Newsletter for Paradigm 97
February 10, 2011
PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.
Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPET
FATIGUE:
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 or faulty information processing and judgment
• 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.”
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FROM A MEMBER
(This was submitted by Wendie (whowland@howlandhealthconsulting.com) who writes: " Seems this increases the evidence for physical (as opposed to strictly psychological) mechanisms for PTSD."
Stellate Ganglion Blockade Shows Promise as Effective, Durable Treatment for PTSD April 30, 2010 — Case reports of immediate, durable, and significant reductions in symptoms of posttraumatic stress disorder (PTSD) are now appearing in the literature following the use of stellate ganglion block (SGB) in severe PTSD unresponsive to medical intervention. A report of 2 PTSD patients who were successfully treated with SGB was published online April 20 in Pain Practice.
Sean Mulvaney, MD, Consortium for Health and Military Performance, Uniformed Service University, Bethesda, Maryland, and colleagues reported the successful use of SGB in 2 patients with symptoms of PTSD. Before receiving the SGB, pretreatment scores on the Posttraumatic Stress Disorder Checklist (PCL) were 76 of a maximum score of 85 for the first patient and 54 in the second patient.
After SGB blockade with ropivacaine delivered at the level of the sixth cervical vertebra on the right side, 1 patient indicated that global feelings of anxiety improved from a pre-SGB level of 8 of 10 to a 2 of 10 after the procedure. Post-SGB PCL scores for the second patient decreased to 24, with the minimum score being 17. ...
http://www.medscape.com/viewarticle721079
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MEDICAL NEWS
UMDNJ, Settle Lawsuit Regarding Moral Objections to Assisting at Abortions
Twelve New Jersey nurses working on the same-day services (SDS) unit of the University Hospital in Newark, New Jersey, filed suit on October 31, 2011, against the University of Medicine and Dentistry of New Jersey (UMDNJ), alleging that the institution's officials demanded that the nurses assist in abortions, despite their religious and moral objections, or their employment would be terminated. In what was to be a public hearing of oral arguments and rebuttals for both sides on December 22, 2011, the attorneys instead reached a settlement in New Jersey's U.S. District Court. ...
http://journals.lww.com/ajnonline/Fulltext/2012/02000/Nurses,_UMDNJ,_Settle_Lawsuit_Regarding_Moral.7.aspx
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
The Relationship Between Body Mass Index and 30-Day Mortality Risk, by Principal Surgical Procedure. To examine the relationship between body mass index (BMI) calculated as weight in kilograms divided by height in meters squared) and 30-day mortality risk among patients in the participant use data file database
of the American College of Surgeons National Surgical Quality Improvement Program. Obesity is a prevalent chronic disease in the
United States, and general and vascular surgeons are caring for an increasing population of obese patients.
Multivariable logistic regression analysis was used to assess the statistical significance of the relationship between BMI and mortality, with adjustments for patient-level differences in overall mortality risk and principal operating procedures. Odds ratios with 95% CIs were calculated to measure the relative difference in mortality by BMI quintile, with reference to the middle quintile of the BMI. The overall significance of the BMI and of the other covariates was measured using the Wald χ(2) test statistic. A separate multivariable logistic regression model was developed to assess the significance of the interaction between BMI and primary procedure. ...
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(Thank you, Barbara) The Norovirus is behind 18% of outbreaks in U.S. hospitals A study in the American Journal of Infection Control found that norovirus was the most common cause of infection outbreaks, causing 18.2% of all outbreaks in U.S. hospitals in 2008 and 2009. Researchers
noted that 65% of hospital unit closures over the same period were attributed to norovirus. The three next most common causes of outbreaks were Staphylococcus aureus, Acinetobacter spp and Clostridium difficile.
Nurse.com (1/31) http://news.nurse.com/article/20120131/NATIONAL02/102130001
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Study endorses HPV testing for all women over 30 New DNA tests looking for the virus responsible for most cases of cervical cancer make sense for all women aged 30 or over, since they can prevent more cases of cancer than smear tests alone, Dutch researchers said on Thursday.
Results of a five-year study involving 45,000 women provided the strongest evidence yet in favor of using human papillomavirus (HPV) testing, Chris Meijer and colleagues from the VU University Medical Centre in Amsterdam reported in The Lancet Oncology.
Most cases of infection with the sexually transmitted virus are cleared naturally by the immune system, but persistent infection with certain HPV strains can lead to cervical cancer.
