doesn’t come with such visibility into calories, fat, fiber, protein, and key vitamins and nutrients.
Of course, nutrition experts would be happy if Americans ate more of pretty much any fruit or vegetable (only about 32 percent of adults consume recommended levels of fruit and 25 percent recommended levels of veggies, according to government data), but you may be surprised to actually see the nutrition profiles of your favorite produce. Which high-fat fruit can take good care of your ticker? What popular salad topper is shockingly high in sodium?
Avocado
It’s true: Avocados are high in fat, but it’s a super-healthy type! Their monounsaturated fat can help lower cholesterol and keep your heart healthy. Avocados also contain lutein, an antioxidant that strengthens eyesight, and vitamin E, which may lower risk of Alzheimer’s disease. Just be sure to watch your portion size or you could overdo it on fat and calories (a whole medium avocado packs 320 calories and 28 grams of fat!).
Celery
Celery, which is 95 percent water, may not be as nutrient-rich as other produce, but it does contain some healthy compounds, including vitamin A and C, and phthalides, which help lower blood pressure and stress hormones levels. Although celery is also widely touted as a “negative calorie food” — meaning that eating and digesting it burns more calories than the amount in the stalk — experts say the amount of the calorie burn is too small to have a meaningful impact on weight loss.

Blueberry
Blueberries are the second-most popular berry in the United States (behind strawberries), and contain more antioxidants than almost any other fruit or vegetable, according to the USDA. Anthocyanins, the antioxidants that give this fruit its beautifully rich blue hue, may boost brainpower, fight off disease, and slow down the aging process.
Carrot
Mom was right: The high amounts of vitamin A and beta carotene in carrots (and other orange veggies like sweet potatoes and pumpkin) do help keep the eye doctor away, but that’s far from the only way they boost your health. Adequate intake has also been linked to a lower risk of lung and other cancers, a strong immune system, and even maintaining brain health with age.
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Reclast Gets FDA Kidney Failure Warning
The osteoporosis drug zoledronic acid (Reclast) should not be used in patients with significant renal impairment, and physicians should screen patients for kidney dysfunction before starting them on the drug, the FDA said.
The agency ordered the new label warning for the drug after receiving 20 reports of acute kidney failure resulting in death or requiring dialysis.
The new warning indicates that patients with creatinine clearance of less than 35 mL/min or evidence of acute renal impairment should not be given zoledronic acid for osteoporosis.
It also identifies risk factors that physicians should take into consideration when prescribing the product. These include advanced age, concurrent treatment with other nephrotoxic drugs, and dehydration secondary to fever, sepsis, gastrointestinal losses, or diuretic therapy. ...
http://www.medpagetoday.com/ProductAlert/Prescriptions/28320?utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news
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Anti-Seizure Drug May Boost Glioblastoma Survival
Patients undergoing chemotherapy and radiotherapy for malignant glioblastoma appeared to have better overall survival if they also received the anti-seizure medication valproic acid, a retrospective analysis found.
The adjusted hazard ratio for overall survival benefit with temozolomide (Temodar) plus radiation therapy was 0.39 (95% CI 0.24 to 0.63) in patients taking valproic acid, according to Michael Weller, MD, of University Hospital Zurich in Switzerland, and colleagues.
In comparison, similarly treated patients who received an enzyme-inducing anti-epileptic drug, such as carbamazepine, had an adjusted HR for overall survival of 0.69 (95% CI 0.53 to 0.90).
Those receiving valproic acid also fared better than patients not on any anti-epileptic agent, who had an HR of 0.67 (95% CI 0.49 to 0.93), the investigators reported in the Sept. 20 issue of Neurology. ... http://www.medpagetoday.com/Neurology/BrainCancer/28304

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RANDOM FACTS: The Caspian Tiger was the third largest tiger species. The last of this tiger was seen in 1970, after which it has been
declared amongst the extinct animal species. This tiger was found on the lands of Iran, Iraq, Afghanistan, Turkey, Mongolia, Kazakhstan, Caucasus, Tajikistan, Turkmenistan and Uzbekistan.

