PARADIGM97: September 2013

PARADIGM BYTES

Newsletter for Paradigm 97

September 11, 2013

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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SNIPPETS

Nursing2013
December 2012
Volume 42 Number 12
Pages 66 - 68

ROUNDS: Intermittent I.V. infusions in acute care: Special considerations I.V. THERAPY has changed dramatically over the past decade, primarily as a result of a technology revolution.1 The widespread use of intermittent infusions, while improving patient care, can also compromise patient safety if not managed correctly. According to the Infusion Nurses Society (INS), for an intermittent infusion, a drug is added to a small amount of fluid (25 to 250 mL) and infused over 15 to 90 minutes at prescribed intervals.2 Although intermittent infusions can be given in many ways, they're commonly administered as a secondary I.V. piggyback (IVPB) infusion through an established pathway of the primary solution. (See Lining up a secondary IVPB infusion.) Another way to administer intermittent infusions is to administer a secondary infusion concurrently with the primary infusion.2 (See Looking at a simultaneous infusion.)

This article discusses why 0.9% sodium chloride solution flushes before and after administering IVPB medications need to be standardized to ensure delivery of the full dose of medication. This article also reviews the use of a secondary infusion to administer antibiotics that need to be infused more slowly than the primary fluid. Because little research has been conducted on intermittent infusions, including IVPB, most of the information in this article is anecdotal.

Safety concerns

Medication errors can occur in any phase of the administration process.3 According to Lavery, 79% of errors related to I.V. administration were related to the practitioners' lack of knowledge and experience with medications and equipment, such as infusion devices.4 All healthcare practitioners must be aware of their own skill and competencies when delivering I.V. therapy.

The Joint Commission (TJC), in response to sentinel events, developed the first set of National Patient Safety Goals (NPSGs) in July 2002.5 Goal 5 was to improve safety with the use of I.V. infusion pumps and provide a mechanism to prevent free flow on all I.V. infusion pumps.5 Although TJC no longer uses this NPSG, many healthcare institutions have adopted Goal 5 and policies for using I.V. infusion pumps.6

Vancomycin, another antibiotic frequently used in acute care settings, needs to be refrigerated after reconstitution and is generally prescribed every 12 or 24 hours.14 If vancomycin is used to prime the tubing for an infusion pump without 0.9% sodium chloride solution being used to prime it, the residual medication in the primary tubing will be infused when the next dose is delivered. Vancomycin may lose significant potency after being left out at room temperature for an extended period.15 Using twice the amount that the I.V. tubing will hold to flush the line would eliminate residual medication in the I.V. tubing and ensure the full dose of medication is administered at the prescribed time.

Other concerns

Using 0.9% sodium chloride solution to prime and flush the I.V. pump tubing with IVPB therapy is a concern for a patient on fluid restrictions. Be aware that the patient will receive extra fluid and allocate the remainder of the oral fluid to maintain the fluid restriction as prescribed.

If the patient is discharged with I.V. antibiotic therapy, educate the patient and family about the importance of flushing the residual medication in the I.V. pump tubing.

Advancing practice

Healthcare providers prescribe medications and pharmacists dispense them, but it's up to nurses to administer them correctly so patients get the full dose every time. Nurses need to disseminate this information everywhere medications are administered by intermittent infusion and standardize practices.

http://email.lww.com/t?r=1483&c=3591836&l=59027&ctl=4825CA1:B54AB34282EDAD009B9D3A8876CF4D20ABC62CF4A2E7FFFB&

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FROM THE MEMBERS

This editorial from AJN, is by Shawn Kennedy, one of our members.

She wrote: "I've heard a lot lately from nurses railing against performance measures. Such complaints have been escalating since July 2007, when the Centers for Medicare and Medicaid Services (CMS) began requiring hospitals to publicly report scores from a standardized survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, or face eventual reductions in cost reimbursements. The survey assesses patients’ perspectives of hospital care on items such as communication with physicians and nurses, responsiveness of staff, pain management, discharge information, and cleanliness and quietness of the environment. In short, the HCAHPS scores are a measure of those aspects of care known to matter to most hospitalized patients.

Last July I posted a question on AJN’s Facebook page, asking nurses if they felt that HCAHPS measures were helping hospitals increase the quality of care by focusing on the patient experience. We received a slew of responses. While a few said that these measures help “keep us mindful of the person in the patient,” the great majority of responses were negative. Here is a sampling.

* “I am spending so much time on trying to improve performance scores... I have less time to focus on the status of the patient, diagnosis and treatment plan.”

* “The scores reflect the patients’ perception and their satisfaction. Quality [care] does not always equal satisfaction.”

* “I'm honestly sick of hearing about HCAHPS scores!... Things happen that you can't quite help and I just don't think patients understand that.... If only someone explained to patients what to expect during their stay.”