In recent years, tests for these "high-risk" strains have been developed by companies including Roche and Qiagen.
The new tests are known to work well in detecting HPV, but the Dutch study is the first to show they are better than Pap smears alone over two screening rounds set five years apart. ... http://in.reuters.com/article/2011/12/15/us-hpv-idINTRE7BE00320111215
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RANDOM FACTS: The Conquistadors that conquered South America and Mexico during the 1500's came from Spain bringing horses and early guns known as Arquebus'; neither of which had yet reached the Americas.
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Before they were demolished, the Incas of South America made the grave mistake of underestimating the Conquistadors, who's 150 or so explorers were dwarfed by 80,000 Inca warriors. The Inca chief considered them fools for wearing cooking pots on their heads (actually steel helmets).
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Infant acetaminophen in new concentration. The new 160mg/5mL (32mg/mL) infant acetaminophen concentration has been arriving in hospitals, retail pharmacies, and stores, although manufacturers may not be providing notification about the change. Last spring,manufacturers announced a voluntary reformulation of the former 80 mg/0.8mL (100mg/mL) infant drops. All liquid acetaminophen for children under the age of 12 is now in the 160mg/5mL (32mg/mL) strength to make it easier for parents and caregivers to avoid dosing errors. http://www.ismp.org/newsletters/nursing/issues/NurseAdviseERR201112.pdf
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I am a Nurse To most of us, we believe it is a natural call on duty. To many of us, it is more than an art or a science, it is a way of life. To a few in the wrong career, it is a job that makes their ends meet. Nursing takes more than just scoring a 4.0 GPA in prerequisites, tough school work and sleepless nights preparing care plans for patient, night before clinical/practical days.
Guinness book of world record has ranked bachelors of nursing as one of the toughest courses I the world, above medicine, engineering and architecture. This just explains that nurses are not average performers but high functioning scholars. Beyond being high functioning, nurses must have strong social, political, cultural and religious skills that equip them with skills to deal with all lows and highs of life.
Nursing pub is a place where nurses from all over the world share stories, experiences, and tips to the world about who we are. Besides stories, nurses at nursing pub offer health tips, answer public questions that may help make better health related decisions. ... (In my opinion, this article says it all)
http://nursingpub.com/i-am-a-nurse
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Understanding Acute Myocardial Infarction Biomarkers Heart attack, MI & AMI are common terms you might have heard all being associated to the heart. Each nursing or any medical care provider ought to be able to recognize myocardial infarction and take action as soon as possible because it is a life threatening emergency. Time and speed saves heart muscle damage.
Acute myocardial infarction (AMI) is a medical emergency requiring immediate hospitalization; patients suspected of having AMI should be admitted immediately to the coronary or intensive care unit for evaluation and potentially life-saving treatment. (Do you know how AMI is treated? Please tell us in comments section below)
The clinical presentation of AMI is characterized by chest pain, ECG changes, and serial elevation of cardiac biomarkers. (Do you know specific ECG/EKG changes indicate myocardial infarction? Tell us in comments section)
Serum cardiac enzymes and specific cardiac biomarkers may be elevated, indicating cardiac muscle damage, ischemia, necrosis, thereby aiding in the diagnosis of AMI. ...
http://nursingpub.com/understanding-acute-myocardial-infarction-biomarkers
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Mutations in 2 Genes Linked to Rare Autism-Related Disorder --- Research sheds light on Joubert syndrome, which causes physical and mental disabilities
THURSDAY, Jan. 26 (HealthDay News) -- Newly discovered mutations in two adjacent genes cause a rare genetic brain condition called Joubert syndrome, according to a new study.
People with Joubert syndrome have malformation or underdevelopment of the cerebellum and brainstem, resulting in a range of physical and mental disabilities such as poor muscle control and mental retardation.
As many as four in 10 people with Joubert syndrome meet the criteria for an autism diagnosis and other neurocognitive disorders, according to background information in a news release about the research.
In the study, a team led by University of California, San Diego School of Medicine researchers found that mutations in two adjacent genes -- TMEM216 and TMEM138 -- cause Joubert syndrome. ...
http://www.nlm.nih.gov/medlineplus/news/fullstory_121239.html
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HIV ‘saliva’ test as effective as blood test, study finds
Canadian researchers who analyzed data from five global databases found that a saliva test was as effective as the standard blood test in diagnosing HIV virus among high-risk populations, and was about 97% accurate among low-risk populations. The oral bluid test can produce results in about 20 minutes compared with about two weeks for the traditional blood test.
