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. 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