June Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 June 12, 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 Compassion and fatigue January 3, 2012 -- Recent press items have highlighted the devastating effects of nurse under-staffing on patients and nurses alike. Today, Laura Landro's "Informed Patient" column in The Wall Street Journal discussed compassion fatigue among nurses, especially those who regularly care for terminally ill patients. Landro's Health Blog provided additional information about the problem, which may contribute to burnout and high turnover, which in turn add to compassion fatigue. That cycle can lead to worse patient care. The Wall Street Journal pieces include expert comment from several nurses, and the items convey that nurses play an important role in care, though they might have focused more on the danger that impaired nurses pose to patients because of the critical nature of nursing. And on December 31, 2011, the Daily Mail (UK) ran a piece by Sam Greenhill about a woman who, though not a nurse, had "nursed" her 89-year-old grandmother back to health at a hospital, after the physicians and other health professionals had apparently written the patient off. The woman reportedly fed, washed, and advocated for her grandmother while the hospital's actual nurses were too overworked to do so. We're generally critical of media accounts that suggest lay people have acted as "nurses" by providing unskilled care, since that suggests nursing requires no special education or skills. But here it sounds like the lay person did a better job than the real nurses. Of course, despite the happy ending, the piece also presents a distressing picture of what happens when nurses are so overworked that they cannot do the most basic part of their jobs--saving lives. We thank those responsible for these pieces. ... (Try to read all of this...very good) http://www.truthaboutnursing.org/news/2012/jan/wsj.html#ixzz1x9WYff8x ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS (This was sent in by Kurt Ullman, a member of Paradigm97) Thirty-six percent of physicians are not accepting new Medicaid patients, and 26% see no Medicaid patients at all, according to a new survey from a staffing company called Jackson Healthcare. The firm's online survey of 2232 physicians in April found that dermatologists are the least likely (34%) among all specialists to accept new Medicaid patients, followed by endocrinologists and plastic surgeons (36% each), general internists (42%), and physical medicine and rehabilitation specialists (43%). The specialists most willing to make an appointment for a new Medicaid patient are pediatric subspecialists (95%), pathologists (90%), radiologists (86%), anesthesiologists (83%), and general surgeons (81%). The numbers also reveal a lesser degree of physician disenchantment regarding Medicare. Seventeen percent of physicians said they are not accepting new Medicare patients, and 10% said they have closed their practice to Medicare entirely. The specialists least inclined to see new Medicare patients are adult psychiatrists (57%), plastic surgeons (68%), general internists (73%), family physicians (75%), and obstetricians-gynecologists (76%). In contrast, rates of accepting new Medicare patients top 90% among cardiologists, hematologists/oncologists, general surgeons, anesthesiologists, and neurologists. **************** ( I wrote to Kurt): If Medicare paid much more promptly, perhaps those facts would improve. Baby Boomers are going to have to lobby for this to happen . Frankie (This is Kurt's answer): This is only going to get worse. Under the healthcare reform act, much of the money savings come from providers, allegedly (that's another thread altogether), but even if it gets chucked by the Supremes, the 1997 Medicare Sustainability Act calls for something like 30% cuts (allegedly). Kurt ************ NON-MEDICAL NEWS: We have all heard of phishing (if not sure, go to: http://us.norton.com/transactsafely/phishingfaq.jsp for more info) Now, I just learned about Pharming ! How to Protect Against Pharming Pharming is an attempt to defraud Internet surfers by hijacking a Web site’s domain name, or URL, and redirecting users to an imposter Web site where fraudulent requests for information are made. To protect yourself against pharming, follow these basic guidelines: Check the URL of any site that asks you to provide personal information. Make sure your session begins at the known authentic address of the site, with no additional characters appended to it. Maintain effective, up-to-date virus protection. Symantec recommends