A rapid oral test that collects mouth fluids to diagnose HIV is nearly as accurate as traditional blood tests and could help to curb the global HIV/AIDS epidemic, a new study has found.
In a study published Tuesday in The Lancet Infectious Diseases, a group of researchers, led by the Research Institute of the McGill University Health Centre, compared field research studies from five global databases of two rapid test methods — blood tests and an oral fluid test, OraQuick HIV ½.
Researchers found that the oral test was just as effective as the blood test in detecting the virus among high-risk adult populations (injection drug users, men who have sex with men and people having unprotected sex) — and about 97 per cent effective for low-risk populations.
“If you’re really talking about bringing the virus to its knees . . . the oral test is one more way for people to find out their status,” said Dr. Nitika Pant Pai, a McGill medical scientist and the study’s lead author. ...
http://www.thestar.com/news/article/1121379
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RANDOM FACTS: Rainforests only cover about 7% of Earth's surface, but they are home to 50% of the plant and animal species on
the planet. Also: Burning rainforests accounts for roughly 30% of the carbon dioxide releases in the air.
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FDA approves new treatment for most common type of skin cancer Today, Erivedge (vismodegib) was approved by the U.S. Food and Drug Administration to treat adult patients with basal cell carcinoma, the most common type of skin cancer. The drug is intended for use in patients with locally advanced basal cell cancer who are not candidates for surgery or radiation and for patients whose cancer has spread to other parts of the body (metastatic).
Erivedge, reviewed under the agency’s priority review program, is the first FDA-approved drug for metastatic basal cell carcinoma. Erivedge was reviewed under the FDA’s priority review program that provides for an expedited six-month review of drugs that may offer major advances in treatment. The drug is being approved ahead of the March 8, 2012 prescription user fee goal date.
Basal cell carcinoma is generally a slow growing and painless form of skin cancer that starts in the top layer of the skin (epidermis). The cancer develops on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation.
Erivedge is a pill taken once a day and works by inhibiting the Hedgehog pathway, a pathway that is active in most basal cell cancers and only a few normal tissues, such as hair follicles.
“Our understanding of molecular pathways involved in cancer, such as the Hedgehog pathway, has enabled the development of targeted drugs for specific diseases,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “This approach is becoming more common and will potentially allow cancer drugs to be developed more quickly. This is important for patients who will have access to more effective therapies with potentially fewer side effects.”
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm289545.htm
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RANDOM FACT: According to a study by the American Journal of Public Health, adults who watch three hours of TV a day are more likely to be obese than those who keep it under an hour.
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RANDOM FACT: Soft drinks represent the largest single source of added sugars in the American diet. The average American will drink 54 gallons of soft drink a year.
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First patients shown to improve with embryonic stem cells (Reuters) - Before treatment, the 51-year-old graphic artist was legally blind, unable to read a single letter on a standard eye chart. She has suffered from Stargardt's disease, the most common form of macular degeneration in young patients, since she was a teenager, and it was getting progressively worse.
A second patient, aged 78, suffered from dry macular degeneration -- the leading cause of blindness in the elderly -- and could not even see well enough to go shopping. ...
http://www.reuters.com/article/2012/01/24/us-stemcells-idUSTRE80M21R20120124?feedType=nl&feedName=ushealth1100
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FDA approves Kalydeco to treat rare form of cystic fibrosis Breakthrough therapy targets defective protein
The U.S. Food and Drug Administration today approved Kalydeco (ivacaftor) for the treatment of a rare form of cystic fibrosis (CF) in patients ages 6 years and older who have the specific G551D mutation in the Cystic Fibrosis Transmembrane Regulator (CFTR) gene.
CF is a serious genetic disorder affecting the lungs and other organs that ultimately leads to an early death. It is caused by mutations (defects) in a gene that encodes for a protein called CFTR that regulates ion (such as chloride) and water transport in the body. The defect in chloride and water transport results in the formation of thick mucus that builds up in the lungs, digestive tract and other parts of the body leading to severe respiratory and digestive problems, as well as other complications such as infections and diabetes.
CF, which affects about 30,000 people in the United States, is the most common fatal genetic disease in the Caucasian population. About 4 percent of those with CF, or roughly 1,200 people, are believed to have the G551D mutation.