Reading these, I wondered whether people who'd recently had a loved one hospitalized or been patients themselves would feel differently. And I thought about the comment that “someone” should explain to patients what to expect—shouldn't that “someone” be the admitting nurse? When I practiced, the admitting nurse oriented the patient to the hospital environment and explained likely aspects of care (such as diagnostic and laboratory tests, therapies, medications, diet, and activity level). Isn't that the practice now?" ...

http://journals.lww.com/ajnonline/Fulltext/2013/09000/It_s_About_the_Patients.1.aspx#P9

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INTERESTING READING

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

Injuries and musculoskeletal disorders (MSDs) are common in nurses and other healthcare workers and are often caused by manually lifting and moving patients.
This is more than just an inconvenience; these injuries are often life altering and career ending.

ANA’s new breakthrough guide will help to prevent injuries and protect nurses and other healthcare workers. The guide contains eight overarching safe patient handling and mobility (SPHM) standards. These national interdisciplinary standards address the responsibilities of the employer or health care organization and those of healthcare workers and ancillary/support staff and are applicable across the care continuum.

Following these standards is critical for hospitals and other healthcare organizations in promoting a culture of safety through the development of safe and effective SPHM programs. Don’t waste another day. Protect employees, improve attendance rates and reduce workers' compensation costs. For more information on SPHM programs go here.

Bulk orders of 20 or more receive a 20% discount off the list price.

http://email.lww.com/t?r=1483&c=3599543&l=232217&ctl=4846009:B54AB34282EDAD0035B1660948800E0850CB97921045BA00&
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Legislation Introduced to Reduce Worker Injuries, Promote Safer Patient Handling
The Nurse and Health Care Worker Protection Act of 2013, introduced in the U.S. House of Representatives in June, incorporates essential content from the American Nurses Association's recently issued Safe Patient Handling and Mobility: Interprofessional National Standards.

U.S. Population Health Improves, Yet Lags Behind...
Although U.S. death rates fell and life expectancy rose between 1990 and 2010, improvements "have not kept pace with advances in population health in other wealthy nations," according to study findings reported in JAMA.

CDC Data Show Dramatic Rise in Coccidioidomycosis in Southwest
The incidence of valley fever (coccidioidomycosis) increased in five states, from 2,265 cases in 1998 to over 22,000 cases in 2011, according to a study by the Centers for Disease Control and Prevention (CDC). Most cases were reported in Arizona and California.

Quick Takes

The U.S. Food and Drug Administration has warned that the antihypertensive agent olmesartan can cause severe, chronic diarrhea and weight loss, with symptoms arising even months or years after taking the drug.

The Joint Commission and the American Medical Association have released Proceedings from the National Summit on Overuse, which identifies five overused medical interventions and provides suggestions for limiting them.

The U.S. Preventive Services Task Force recommends against screening for primary open-angle glaucoma in adults without visual symptoms who are seen in a primary care setting.

Based on an analysis of proposed health insurance rates in 11 states, the U.S. federal government estimates that 2014 premiums for individuals and small businesses will be nearly 20% lower than anticipated.

http://mail.aol.com/37966-211/aol-6/en-us/mail/DisplayMessage.aspx?ws_popup=true

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Quiz Time

An appropriate strategy for managing hyperglycemia caused by glucocorticoids is to:

a. use a correction scale with long-acting insulin.

b. use an insulin infusion protocol for post-transplant patients.

c. give NPH insulin, with the dosage based on the patient’s height.

d. keep insulin dosages stable when corticosteroids are decreased.

(Answer at end of Newsletter)

Eyes: The Windows to Stroke Risk?

MONDAY, August 12, 2013 — A simple eye exam can shed light on cases of high blood pressure as a primary risk factor for stroke. “Our focus in this current study was to examine people who already have a high blood pressure,” said Kamran Ikram, MD, PhD, lead author of the study. Dr. Ikram is assistant professor in the Singapore Eye Research Institute at the National University of Singapore.

“Among all those persons who have high blood pressure," Dr. Ikram said, "it is still not possible to predict exactly who will develop a stroke," a condition in which a blood clot or bleeding in the brain can cause disability or death.

Ikram and other researchers followed 2,907 patients with high blood pressure — ages 50 to 73 years — for 13 years to see if there was a way to predict stroke among those with hypertension.

“As the back side of the eye — called the retina — gives an easily assessable way to examine damage to small blood vessels due to high blood pressure," Ikram said, "we tried to examine if such a simple eye examination may also give additional information on the development of stroke.” The eye’s retina has a layer of light-sensitive cells where, if there were differences among the high blood pressure patients, they would be clearly visible.

During the course of the long study, 146 of the patients had stroke from a blood clot in the brain, and 15 more had stroke from bleeding in the brain.

“In our study this eye exam was performed in a research setting,” added Ikram. “We showed in persons with high blood pressure that damage to the blood vessels in the retina, called hypertensive retinopathy, is linked to an increased risk of stroke,” he said. This difference in risk existed even if high blood pressure was under control with medication.

http://www.everydayhealth.com/heart-health/eyes-the-windows-to-stroke-risk.aspx?xid=aol_eh-cardio_5_20130812_&aolcat=ESR&ncid=webmail4

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There are many things that are true, and many things that
people just believe are true.