Norton AntiVirus. Use a trusted, legitimate Internet Service Provider. Rigorous security at the ISP level is your first line of defense against pharming. Check the certificate. It takes just a few seconds to tell if a site you land on is legitimate. On the latest version of Internet Explorer and on many other commonly available Web browsers, go to "File"" in the main menu and select "Properties",or right click your mouse anywhere on the browser screen and, from the menu that pops up, click on"Properties. When the "Properties" box pops up, click on "Certificates" and check if the site carries a secure certificate from its legitimate owner. Block suspicious Web sites automatically. Norton Internet Security detects and blocks fake Web sites, making it easier for you to be confident most of the sites you are using are legitimate. http://us.norton.com/transactsafely/prevention.jsp?om_em_cid=hho_email_clubnorton_apr12_nam_us_A ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days As America's waistline expands, costs soar (Reuters) - U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960. The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows. Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops. ... http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430?feedType=RSS&feedName=healthNews *********************** RANDOM FACT: A report by the American Journal of Epidemiology states that long term job stress is worse for your heart than gaining 40 pounds or aging 30 years. ********************** How to Control 4 Common Body Odors The Skunk Ape of the Everglades announces its arrival with an aroma that’s part chicken coop, part outhouse, and the creature certainly grabs our imagination. But there’s nothing captivating about our own body odor. Luckily, we have a fix for the fumes! Here are 4 common body odors and tips to control them: Smelly feet: If the 250,000 sweat glands in your feet cause excessive sweating or if you wear damp socks or shoes for too long, your feet can stink. The solution? Zap the overgrowth of stinky bacteria: After washing and drying your feet, apply a diluted solution of lemongrass oil or verbena oil. Underarm odor: Anxiety, hormones, and armpit hair can turn your sweat sour. Wildly overactive sweat glands (i.e., hyperhidrosis) can also cause underarm odor. Most folks need deodorants, not antiperspirants, but if you really suffer from armpit odor, try a boric acid or tannic acid solution. Still dripping? Put on 20% aluminum at night and wash it off in the morning, or try antibiotic creams to kill multiplying bacteria. If you have hyperhidrosis, Botox turns off the faucet. Beta-blockers (high blood pressure medication) can help relieve chronic, stress-related sweating. Bad breath and flatulence: What you eat fuels bad breath and flatulence. Food odors -- onions, garlic, and curry, for example -- pass into your bloodstream and the aromas are exhaled from your lungs. The intestines pump out methane when you can’t cope with carbs or don’t have good bacteria in your guts. Remedy bad breath by flossing, brushing teeth and tongue, and drinking plenty of water. For flatulence, try Beano and probiotics (spore forms). http://www.realage.com/beauty-skin-care/how-to-control-4-body-odors?eid=1010657395&memberid=4687812 ************************** RANDOM FACT: On Oct. 22, 1987 a Japanese buyer, Eiichi Kobayashi, purchased the Old Testament portion of a Gutenberg Bible for $5.4 million dollars at a Christie's Auction. The last sale of a complete version took place nine years before, again at a Christie's, for $2.2 million. Today, single pages from the first-edition Bibles fetch $25,000 each. In addition to providing their well-known Bibles in hotel rooms, the Gideons also distribute Bibles to militaries of various countries, to hospitals, nursing homes, and prisons. ******************* AORN study highlights benefits of double-gloving Double-gloving with inner indicator gloves may protect nurses’ skin from needle sticks, according to results of a 24-month study published by the Association of periOperative Registered Nurses. The study in the March issue of AORN Journal examined the effect of double-gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. Denise Korniewicz, RN, PhD, FAAN, senior associate dean of research at the University of Miami School of Nursing & Health Studies, and Maher El-Masri, RN, PhD, associate professor and research leadership chairman at the University of Windsor in Canada, found that healthcare providers observed blood on their hands after surgery less frequently when they wore two pairs of gloves than when