“Kalydeco is an excellent example of the promise of personalized medicine – targeted drugs that treat patients with a specific genetic makeup,” said FDA Commissioner Margaret A. Hamburg, M.D. “The unique and mutually beneficial partnership that led to the approval of Kalydeco serves as a great model for what companies and patient groups can achieve if they collaborate on drug development.”
The FDA reviewed and approved Kalydeco in approximately three months under the agency’s priority review program that is designed to expedite the review of drugs. The priority review program uses a six-month review, instead of the standard 10 months, for drugs that may offer significant advances in treatment over available therapy. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm289633.htm
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MIAMI, Jan. 31 (UPI) -- Drinking diet soft drinks on a daily basis might increase the risk stroke, heart attack and vascular death, U.S. researchers said.
Hannah Gardener and colleagues from the University of Miami Miller School of Medicine and at Columbia University Medical Center in New York also found regular soft drink consumption and a more moderate intake of diet soft drinks do not appear to be linked to a higher risk of vascular events.
http://www.upi.com/Health_News/2012/01/31/Diet-soda-linked-to-stroke-heart-attack/UPI-44911328067236/#ixzz1l9VXba1u
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RANDOM FACTS: Adding three of four sugar cubes to a suitcase before storage will help prevent musty odors.
and
A spoonful of sugar added to a vase of water will prolong the life of freshly cut flowers.
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Researchers Spot Potential Bile Duct Cancer Drug Targets --- Mutations in two genes found in tumors appear to fuel their growth THURSDAY, Jan. 26 (HealthDay News) -- Researchers who identified a new genetic signature associated with bile duct cancer say their discovery could lead to targeted treatment for the deadly cancer.
The team at the Massachusetts General Hospital Cancer Center screened samples from 287 patients with gastrointestinal tumors and found that growth-enhancing mutations in two genes (IDH1 and IDH2) may account for nearly one-fourth of bile duct tumors that develop in the liver. Mutations in IDH1 were found in 13 percent of all bile duct tumors and in 23 percent of those within the liver itself. Mutations in IDH2 were less common. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_121243.html
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CDC: Cancer Screening Below Target Rates
Jan. 26, 2012 -- Screening rates for breast, cervical, and colorectal cancer remain below target levels in the United States and are especially low among Asians and Hispanics, the CDC reports.
Screening rates for breast and cervical cancer have remained relatively stable over the past decade, with about 3 out of 4 eligible women receiving mammograms and 4 out of 5 having Pap tests to screen for cervical cancer. Target rates set by federal officials in the Healthy People 2020 initiative are 81% and 93%, respectively, for breast and cervical cancer screening. ... http://www.webmd.com/cancer/news/20120126/cdc-cancer-screening-below-target-rates
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Rate of Leg, Foot Amputations Among Diabetics Drops: CDC TUESDAY, Jan. 24 (HealthDay News) -- The rate of leg and foot amputations among diabetes patients aged 40 and older fell by 65 percent between 1996 and 2008, a new U.S. government study shows.
The analysis of data from the National Hospital Discharge Survey found that the rate of non-traumatic lower-limb amputations among adults with diagnosed diabetes was 3.9 per 1,000 in 2008, compared with 11.2 per 1,000 in 1996, according to the U.S. Centers for Disease Control and Prevention.
Non-traumatic lower-limb amputations are the result of circulatory problems that are common among people with diabetes, as opposed to traumatic amputations caused by injuries.
In 2008, the rate of diabetes-related leg and foot amputations was higher for men than women (6 versus 1.9 per 1,000) and higher for blacks than for whites (4.9 versus 2.9 per 1,000). Adults aged 75 and older had the highest rate (6.2 per 1,000) of all age groups. ... (I believe that nurses play a very large role in the observance and reporting of potential leg and foot wounds; they also play a vital role with the wound care of these wounds.)
