Newsletter for Paradigm 97

PARADIGM BYTES Newsletter for Paradigm 97 December 13, 2012 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. ***~~~***~~~***~~~*** SNIPPETS AJN, American Journal of Nursing:December 2012 - Volume 112 - Issue 12 - p 15 doi: 10.1097/01.NAJ.0000423491.98489.70 Barriers to Implementing Evidence-Based Practice Remain High for U.S. Nurses Getting past “We've always done it this way” is crucial. Evidence-based practice (EBP), a problem-solving approach to patient care that integrates the best evidence from well-designed studies with clinicians' expertise, patient assessments, and patients' own preferences, leads to better, safer care; better outcomes; and lower health care costs. Yet despite the fact that nurses report that engaging in EBP leads to greater professional satisfaction, nurses in the United States aren't consistently using it. To assess nurses' current readiness and willingness to implement EBP, Melnyk and colleagues at Ohio State University (OSU), Columbus, conducted a descriptive survey of a random sample of 1,015 members of the American Nurses Association. The results showed that only 34.5% of respondents (350) agreed or strongly agreed that their colleagues consistently used EBP in treating patients. Although a majority (76.2%) felt it was important for them to have more education and skills in EBP, most found educational opportunities wanting, as they did access to knowledgeable mentors, resources, and tools needed to use EBP. The two most frequently cited barriers to EBP, however, were a lack of time and an organizational culture that didn't support it—getting past workplace resistance and the constraining power of the phrase, “That's the way we've always done it here.” “There's a resistance that staff nurses are getting from nurse managers and nurse leaders,” says Melnyk. “That's a big problem, because managers are critical for providing the support needed to do this and for providing role models.” Education is a big factor, Melnyk points out. “People educated 20 years ago didn't learn an EBP approach to care,” she says, adding that educators still spend more time teaching students how to do rigorous research than they do teaching them how to use research in practice. “Behavior change is tough,” says Melnyk, who is also dean of the College of Nursing, associate vice president for health promotion, and chief wellness officer at OSU. The key seems to lie in creating a context and support system under which EBP efforts can be sustained. Nurse leaders who want to encourage EBP among their staff, Melnyk says, “need to realize that a one- or two-day workshop isn't likely to cause sustainable change.” To really make it happen, she believes, nurse leaders need to place enough EBP mentors at the bedside who can work hand in hand with clinicians to help them learn these skills and implement them consistently. Melnyk and her colleagues at OSU are currently launching an online continuing education program so that people can access EBP mentorship skills from around the world. Information on the program can be found at http://bit.ly/Ps1pgw.—Laura Wallis Reference: Melnyk BM, et al. J Nurs Adm. 2012;42(9):410–7© 2012 Lippincott Williams & Wilkins, Inc. ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Australia's tobacco marketing laws give retailers a headache (Is this a great idea, or what?) (Reuters) - James Yu, who runs the King of the Pack tobacconist in central Sydney, is indignant about Australia's stringent anti-tobacco laws making manufacturers package cigarettes in drab olive green packs with pictures of ill babies and diseased body parts. The packages, mandatory from Saturday when the laws take effect, make it hard to tell brands apart, complicating deliveries and adding to costs. ... http://www.reuters.com/article/2012/11/30/us-australia-cigarettes-idUSBRE8AT08N20121130?feedType=RSS&feedName=healthNews *************************** Judge orders tobacco companies to admit deception (Reuters) - Major tobacco companies that spent decades denying they lied to the U.S. public about the dangers of cigarettes must spend their own money on a public advertising campaign saying they did lie, a federal judge ruled on Tuesday. The ruling sets out what might be the harshest sanction to come out of a historic case that the Justice Department brought in 1999 accusing the tobacco companies of racketeering. U.S. District Judge Gladys Kessler wrote that the new advertising campaign would be an appropriate counterweight to the companies' "past deception" dating to at least 1964. ... http://www.reuters.com/article/2012/11/28/us-usa-tobacco-idUSBRE8AQ18A20121128?feedType=RSS&feedName=healthNews ******************** J&J says it won't enforce AIDS drug patent in Africa (Reuters) - Generic manufacturers are to be given a free rein to make cheap copies of Johnson & Johnson's HIV/AIDS drug Prezista for sale in Africa and other poor countries. U.S. healthcare group J&J said on Thursday it would not enforce patents, provided generic firms made high-quality versions of the drug - known generically as darunavir - for sub-Saharan Africa and Least Developed Countries. Prezista is a relatively new drug used when patients develop resistance to older antiretrovirals. The need for it was expected to grow rapidly as more patients in Africa stop responding to existing therapies. ... http://www.reuters.com/article/2012/11/29/us-aids-jj-africa-idUSBRE8AS0PN20121129?feedType=RSS&feedName=healthNews ******************** ++++ ANNOUNCEMENT ++++ The Truth about Nursing hands out awards for those who help nursing especially those in the media. This year Wendie Howland, a long-time member of Paradigm97 was awarded. The award was to Wendie Howland, for relentlessly monitoring Help a Reporter Out (HARO) and educating reporters seeking health experts that the better choices for their stories are often nurses, rather than the physicians they seek; Wendie writes "I am astonished and honored to be included in the Truth About Nursing 2011 awards. Please support their work! " Congratulations, Wendie !! ~~**~~**~~**~~**~~**~~ FROM A MEMBER MarGerlach (Marlene) sent this in and wrote: "The article explains why germs are becoming resistant to even the most powerful antibiotics and how we can protect ourselves against the evolving "super bugs". Hope you take a few minutes of your time to read it, and that you find it as informative as I did." http://www.naturalnews.com/022800_antibiotic_antibiotics_infection.html Thank you, Marlene ! ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days (This article is interesting and informative was presented as a CEU, however, after reading all the nurse's comments, I wouldn't plan to do any more than read the article.). The beat goes on: A pacemaker primer Nearly 400,000 cardiac pacemakers and cardioverter-defibrillators are implanted annually in the United States. In some cases, pacemakers are used as a temporary intervention to support a patient through an acute episode. In other situations, as for patients with permanent conditions that require cardiac pacing, pacemakers are implanted surgically. Whether temporary or permanent,a pacemaker generates an electrical impulse that travels via one or more leadwires, or leads, which in turn stimulate the myo­cardium to depolarize and initiate a contraction. A pacemaker’s primary function is to keep the ventricles beating at a rate that maintains sufficient blood pressure and perfuses all organs adequately. ... http://www.americannursetoday.com/Article.aspx?id=8850& fid=8812#comments ********************* Physiology review: Circulatory system (Now guys, do not assume that this is such basic info, you don't have time to fool with this article. You are very mistaken--it starts off kindergarten but jumps to college level quickly). Chances are that you frequently care for patients with cardiac and circulatory conditions and administer drugs affecting the circulation. This review of the circulatory system increases your knowledge base so you can more efficiently assess patients with signs and symptoms of cardiovascular problems. The circulatory system includes the heart, blood vessels, and regulatory controls (such as the autonomic nervous system, catecholamines, and hormones). Its main function is to deliver oxygen and substrate (glucose) to cells. The circulatory system also transports byproducts of cellular metabolism—66% in the form of carbon dioxide (CO2) to the lungs and the remaining 33% to the kidneys as breakdown products of protein metabolism. Metabolism of oxygen and glucose (cellular combustion) produces heat, which is conducted through the circulation and warms the body. February 2012 Vol.7 No.2 Author: PennyAndrews RN BSN and Nader M.Habashi MD FACP FCCP http://www.americannursetoday.com/Article.aspx?id=8756&fid=8714 ********************* Do you think nurses are responsible for managing poor performers at work? A person wrote the following: Whose Job is it to Manage Poor Performers? (vickihess.com) I was reading about a survey today from Robert Half International about how much time supervisors spend managing poor performers (17%). I hear staff members in many organizations complain about poor performers and their... ******** Another nurse wrote: I don't believe so we have enough on our plate during work if you are referring to a staff nurse's role. Management and HR should do it. I think though the managers should look at first why the person is a "poor performer". Is it because of lack of training or true poor performance or just plain old fashioned laziness? Especially in the nursing field orientation to an area is priceless but it is sometimes skimped on in this day and age due to time and money constraints in an organization. Many times fellow coworker nurses help out the nurse struggling during a shift but we must finish our own work as well. So, Paradigm97 members, what are your thoughts/opinions on this? We have all had to endure this situation- at least once in our careers. Let me hear from you, please. RNFrankie@AOL.com *************** RANDOM FACTS: While gold is currently around $1,700 an ounce, it reached an all-time high in 2011 of nearly $1,800 an ounce. Of course, gold has always been valuable not only as a material resource but also as a commodity. *** Gold is the sixteenth most rare of the chemical elements. Though it is one of the rarest metals, gold was the first to be discovered by man. *** It took half a year for word to reach the Atlantic coast that gold has been discovered in California. The discovery was made in 1848, but John Augustus Sutter and James Marshall tried to keep it a secret. It wasn't until President Polk, in December 1848, announced the discovery that the gold rush of 1949 began. *********** Quiz Time A Clinical Nurse Leader (CNL) program prepares nurses as advanced generalists: True False (Answer at end of Newsletter) Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 **************** Injection Safety: Injection safety is part of the minimum expectation for