For example; we all know that going out in the cold with a wet head will make you sick, but in numerous studies addressing the topic, people who are chilled are no more likely to get sick than those who were not. And a wet or dry head makes no difference.

What other "facts" do we all know to be true which really aren't?

RANDOM FACTS:

Sugar makes kids go crazy.

The Journal of the American Medical Association published a review of 23 studies on the subject of kids and sugar, the conclusion: Sugar doesn't affect behavior. And it's possible that it is the idea itself that is so ingrained as fact that it affects our perception.

*** Bonus Fact:

Cholesterol in eggs is bad for the heart.

The perceived association between dietary cholesterol and risk for coronary heart disease stems from dietary recommendations proposed in the 1960s that had little scientific evidence, other than the known association between saturated fat and cholesterol and animal studies where cholesterol was fed in amounts far exceeding normal intakes. Since then, study after study has found that dietary cholesterol (the cholesterol found in food) does not negatively raise your body's cholesterol. It is the consumption of saturated fat that is the demon here. So eat eggs, don't eat steak.
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Vitamin D: A Wonder Drug in the Battle Against MS and Narcolepsy?

Maximizing your vitamin D levels may be your single greatest weapon in combating a wide range of illnesses including multiple sclerosis (MS), narcolepsy, rheumatoid arthritis, inflammatory bowel disease, type 1 diabetes, psoriasis, and even some cancers. Vitamin D is classified as an essential, fat-soluble vitamin. Physicians now recognize that it also functions as a hormone-like compound. Hormones are your body’s chemical messengers and are responsible regulating growth and development, metabolism, mood and other vital functions.

People living with these varied illnesses share a common factor. They are often either deficient or have less than optimal values of vitamin D. However, there is a chicken or egg type confusion in that physicians do not know if these individuals develop the illness because they are low in vitamin D or if their disorders are directly responsible for the low vitamin D levels. Or it may be a combination of these two facts.

Our 21st century lifestyles contribute to our less than optimal levels of vitamin D. We spend much less time outdoors than our parents and grandparents. Even when we do spend time outdoors, we often apply sunblock that prevents us from making adequate levels of vitamin D. Our other main source of vitamin D was from animal protein. However, modern agricultural practices limit animals’ exposure to direct sunlight and thus our food supply has lower levels of vitamin D. ... http://www.everydayhealth.com/columns/brad-robynn-mann-sleeping-with-ms/vitamin-d-the-wonder-drug-in-the-battle-against-ms-narcolepsy-and-more/?xid=aol_eh-ms_1_20130812_&aolcat=AJA&ncid=webmail18

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Family caregivers are providing complex care in the home. Consider these numbers from “Home Alone: Family Caregivers Providing Complex Chronic Care,” which reports on a survey of 1,677 family caregivers:

46%:
Percentage of family caregivers who perform medical or nursing tasks for people with multiple chronic physical and cognitive conditions

3 out of 4:
Proportion of family caregivers who manage medications, including administering IV fluids and injections

More than 60% :
Percentage of family caregivers who learned to manage at least some of the medications on their own

35%:
Of family caregivers who provide medical or nursing tasks, percentage who provide wound care

66%:
Percentage of those providing wound care who rated it as hard

69%:
Percentage of care recipients who do not have home visits by any healthcare professional

Source: Home Alone: Family Caregivers Providing Complex Chronic Care. October 2012.

Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901
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TUESDAY, July 30, 2013 (HealthDay News) — Wide fluctuations in blood pressure may be associated with memory and thinking difficulties in older adults already at high risk for heart disease, a new European study suggests.

Regardless of average blood pressure, "high variability in blood pressure may lead to mental impairment," said lead researcher Dr. Simon Mooijaart, director of the Institute for Evidence-Based Medicine in Old Age in Leiden, the Netherlands.

The three-year study, published July 30 in the online edition of the BMJ, involved more than 5,000 seniors, average age 75.

Fluctuating blood pressure has previously been linked with an increased risk of stroke, and evidence is mounting that factors that disrupt blood flow to the brain contribute to dementia's development and progression, the researchers noted.

However, because the study shows only an association, not a cause-and-effect relationship, Mooijaart cautioned that it is still too early to make definitive claims about blood pressure inconsistency and mental decline.

"It's an interesting association, because it might very well be causal," he said. If it is causal, controlling these fluctuations with blood pressure medication might help reduce the risk of dementia, Mooijaart added. But further research is needed, the study authors noted. ...

http://www.everydayhealth.com/hypertension/0731/blood-pressure-swings-could-be-linked-to-mental-decline-study.aspx?xid=aol_eh-news_11_20130729_&aolcat=HLT&ncid=webmail6

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Americans with irregular heartbeats to double: study

(Reuters Health) - If current trends continue, the number of Americans who experience a dangerous irregular heartbeat called atrial fibrillation will more than double in the next 16 years, according to a new study.

In 2010, some five million U.S. adults had been diagnosed with atrial fibrillation, or AF, but the study projects about 12 million cases by the year 2030.