http://www.nlm.nih.gov/medlineplus/news/fullstory_121142.html
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Examining Our Biases About Mental Illnesses “There's nothing really wrong with him, it's just anxiety.” How many times have you heard someone say this—or said it yourself? Mental health problems are among the most marginalized health conditions in the United States. They're viewed as less “real” than physical illnesses; there's no tumor to be palpated, no abnormality to be spotted on an X-ray. Emotional and psychological problems are often thought to be under a person's control in a way that, say, multiple sclerosis or cancer is not. And because mental health problems can be construed as signs of weakness, sufferers may hide their symptoms. People who suffer from a mental illness need to feel comfortable seeking care and to trust that they'll be treated with skill, compassion, and respect. This is vital: studies consistently find that mental illnesses, particularly depression, take a terrible toll on health. Such illnesses have been associated with an increased risk of stroke, coronary artery disease, and dementia, as well as increased mortality in people with cancer, diabetes, or chronic kidney disease and following a myocardial infarction or coronary artery bypass surgery. ... http://journals.lww.com/ajnonline/Fulltext/2012/02000/Examining_Our_Biases_About_Mental_Illnesses.1.aspx
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RANDOM FACT: Hawaii is the most isolated population center on the face of the earth. Hawaii is 2,390 miles from California; 3,850 miles from Japan; 4,900 miles from China; and 5,280 miles from the Philippines.
Also: Honolulu's zenith star, (the star that rises directly above it) is Arcturus. The Hawaiians called it Hokule'a. (Hoe koo lay uh.)
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The effects of psychoeducation and telephone counseling on the adjustment of women with early-stage breast cancer☆
Background
Throughout the illness trajectory, women with breast cancer experience issues that are related to physical, emotional, and social adjustment. Despite a general consensus that state-of-the-art treatment for breast cancer should include educational and counseling interventions to reduce illness or treatment-related symptoms, there are few prospective, theoretically based, phase-specific randomized, controlled trials that have evaluated the effectiveness of such interventions in promoting adjustment. ... http://www.appliednursingresearch.org/article/S0897-1897%2809%2900109-8/abstract?elsca1=etoc&elsca2=email&elsca3=0897-1897_201202_25_1&elsca4=saunders
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Chlamydia trachomatis Testing Sensitivity in Midstream Compared With First-Void Urine Specimens
Abstract
http://www.annfammed.org/content/10/1/50.full
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RANDOM FACTS: At the age of thirty-five, Martin Luther King, Jr., was the youngest man to have received the Nobel Peace Prize.
Martin Luther King Jr. Day was not officially observed in all 50 states until January, 2000.
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Owner and Employee of Miami Home Health Company Plead Guilty in $22 Million Health Care Fraud Scheme
WASHINGTON – The owner and an employee of a Miami health care agency pleaded guilty for their participation in a $22 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.
Marietha Morales, 38, pleaded guilty on Jan. 24, 2012, before U.S. District Judge Seitz to one count of conspiracy to commit health care fraud and Eduardo Saborit-Dominguez, 48, pleaded guilty today before Judge Seitz to one count of conspiracy to violate the Anti-Kickback Statute. Sentencing for both defendants is scheduled for May 23, 2012. The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years.
According to the court documents, Morales was the president and Saborit-Dominguez was an employee of Prime Home Health Services Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. ...
http://www.stopmedicarefraud.gov/HEATnews/florida/index.html#jan-26-2012 ***********
Headache affects 50 percent of HIV/AIDS patients in the United States, and many of those headaches are severe, a new study says. (HealthDay News)
Researchers who interviewed 200 HIV/AIDS clinic patients from Montgomery, Ala., found that 27.5% experienced chronic migraines, compared with 2% of the general population. About 27.5 percent of the 200 HIV/AIDS patients in the study suffered "chronic migraine," a rare condition in which a person has migraine symptoms (with or without other headaches) for 15 or more days a month. This condition occurs in only 2 percent of the general population.
"This translates into a 13-fold increased risk of chronic migraine among patients with HIV disease," study author Todd Smitherman, an assistant professor of psychology at the University of Mississippi, said in a university news release.
"The strongest predictor of headache was the severity of HIV disease, such that patients with more advanced disease had more frequent, more severe and more disabling migraines," he added.
The frequency and severity of migraines increased with the advancement of HIV/AIDS. Researchers advised care providers to monitor headache symptoms in patients with HIV. ... http://consumer.healthday.com/Article.asp?AID=659604
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RANDOM FACTS: Macaroni and Cheese is the #1 cheese recipe in America. In any given twelve-week period, approximately one-third of the population of the U.S. will eat mac and cheese at least once. Bonus Fact: The average American ate 30 lbs of cheese in the year 2000, up from 11 lbs in 1970.
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HUMOR SECTION
Farmer Joe decided his injuries from the accident were serious enough to take the trucking company (responsible for the accident) to court. In court, the trucking company''s fancy lawyer was questioning farmer Joe. "Didn't you say, at the scene of the accident, ' I'm fine?'" questioned the lawyer.