safe care anywhere healthcare is delivered; yet, CDC has had to investigate numerous outbreaks of life-threatening infections caused by injection errors. Since 2001, at least 150,000 U.S. patients have been negatively impacted by unsafe medical injections. When healthcare providers fail to follow basic infection control practices during injection preparation and administration, patients can be exposed to life-threatening illnesses such as hepatitis and/or bacterial infections. To assist you in covering this important topic, CDC is releasing a digital press kit about the impact of unsafe injection practices in U.S. healthcare settings. The digital press kit includes fact sheets, an infographic, videos and podcasts, and quotes from CDC experts. View DPK [ http://www.cdc.gov/media/releases/2012/dpk-unsafe-injections.html ] In addition, to further educate healthcare providers about safe injection practices, CDC is releasing several new educational pieces today. See: http://www.oneandonlycampaign.org/news/new-tools-help-clinicians-ensure-every-injection-safe ************** Rozalfaro writes: I'm not surprised.... and I agree. Thank you Roz for sending the following: The U.S. health care system wasted $750 billion in 2009. This amount of money could provide health insurance for many—150 million workers, for example—according to the Institute of Medicine (IOM) report, Best Care at Lower Cost. The report identifies deficiencies, such as primary care physicians needing to coordinate with an average of 229 other physicians in a single year to treat Medicare patients, and 75% of hospital patients not knowing the clinician overseeing their care. But it also defines ways to improve heath care, including computing, information science, and connectivity tools that enhance patient–physician communication. The safety and quality of care will improve by applying evidence-based practices and including patients, families, and other caregivers on the care team. The IOM envisions a learning health care system that combines science and informatics, patient–clinician partnerships, incentives, and a culture that promotes continuous improvements. Read Mary D. Naylor's post about the role of nurses in such changes on AJN's blog, Off the Charts, at http://bit.ly/Rpy1BR. AJN The American Journal of Nursing Free Access **************** Simple measures cut infections caught in hospitals Chicago (AP) -- Preventing surgery-linked infections is a major concern for hospitals and it turns out some simple measures can make a big difference. A project at seven big hospitals reduced infections after colorectal surgeries by nearly one-third. It prevented an estimated 135 infections, saving almost $4 million, the Joint Commission hospital regulating group and the American College of Surgeons announced Wednesday. The two groups directed the 2 1/2-year project. Solutions: included having patients shower with special germ-fighting soap before surgery, and having surgery teams change gowns, gloves and instruments during operations to prevent spreading germs picked up during the procedures. ... http://hosted.ap.org/dynamic/stories/U/US_MED_HOSPITAL_LINKED_INFECTIONS?SITE=AP&SECTION =HOME&TEMPLATE=DEFAULT&CTIME=2012-11-28-16-12-15 ************************** Heavy patient workloads for nurses have been associated with poor patient outcomes and low job satisfaction. Yet few states require hospitals to maintain minimum nurse-to-patient ratios, leaving nurses to care for a significant number of patients at a time Link between heavy workloads and poor patient outcomes: Many studies have found that heavier nursing workloads are associated with poor patient outcomes, including more patient deaths, complications, and medical errors.1 For example, one study found that each additional patient added to a nurse’s workload increased mortality within 30 days of admission by 7 percent, and increased the risk of an undetected medical complication leading to preventable death or harm (known as a "failure to rescue") by a similar amount.2 A meta-analysis of 90 studies found that increased registered nurse (RN) staffing was associated with lower mortality on intensive care, medical, and surgical units; reduced risk of hospital-acquired pneumonia, unplanned extubation, respiratory failure,cardiac arrest, and failure to rescue;and shorter lengths of stay for surgical (31 percent) and intensive care unit (ICU) patients (24 percent).3 Other studies have confirmed that higher nurse staffing yields better patient outcomes, including shorter lengths of stay and lower rates of urinary tract infections, upper gastrointestinal bleeding, pneumonia, shock, cardiac arrest, and failure to rescue.4 Negative implications for nurses as well: The study cited above found that each additional patient assigned to a nurse led to a 23-percent increase in the risk of nurse-reported “burnout” and a 15-percent increase in the risk of a nurse being dissatisfied with his/her job.2 Another study found that nurses in states without mandated minimum staffing ratios reported greater levels of burnout,job dissatisfaction, and turnover; these nurses also felt that patients received poorer quality care.5 Few states addressing minimum staffing levels through legislation: Despite the evidence cited above, only a handful of states have any type of legislation related to minimum nurse-to-patient ratios, with most having requirements that address only a specific unit or type of unit (e.g., the operating room or ICU). Legislators remain reluctant to require hospitals and health systems to hire more nurses, particularly with ongoing shortages in many areas. In 2001, there were 264,000 licensed nurses in California (544 working nurses per 100,000 population), compared to a national average of 782 per 100,000; California ranked next to last among the 50 states. ... http://www.nationalnursesunited.org/news/entry/state-mandated-nurse-staffing-levels-lead-to-lower-patient-mortality-and-hi/ (Not certain why the bullets remained despite all my efforts, any suggestions)? ******************** RANDOM FACTS: The human body is an incredible machine. It is an engineering miracle we don't take enough time to appreciate! Man has tiny bones once meant for a tail and unworkable muscles once meant to move his ears. *** And: If 80 percent of your liver were to be removed, the remaining part would continue to function, and eventually the liver would have reconstituted itself to its original size. ******************** Small sachets are big help for clean water in developing world Reuters) - Greg Allgood tears open a small sachet and dumps the powder into a large plastic container filled with brown, murky water. After about five minutes of stirring, clumps of sludge form and sink to the bottom as the water starts to clear. "You let it settle, pour it through a cotton cloth and then you wait 20 minutes and it's ready to drink," said Allgood, the U.S.-based director of Procter & Gamble Co's not-for-profit programme to provide clean water in developing nations and disaster zones. ... http://www.reuters.com/article/2012/11/29/us-water-sachets-idUSBRE8AS08720121129?feedType=RSS&feedName=healthNews ************** Most Women Who Choose Double Mastectomy Don't Need To, Study Shows TUESDAY, Nov. 27 (HealthDay News) -- Almost 70 percent of women with breast cancer who choose to have both breasts removed as a precaution actually have a low risk of developing cancer in the healthy breast, a new study finds. Worry about recurrence -- which is understandable -- typically drives the decision to have the opposite breast removed, said study author Dr. Sarah Hawley, an associate professor of internal medicine at the University of Michigan Health System in Ann Arbor. The procedure is called a contralateral prophylactic mastectomy (CPM). However, that worry can be out of proportion to actual risk, she said. "Our point is that worry about recurrence probably should not drive choice for CPM since this procedure will not reduce the risk of cancer recurrence; it is only going to reduce the risk of developing a new primary in the non-affected breast," she said. ... https://www.nlm.nih.gov/medlineplus/news/fullstory_131705.html *************** How to manage incontinence-associated dermatitis Moisture-related skin breakdown has been called many things-perineal dermatitis, irritant dermatitis, contact dermatitis, heat rash, and anything else caregivers could think of to describe the damage occurring when moisture from urine or stool is left on the skin. At a 2005 consensus conference, attendees chose the term incontinence-associated dermatitis (IAD). IAD can be painful, hard to properly identify, complicated to treat, and costly. It’s part of a larger group of moisture-associated skin damage that also includes intertrigo and periwound maceration. IAD prevalence and incidence vary widely with the care setting and study design. Appropriate diagnosis, prompt treatment, and management of the irritant source are crucial to long-term treatment. ... http://woundcareadvisor.com/how-to-manage-incontinence-associated-dermatitis/ *************** The popularity of dietary supplements continues among adults in the U.S. Consider these facts from a 2011 report from the National Center for Health Statistics: Over 40%: Percent of adults who used dietary supplements between 1988 and 1994 1: Over 50%: Percent of adults who used dietary supplements between 2003 and 2006 The most commonly used dietary supplement is multivitamins/multiminerals. 