That's a best guess, said study coauthor Dr. Daniel Singer, professor of medicine at Harvard Medical School in Boston, but the potential range is between 7 million and 17 million Americans diagnosed with the condition.

"By any estimate, there are going to be lots of (predominantly older) Americans with AF in 2030," Singer told Reuters Health by email.

"It's a very big problem," said Dr. Jonathan Piccini, who studies the evaluation and management of atrial fibrillation at Duke University Medical Center in Durham, North Carolina. ...

http://links.reuters.com/r/5Y3GW/I7J7D/HYNMBE/WLTM4M/CWXB8Z/YT/h?a=http://links.reuters.com/r/5Y3GW/I7J7D/HYNMBE/WLTM4M/4V2N91/YT/h

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(Learn something new each day??? )

(Reuters) - The U.S. Food and Drug Administration, after decades of consideration, has proposed limiting the amount of inorganic arsenic in apple juice to the same level of the potential cancer-causing chemical allowed in U.S. drinking water.

Although the vast majority of apple juice that has been tested by the FDA over the years has contained low levels of inorganic arsenic that were considered safe, the FDA has been wrestling whether to set limits because of the cancer risk.

The agency on Friday proposed a limit of 10 parts per billion (ppb) for inorganic arsenic in apple juice, the level set by the U.S. Environmental Protection Agency (EPA) for arsenic in drinking water. (link.reuters.com/jac69t)

"This action level will keep any apple juice that may have more inorganic arsenic than that out of the marketplace," Michael Taylor, the FDA's deputy commissioner for foods and veterinary medicine, said in a blog post.

Last year the agency tested 94 samples of arsenic in apple juice and found that all were below the 10 ppb threshold for inorganic arsenic. The FDA is now setting that limit as the allowable future benchmark. It will accept public comments on its recommendations for 60 days.

Inorganic arsenic may be found in foods because it is present in the environment, both as a naturally occurring mineral and due to the use of arsenic-containing pesticides.

Inorganic arsenic has been associated with skin lesions, developmental effects, cardiovascular disease, neurotoxicity and diabetes. Organic forms of arsenic, also found in soil and ground water, are considered essentially harmless.

Some consumer groups said the limit on arsenic is a good first step, but the carcinogen needs to be limited further. ...

http://www.reuters.com/article/2013/07/12/us-fda-applejuice-idUSBRE96B0ED20130712?feedType=RSS&feedName=healthNews

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It is what makes us go, through the air anyway. Thrust is a force created by the acceleration of matter, like air. This is an application of Newton's Second Law of Motion expressed as Force = Mass x Acceleration. There are several ways to accomplish this, some better than others, but the goal is to get us from one place to another as quickly and efficiently as possible.

RANDOM FACT:

A "pound of thrust" is equal to a force able to accelerate 1 pound of material 32 feet per second per second (32 feet per second per second happens to be equivalent to the acceleration provided by gravity). Therefore, if you have a jet engine capable of producing 1 pound of thrust, it could hold 1 pound of material suspended in the air if the jet were pointed straight down.

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Bonus Fact:

According to the Guinness Book of Records, the General Electric GE90 is the most powerful jet engine in the world. Normally generating over 122,000 pounds of thrust, the GE90 generated a record 127,900 pounds of thrust as part of a one-hour, triple-red-line engine stress test. The space shuttle's main engines, on the other hand, produce about 418,000 pounds of thrust each at liftoff.

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FRIDAY, July 26 (HealthDay News) -- Pressure Ulcers (AKA Bedsores) affect hospitalized children more often than previously believed and most of them are caused by medical devices, a new study finds.

Researchers at Cincinnati Children's Hospital Medical Center found that at least 10 percent of children admitted to the hospital developed bedsores, also called pressure ulcers. That rate is more than twice as high as was thought to occur in youngsters.

Compared with adults, in whom more than 70 percent of bedsores occur due to pressure on bony parts of the body, this study found that most of these skin tissue injuries in children are caused by medical devices.

"These devices include face masks used in delivering mechanical ventilation to the sickest patients, tracheotomy tubes, pulse oximeters and orthopedic casts," study author Marty Visscher, director of the skin sciences program, said in a medical center news release.

"While often lifesaving, these devices can cause pressure ulcers that can be quite serious. Their incidence is higher in critically ill patients, with increased infection, pain and prolonged hospitalization," she explained.

The study was published online in the journal Pediatrics. ...

   http://r.smartbrief.com/resp/eDjDDrrXoMfTwWiMfDcXdUfCEZpJ?format=standard
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ANA: Health plans should include APRNs to qualify for insurance exchanges

Advanced practice registered nurses should be included in health plans in order to qualify for inclusion in state health insurance exchanges, The American Nurses Association said in a proposal submitted to the CMS. "Findings from several decades of research consistently demonstrate that APRNs provide safe, quality care with comparable patient outcomes to physicians and even higher patient satisfaction rates," ANA President Karen Daley said. BeckersHospitalReview.com (7/29)

                   http://r.smartbrief.com/resp/eDjDDrrXoMfTwWlMfDcXdUfCLXGl?format=standard

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Dose of ADHD drug may help elderly avoid falls

A single dose of methylphenidate, used to treat attention deficit hyperactivity disorder and narcolepsy, helps to improve balance control during walking and reduces the risk of falls among elderly adults, according to recent findings.