Farmer Joe responded, "we.., I'll tell you what happened. I had just loaded my favorite mule....Bessie into the..." " I didn't ask for any details," the lawyer interrupted, just answer the question. Did you not say, at the scene of the accident, 'I'm fine'!"
Farmer Joe said, "Well I had just got Bessie into the trailer and I was driving down the road..."
The lawyer interrupted again and said, "Judge, I am trying to establish the fact that, at the scene of the accident, this man told the Highway Patrolman on the scene that he was just fine. Now several weeks after the accident he is trying to sue my client. I believe his is a fraud. Please tell him to simply answer the question."
By this time the Judge was fairly interested in Farmer Joe's answer and said to the lawyer, "I'd like to hear what he has to say about his favorite mule Bessie."
Joe thanked the Judge and proceeded, "Well, as I was saying, I had just loaded Bessie, my favorite mule, into the trailer and was driving her down the highway when this huge semi-truck and trailer ran the stop sign and smacked my truck right in the side. I was thrown into one
ditch and Bessie was thrown into the other. I was hurting real bad and didn't want to move. However, I could hear ole Bessie moaning and groaning. I knew she was in terrible shape just by her groans.
Shortly after the accident, a Highway Patrolman came on the scene. He could hear Bessie moaning and groaning so he went over to her. After he looked at her, he took out his gun and shot her between the eyes.
Then the Patrolman came across the road with this gun in his hand and looked at me. He said, "your mule was in such bad shape I had to shoot her. How are you feeling?"
It was then that I said, "I'm fine" ."
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess.
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.
Free CEs http://www.myfreece.com/welcome.asp
https://nursing.advanceweb.com/CE/TestCenter/Main.aspx
This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com.
This is an excellent nursing site, check it out: http://nursingpub.com/
An interesting website: http://www.uptodate.com/home/clinicians/index.html
Back issues of the ISMP newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance
info@sharedgovernance.org www.sharedgovernance.org
Decubqueen's website: www.accu-ruler.com
http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.nationalnurse3.blogspot.com/
RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html
Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263
The Nursing Site http://thenursingsite.com .
http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.snopes.com
http://www.solutionsoutsidethebox.net/ Raconte's website
http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3
National Do Not Call Registry
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood
Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/
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MEDICAL RECALLS
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North American Rescue, LLC Announces A Follow-Up to the Recall of Crickit® Convenience Kits Because of Possible Health Risk Related to Nationwide Recall of Triad Povidone Iodine Prep Pads February 6, 2012 – Greer, SC, February 6, 2012-Under the direction of the FDA, North American Rescue, LLC (NAR) today announces the market recall of the NAR Surgical Crichothyroidotomy Kit or Crickit®, due to potential contamination of the povidone iodine prep pads, manufactured by Triad Group. This recall is a follow up to the recall initiated on May 5, 2011. North American Rescue, LLC has successfully contacted 97% of our customers and requested they contact our customer service department for return instructions. North American Rescue, LLC requests all recipients who have further distributed these devices to forward this communication to their customers to facilitate the removal of all affected product.
This is North American Rescue’s final attempt to reach out to customers who may still be in possession of these devices.
The Crickit® Kit component may be found inside a larger kit, the NAR Medic Trauma Pack Kits, available in 4 colors for which the codes are listed below. Only the Crickit® component is being recalled. Please see the attached lot numbers for the affected Crickit® Kits. The affected lot numbers for the Medic Trauma Pack Kits can be found on the North American Rescue website www.narescue.com. Please note that this product has been discontinued and therefore is no longer included in the Medic Trauma Pack Kits. ... http://www.fda.gov/Safety/Recalls/ucm290639.htm?source=govdelivery
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St. Jude Medical, Riata and Riata ST Silicone Endocardial Defibrillation Leads: Class 1 Recall - Failures with Lead Insulation
FDA notified healthcare professionals of a Class I Recall of the St. Jude Medical Riata and Riata ST Silicone Endocardial Defibrillation Leads. The silicone insulation covering these defibrillation leads is at risk of premature abrasion. When abrasion occurs, the conductors inside the leads can come out (externalized) of the insulation. Leads with externalized conductors may develop electrical dysfunction and not work as intended. In the event the device does not work as intended, should a life-threatening heart rhythm occur, pacing or defibrillation therapy may not be delivered as intended. This may result in serious adverse events, including death.