28%: Percent of women 60 years or older who took supplemental calcium between 1988 and 1994 61%: Percent of women 60 years or older who took supplemental calcium between 2003 and 2006 Source: http://www.cdc.gov/nchs/ ************************* FDA permits marketing of the first hand-held device to aid in the detection intracranial hematomas. The U.S. Food and Drug Administration today allowed marketing of the first hand-held device intended to aid in the detection of intracranial hematomas, using near-infrared spectroscopy. The device, called the Infrascanner Model 1000, can help health care providers identify patients with critical head injuries who need an immediate brain imaging study. Intracranial hematomas occur when blood from a ruptured blood vessel collects within the brain or between the skull and the brain. As blood expands within the brain or in the narrow space between the brain and the skull, the brain becomes compressed. This can produce symptoms such as headaches, vomiting, dizziness, lethargy, weakness in the arm or leg on one side of the body, seizures, or unconsciousness. An intracranial hematoma can be life-threatening if it is not treated immediately. According to the Centers for Disease Control and Prevention, each year about 1.7 million people in the United States experience a traumatic brain injury. The Infrascanner, Model 1000, uses a scanner that directs near-infrared light, a wavelength of light that can penetrate tissue and bone, into the skull. Blood from intracranial hematomas absorbs the light differently than other areas of the brain. The scanner detects differences in light absorption (optical density) and transmits the information wirelessly to a display on a hand-held computer. ... http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm283520.htm ********************* This is from Truth About Nursing's site ---Please check the site out and see why I think we need to support it with $5 to $25. Sandy really accomplishes a lot in demanding the true and correct representation of nurses. One Day in the Life of the Uninsured November 2012 –The new documentary The Waiting Room follows patients and staff in the overcrowded emergency room at Highland Hospital, which serves the poor and working class of Oakland, California. Working with footage shot over just 24 hours, director Peter Nicks takes a good look at how the United States cares for its underinsured residents. The result is a quiet but compelling indictment of our dysfunctional health financing system. We see Highland's staff try, with skill and patience, to help emergency patients with ailments from gunshot wounds or chronic back pain, although what many of them really need is good primary care. ... https://www.truthaboutnursing.org/media/documentaries/waiting_room.html *************** The Evidence is in: RN-to-Patient Ratios Save Lives A major new study led by one of the nation's most eminent nurse researchers provides compelling new evidence that California's landmark RN-to-patient staffing law reduces patient mortality, assures nurses more time to spend with patients, and substantially promotes retention of experienced RNs. "This research documents what California RNs have long known - safe staffing saves lives. We see the effects every day at the bedside in improved patient care, an enhanced quality of life for patients, and nurses able to more safely practice the profession to which we have dedicated our lives," said Malinda Markowitz, RN, co-president of the California Nurses Association, a National Nurses United founding affiliate. CNA/NNU, Sponsor of Law, Cites Major Gains for Patient Safety, RN Shortage CNA/NNU, the nation's largest organization of direct care RNs with 155,000 members, sponsored the California law and has fought off repeated hospital industry attempts to erode it, including a well-chronicled fight with Gov. Arnold Schwarzenegger who sought to roll back the law in late 2004. ... http://www.nationalnursesunited.org/press/entry/the-evidence-is-in-california-rn-to-patient-ratios-save-lives/ ********************** RANDOM FACT: The odds of winning are astronomical: about 175 million-to-1, according to Powerball. And even if you do win, you won't bring home all $550 million. The federal government takes a quarter of the jackpot in taxes, most states take a small share, and some cities even take a slice. That puts the actual cash value of the winnings around $360 million. *** BONUS FACT: If you do win you could fall prey to the "lottery curse". According to Chelmsford wealth counselor Szifra Birke, roughly one-third of lottery winners find themselves in serious financial trouble or bankrupt within five years of turning in their lucky numbers. But I bet most people would be willing to take the risk. ~~**~~**~~**~~**~~**~~ HUMOR SECTION (I read this one before...and enjoyed it too much not to use it again). While visiting Annapolis, a lady tourist noticed several students on their hands and knees assessing the courtyard with pencils and clipboards in hand. "What are they doing?" she asked the tour guide. "Each year," he replied with a grin, "the upperclassmen ask the freshmen how many bricks it took to finish paving this courtyard." When they were out of earshot of the freshmen, the curious lady asked the guide: "So, what's the answer?" The guide replied: "One." ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. 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 ~~~~~~~~~~~ CE A Perfect Match Preventing Blood Incompatibility Errors Objectives: The goal of this program is to educate nurses and paramedics about blood incompatibility errors and the evidence-based practices to prevent them. After studying the information presented here, you will be able to: List three factors that contribute to blood incompatibility errors Describe blood type compatibility between the donor and recipient Explain the procedure for safely administering blood transfusions This course will be updated or discontinued on or before 10/9/2015 https://ce.nurse.com/ce481/a-perfect-match-preventing-blood-incompatibility-errors/?utm_source=florida-regional-ezine_12-9-12&utm_medium=email&utm_campaign=regionalezinezine ~~**~~**~~**~~**~~**~~ 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/ 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 If you're buying a used car, it is recommended having a mechanic inspect it first. Screen the car's VIN through the free database at carfax.com/flood Rozalfaro's Website http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Accutron, Inc. Ultra PC% Cabinet Mount Flowmeters for Nitrous Oxide-Oxygen Sedation Systems Model Numbers: Affected Model and Serial numbers are available on the FDA’s website Manufacturing and Distribution Dates: The affected product was manufactured from November 2009 to April 2009 and distributed from November 26, 2008, to June 9, 2011. Intended Use: The Ultra PC% flowmeter is used to control the flow of gases used in nitrous oxide-oxygen sedation systems. Nitrous oxide-oxygen sedation systems are used to sedate patients during certain dental procedures. Recalling Firm: Accutron, Inc. 1733 West Parkside Lane Phoenix, Arizona 85027-1382 Reason for Recall: The flowmeter may continue to release nitrous oxide gas when the oxygen is turned off. When not mixed with oxygen, inhaling nitrous oxide can lead to temporary and permanent brain damage and death. ... http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm324090.htm ********************** Touchscreen for Hospira Symbiq Infusion System, Models 16026 and 16027 Product: Symbiq Infusion System Models and Serial Numbers: 16026 Symbiq One Channel Infuser 16027 Symbiq Two Channel Infuser All serial numbers for these models are potentially affected by this recall. Distribution Dates: All Intended Use: The Symbiq infusion pump is a prescription device used to deliver controlled amounts of medications or other fluids to patients through intravenous, intra-arterial, epidural, and other acceptable routes of administration. The touchscreen is used to control infusion pump settings for patient therapy. Recalling Firm: Hospira Inc., 275 N Field Dr, Lake Forest, Illinois 60045-2579 Reason for Recall: The Symbiq pump touchscreen may not respond to user selection, may experience a delayed response or may register a different value from the value selected by the user. Failure of the touchscreen to respond to user input could result in a delay or interruption in therapy or over delivery or under delivery of medication if the user does not confirm the programmed values on the pump's confirmation screen before starting the infusion. ************************* Atorvastatin Calcium Tablets by Ranbaxy Inc.: Recall - Presence of Foreign Substance On November 9, 2012, Ranbaxy Inc. initiated a voluntary recall of 41 affected lots of Atorvastatin Calcium Tablets (10 mg, 20 mg and 40 mg) which is a solid oral dosage form, to the retail level. The Company is taking this voluntary action as a precautionary measure due to the fact that we cannot exclude the possibility that the affected lots may contain very small glass particles resembling a fine grain of sand (less than 1 mm in size). Because of the size of the particles which may be present in the affected lots it is unlikely to cause a significant safety concern. However, the possibility of adverse experiences arising primarily due to physical irritation cannot be ruled out. The product is used to lower blood cholesterol and is packaged in plastic bottles, as 90 and 500 tablets per bottle. The affected lots of Atorvastatin Calcium Tablets and their respective NDC code, expiration date information can be found in the Firm Press Release. The recall does not affect or relate to the 80 mg dosage strength of Atorvastatin Calcium Tablets. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm329955.htm *************** Mindray A3 and A5 Anesthesia Delivery System: Class I Recall - Gasket Leak FDA notified health professionals of a Class I Recall of the Mindray A3 and A5 Anesthesia Delivery System. The affected devices may have a gasket leak which could cause an interruption of or inadequate patient anesthesia and ventilation, temporary or permanent patient injury, or death. The gasket leak could also cause injury to bystanders and operating room personnel due to exposure from leaking anesthesia gases. The company has identified the cause of the leak as a small step in the gasket surface which may interfere with the full seating of the gasket within the canister. The leak may be identified during the Automatic Circuit Leak and Compliance Test performed at start up and during the Manual Leak Test recommended before each use. The devices were manufactured between May 2011 to March 2012 and distributed between May 31, 2011 to July 15, 2012. The A3 and A5 anesthesia delivery systems are used to administer continuous or intermittent general anesthesia gases and maintain a patient’s breathing during surgery. These devices are used for both pediatric and adult patients. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm330249.htm ************ Isovue (iopamidol injection) Pre-Filled Power Injector Syringes by Bracco Diagnostics Inc.: Recall - Presence of Particulates Bracco Diagnostics Inc. (BDI) is voluntarily initiating a Class I recall of nine (9) lots of Isovue (iopamidol injection) Pre-Filled Power Injector Syringes (Isovue PFS, to be used in combination with Stellant CT Injection Systems) due to the presence of visible particles in syringes observed at the end of standard stability studies on retained samples.These products were distributed to wholesalers and distributors nationwide. BDI has received no reports of adverse events or customer complaints associated with these lots. However, it should be noted that the visible particles in the lots subject to this recall have the potential to cause adverse health consequences. The dates for distribution of the nine (9) affected lots were from January 21, 2010 through May 9, 2012. For a list of products affected see the Firm Press Release. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm329948.htm ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: Tradiewhitey@bellsouth.net (Traci) November 20, 2012 Sterling4@bellsouth.net (Janet) November 20, 2012 Mikeydot@bellsouth.net (Dottie) November 30, 2012 smdmgadawgs@gmail.com (Sonia) November 30, 2012 Nankristin@yahoo.com (Nan) December 6, 2012 ~~**~~**~~**~~**~~**~~ 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 ~~**~~**~~**~~**~~**~~ 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) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ 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. ~~**~~**~~**~~**~~**~~ We may have found a cure for most evils; but it has found no remedy for the worst of them all -- the apathy of human beings. --Helen Keller Would really like to hear from you..... Frankie RNFrankie@AOL.com Correct answer to the Quiz: True. CNL programs at the master’s or post-master’s level prepare nurses to be advanced generalists. A CNL oversees the care coordination and integration of care for a distinct group of patients. Learn more at http://www.aacn.nche.edu/CNC/cnlcert.htm