Falls in older adults are the leading cause of hip fractures and other injury-related visits to EDs and of accidental death, according to the CDC. Age-related deterioration in gait and balance is a contributing factor in falls.

According to a small study of 30 healthy adults (My underlining) published online in The Journals of Gerontology, researchers at Ben-Gurion University of the Negev in Israel found a single dose of methylphenidate, or MPH, improves walking by reducing the number of step errors and the step error rate in both single and dual tasks.... http://news.nurse.com/article/20130728/NATIONAL06/107290023
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No increased birth defect risk found with oral fluconazole, with one exception

The overall risk of birth defects was not increased among infants whose mothers took oral fluconazole during the first trimester of pregnancy, in a large registry study that provides "largely reassuring" results regarding the teratogenicity of this drug, according to the authors.

In the study that included data on more than 7,000 pregnancies exposed to fluconazole in Denmark, fluconazole (largely at the most commonly prescribed 150-mg or 300-mg single doses) was also not associated with an increased risk of 14 of the 15 specific birth defects that have been associated with azole antifungal drugs in human or animal studies. But the risk of tetralogy of Fallot was increased by about threefold, an association that needs to be studied further, concluded Ditte Mølgaard-Nielsen and her associates in the department of epidemiology research, Statens Serum Institut, Copenhagen. ...

http://r.smartbrief.com/resp/eIubDrrXoMfXeeoofDcXdUfCMXFn?format=standard
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Many pediatric UTI patients are given antibiotics without urine tests The American Academy of Pediatrics recommends that urinalysis or urine culture be performed before prescribing antibiotics to children aged 2 months to 24 months for treatment of urinary tract infections, but researchers found that many doctors skipped these tests. Urinalysis was conducted in 76% of 40,603 UTIs treated with antibiotics in 28,678 children, while a urine culture was collected in 57% of cases. Of all the age groups, patients younger than age 2 were the least likely to undergo such tests, according to the study published in the journal Pediatrics. Pharmacy Times online (8/28)

New research suggests that pediatricians may often prescribe antibiotics for urinary tract infections (UTIs) without first obtaining urine tests, despite guidelines that suggest otherwise.

The American Academy of Pediatrics currently suggest that providers obtain a urinalysis or a urine culture for children aged 2 to 24 months before prescribing antibiotics for a UTI, and current guidelines from the National Institute for Health and Clinical Excellence recommend urine testing in children aged 3 to 36 months. Testing is recommended for infants and young children, as they cannot communicate and often present with symptoms associated with multiple conditions. Older children can communicate their symptoms more effectively; therefore, there are no guidelines for testing in children older than 3 years.

The study, published online on August 5, 2013, in Pediatrics, evaluated urine-testing trends in children younger than 18 years who were prescribed antibiotics for UTIs from 2002 to 2007. Using a large claims database, the researchers collected information on age, gender, diagnosis, and treatment. In order to see whether guidelines were followed by practitioners, children were divided into 4 age categories: younger than 2, 2 to 5, 6 to 12, and 13 to 17 years. - See more at: http://www.pharmacytimes.com/news/Children-Given-Antibiotics-for-UTIs-Without-Urine-Testing#sthash.olxqUCzC.dpuf

                   http://r.smartbrief.com/resp/eIubDrrXoMfXeeocfDcXdUfCMntU?format=standard

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India is about 1/3 the size of the United States, yet it is the second most populous country in the world, with a population of 1,166,079,000. India is the seventh largest country in the world, at 1.27 million square miles.

RANDOM FACT: The British Raj, or British rule, lasted from 1858 to 1947 (although they had a strong presence in India since the 1700s). British influence is still seen in Indian architecture, education system, transportation, and politics. Many of India's worst famines are associated with British rule in India.
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Bonus Fact: Indians made significant contributions to calculus, trigonometry, and algebra. The decimal system was invented in India in 100 B.C. The concept of zero as a number is also attributed to India.
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10 Tips to Make Your Resume Stand Out         How to get noticed above all the rest.

Follow these 10 tips to amp up your resume and leave an unforgettable impression on your future employer.