The recall includes the following model numbers:
Riata (8F) Silicone Endocardial Defibrillation Leads
Models: 1560, 1561, 1562, 1570, 1571, 1572, 1580, 1581, 1582, 1590, 1591, 1592
Riata ST (7Fr) Silicone Endocardial Defibrillation Leads
Models: 7000, 7001, 7002, 7010, 7011, 7040, 7041, 7042
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm284390.htm
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Bedford Laboratories Issues Guidance On 2011 Voluntary Recall Of PolymyxinBFor Injection USP And Vecuronium Bromide For Injection Related To Glass Particles
January 10, 2012 - Bedford Laboratories today issued updated guidance on the following nationwide voluntary product recalls originally issued on August 2, 2011:
Polymyxin B for Injection USP, 500,000 Units per vial – NDC #55390-139-10
Lot 1942980 – Exp. Date August 2013 and Lot 1895027 – Exp. Date June 2013
Vecuronium Bromide for Injection, 10 mg per vial – NDC #55390-037-10
Lot 1865067 – Exp. Date May 2012
Vecuronium Bromide for Injection, 20 mg per vial – NDC #55390-039-10
Lot 1865069 – Exp. Date February 2012
The recalls were initiated on August 2, 2011 after the discovery of a visible glass particle in a limited number of vials within the lots listed above to the user level. To date, there have been no reports of adverse events for the lots being recalled.
Polymyxin B is indicated in the treatment of acute infections caused by susceptible strains of Pseudomonas aeruginosa. Polymyxin B sulfate is a drug of choice in the treatment of infections of the urinary tract, meninges, and bloodstream caused by susceptible strains of Ps. aeruginosa. It may also be used topically and subconjunctivally in the treatment of infections of the eye caused by susceptible strains of Ps. aeruginosa.
Vecuronium Bromide is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
http://www.fda.gov/Safety/Recalls/ucm286953.htm
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Bedford Laboratories Issues A Voluntary Nationwide Patient Level
Recall Of Acetylcysteine Solution, USP, LOT 1877093
Acetylcysteine Solution, USP, (Manufactured for Roxane Laboratories, Inc.) 20%, 30 mL per vial – NDC #0054-3026-02 – Lot 1877093 – Exp. Date June 2013
This voluntary recall was initiated on December 20, 2011 after the discovery of a single visible glass particle in a vial within the lot listed above. There have been no complaints or adverse events related to a piece of glass in vials of this lot. All other product parameters were within specifications.
Acetylcysteine for inhalation is usually delivered via a Nebulizer, but can also be delivered via direct instillation into a tracheostomy, or into the bronchial-pulmonary tree during bronchosopy. Glass particles can cause airway obstruction resulting in symptoms of choking, wheezing, difficulty breathing, coughing and potentially hemoptysis. Use of an inhaled product with glass particles has the potential to cause choking which could be life-threatening. Aerosolization of small glass particles in the airways could result in recurrent infections (due to obstruction of airways, and decreased clearance of airway secretions).
Acetylcysteine is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretion. Acetylcysteine, administered orally, is indicated as an antidote to prevent or lessen hepatic injury which may occur following the ingestion of a potentially hepatotoxic quantity of acetaminophen.
The key component of this update is the extension of the recall to the patient level. This recall is limited to the one lot number listed above.
http://www.fda.gov/Safety/Recalls/ucm290204.htm?source=govdelivery
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Vitaflo USA Renastart: Recall - Possible Health Risk Due To Incorrectly Labeled Cans Vitaflo USA has announced a voluntary recall of Renastart 14.11 oz (400g) cans, Batch Number 12832, because some of the product shipped throughout the United States during the period December 29, 2011 through January 26, 2012 was incorrectly labeled. Some immediate consequences of using the incorrectly labeled product may result in high potassium blood levels (hyperkalemia) or high sodium levels in the blood (hypernatremia). All other Vitaflo products, including Renastart cans in batches other than 12832 and Renastart packed in sachets, are not affected.