November PARADIGM BYTES

PARADIGM BYTES Newsletter for Paradigm 97 November 17,2012 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. ***~~~***~~~***~~~*** SNIPPET Sentinel Event Alert Issue 48: Health care worker fatigue and patient safety The link between health care worker fatigue and adverse events is well documented, with a substantial number of studies indicating that the practice of extended work hours contributes to high levels of worker fatigue and reduced productivity. These studies and others show that fatigue increases the risk of adverse events, compromises patient safety, and increases risk to personal safety and well-being. While it is acknowledged that many factors contribute to fatigue, including but not limited to insufficient staffing and excessive workloads, the purpose of this Sentinel Event Alert is to address the effects and risks of an extended work day and of cumulative days of extended work hours. The impact of fatigue Fatigue resulting from an inadequate amount of sleep or insufficient quality of sleep over an extended period can lead to a number of problems, including: • lapses in attention and inability to stay focused • reduced motivation • compromised problem solving • confusion • irritability • memory lapses • impaired communication • slowed diminished reaction time • indifference and loss of empathy6 Contributing factors to fatigue and risks to patients Shift length and work schedules have a significant effect on health care providers’ quantity and quality of sleep and, consequently, on their job performance, as well as on the safety of their patients and their individual safety. This fact has been borne out in numerous studies. Findings from a groundbreaking 2004 study of 393 nurses over more than 5,300 shifts – the first in a series of studies of nurse fatigue and patient safety – showed that nurses who work shifts of 12.5 hours or longer are three times more likely to make an error in patient care.7 Additional studies show that longer shift length increased the risk of errors and close calls and were associated with decreased vigilance,7 and that nurses suffer higher rates of occupational injury when working shifts in excess of 12 hours.8 Still, while the dangers of extended work hours (more than 12 hours) are well known, the health care industry has been slow to adopt changes, particularly with regard to nursing. “An overwhelming number of studies keep saying the same thing – once you pass a certain point, the risk of mistakes increases significantly,” says Ann Rogers, Ph.D., R.N., FAAN, a nationally renowned sleep medicine expert with Emory University’s Nell Hodgson Woodruff School of Nursing. “We have been slow to accept that we have physical limits and biologically we are not built to do the things we are trying to do.” Resident physician duty hours have also been the focus of many studies. While the Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour restrictions in July 2003 limiting work shifts to a maximum of 30 hours and no more than 80 hours of work per week, numerous subsequent studies indicate that risks to patient safety and personal injury remain high for resident physicians working recurrent 24-hour shifts.9,10 In September 2010, ACGME published the final version of new standards, which became effective in July 2011 (www.acgme-2010standards.org). An article in the November 2007 Joint Commission Journal on Quality and Patient Safety concludes that evidence strongly suggests that extended duration work shifts significantly increase fatigue and impair performance and safety.11 The article reports that residents who work traditional schedules with recurrent 24-hour shifts: • Make 36 percent more serious preventable adverse events than individuals who work no more than 16 consecutive hours.12 • Make five times as many serious diagnostic errors12 • Have twice as many on-the-job attentional failures at night13 • Experience 61 percent more needlestick and other sharp injuries after their 20th consecutive hour of work14 • Experience a 1.5 to 2 standard deviation deterioration in performance relative to baseline rested performance on both clinical and non-clinical tasks15 • Report making 300 percent more fatigue-related preventable adverse events that led to a patient’s death16 A subsequent 2009 study also reveals an increased rate of complications among post-nighttime surgical procedures performed by attending physicians who had slept less than six hours.17 “We have a culture of working long hours, and the impact of fatigue has not been a part of our consciousness,” says Christopher P. Landrigan, M.D., M.P.H., director of the Sleep and Patient Safety Program, Brigham and Women's Hospital. The author of several research studies exploring the effects of provider sleep deprivation on patient and provider safety, Dr. Landrigan stresses the importance of reduced work hours for all health care workers, and the need for widespread education of health care providers to recognize their limits. “Most are unaware of sleep and circadian biology and the degree that it affects performance. And, most do not realize how much research supports the need to make changes.”18,19 Actions suggested by The Joint Commission There are some evidence-based actions that health care organizations can take to help mitigate the risks of fatigue that result from extended work hours – and, therefore, protect patients from preventable adverse outcomes. For all organizations: 1. Assess your organization for fatigue-related risks. This includes an assessment of off-shift hours and consecutive shift work, and a review of staffing and other relevant policies to ensure they address extended work shifts and hours. 2. Since patient hand-offs are a time of high-risk – especially for fatigued staff – assess your organization’s hand-off processes and procedures to ensure that they adequately protect patients.20 3. Invite staff input into designing work schedules to minimize the potential for fatigue. 4. Create and implement a fatigue management plan that includes scientific strategies for fighting fatigue. These strategies can include: engaging in conversations with others (not just listening and nodding); doing something that involves physical action (even if it is just stretching); strategic caffeine consumption (don’t use caffeine when you’re already alert and avoid caffeine near bedtime); taking short naps (less than 45 minutes).21,22 These strategies are derived from studies conducted by the National Aeronautics and Space Administration (NASA), which state that people can maximize their success by trying different combinations of countermeasures to find what works for them. The NASA studies stress that the only way to counteract the severe consequences of sleepiness is to sleep.21 Strategies for determining shift durations and using caffeine to combat fatigue can be found in chapter 40 of “Patient Safety and Quality: An Evidence-Based Handbook for Nurses.”23 5. Educate staff about sleep hygiene and the effects of fatigue on patient safety. Sleep hygiene includes getting enough sleep and taking naps, practicing good sleep habits (for example, engaging in a relaxing pre-sleep routine, such as yoga or reading), and avoiding food, alcohol or stimulants (such as caffeine) that can impact sleep.21,22 Safety culture (for all organizations): 6. Provide opportunities for staff to express concerns about fatigue. Support staff when appropriate concerns about fatigue are raised and take action to address those concerns. 7. Encourage teamwork as a strategy to support staff who work extended work shifts or hours and to protect patients from potential harm.20 For example, use a system of independent second checks for critical tasks or complex patients. 8. Consider fatigue as a potentially contributing factor when reviewing all adverse events. For organizations with a current policy that allows for sleep breaks for staff defined as essential by the organization: 9. Assess the environment provided for sleep breaks to ensure that it fully protects sleep. Fully protecting sleep requires the provision of basic measures to ensure good quality sleep, including providing uninterrupted coverage of all responsibilities (including carrying pagers and phones, and coverage of both admissions and all continuing care by another provider), and providing a cool, dark, quiet, comfortable room, and, if necessary, use of eye mask and ear plugs. See relevant Joint Commission requirements: LD.01.03.01 element of performance 5, LD.03.06.01 EP 3, LD.04.01.01 EP 2, LD.04.04.05 EP 13, PI.02.01.01 EPs 12-14, (hospital and long term care); NR.02.01.01 EP 1-6, NR.02.02.01 EP 1-4, (hospital) References ...(if you want the references [too many for this newsletter SNIPPET], write me : RNFrankie@AOL.com. Will send them to you -- no problem.) ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Over-The-Counter Eye Drops and Nasal Sprays: Drug Safety Communication - Serious Adverse Events From Accidental Ingestion by Children FDA is warning healthcare professionals and the public that accidental ingestion by children of over-the-counter eye drops used to relieve redness and nasal decongestant sprays can result in serious and life-threatening adverse events. The eye drops and nasal sprays that have been involved in the cases of accidental ingestion contain the active ingredients tetrahydrozoline, oxymetazoline, or naphazoline. The cases of accidental ingestion reviewed by FDA occurred in children 5 years of age and younger. No deaths were reported; however, serious events requiring hospitalization such as nausea, vomiting, lethargy, tachycardia, decreased respiration, bradycardia, hypotension, hypertension, sedation, somnolence, mydriasis, stupor, hypothermia, drooling, and coma have occurred. Ingestion of only a small amount (1-2 mL; for reference, there are 5 mL in a teaspoon) of the eye drops or nasal spray can lead to serious adverse events in young children. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm325729.htm ********** Meningitis Outbreak: Pharmacy Violated License The compounding pharmacy at the center of the fungal meningitis outbreak was not following the requirements of its state license, according to a spokeswoman for the Massachusetts Department of Public Health. The New England Compounding Center in Framingham, Mass., shipped more than 17,000 vials of a steroid -- now implicated in the outbreak -- to pain clinics in 23 states. But Dr. Madeleine Biondolillo, director of the state's Bureau of Health Care Safety and Quality, said the company was meant to make up drugs only in response to a doctor's prescription for an individual patient. "This organization chose to apparently violate the licensing regulations under which they were allowed to operate," Biondolillo told reporters in a telephone news conference Thursday.... Read this story on www.medpagetoday.com. http://abcnews.go.com/Health/Wellness/meningitis-outbreak-pharmacy-violated-license/story?id=17462609#.UHjQua7cDKc ; ************************ Fairfield Univ. nabs $700K grant for nursing program Fairfield University's School of Nursing is receiving a $700,000 federal grant to help students pay for courses to become nurse practitioners so they can specialize in primary care. The grant, from the United States Health Resources and Services Administration (HRSA), is part of a national effort to increase the number of primary care providers that are expected to be needed as a result of more people having health insurance under the Affordable Care Act. The intent is for the Fairfield nurse practitioners to work as health care providers in health professional shortage areas, such as Bridgeport, New Haven and Norwalk. Although regulations vary from state to state, in Connecticut nurse practitioners can practice independently. They can also practice in multiple settings like a clinic or physician's practice. At Fairfield, nurse practitioner students are encouraged to start their own businesses as well. ... http://www.hartfordbusiness.com/apps/pbcs.dll/article?AID=/20121030/NEWS01/121039989 ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction (Abstract) Extended work shifts of twelve hours or longer are common and even popular with hospital staff nurses, but little is known about how such extended hours affect the care that patients receive or the well-being of nurses. Survey data from nurses in four states showed that more than 80 percent of the nurses were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. ... for the full story, go to website) http://content.healthaffairs.org/content/31/11/2501.abstract?utm_source=BenchmarkEmail&utm_campaign= Weekly_eNewsletter_November_12th_2012&utm_medium=email ************* (I know that this issue has been addressed twice before, but this time the joint commission considers it a Sentinel Event.) Sentinel Event Alert Issue 48: Health care worker fatigue and patient safety The link between health care worker fatigue and adverse events is well documented, with a substantial number of studies indicating that the practice of extended work hours contributes to high levels of worker fatigue and reduced productivity. These studies and others show that fatigue increases the risk of adverse events, compromises patient safety, and increases risk to personal safety and well-being. While it is acknowledged that many factors contribute to fatigue, including but not limited to insufficient staffing and excessive workloads, the purpose of this Sentinel Event Alert is to address the effects and risks of an extended work day and of cumulative days of extended work hours. ( This file can be downloaded ). http://www.jointcommission.org/sentinel_event.aspx ****************************** RANDOM FACTS: Halloween, celebrated on Oct. 31, originally started as nothing more than an autumn harvest festival. Today,the holiday is associated with ghosts, costumes and, of course, candy. It has long been thought that Halloween is the one day of the year the dead can return to earth. *** Halloween was actually a Celtic holiday. It was originally called Samhain meaning "end of summer". In ancient Celtic Ireland,October 31st marked the official end of summer. ********* QUIZ TIME: A nurse working in the intensive care unit administers 100 mg of diazepam I.V. as ordered by the new resident. Although she conducts frequent assessments and records her findings, the patient dies of respiratory arrest. This is an example of which category of error? a. Failure to assess and monitor. b. Failure to act as patient advocate. c. Failure to use equipment properly. d. Failure to document. (Answer at end of Newsletter) Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ************* Hormone therapy may cut Alzheimer's risk in menopausal women CHICAGO (Reuters) - The latest data from a long-running study of hormone therapy suggests women who started taking hormone replacements within five years of menopause were 30 percent less likely to develop Alzheimer's disease than women who started years later. The findings, reported on Wednesday in the journal Neurology, add to evidence suggesting that taking hormone treatments around the time of menopause may be doing more than just helping women cope with hot flashes and night sweats. "Our results suggest that there may be a critical window near menopause where hormone therapy may possibly be beneficial," Peter Zandi of Johns Hopkins University in Baltimore, one of the study leaders, said in a statement. ... http://www.reuters.com/article/2012/10/24/us-hormones-alzheimers-idUSBRE89N1S020121024?feedType=RSS&feedName=healthNews ************************* Risk gene for Alzheimer's disease associated with lower brain amyloid NIH study reveals multiple mechanisms may play role in complex disorder Researchers investigating a known gene risk factor for Alzheimer’s disease discovered it is associated with lower levels of beta amyloid — a brain protein involved in Alzheimer's — in cognitively healthy older people. The findings suggest that a mechanism other than one related to beta amyloid accumulation may influence disease risk associated with the gene. The study, by researchers at the National Institute on Aging (NIA) at the National Institutes of Health, was published online September 27, 2012 in the journal Biological Psychiatry. The scientists studied a variation in the complement receptor-1 (CR1) gene, a newly identified gene associated with risk for late-onset Alzheimer's disease, in cognitively normal older volunteers. Participants with this gene variant were found to have less brain amyloid than those without the risk variant. In addition, the CR1 gene variant was found to interact with APOE, the most robust genetic risk factor for Alzheimer’s disease, to influence the amount of brain amyloid.... http://www.nih.gov/news/health/oct2012/nia-01.htm *********************** An important article from American Medical News. Misunderstandings among physicians about living wills, advance directives and do-not-resuscitate orders are common, according to research and medical experts. A series of surveys by QuantiaMD, an online physician learning collaborative, found that nearly half of health professionals misunderstood the components of living wills. Ninety percent of those surveyed were physicians. The survey findings provided characteristics of a patient who had a living will and asked respondents to identify the patient’s code status. Of about 10,000 respondents, 44% incorrectly identified the patient as having a DNR, and 16% did not know the code status. About 41% correctly identified the patient’s status as a full code. ... http://www.ama-assn.org/amednews/2012/10/29/prsa1029.htm ******************** Lilly trials boost amyloid link to Alzheimer's-analysis n"(Reuters) - Levels of a protein believed to be a main cause of Alzheimer's disease rose in the blood of patients treated with Eli Lilly's experimental drug in late-stage trials, suggesting the protein, beta amyloid, was removed from the brain as intended, researchers said on Monday. Lilly in August disclosed that its drug solanezumab did not significantly arrest progression of the memory-robbing disease in the pair of Phase III studies, which tested patients with mild to moderate symptoms of Alzheimer's. But the company later said an analysis of combined data from the two trials suggested the drug significantly slowed cognitive decline in patients with only mild symptoms, although it did not slow the decline of their physical function. ... http://www.reuters.com/article/2012/10/29/us-lilly-alzheimers-biomarkers-idUSBRE89S15I20121029?feedType=RSS&feedName=healthNews ***************** RANDOM FACTS: The major change from the Phoenician alphabet to the Greek one of the eighth century was the addition of five letters to represent the vowel sounds. Today's geometry is based on the ideas of ancient Greeks Pythagoras and Euclid. ************************ Energy drink caffeine levels often stray from labels: study (Reuters) - "Energy drinks do not always divulge how much caffeine they contain, and when an amount is listed on a label, it is not always accurate, Consumer Reports magazine has found. According to a study released on Thursday by the magazine, 11 of the 27 top-selling energy drinks in the United States do not specify the amount of caffeine in their beverages. Of the 16 drinks that did list a specific caffeine amount, five had more caffeine per serving than was listed and the average amount over was more than 20 percent. The study comes fast on the heels of news that U.S. health regulators are investigating reports of five deaths that may be associated with Monster Beverage Corp's Monster Energy drink. ... http://www.reuters.com/article/2012/10/25/us-energydrinks-caffeine-idUSBRE89O0WF20121025?feedType=RSS&feedName=healthNews *********************** Autism Tough to Spot Before 6 Months of Age, Study Suggests Signs didn't typically emerge until later, and early diagnosis didn't mean case was more severe TUESDAY, Oct. 30 (HealthDay News) -- The development of 6-month-old babies who are diagnosed with autism in toddlerhood is very similar to that of children without autism, a new study suggests. "We always thought that if a child had autism, we would be able to tell during infancy . . . but we were wrong," said study author Rebecca Landa, director of the Center for Autism and Related Disorders at Kennedy Krieger Institute in Baltimore. "At 6 months of age, babies who end up with autism by age 3 are scoring similarly on tests to children who didn't have autism." The study also sheds doubt on the notion that cases of autism that are spotted early are necessarily more severe. The researchers report that youngsters with early-identified autism (spotted at or before 14 months of age) did initially perform less well than a group whose autism was identified later. However, by the time children from both of these groups reached 3 years of age the gap narrowed so that they showed very similar levels of function. The study is published Oct. 30 in the journal Child Development. Affecting about one in 88 American children, conditions on the autism spectrum are developmental disorders that cause difficulties in social skills, language and communication. They can range from mild to severe, and are typically identified by the age of 3. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_130809.html ************************** RANDOM TIDBIT: The first president to decorate the White House Christmas tree in the United States was Franklin Pierce. ************ Roche probed for not reporting side effects LONDON (AP) — Europe's top drug regulator announced Tuesday it is taking action against pharmaceutical giant Roche for allegedly failing to properly report the side effects of 19 drugs being used by U.S. patients. It is the first time the European Medicines Agency has begun a so-called 'infringement proceeding' against a drug maker. European regulations lay out numerous requirements for pharmaceuticals, including reporting suspected side effects and submitting such cases to officials. Eight of the drugs involved are used for the treatment of cancer, including breast cancer. They include Avastin, Herceptin, Tarceva, and Xeloda. The flu drug Tamiflu was also included in the list. British authorities brought the problem to the attention of the European authorities in May after noticing "serious shortcomings" in how Roche AG reported potential side effects. ... http://health.yahoo.net/news/s/ap/roche-probed-for-not-reporting-side-effects **************** Navigating Hospital Politics--Nurse Zone October 18, 2012 - Nearly every work environment has stressors, difficult interpersonal dynamics and office politics, and in health care these issues are often intensified because of the life-and-death nature of the work. Nurses are under stress due to shift work, the emotional nature of caring for patients and because they are often asked to do more with less. All of these factors can lead to tensions among co-workers. It is important for nurses to be aware of the dynamics in their environment and to learn how to handle tense situations productively while avoiding unnecessary drama. ... http://www.nursezone.com/Nursing-News-Events/more-news/Navigating-Hospital-Politics_40664.aspx ; ******************** Wireless Revolution in Home Health Improving wireless technology empowers home health nurses to chart and educate remotely. With texting, tweeting, Facebook PMing and Gchat increasingly replacing face-to-face or telephone conversations, it's only logical that clinicians will find a way to enhance provider-patient communications. But don't expect 140 characters to replace a discharge planning session anytime soon. While healthcare communication capabilities are advancing every day, clinicians feel an increasing responsibility to display professionalism and maintain patient privacy. Nowhere is the potential for technological advancement greater than in the arena of home care. As the national focus shifts to keeping patients in their own homes (and out of ED admissions), technology is increasingly enabling patients to connect with their clinicians remotely. The trend is official now. In October, the Federal Communications Commission (FCC) allocated use of the 2360-2400 MHz bandwidth for medical use. Those bands were previously reserved for flight testing in the aerospace industry. This change should further facilitate real-time monitoring. ... http://nursing.advanceweb.com/Features/Articles/Wireless-Revolution-in-Home-Health-2.aspx ************************** RANDOM TIDBIT: Hot cockles was a popular game at Christmas in medieval times. Players took turns striking a blindfolded player, who had to guess the name of the person delivering each blow. *************** Revison of F-tag 322: Feeding tubes By: Melissa D'Amico October 25th, 2012 http://tinyurl.com/bmrzoa5 (Thank you, Barbara) On September 27, 2012, the Centers for Medicare & Medicaid Services (CMS) published an advance copy of revisions to F-tag 322, Feeding Tubes, Appendix PP of the State Operations Manual. Implementation of these changes will be no later than November 30, 2012. Here are some key points you should be aware of: “Naso-gastric tube” now refers to any feeding tube used to provide enteral nutrition to a resident by bypassing oral intake. There are now definitions related to avoidable/unavoidable use of a feeding tube. “Avoidable” means there is not a clear indication for using a feeding tube or there is insufficient evidence that it provides a benefit that outweighs associated risks. “Unavoidable” means there is a clear indication for using a feeding tube or there is sufficient evidence that it provides a benefit that outweighs associated risks. The memorandum offers some examples of some possible benefits of using a feeding tube: Addressing malnutrition and dehydration; Promoting wound healing; and Allowing the resident to gain strength, receive appropriate interventions that may help restore the resident’s ability to eat and, perhaps, return to oral feeding. Also included are examples of some possible adverse effects of using a feeding tube: Diminishing socialization, including, but not limited to, the close human contact associated with being assisted to eat or being with others at mealtimes; Not having the opportunity to experience the taste, texture, and chewing of foods; Causing tube-associated complications; and reducing the freedom of movement related to efforts to prevent the resident from pulling on the tube or other requirements related to the tube or the tube feeding. The memorandum highlights resident’s right to treatment and facility responsibilities in the use of feeding tubes. According to CMS: If a resident has had a feeding tube placed prior to admission or in another setting while residing in the facility, the physician and interdisciplinary care team review the basis (e.g., precipitating illness or condition change) for the initial placement of the feeding tube and the resident’s current condition to determine if there is a continued rationale for its use and to ensure that its continued use is consistent with the resident’s treatment goals and wishes. Decisions to continue or discontinue the use of a feeding tube are made through collaboration between the resident (or a legal representative for a resident who lacks capacity to make and communicate such decisions), the physician, and the interdisciplinary care team. This includes a discussion of the relevance of a feeding tube to attaining a resident’s goals (e.g., whether the nutritional intervention is likely to have a significant impact on the individual’s underlying condition or overall status). Further, there is a new investigative protocol for feeding tubes that facilities should be aware of. This protocol includes: Observations Interviews Record reviews Review of facility practices http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Survey CertificationGenInfo/Downloads/Survey-and-Cert-Letter-12-46.pdf -- ************************** Quick Survey May Pick Up Ovarian Cancer Warnings: Study (HealthDay News) -- A simple three-question survey might identify women who have symptoms that may indicate ovarian cancer,according to a new study. The two-minute paper-and-pencil questionnaire can be given in a doctor's office and checks for six warning signs that may improve early detection of ovarian cancer, according to researchers at the Fred Hutchinson Cancer Research Center in Seattle. The survey asks women if they are experiencing one or more of the following symptoms: abdominal and/or pelvic pain; feeling full quickly and/or unable to eat normally; abdominal bloating and/or increased abdomen size. It also asks about the frequency and duration of these symptoms. The study included 1,200 women, ages 40 to 87, who completed the questionnaire. Five percent had a positive symptom score that indicated the need for further tests. Of this group of about 60 women, one was diagnosed with ovarian cancer. Of the 95 percent of women who had a negative symptom score, none developed ovarian cancer during one year of follow-up. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_129740.html *********************** November is Lung Cancer Awareness Month: 1: Lung cancer is the leading cancer killer in men and women in the United States. 2: Lung cancer causes more deaths than the next three most common cancers combines (colon, breast, and prostate) 4.3%: Percent increase in lung cancer between 1999 and 2008 226,160: Number of new cases of lung cancer expected to be diagnosed in 2012, representing almost 14% of all cancer diagnoses. 3: Lung cancer is the most common cancer worldwide. Source: http://www.lung.org/ Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************** Retina's Thickness May Be Tied to Severity of MS, Study Suggests MONDAY, Oct. 1 (HealthDay News) -- Using a high-tech imaging process to measure the thickness of the eye's retina may one day predict the progression of multiple sclerosis, a new study suggests. The finding might lead to better ways to judge the effectiveness of treatments because different parts of the retina seem to indicate different aspects of the disease and the toll it takes on different parts of the brain, the researchers said. The report was published online Oct. 1 in the Archives of Neurology. Multiple sclerosis is thought to be an autoimmune disease that attacks the central nervous system, which consists of the brain, the spinal cord and optic nerves. Symptoms range from mild effects, such as numbness in the limbs, to severe, such as paralysis or blindness. "In treating multiple sclerosis we have been tremendously successful in reducing the number of attacks," said Dr. Ari Green, assistant clinical director of the Multiple Sclerosis Center at the University of California, San Francisco, and author of an accompanying editorial in the journal. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_129804.html *************************** Study: Reporting medical errors may help reduce them in multi-site clinical practices Documenting adverse events improves perceptions of safety and may decrease incidents in multi-site clinical practices, according to a study from researchers at the University of Pennsylvania. http://www.uphs.upenn.edu/news/News_Releases/2012/10/safety/?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_Novemberr_5th_2012&utm_medium=email *********************** Study: Online prostate cancer information may be hard for patients to understand Although experts recommend that patient-education materials be written at the fourth-through-sixth grade level, a study published online by the Journal of Urology found that only 4.8% of websites describing prostate cancer were written below a high school reading level. The median reading level was 12th grade. http://www.loyolamedicine.org/News/News_Releases/news_release_detail.cfm?renderforprint=1&var_news_release_id=973441944&utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_Novemberr_5th_2012&utm_medium=email ************************* FDA approves Synribo for chronic myelogenous leukemia On Oct. 26, the U.S. Food and Drug Administration (FDA) approved Synribo (omacetaxine mepesuccinate) for the treatment of adults with chronic myelogenous leukemia. Synribo blocks certain proteins that promote the development of cancerous cells. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm325895.htm?