Pick the best type of resume for your situation. Are you applying to a job within your field? If so, you should write a chronological resume showcasing your previous employers and accomplishments. On the other hand, if you're applying to a position in a different field, a skill-based resume that highlights the relevant experience you obtained from education, employment and hobbies is ideal. Are you seeking a high-level position in academia or a research field? Then a curriculum vitae (CV) would be the best fit. This type of detailed synopsis features your areas of interest, accomplishments, published works, presentations and associations.
Write a professional profile instead of an objective statement. Most employers prefer a professional profile since it illustrates the value you'll bring to the organization. It also gives you the perfect platform to summarize your experience and areas of expertise.
Match your resume to the job description. Focus on relevant accomplishments in your resume that pertain to the specific position you're looking at and remove ones that aren't applicable. Reorganize your lists so the most relevant items appear at the top. That's where recruiters will be looking first and what they're most likely to remember later on.
Target your accomplishments rather than duties. Numbers are excellent ways to showcase achievements. Instead of writing "implemented electronic records system" on your resume, get more specific. Put something like "implemented electronic records system that reduced costs by $2 million."
Write a keyword-friendly resume. Since agencies and human resources receive so many resumes, they often rely on software that searches for keywords to find qualified candidates. Placing the right keywords can make your resume jump to the top of the pile. What keywords should you include? First, look at the job description to identify the terms and phrases that appear most frequently. Then, use spelled-out and abbreviated versions of each one. For example, if you're applying to an RN position, you want to use both "registered nurse" and "RN" in your resume. Some employers may search for either keyword, so you want to have both scenarios covered.
Add professional achievements and special skills. Set yourself apart by listing the career-related highlights that have made your journey unique, such as awards, associations, publications, honors, committees, foreign languages, computer expertise, etc. This section is even more important if you're building a curriculum vitae.
Make your resume the appropriate length. The size of your resume should be based on your experience. If you're a new grad, your resume should only be one page. A seasoned professional can have up to two full pages. And a curriculum vitae can easily be four or more pages since it offers a more detailed synopsis.
Proofread multiple times. Review your resume for grammatical errors and typos. Then slowly read through it again to double check that everything is correct. It's also a good idea to ask one of your trusted colleagues to look over your resume for mistakes.
Update your LinkedIn account. Take the accomplishments you listed on your resume, add them to your LinkedIn account and expand on them however you see fit now that you aren't limited by a page count. Employers are likely to look there to learn more about your career and your qualifications. They'll also be checking out the professionals in your network, so don't forget to add people you currently work with, as well as those you've worked with in the past.
Send your resume to the right people. If you saw a posting on a job board like ADVANCE Healthcare Jobs, you should apply directly to that position through that job board. It's the easiest way to do it, and it also ensures that your resume is going to the appropriate contact. However, if you find an opportunity some other way, you should send your resume directly to the company. Most ads include specific instructions on who to contact, but you can also track down the right email address by going to the company's website or LinkedIn page.

By following these tips, your resume will get noticed and you'll shine among rival job seekers. Good luck in finding your next opportunity!

http://nursing.advanceweb.com/Features/Articles/10-Tips-to-Make-Your-Resume-Stand-Out.aspx

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New Clue in the Autism Puzzle — A Link to an Anti-Seizure Drug

It is one of the enduring mysteries of medical science: What is behind the dramatic increase in the diagnosis of autism?

Many researchers are working on this question, but there are still few answers. So it is encouraging when any trigger for autism is discovered.

Researchers in Denmark followed more than 500,000 women through pregnancy and after the birth of their children, looking for those autism triggers.

They found women who had taken the anti-seizure drug valproate during their pregnancy were five times more likely to have a child with autism.

Valproate is used to treat epilepsy as well as anorexia nervosa, PTSD, and bipolar disorder. It is known to cause birth defects; but in some cases, it is the only effective drug to treat epilepsy. Since epilepsy itself can pose a risk to a pregnant mother and her fetus, it is sometimes given in low doses to pregnant women.

http://www.everydayhealth.com/sanjay-gupta/new-clue-in-the-autism-puzzle-a-link-to-an-anti-seizure-drug.aspx?xid=aol_eh-gen_4_20130805_&aolcat=HLT&ncid=webmail19

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How much younger does plastic surgery make you look? Three years

Most people have facial plastic surgery because they’re hoping to shave a decade or so off their perceived age. But a new study published in JAMA Facial Plastic Surgery has found that the average amount of “years saved” is only three – and we’re not talking dog years.

“Typically, we tend to tell patients they’ll look less tired and more refreshed and try not to overpromise and say ‘You’ll look X years younger,’ because we don’t want to create unrealistic expectations,” says Dr. A. Joshua Zimm, a Manhattan plastic surgeon and one of the coauthors.

The study, he says, was an attempt to “scientifically quantify the degree of change in someone’s age as perceived by a lay person.”

In other words, they were looking for the brutal honesty of strangers.

Toward that end, Zimm and four colleagues tracked 204 facial plastic surgery patients, all of whom had opted for primary facial surgical procedures such as facelifts, neck lifts, upper or lower blepharoplasty (eye lifts) and brow lifts at the same Toronto, Canada, plastic surgery clinic. ...

http://www.nbcnews.com/health/how-much-younger-does-plastic-surgery-make-you-look-three-6C10820780
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Acetaminophen: Drug Safety Communication - Association with Risk of Serious Skin Reactions

FDA notified healthcare professionals and patients that acetaminophen has been associated with a risk of rare but serious skin reactions. Acetaminophen is a common active ingredient to treat pain and reduce fever; it is included in many prescription and over-the-counter (OTC) products. These skin reactions, known as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP), can be fatal. These reactions can occur with first-time use of acetaminophen or at any time while it is being taken. Other drugs used to treat fever and pain/body aches (e.g., non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen) also carry the risk of causing serious skin reactions, which is already described in the warnings section of their drug labels.