they wore a single pair. The researchers also found the frequency of changing gloves during surgery was significantly higher among healthcare providers who wore dark-colored gloves under light-colored gloves than among those wearing two pairs of gloves of the same color. The majority of healthcare providers in the study expressed favorable views about double-gloving, according to an AORN news release. The study is available via subscription or purchase at http://bit.ly/GYuDxj. http://news.nurse.com/article/20120409/NATIONAL01/304090021 ********************* RANDOM FACT: In its 2008 Death on the Job Report, the AFL-CIO ranked commercial fishing as the occupation with the highest fatality rate, with 150 deaths per 100,000 workers. ***************** U.S. gives nod to Eli Lilly's brain plaque test Reuters - U.S. regulators gave the nod to an imaging test from Eli Lilly and Co. that can for the first time help doctors detect brain plaque tied to Alzheimer's disease, the company said. The U.S. Food and Drug Administration approved the radioactive dye, called Amyvid, to help doctors rule out whether patients have Alzheimer's, the most common form of dementia, Lilly announced late on Friday. The dye binds to clumps of a toxic protein called beta amyloid that accumulates in the brains of patients with Alzheimer's. Doctors can then see the plaque light up on a positron emission tomography, or PET, scan. Patients with Alzheimer's always have some brain plaque, so its absence in the test would tell doctors to look for other causes of mental decline, such as depression or medications, Lilly has said. ... http://www.reuters.com/article/2012/04/07/us-fda-lilly-amyvid-idUSBRE8360C220120407?feedType=RSS&feedName=healthNews *********************** Nurses’ assessments of individualised care in long-term care institutions Journal of Clinical Nursing (full text available) Aims.  The aims of this study were to explore nurses’ assessments of individualised care in long-term care wards and to examine how their sociodemographic variables were associated with their views of such care. Background.  Although the importance of individualised care is highlighted both by nurses and by older people, there is a limited amount of research about individualised care, especially in the long-term care of older people. Design.  An exploratory design was employed. Methods.  Data were collected using questionnaires [Individualised Care Scale (ICS)-Nurse] from nurses (n = 283, n = 215, response rate 76%) working in the long-term care wards (n = 19) of four institutions in 2009. Data were analysed statistically. Results.  Overall, nurses perceived that they supported patient individuality during nursing activities but the care they provided was not so individualised. Nurses perceived that they supported older peoples’ individuality in the clinical situation and in decisional control over care well but supported older peoples’ individual life situation to a lesser extent. The higher the nurses’ age, the longer the working experience in health care or experience in the current ward, the more positive views they had about the support of individuality. Conclusions.  This study identified some shortcomings in the realisation of individuality in the care of older people. Nurses seem to think they generally provide individualised care but this was not necessarily realised in the current evaluations of the care they delivered. Relevance to clinical practice.  There is need to identify issues that may help in developing individualised care in clinical practice. Nurses’ attitude to older people in the geriatric care settings needs exploration. Nurses may focus on physiological needs that may hinder the recognition of older patient’s individuality. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2011.03855.x/abstract;jsessionid=287B14BCA8D9C27F28454B634EA07DA9.d01t02 ************************* Childbirth takes longer now than 50 years ago: study Many tasks can be tackled more quickly now than 50 years ago, but delivering a baby naturally it seems is not one of them, according to a U.S. government study. Compared with the 1960s, U.S. women have in recent years spent two to three hours longer in labor, according to researchers at the U.S. National Institutes of Health, who said the findings suggest doctors may need to rethink the definition of "normal" labor. The extra time is spent in the first stage of labor - the longest part of the process, before the "pushing" stage, according to findings published in the American Journal of Obstetrics & Gynecology. Mothers are different as well. On average, they're older