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_Novemberr_5th_2012&utm_medium=email ******************* RANDOM FACT: Washing your hands after going to the bathroom can reduce the spread of diarrheal diseases by almost half. The germs on your fingers double after using the toilet, but 50 percent of men and 25 percent of women do not wash their hands afterward. (What a good patient teaching/ child teaching ) ~~**~~**~~**~~**~~**~~ HUMOR SECTION A woman visited a psychic of some local repute. In a dark and gloomy room, gazing at the Tarot cards laid out before her, the Tarot reader delivered the bad news: "There is no easy way to say this so I'll just be blunt: Prepare yourself to be a widow. Your husband will die a violent death this year." Visibly shaken, the woman stared at the psychic's lined face, then at the single flickering candle, then down at her hands. She took a few deep breaths to compose herself. She simply had to know. She met the Tarot reader's gaze, steadied her voice and asked, "Will I get away with it?" ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. 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 ~~**~~**~~**~~**~~**~~ 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/ 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. Screen the car's VIN through the free database at carfax.com/flood Rozalfaro's Website http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Medical Device recalls including hyperbaric chambers.... http://www.accessdata.fda.gov/scripts/enforcement/enforce_rpt-Product-Tabs.cfm?action=Expand+Index&source=govdelivery&w=11142012 ************* Ameridose, LLC, based in Westborough, Mass., is voluntarily recalling all of its unexpired products in circulation. The FDA is currently conducting an inspection of Ameridose’s facility. Although this inspection is ongoing, the FDA’s preliminary findings have raised concerns about a lack of sterility assurance for products produced at and distributed by this facility. Use of non-sterile injectable products can represent a serious hazard to health that could lead to life-threatening injuries. Products from Ameridose can be identified by markings that indicate Ameridose by name or by its company logo. A complete list of all products subject to this recall can be accessed at www.ameridose.com. This recall is not based on reports of patients with infections associated with any of Ameridose’s products, and the agency recommended this recall out of an abundance of caution. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm326370.htm ************************ Hospira Symbiq Infusion System Touchscreen: Class I Recall - May Not Respond to Selection These devices may not respond to user selection, may experience a delayed response or may register a different value from the value selected by the user. Failure of the touchscreen to respond to user input could result in a delay or interruption in therapy or over delivery or under delivery of medication if the user does not confirm the programmed values on the pump's confirmation screen before starting the infusion. All serial numbers for these models are affected by this recall. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm326080.htm ************************** Stryker Instruments Neptune1Silver and Neptune2 Ultra Waste Management System (Neptune1Silver and Neptune 2 Ultra): Safety Communication-Reports of Serious Tissue Damage Healthcare providers should NOT to use the Neptune 1 Silver Waste Management System or the Neptune 2 Ultra Waste Management System unless there is no alternative suction device or waste management system available. Facilities should evaluate the risks and benefits of using the Neptune 1 Silver or the Neptune 2 Ultra. If your facility does not have an alternative means for surgical waste disposal during surgery, you must complete the Certificate of Medical Necessity and send it back to Stryker. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm322811.htm ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: nineiron@bellsouth.net Andrea November 5, 2012 dawnkarst74@hotmail.com (Dawn) November 14, 2012 ~~**~~**~~**~~**~~**~~ 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.... So please send me your new name/address, okay? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ 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. ~~**~~**~~**~~**~~**~~ Quote of the Day "It is not how much you do but how much love you put in the doing.” - Mother Theresa Write me with your opinions...suggestions, please !.... Frankie RNFrankie@AOL.com Correct answer: b. By not questioning the excessive amount of diazepam, Jennifer failed to advocate for her patient. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901

PARADIGM BYTES for October 2012

PARADIGM BYTES Newsletter for Paradigm 97 October 19, 2012 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. ***~~~***~~~***~~~*** SNIPPETS Five Foods that raise the HDL What should my HDL be? (I think of HDL as Healthy; LDL as lethal) According to the American Heart Association, men should aim for HDL levels of 40 mg/dL or greater, and women should aim higher than 50 mg/dL. Levels of 60 mg/dL or more for both genders have been linked to lower disease risks and protection against heart disease. Genetics can affect your HDL level, but lifestyle choices still also play a role. If you want to fight your genes and improve your HDL levels, the following foods can help. Apples: Nuts: Walnuts, almonds, peanuts, pistachios, pecans, peanuts, and hazelnuts are all good sources of heart-healthy fats and are great to add to your diet to increase your intake. Add nuts to cereal, yogurt, salad, stir fries, pasta dishes or rice. You can eat them raw, baked or lightly toasted, too. Seafood: Fatty fish like salmon, mackerel, albacore tuna, and halibut are highest in omega-3 fatty acids, a specific type of unsaturated fat shown to be most beneficial for heart health and reduce the risk of death by heart attack. It is recommended to eat at least 2 servings of fish per week. If you don't eat seafood, you could try fish oil supplements; flaxseed and walnuts contain omega 3’s as well, but fish contains the most usable form of omega-3s. Olive Oil: Olive oil is high in unsaturated fats and can help you elevate your HDL. Replace butter and fried foods with foods cooked lightly in a heart-healthy olive oil, and switch to an oil-based vinaigrette for your salads. Oil is healthy, but it's high in fat and calories, so remember to practice moderation and keep your portions in check! Avocado: Although many dieters shy away from this fruit because of its high fat content, it's perfectly good for you thanks to its heart-healthy fats. Mash avocado to use as a spread on your sandwich or wrap, dice it into your salad, add it to omelets or whip up some homemade guacamole to enjoy with veggies or whole grain crackers. Oatmeal: Fiber, especially soluble fiber, can help bump up your HDL while reducing LDL. Oatmeal is an excellent source of soluble fiber, as is rice, bran, barley, dried peas and beans, and certain fruits like prunes and apples. A couple servings a day of these heart-healthy foods can have a positive effect on your HDL. Exercise: Along with these HDL-boosting foods, don’t forget the daily exercise! Regular exercise signals your body to produce more HDL, making physical activity one of the most important factors to raising your HDL. Start with just 5-10 minutes a few days a week, but gradually increase until you're active for at least 30 minutes 5 days per week. Your heart will thank you! ~~**~~**~~**~~**~~**~~ MEDICAL NEWS We are This Close to the end of polio September 14, 2012 The world is this close to ending polio forever. India has gone over a year without a single new case, and the crippling disease is now endemic to only three countries. Two drops of oral polio vaccine per child is all it takes to prove that children everywhere can be protected against vaccine-preventable diseases. We have a window of opportunity of historic proportions to eradicate polio. But our progress is threatened by a funding shortfall of almost US$ 1 billion through 2013. Health ministers around the world have declared polio an "emergency for global public health". We call on you to help us fund the critical work of the Global Polio Eradication Initiative. Help us secure two drops of polio vaccine for every child. Together, we can create a polio-free world, and ensure that no child suffers or dies from polio again. We are this close to reaching every child in the world. Click on the petition to bring us closer to the end of polio by registering your support for Rotary. (I had polio 9yo...a so called non-paralytic ...paralyzed for a month) http://www.globalcitizen.org/Content/Content.aspx?id=b2ed2632-572d-495b-8367-4154104312c9&ncid=webmail2 ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Influenza and pneumococcal disease vaccinations are recommended for older adults. All statistics refer to people age 65 and older: 63%: Percent of people who reported receiving a flu shot in the past 12 months 54%: Percent of Hispanics who received a flu shot, compared to 52% for Whites and non-Hispanic Blacks 60%: Percent of people who have ever received a pneumonia vaccine 39%: Percent of Hispanics who have ever received a pneumonia vaccine, compared to 46% for non-Hispanic Blacks and 64% of Whites Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 **************************** Learn more about immunizations at: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Improving-Your-Practice/Immunizations?