Health care professionals should be aware of this rare risk and consider acetaminophen, along with other drugs already known to have such an association, when assessing patients with potentially drug-induced skin reactions. Any patient who develops a skin rash or reaction while using acetaminophen or any other pain reliever/fever reducer should stop the drug and seek medical attention right away. Anyone who has experienced a serious skin reaction with acetaminophen should not take the drug again and should contact their health care professional to discuss alternative pain relievers/fever reducers.... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm363519.htm

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Soon, there may be a pharmaceutical fix for those who struggle with diet  and exercise. 






Scientists at The Scripps Research Institute (TSRI) have successfully tested a drug, called SR9009, in mice that kickstarts 
metabolism and results in increased muscle development.
Essentially, it's an exercise regime in a pill.

“SR9009 alters the metabolic profile of skeletal muscle in a manner similar to the changes observed [in] animals [that] are endurance trained. Basically, the drug sends a signal to the muscle to tell it to modify its metabolism,” says drug developer Thomas Burris, Ph.D., a professor in the department of molecular therapeutics at TSRI.

Do Miracle Diet Pills Exist?

Half of the mice studied showed improved running endurance in terms of both time and distance. “What was clearly interesting was that a small, drug-like molecule could increase metabolic rate in skeletal muscle and increase exercise endurance,” Burris adds.

http://health.yahoo.net/articles/fitness/new-drug-mimics-effects-exercise-muscles

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Role of coenzyme Q10 (CoQ10) in cardiac disease, hypertension and Meniere-like syndrome






(excuse the spacing...I've given up trying to fix it... !)

Coenzyme Q10 (ubiquinone) is a mitochondrial coenzyme which is essential for the production of ATP. Being at the core of cellular energy processes it
assumes importance in cells with high energy requirements like the cardiac cells which are extremely sensitive to CoQ10 deficiency produced by
cardiac diseases.

CoQ10 has thus a potential role for prevention and treatment of heart ailments by improving cellular bioenergetics. In

addition it has an antioxidant, a free radical scavenging and a vasodilator effect which may be helpful in these conditions. It
inhibits LDL oxidation and thus the progression of atherosclerosis.

It decreases pro-inflammatory cytokines and decreases blood viscosity which is helpful in patients of heart failure and coronary artery disease.
It also improves ischemia and reperfusion injury of coronary revascularisation. ...
http://www.veq10.com/uploads/documents/1346053262.pdf

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HEART ATTACKS AND WATER!
How many folks do you know who say they don't want to drink anything before going to bed because they'll have to get up during the night.

Heart Attack and Water - (Very interesting).

I asked my Doctor why people need to urinate so much at night time. Answer from my Cardiac Doctor was gravity holds water in the lower part of your body when you are upright (legs swell). When you lie down and the lower body (legs and etc) seeks level with the kidneys, it is then that the kidneys remove the water because it is easier. This then ties in with the last statement!

I knew you need your minimum water to help flush the toxins out of your body, but this was news to me.

Correct time to drink water.
Very Important. From A Cardiac Specialist!

Drinking water at a certain time maximizes its effectiveness on the body.

2 glasses of water after waking up - helps activate internal organs.
1 glass of water 30 minutes before a meal - helps digestion.
1 glass of water before taking a bath - helps lower blood pressure.
1 glass of water before going to bed - avoids stroke or heart attack.

I can also add to this.

Water at bed time will also help prevent night time leg cramps. Your leg muscles are seeking hydration when they cramp and wake you up with a Charlie Horse.

Mayo Clinic Aspirin Dr. Virend Somers, is a Cardiologist from the Mayo Clinic, who is lead author of the report in the July 29, 2008 issue of the Journal of the American College of Cardiology.

Most heart attacks occur in the day, generally between 6 A.M. and noon. Having one during the night, when the heart should be most at rest, means that something unusual happened. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame.

1. If you take an aspirin or a baby aspirin once a day, take it at night.
The reason: Aspirin has a 24-hour "half-life"; therefore, if most heart attacks happen in the wee hours of the morning, the Aspirin would be strongest in your system.

2. FYI, Aspirin lasts a really long time in your medicine chest, for years, (when it gets old, it smells like vinegar).

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HUMOR SECTION

A distraught senior citizen phoned her doctor's office. "Is it true," she wanted to know, "that the medication you prescribed has to be taken for the rest of my life?"

'Yes, I'm afraid so,' the doctor told her. There was a moment of silence before the senior lady replied, "I'm wondering, then, just how serious is my condition because this prescription is marked 'NO REFILLS' "

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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 Dr Robert Hess.

Pay Only $34.99 for a full year of CONTACT HOURS

This collection of 3 CE articles worth a total of 6.9 contact hours will provide you with the latest resources and insights to help you screen for domestic violence and provide the best patient care. This bundle is available at a reduced rate of $19.99 – a savings of more than $45 if purchased individually!
Lippincott's NursingCenter.com.