Bonus Fact: Aurochs was a large-sized cattle-species. It is recorded to have gone into extinction in 1627. It is said that this cattle evolved from India, migrating to the Middle-East, reaching Europe.
(Wonder just how much "we" helped them to become extinct-- bet we had a large part in that play).
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A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response. For more information see Sentinel Event Policy and Procedures.
Sentinel Event Alert, Issue 45: Preventing violence in the health care setting
Once considered safe havens, health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide. As criminal activity spills over from the streets onto the campuses and through the doors, providing for the safety and security of all patients, visitors and staff within the walls of a health care institution, as well as on the grounds, requires increasing vigilant attention and action by safety and security personnel as well as all health care staff and providers. ...
http://www.jointcommission.org/sentinel_event_alert_issue_45_preventing_violence_in_the_health_care_setting_/
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RANDOM FACTS: Last year Treasury printed more $100 bills than dollar bills for the first time. There are now more than seven billion pictures of Benjamin Franklin in circulation.

Bonus Fact: Thanks to technological advances, the average dollar bill now circulates for 40 months, up from 18 months two decades ago, according to Federal Reserve estimates.
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Study questions testosterone's link to early death (Reuters) Drooping testosterone levels probably don't cut years off a man's life, although earlier studies had suggested they might, according to a new report.
Instead, decreases in the male sex hormone may simply be a sign of overall health status, which also dips with age, researchers say.
The findings come in the wake of surging interest in testosterone's role in men's sex drive, their mood and thinking, and even early death.
While drug companies refer to "low T" as a treatable medical problem affecting millions of American men, critics say they are trying to make a buck by turning normal aging into a disease. ...
http://www.reuters.com/article/2011/08/19/us-testosterone-study-idUSTRE77H78A20110819?feedType=nl&feedName=ushealth1100
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Method to Detect When Patients Wake During Surgery Fails to Impress Tool looking at exhaled anesthesia superior to brain monitoring, study finds
WEDNESDAY, Aug. 17 (HealthDay News) -- A newer technology intended to alert doctors when patients are regaining consciousness while under anesthesia is no better than conventional monitoring systems in lowering the incidence of "anesthesia awareness," new research shows.
In fact, the newer system -- which measures electrical activity in the brain and is known as bispectral index (BIS) monitoring -- actually picked up on fewer incidents than the standard system, which measures the amount of anesthesia when a patient exhales.
Anesthesia awareness takes place when a patient under general anesthesia can remember what happened during surgery. It occurs in up to 1 percent of high-risk patients, or 20,000 to 40,000 U.S. patients a year.... http://consumer.healthday.com/Article.asp?AID=655991
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Nocturnal Acute Coronary Syndrome Linked to Belly Fat, Disordered Sleep
Nighttime acute coronary syndrome (ACS) occurred significantly more often in patients with visceral fat accumulation and sleep-disordered breathing, investigators reported.
Among 25 patients with nighttime onset of ACS, two-thirds of those with ≥100 cm2 of visceral fat accumulation also had sleep-disordered breathing as compared with a fourth of patients with less visceral fat. ...
http://www.medpagetoday.com/Cardiology/AcuteCoronarySyndrome/28117?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=379846
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#65 Time is money... On average, coupon users save $8.00 per supermarket visit from 13 minutes of clipping--more than $400/year, according to the coupon industry. Those who devote 20 minutes/week to the task shave their annual grocery bill by nearly
$ 1,000.00.

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HUMOR SECTION

A High-School student stared thoughtfully at the second question on his exam, which read, "State the number of tons of coal shipped out of America in any given year."
Suddenly, his brow cleared, and he wrote.............." 1492 None".
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Two sisters are we, one dark and one fair.
In twin towers dwelling, we're quite the pair.
One from the land and one from the sea.
Tell us truly, who are we?

(don't cheat, now)


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ANSWER: Salt and pepper.

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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess.

Pay Only $34.99 for a full year of CONTACT HOURS

www.nurse.com for CNE offerings.