and weigh more, and their newborns are bigger too. ... http://www.reuters.com/article/2012/04/02/us-childbirth-idUSBRE82T16M20120402?feedType=RSS&feedName=healthNews ***************************** RANDOM FACT: A solar flare is an enormous explosion in the solar atmosphere, involving sudden bursts of particle acceleration, plasma heating, and bulk mass motion. It is believed to result from the sudden release of energy stored in the magnetic fields that thread the solar corona in active regions around sunspots. The largest of solar flares can be equal to billions of one-megaton nuclear bombs! ********************* Thanks to the ACA, insurers cannot drop or deny coverage because of pre-existing conditions, children up to the age of 26 are now allowed to stay on their parent’s insurance plans, and Seniors are protected from the Medicare “Donut Hole” that threatened so many of our most vulnerable citizens. These are just some of the initial life-changing benefits that are cause for celebration today. •Take a look at our quick Summary of Benefits and Protections -- Do your Patients know what the ACA is already doing for them? http://www.nursingworld.org/HCR-Brief.aspx •Visit http://www.healthcareandyou.org/-- ANA partnered with organizations that represent consumers, physicians, hospitals and pharmacists to create this website, which provides easy-to-understand information about the health care law. Find out what’s happening in your state and what Health Care Reform means for you! ************************* Diagnosis and treatment of osteopenia Gulay Karaguzel and Michael F. Holick Osteopenia is a term to define bone density that is not normal but also not as low as osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score −1 to −2.5. There are many causes for osteopenia including calcium and vitamin D deficiency and inactivity. Genetics plays an important role in a person’s bone mineral density and often Caucasian women with a thin body habitus who are premenopausal are found to have osteopenia. Correction of calcium and vitamin D deficiency and walking 3 to 5 miles a week can often improve bone density in the hip and spine. There are a variety of pharmaceutical agents that have been recommended for the treatment of osteopenia and osteoporosis including hormone replacement therapy, selective estrogen receptor modulator therapy, anti-resorptive therapy. In addition patients with osteoporosis who have failed anti-resorptive therapy can have a significant improvement in their bone density with anabolic therapy. (The full article is in PDF form. You can get it at following link: http://www.springerlink.com/content/t68034062172t010/ ************************ RANDOM FACT: By 2010, no state had a prevalence of obesity less than 20%. 36 states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more. Historically, obesity primarily afflicted adults, but this has changed in the last 2 decades. 15-25% of American children and adolescents are now obese. Children and adolescents who are obese are likely to be obese in adulthood and to develop obesity-related health problems. *********************** Half of Stroke Victims Don't Call 911, Research Shows Public needs more education about telling symptoms, experts say FRIDAY, March 16 (HealthDay News) -- Slightly more than half of Americans with stroke symptoms call 911, a rate that hasn't changed since the mid-1990s, a new study finds. The study highlights the need for more public education about stroke symptoms and the importance of early treatment, said the researchers from New York-Presbyterian Hospital/Weill Cornell Medical Center. "People do not always recognize the seriousness of stroke symptoms, or instead of calling 911 they may call their primary-care physician for an appointment and lose valuable time as the damage becomes irreversible," study leader Dr. Hooman Kamel, a neurologist at New York-Presbyterian Hospital/Weill Cornell, said in a medical center news release. The researchers examined data from more than 1,600 stroke cases collected by the National Hospital Ambulatory Medical Care Survey between 1997 and 2008. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_123037.html ************************** RANDOM FACT : U.S. citizens are not legally permitted to come in contact with extraterrestrials or their vehicles, according to the Code of Federal Regulations, implemented in 1969. RANDOM FACT #2: In July of 1947, the U.S. Army Air Force announced that they had recovered a flying saucer that crashed near Roswell Air Field in New Mexico. Within hours, however, the Army dismissed the statement, claiming the saucer was a misidentified weather balloon. ***************** Reducing Bloodstream Infections in an Outpatient Hemodialysis Center - New Jersey, 2008 - 2011 The Centers for Disease Control and Prevention's March 16, 2012 Morbidity and Mortality Weekly Report featured a New Jersey hemodialysis clinic's use of recommended interventions and dialysis event surveillance data to reduce the number of bloodstream infections in the facility. http://www.cdc.gov/mmwr/pdf/wk/mm6110.pdf ************* (Thank you, Barbara ) : DENTAL X-RAYS LINKED TO COMMON BRAIN TUMOR (Reuters Health) - A new study suggests people who had certain kinds of dental X-rays in the past may be at an increased risk for meningioma, the most commonly diagnosed brain tumor in the U.S. http://www.reuters.com/article/2012/04/10/us-dental-x-rays-idUSBRE8390GM20120410?DCMP=NWL-pro_healthlawpulse ***************** U.S. News - Nurse sentenced to life for killing patients by injecting ... Apr 2, 2012 – A Texas jury on Monday sentenced a former nurse to life in prison after ... patients by injecting bleach into their kidney dialysis lines, the Lufkin ... http://tinyurl.com/6tcvfjq http://www.usatoday.com/news/nation/story/2012-04-02/nurse-bleach-injection-dialysis/53952548/1 ******************** GENE STUDIES BEGIN TO UNRAVEL AUTISM PUZZLE (Reuters) - A sweeping study of hundreds of families with autism has found that spontaneous mutations can occur in a parent's sperm or egg cells that increase a child's risk for autism, and fathers are four times more likely than mothers to pass these mutations on to their children. http://www.reuters.com/article/2012/04/04/us-autism-usa-genes-idUSBRE83312820120404?DCMP=NWL-pro_healthlawpulse&&& Related Resources Autism research may be about to bear fruit http://news.lp.findlaw.com/ap_stories/other/1500/04-09-2012/20120409145000_14.html?DCMP=NWL-pro_healthlawpulse *********************** Health care groups respond to proposed ICD-10 extension The CMS plan to delay the ICD-10 compliance date for a year has received mixed reaction from industry stakeholders. The Medical Group Management Association applauded the move but expressed concerns that the ICD-10 implementation process remains flawed. Meanwhile, the American Health Information Management Association reiterated its stance against ICD-10 delay and advised health groups to stay focused on their implementation efforts. http://r.smartbrief.com/resp/dBsjCPaXbgeududlImko ************** HHS panel updates HIV treatment guidelines The HHS Panel on Antiretroviral Guidelines for Adults and Adolescents has released new guidelines for the treatment of patients with HIV. The new guidance includes revisions in the recommendations on starting antiretroviral therapy, drug interactions tables, co-infection and prevention of secondary transmission. Medscape (free registration) (4/10)      Study examines end-of-life cancer care http://r.smartbrief.com/resp/dBsjCPaXbgeuduaJJGGW ************ A study in Health Affairs said no particular type of hospital provided better cancer care for patients when considering National Quality Forum measures such as ICU admissions, chemotherapy usage or hospice care at the end of life. Researchers from the Dartmouth Institute for Health Policy & Clinical Practice found a large number of inpatient services were provided to terminally ill patients and said hospitals need to examine such care and "question its alignment with patient preferences -- whether they be for early supportive care or aggressive treatment in the last days of life." Modern Healthcare (free subscription required) (4/9)      http://r.smartbrief.com/resp/dBsjCPaXbgeuduaVNfNJ *************** Study looks at maternal-fetal Staphylococcus aureus transmission Maternal methicillin-resistant Staphylococcus aureus colonization at 34 to 37 weeks of gestation or at delivery increased the risk of babies carrying the bacteria, according to a study in the journal Pediatrics. Researchers also found that infant Staphylococcal colonization peaked at 2 months of age, with a rate of 20.9%. PediatricSuperSite.com (4/11) http://r.smartbrief.com/resp/dBsjCPaXbgeudubhRZwk ************** An Evidence-Based Approach to COPD: Part 1 Corbridge, Susan PhD, APN, ACNP, AE-C; Wilken, Lori PharmD, TT-S, AE-C, BCACP; Kapella, Mary C. PhD, RN; Gronkiewicz, Cindy MS, RN, ACNS-BC, AE-C OVERVIEW: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting as many as 24 million Americans and resulting in 1.5 million ED visits, 700,000 hospital admissions, and 124,000 deaths annually. This article, the first in a two-part series on COPD, outlines current guidelines and other