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_October_1st_2012&utm_medium=email Source Older Americans 2012: Key Indicators of Older Americans 2012. This is the sixth in a series of reports by the Federal Interagency Forum on Aging-Related Statistics (Forum) describing the overall condition of the U.S. population age 65 and over. *********************** RANDOM FACT: In the 24 hours since this time yesterday, over 200,000 acres of rainforest have been destroyed in our world. Fully 13 million tons of toxic chemicals have been released into our environment. Over 45,000 people have died from starvation, 38,000 of them children. And more than 130 plant and animal species have been driven to extinction by the actions of humans. And all this just since yesterday. --Thom Hartmann **************************************** Finding a new virus: Spit, sequencing and serendipity Professor Maria Zambon's first thought when her team of scientists matched a virus from a patient's sputum to one never before seen in humans was: "Oh no, this is going to be tricky." In her north London laboratory last Saturday, an email came in from another specialist virology team in The Netherlands with a 99.5 percent match to a virus from the same family as SARS, a disease that emerged in 2002 and killed 800 people. Her thoughts moved swiftly to the risk of an international outbreak. "Of course it's really interesting scientifically to get this kind of result, but you also think about what it might mean," she said in an interview. "Is this the tip of an iceberg? Or is this an isolated event?" ... http://www.reuters.com/article/2012/09/28/us-virus-discovery-idUSBRE88R0U620120928?feedType=RSS&feedName=healthNews *********************** RANDOM FACT: Protein is rare in some parts of Kenya, so natives drink cow's blood for nourishment instead. ******************* New virus not spreading easily between people: WHO Reuters) - A new and potentially fatal virus from the same family as SARS which was discovered in a patient in London last week appears not to spread easily from person to person, the World Health Organization (WHO) said on Friday. In an update on the virus, which has so far killed a Saudi man and made a patient from Qatar critically ill, the United Nations health agency said it was working with international partners to understand the public health risk better. "From the information available thus far, it appears that the novel coronavirus cannot be easily transmitted from person to person," it said in a statement. The WHO put out a global alert on Sunday saying a new virus had infected a 49-year-old Qatari who had recently travelled to Saudi Arabia, where another man with the same virus had died. The Qatari was described as critically ill on Tuesday and is being treated in a London hospital. No new confirmed cases of infection with the virus have since been reported, the WHO said. The new virus shares some of the symptoms of SARS, or Severe Acute Respiratory Syndrome, another coronavirus, which emerged in China in 2002 and killed around a tenth of the 8,000 people it infected worldwide. ... http://www.reuters.com/article/2012/09/28/us-virus-who-idUSBRE88R0F220120928?feedType=RSS&feedName=healthNews ********************************* September was Sepsis Awareness Month. 58%: Percent of Americans who have never heard of sepsis. 27 seconds: Every 27 seconds, someone in the U.S. is diagnosed with sepsis. 2.5 minutes: Every 2.5 minutes, someone dies from sepsis in the U.S. 215,000: Number of deaths from sepsis annually in the U.S. Sources: http://www.sepsisalliance.org/sepsisawarenessmonth/ Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ******************* RANDOM FACT: The early Olympic Games were celebrated as a religious festival from 776 B.C. until 393 A.D., when the games were banned for being a pagan festival (the Olympics celebrated the Greek god Zeus). In 1894, a French educator Baron Pierre de Coubertin, proposed a revival of the ancient tradition, and thus the modern-day Olympic Summer Games were born. Bonus Fact: The first Olympics covered by U.S. television was the 1960 Summer Games in Rome by CBS. *********************** Quiz Time Which statement about the transition from acute to chronic pain is correct? a. Chronic pain represents an adaptive change to an injury or a noxious stimulus. b. The development of chronic pain follows a predictable course over a specified period. c. Emotions and beliefs don’t play a role in the transition from acute to chronic pain. d. The transition from acute to chronic pain is marked by sensitization. (answer at end of Newsletter) ****************** RANDOM FACT: In the fifth century, it was believed that castration cured the plague. ******************* ICD Patients Need Psych Support By Crystal Phend, Senior Staff Writer, MedPage Today Published: September 25, 2012 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner An implantable cardioverter-defibrillator (ICD) needs to be accompanied by education and psychological help, the American Heart Association urged. Routine screening and appropriate treatment for the anxiety, depression, and post-traumatic stress disorder common in ICD recipients were recommended in a scientific statement from the group appearing online in Circulation. ... Action Points An ICD needs to be accompanied by education and psychological help. Point out that the statement suggested a quick screen using the Patient Health Questionnaire to ask about lack of interest or pleasure in doing things or feeling down, depressed, or hopeless over the prior 2 weeks, followed by a full screen for a "yes" response to one or both questions. http://www.medpagetoday.com/Cardiology/Arrhythmias/34948 Why not any patient with a body changing surgery, e.g. amputations? ~~**~~**~~**~~**~~**~~ HUMOR SECTION A wife asked her husband, "Honey, could you please run to the store and get a carton of milk, and if they have eggs, get a dozen." A while later the husband returned with a case of quart milk cartons. Staring incredulously at the 12-pack case of milk, his wife asked, "Why the hell did you buy so much milk?" Her husband said, "Well, they had eggs." (you may have to re-read this, as I did) ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. 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 ~~**~~**~~**~~**~~**~~ 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/ 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. Screen the car's VIN through the free database at carfax.com/flood Rozalfaro's Website http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10 mg/500 mg (Watson Laboratories): Recall - Potential for Oversized and Superpotent Tablets A complaint was received for tablets that were thicker and darker shade than the other tablets. It is possible that some tablets from lots 519406A and 521759A exceed the weight specification and may contain higher than indicated amounts of the ingredients Hydrocodone Bitartrate and/or Acetaminophen. Unintentional ingestion of excessive amounts of acetaminophen may potentially result in an adverse event, including liver toxicity, especially in patients on other acetaminophen containing medications, patients with liver dysfunction, or people who consume more than 3 alcoholic beverages a day. Acetaminophen overdose can potentially cause severe liver damage, at times resulting in liver transplant or death. Unintentional ingestion of excessive amounts of hydrocodone may result in an increase in the severity or frequency of side effects, such as sedation or respiratory depression, particularly in patients who are elderly, have severe kidney or liver impairment, or are also taking interacting medications, such as sedating medications or certain antidepressants. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm320610.htm ******************************** St. Jude Medical Riata Implantable Cardioverter Defibrillator (ICD) Leads: Safety Communication - Premature Insulation Failure These leads have an increased risk of premature insulation failure that can impact the lead’s ability to function properly. Many factors contribute to the lifespan of an ICD lead, including the age and activity level of the patient. On average, an ICD lead is expected to last at least 10 years. The FDA is aware of an increase in frequency of reported Riata insulation failures, beginning approximately four years after implant. Insulation failure may cause some of the electrical conductors inside Riata leads to move within (migrate), or move entirely outside (externalize), the outer lead insulation. These changes may be detectable on X-ray or fluoroscopic imaging. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm315718.htm *************************** Hospira Propofol Injectable Emulsion: Recall- Glass Vial Defect Hospira and FDA notified healthcare professional of a nationwide recall of three lots of Propofol Injectable Emulsion, 1%, 1g/100 mL, due to visible particles embedded in the glass to the user level. There may be potential for product to come into contact with the embedded particles and the particles may become dislodged into the solution. In the event in which particulate matter could be injected into a patient, there may be the potential for patient injury where medical intervention may be required. Risks associated with this defect could include tissue necrosis in one or more organsthat could result in stroke, myocardial infarction, respiratory failure, and loss of renal and hepatic function. ,,, http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm315746.htm ************** September 24, 2012 : Recall of Typhim Vi, Typhoid Vi Polysaccharide Vaccine PRODUCT / LOT NUMBER / EXPIRATION DATE: Prefilled syringes (NDCa 49281-790-51) Lots: E1287-1 (Expiration Date 20NOV12), E1288-1 (Expiration Date 17NOV12), G0481-1 (Expiration Date 07SEP13), G0507-1 (Expiration Date 20SEP13), G0508-1 (Expiration Date 27SEP13) 20-dose vials (NDC 49281-790-20) Lot G1130-1 (Expiration Date 18MAR13) MANUFACTURER: Sanofi Pasteur SA Marcy L’Etoile, France As a precautionary measure, Sanofi Pasteur is voluntarily recalling some lots of Typhim Vi vaccine (prefilled syringes and 20-dose vials). The vaccine met all release requirements at the time of distribution. Sanofi Pasteur is taking this action because these lots are at risk for lower antigen content. There is no safety concern related to this action. Sanofi Pasteur asks that you promptly examine your inventory. If you have any remaining doses from the above lots of the prefilled syringes or the 20-dose vials, PLEASE DO NOT USE THESE DOSES. Instructions for returning product are included in the Recall Notification. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/Recalls/ucm321705.htm?source=govdelivery ********************** NOTICE: You are encouraged to report all serious adverse events and product quality problems to FDA MedWatch at www.fda.gov/medwatch/report.htm ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: glrxroland@yahoo.com (Gina) September 2, 2012 (Our Third Pharmacist) dustynicolebailey@hotmail.com (Dusty) September 27, 2012 rnpftno_1@bellsouth.net (Marilyn) September 30, 2012 ~~**~~**~~**~~**~~**~~ 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.... So please send me your new name/address, okay? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ 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. ~~**~~**~~**~~**~~**~~ THOUGHTS FOR THE DAY It was terribly dangerous to let your thoughts wander when you were in any public place or within range of a telescreen. The smallest thing could give you away. A nervous tic, an unconscious look of anxiety, a habit of muttering to yourself-anything that carried with it the suggestion of abnormality, of having something to hide. In any case, to wear an improper expression on your face ... was itself a punishable offense. There was even a word for it in Newspeak: facecrime... --George Orwell Ways may someday be developed by which the government, without removing papers from secret drawers, can reproduce them in court, and by which it will be enabled to expose to a jury the most intimate occurrences of the home. -- Justice Louis Brandeis Would really like to hear from you..... Frankie RNFrankie@AOL.com Correct answer to the Quiz: d. The transition from acute to chronic pain is marked by sensitization, which may be primary (occurring at the injury site and known as peripheral sensitization) or secondary (occurring in the central nervous system).