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/

I receive these notices from FDA regularly. Let me know if you want them included in the newsletter , please. These recalled items are primarily food products: http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm270461.htm

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/


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

Ripoff Reports: http://www.ripoffreport.com This is a consumer reporting Web site and publication, by consumers, for consumers, to file and document complaints about companies or individuals. Unlike the Better Business Bureau, Ripoff Report does not hide reports of "satisfied" complaints. All complaints remain public and unedited in order to create a working history on the company or individual in question.

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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SATURN Statin Trial a Dead Heat Rosuvastatin (Crestor) failed to beat atorvastatin (Lipitor) for improving atheroma volume in a large head-to-head trial, the drug's manufacturer reported. AstraZeneca issued a terse statement outlining the top-line results of the trial.
"The results for the primary efficacy measure, which was change from baseline in percent atheroma volume in a ≥40 mm segment of the targeted coronary artery as assessed by intravascular ultrasound (IVUS), demonstrated a numerically greater reduction in favor of Crestor versus atorvastatin but did not reach statistical significance," the statement said.
The two-year SATURN study compared 40 mg/day of rosuvastatin to 80 mg/day of atorvastatin in some 1,300 patients.
However, the company said, rosuvastatin treatment did lead to a significantly greater reduction in the trial's secondary efficacy measure, total atheroma volume within the targeted coronary artery.
AstraZeneca's statement did not give numerical results. It said the data and interpretations would be presented at the American Heart Association's scientific meeting in November. http://www.medpagetoday.com/Cardiology/Atherosclerosis/28333
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FDA Reviewer Slams Xarelto for Stroke Prevention in Afib
WASHINGTON -- Rivaroxaban (Xarelto) is not as effective as warfarin for preventing strokes in patients with atrial fibrillation and should not be approved for the new indication, according to an FDA reviewer.
That opinion was set forth in briefing documents prepared for the FDA's Cardiovascular and Renal Drugs Advisory Committee meeting Thursday. The committee will review Johnson & Johnson's application to extend marketing approval for its direct oral factor Xa inhibitor rivaroxaban to include prevention of stroke and systemic embolism in patients with nonvalvular approved atrial fibrillation.
But, in its briefing documents the company argued that the "benefits of treatment with rivaroxaban clearly outweigh the risks when compared with warfarin therapy."
Results from the company-sponsored ROCKET-AF study found that rivaroxaban (Xarelto) was at least as good as warfarin for stroke prevention in atrial fibrillation, with a similar rate of major bleeding and greater ease of use. Johnson & Johnson is seeking approval that indicates their drug works better at preventing strokes than warfarin. ...
http://www.medpagetoday.com/Cardiology/Strokes/28367
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FDA Warns of New Infections With TNF Blockers
The Food and Drug Administration has updated the boxed warning for all tumor necrosis factor-alpha (TNFα) inhibiting drugs to reflect the risk of infection from the bacteria Legionella and Listeria.
There now have been more than 100 cases of infection with these pathogens, according to the agency.
The TNFα inhibitors licensed in the United States are infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab pegol (Cimzia), and golimumab (Simponi).
The drugs are used to treat rheumatoid arthritis, psoriatic arthritis, plaque psoriasis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and juvenile idiopathic arthritis.
Serious infections involving viral, bacterial, and mycobacterial pathogens are a recognized risk of treatment with these and other immunosuppressive drugs.
A total of 80 cases of Legionella pneumonia have been reported to the FDA among patients receiving TNFα inhibitors, most often for rheumatoid arthritis. ... http://www.medpagetoday.com/ProductAlert/Prescriptions/28396

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NURSING HINTS CORNER
Tape Prep: Before taping a NG (nasogastric) tube to a patient's face, wipe the area with a Skin-Prep swab pad. This will remove oil from the skin, so the tape will stick better. Let the invisible residue dry for 30 + seconds before applying tape. (this skin prep also works beautifully when applying a Texas catheter--no sting). Cynthia Mace Mills, RN, MSN

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.151, Springhouse Corporation/www.springnetcom. ;

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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.

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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

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NOTICE:
I attempt to send newsletters to your 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.... So please send me your new name/address, okay? 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

What we leave behind is not
what is engraved in stone monuments,
but what is woven into the lives of others.
--Pericles

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