evidence-based recommendations on diagnosing and managing stable COPD in the outpatient setting. Part 2 will appear in a future issue of AJN and will focus on managing acute exacerbations of COPD. AJN, American Journal of Nursing: March 2012 - Volume 112 - Issue 3 - p 46–57 doi: 10.1097/01.NAJ.0000412639.08764.21 Feature Articles http://journals.lww.com/ajnonline/Fulltext/2012/03000/An_Evidence_Based_Approach_to_COPD___Part_1.22.aspx?WT.mc_id=EMxj08x20120416xL14 ~~**~~**~~**~~**~~**~~ HUMOR SECTION "The Supreme Court has ruled that anybody can be strip-searched for any kind of arrest. That's something to think about the next time you bring 12 items into a 10-item-or-less lane." -Jay Leno A couple in their nineties are both having problems remembering things. During a checkup, the doctor tells them that they're physically okay, but they might want to start writing things down to help them remember Later that night, while watching TV, the old man gets up from his chair. 'Want anything while I'm in the kitchen?' he asks. 'Will you get me a bowl of ice cream?' 'Sure..' 'Don't you think you should write it down so you can remember it?' she asks. 'No, I can remember it..' 'Well, I'd like some strawberries on top, too. Maybe you should write it down, so as not to forget it?' He says, 'I can remember that. You want a bowl of ice cream with strawberries.' 'I'd also like whipped cream. I'm certain you'll forget that, write it down?' she asks. Irritated, he says, 'I don't need to write it down, I can remember it! Ice cream with strawberries and whipped cream - I got it, for goodness sake!' Then he toddles into the kitchen. After about 20 minutes, the old man returns from the kitchen and hands his wife a plate of bacon and eggs.. She stares at the plate for a moment. 'Where's my toast ?' ~~**~~**~~**~~**~~**~~ 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. Complete Your CE Now-Less than $6 per hour ANCC & State Board approved ; Instant certificates - no waiting No tests required (excluding Florida) ; High-quality, evidence-based course material http://advprjo61.securesites.net/CMEResource20111012Nurse.php 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/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. Sentinel Events.........Joint commission. http://www.jointcommission.org/sentinel_event.aspx This is an excellent nursing site, check it out: http://nursingpub.com/ Back issues of the ISMP newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp. Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ 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.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 This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Roche Diagnostics Operations Elecsys Troponin I and Elecsys Troponin I STAT Immunoassays: Recall – With certain types of plasma samples, doctors may receive a falsely low result (up to a maximum of 50% lower than the actual concentration of Troponin I). These incorrect results may cause serious adverse health consequences, including death. The affected lot numbers are 163176 and 163177. Elecsys Troponin I and Elecsys Troponin I STAT Immunoassays are used to determine heart damage as an aid in the diagnosis of a heart attack. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm301483.htm ************************ Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume The affected product is a prefilled glass cartridge for use with the Carpuject Syringe system. The affected lot number is 10830LL, with an expiration date of April 1, 2013. Morphine Sulfate Carpujects 4 mg/mL are packaged in Slim-Pak tamper detection packages with each box containing 10 Carpujects (NDC 0409-1258-30). The affected lot was distributed in January 2012. It was initially distributed to wholesalers and a limited number of hospitals in Arizona, Colorado, Hawaii, Illinois, Indiana, Michigan, Minnesota, Ohio, Texas and Virginia. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm300852.htm *********************** Thoratec Corporation, HeartMate II Left Ventricular Assist System (LVAS): Class 1 Recall- Outflow Graft May Kink or Deform FDA is notifying health care professionals of a Class 1 Recall due to detachment of the bend relief from its intended position around the proximal outflow graft may allow the graft to kink or deform, resulting in reduction of blood flow from the HeartMate II LVAS pump, pump/graft thrombosis, or perforation of the outflow graft. Additionally, the metal end of the bend relief may be sharp and cause erosion and cutting of the outflow graft. This product may cause serious adverse health consequences, including death. Model numbers affected: 103393, 103695, 104692, 104911, 104912. The HeartMate II LVAS is indicated for use as a bridge to transplantation in heart transplant candidates at risk of imminent death from non-reversible left ventricular failure. It is also indicated for use in patients with New York Heart Association (NYHA) Class IIB of IV end-stage left-ventricular failure who have received optimal medical therapy for at least 45 of the last 60 days and who are not candidates for heart transplantation. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm298710.htm *********************** Thoratec Corporation Issues Update on Worldwide Medical Device Correction Notification Relating to Sealed Outflow Graft Used With HeartMate II® Left Ventricular Assist System Thoratec Corporation initiated a voluntary worldwide medical device correction notification of all serial numbers of the HeartMate II® Left Ventricular Assist Systems (HM II LVAS) having Catalog No. 104692, 103393, 104911, or 104912. Thoratec took this action based upon reports of the sealed outflow graft bend relief not being properly connected to the HeartMate II LVAS. The reported incidence of the defect, disconnected outflow graft bend relief, is 0.91% (29/3,200). Of these 29 incidents, 24 were observed in x-ray images or during surgical procedures, and were thus unlikely to be related to patient symptoms. However, in at least one reported case, it is noted that the disconnected bend relief may have contributed to the need for reoperation. The bend relief is designed to prevent kinking of the outflow conduit that connects the HeartMate II pump to the ascending aorta. ... http://www.fda.gov/Safety/Recalls/ucm296981.htm?source=govdelivery ********************** Dialysate Concentrates Used in Hemodialysis: Safety Communication - Alkali Dosing Errors FDA is notifying health care providers to consider the presence and quantity of acetate, citrate, and/or acetic acid in dialysate concentrates when determining the patients’ dialysate prescription. The FDA received a complaint describing alkali dosing errors that occurred during hemodialysis using dialysate concentrates containing acetic acid and acetate. When metabolized, these potential sources of alkali can contribute to elevated bicarbonate levels in patients undergoing hemodialysis. This can contribute to metabolic alkalosis, which is a significant risk factor associated with cardiopulmonary arrest, low blood pressure, hypokalemia, hypoxemia, hypercapnia, and cardiac arrhythmia. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm305630.htm ************************ Baxa Corporation Abacus Total Parenteral Nutrition (TPN) Calculation Software: Class I Recall - Potential Dosing Errors A number of errors have been reported by Abacus software users as a result of ordering salt based parenteral nutrition ingredients on an ion based ordering template. Abacus TPN Calculation Software is designed and intended to allow the ordering of electrolytes in only one of two ways: as a salt (such as calcium gluconate 10%) or as an elemental ion (such as calcium). However, if a dosage is entered into the system based on one method, when the template is configured for the other method, a dosing error can occur. The problem associated with mix-ups related to salt-based or ion-based ordering of electrolytes is not exclusive to calcium gluconate. Affected catalogue numbers include: 8300-0045: Abacus Calculator Only (Abacus CE) 8300-0046: Abacus Single Work Station (Abacus SE) 8300-0047: Abacus Multi-Work Station (Abacus ME) : http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm305762.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: hollie_lynne@yahoo.com (Hollie) April 27, 2012 tami.berube@yahoo.com (Tami) June 5, 2012 cathie.grant@sgmc.org (Cathie) June 7, 2012 dbusseyRN@gmail.com (Darcy) June 7, 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....lol So please send me your new name/address, ok? 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. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY I am a most unhappy man. I have unwittingly ruined my country. A great industrial nation is now controlled by its system of credit. We have come to be one of the worst ruled, one of the most completely controlled and dominated Governments in the world -- no longer a government by free opinion, no longer a government by conviction and the vote of the majority, but a government by the opinion and duress of a small group of dominant men. -- Woodrow Wilson 1919 Hope to see you online/ or better yet....write me..... Frankie RNFrankie@AOL.com