BACKGROUND: Renastart is a powdered medical food used in the dietary management of pediatric renal disease, for patients one year and older. Renastart 14.11oz (400g) product in cans is sold only in the United States. Following a customer complaint regarding the way the product was dissolving, Vitaflo determined that a small number of cans of a different product may have been wrongly labeled as Renastart.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm289705.htm
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Pfizer Announces Voluntary Nationwide Recall of Lo/Ovral®-28 and Norgestrel/Ethinyl Estradiol Tablets Due to Possibility of Inexact Tablet Counts or Out of Sequence Tablets January 31, 2012 - NEW YORK, N.Y. – Pfizer Inc. announced today that it has voluntarily recalled 14 lots of Lo/Ovral®-28 (norgestrel and ethinyl estradiol)Tablets and 14 lots of Norgestrel and Ethinyl Estradiol Tablets (generic) for customers in the U.S. market. An investigation by Pfizer found that some blister packs may contain an inexact count of inert or active ingredient tablets and that the tablets may be out of sequence. The cause was identified and corrected immediately.
These products are oral contraceptives indicated for the prevention of pregnancy in women who elect to use oral contraceptives as a method of contraception. These tablets were manufactured and packaged by Pfizer Inc., commercialized by Akrimax Rx Products and labeled under the Akrimax Pharmaceuticals brand. This product is distributed to warehouses, clinics and retail pharmacies nationwide.
As a result of this packaging error, the daily regimen for these oral contraceptives may be incorrect and could leave women without adequate contraception, and at risk for unintended pregnancy. You can either go to the weblink for further info, or for a complete listing, please write me-- RNFrankie@AOL.com-- and I will send it to you. There are too many lot numbers to list on this page .
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm289803.htm
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Cephalon, Inc. issues a voluntary nationwide recall of Treanda® (bendamustine HCL) for Injection 25mg/Vial January 27, 2012 - Cephalon, Inc. is voluntarily recalling Treanda® (bendamustine HCL) for Injection 25mg/8mL; lot TB30111, expiration date 12/2012. This product lot is being recalled due to the presence of particulate matter found in a single vial, which has been identified as glass fragments.
Treanda® (bendamustine HCL) for Injection 25mg/8mL is indicated for the treatment of chronic lymphocytic leukemia (CLL). Efficacy relative to first-line therapies other than chlorambucil has not been established. Treanda® (bendamustine HCL) for Injection 25mg/8mL is indicated for the treatment of patients with indolent B-cell non-Hodgkin’s lymphoma (NHL) that has progressed during or within 6 months of treatment with rituximab-containing regimen.
This recall is being conducted in consideration of the potential safety issue and risk associated with administration of this product lot. Potential adverse events after intravenous administration of solutions containing particulates may present as an emboli and result in disruption of blood flow causing tissue/organ damage, especially in vulnerable patients such as those undergoing surgery, immunosuppressed individuals, and the elderly, as well as patients with micro or macrovasular disease, such as cardiac and renal disease, who may be more at risk since their vasculature and end organs are already compromised. To date, Cephalon, Inc. has not received any adverse events associated with the use of this product lot that could be attributed to particulate matter. ... http://www.fda.gov/Safety/Recalls/ucm289452.htm?source=govdelivery ******************
Tysabri (natalizumab): Drug Safety Communication - New Risk Factor for Progressive Multifocal Leukoencephalopathy (PML)
FDA notified healthcare profesisonals that testing positive for anti-JC virus (JCV) antibodies has been identified as a risk factor for progressive multifocal leukoencephalopathy (PML). PML is a rare but serious brain infection associated with use of Tysabri (natalizumab) for the treatment of multiple sclerosis (MS) or Crohn's disease.
A patient's anti-JCV antibody status may be determined using an anti-JCV antibody detection test that has been analytically and clinically validated, and has been ordered by a healthcare professional. The Stratify JCV Antibody ELISA test2 was cleared by FDA on January 20, 2012. Testing positive for anti-JCV antibodies means that a person has been exposed to JCV in the past. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm288602.htm
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NURSING HINTS CORNER
Calculating with Confidence
As a a busy nursing supervisor, I taped a small list of dosage calculations to the back of my identification badge. Now, when I am in a crunch, I have quick access to this information. I have taught my staff to do the same, which has saved time and boosted confidence in our unit.
Jacquieline Zobresky, RN, BA
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.174, Springhouse Corporation/www.springnetcom. ;
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
WELCOME TO:
MaureenTWebb@gmail.com (Maureen) January 17, 2012
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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.. So please send me your new name/address, okay? RNFrankie@AOL.com
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)
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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY
"
July 4th, we will be celebrating out independence from the British. I hope that in a couple of years,
we will be able to celebrate our independence from the Chinese."
David Letterman
Feel free to write me...with suggestions and/or 'gentle" criticisms...... Frankie/Frances
RNFrankie@AOL.com
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