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/

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

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm

Metric conversion calculators and tables for metric conversions

http://www.metric-conversions.org/

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MEDICAL RECALLS

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DePuy Orthopaedics - LPS Lower Extremity Dovetail Intercalary Component: Class 1 Recall - Potential for Fracture of Device

FDA and DePuy Orthopaedics notified healthcare professionals of the class 1 recall of the LPS Lower Extremity Dovetail Intercalary Component due to the potential for fracture of the female component, at the dovetail, when exposed to normal physiologic loads while walking. This may also lead to additional pain, infection, loss of function, loss of limb, neurovascular injury or need for revision surgery. Patients greater than 200 pounds and/or those with high levels of activity are at higher risk of fracture.

The LPS Lower Extremity Dovetail Intercalary component is intended for replacement of the mid-shaft portion of the femur, top (proximal), bottom (distal) and/or total femur, and top (proximal) tibia, especially in cases that require extensive resection (i.e. tumors, trauma, infections, etc.).

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm363505.htm

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Cubicin (daptomycin for injection): Recall - Glass Particulate Matter Present in Four Lots

Cubist has notified customers by letter and phone of the voluntary recall of four lots of Cubicin (daptomycin for injection) due to the presence of particulate matter found in a number of vials from four lots shipped from May 2011 to March 2013.

Anyone with an existing inventory of the product lots listed in the firm's press release should determine whether they have product from the recalled lots, quarantine and discontinue distribution of all recalled lots of the product and call Cubist at (855) 534-8309 between the hours of 9 a.m. to 7 p.m. EST, Monday through Friday, to arrange for return and replacement of affected lots.

For healthcare professionals and pharmacists with questions regarding this recall may contact Cubist Medical Information at (877) 282-4786 between the hours of 8 a.m. to 5:30 p.m. EST, Monday through Friday.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm366799.htm

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Gilenya (fingolimod) - Drug Safety Communication: Investigating Rare Brain Infection

FDA is alerting the public that a patient in Europe diagnosed with possible multiple sclerosis (MS) has developed a rare and serious brain infection after taking the drug Gilenya (fingolimod). This is the first case of progressive multifocal leukoencephalopathy (PML), reported following the administration of Gilenya to a patient who had not previously received Tysabri (natalizumab), an MS drug associated with a higher risk of PML. PML is a rare and serious brain infection caused by the John Cunningham (JC) virus that damages the fatty covering of the brain called myelin. PML usually causes death or severe disability. Gilenya is used to treat relapsing forms of MS, a nervous system disease that affects the brain and spinal cord. Novartis reports that approximately 71,000 patients worldwide have been treated with Gilenya.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm366751.htm

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Beacon Hill Medical Pharmacy/Rxtra Solutions: Recall - Lack of Sterility Assurance
Beacon Hill Medical Pharmacy and FDA is notifying health professionals and consumers of the recall of all lots of certain sterile products. FDA has raised a question of sterility assurance for the affected products.The products were distributed nationwide to outlets including hospitals, clinics, and patients who have received orders by directly placing phone calls or faxed prescriptions to the Beacon Hill Medical pharmacy facility in Southfield,Michigan.

The list of sterile injectable products compounded by Beacon Hill/Rxtra Solutions and under recall, in alphabetical order, organized by drug name and strength can be found in the firm's press release at the link below. The products can be identified by lot numbers starting with code 01012013@1 to 07262013@99.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm363460.htm

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Hospira Intravascular Administration Sets

Recall Class: Class I

Date Recall Initiated: April 1, 2013

Products: 14200-04-28 Secondary Blood Set; 14203-04-28 Blood Set; 14206-04-28 Y-Type Blood Set; 14207-04-28 Blood Set; 14210-04-28 Plum Blood Set; 14211-04-28 Plum Blood Set; 14212-04-28 Plum Y-Type Blood Set; 14217-04-28 Y-Type Blood Set and 14219-04-28 Y-Type Blood Set

These affected products were manufactured from July, 2011 through February, 2013 and distributed from July, 2011 through February, 2013.

Use: The Hospira blood sets are used for administration of blood and blood products.

Recalling Firm:
Hospira Inc.
275 N. Field Dr.
Lake Forest, IL 60045
FEI No. 3005579246

Manufacturer:
Hospira Costa Rica Ltda.
La Aurora De Heredia,
1 Km Noreste DPlaza
Real Cariari,
Global Park De Entrada 300,
Mt Oeste Heredia, CR
FEI No. 3002999813

Reason for Recall: It was discovered that there was a potential for the piercing pin on certain ISO-compliant Hospira blood sets to puncture the outer wall of the non-ISO-compliant blood bags during insertion of the pin into the blood bag. This can lead to the leakage of blood and health care provider exposure to blood products. A delay of therapy may also occur and in some cases result in serious adverse health consequences or death.

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ADVERTISEMENTS

from the members

This ad is from Decubqueen (Gerry)..........Accuruler Accurate 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.accuruler.com/.

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NEW MEMBERS

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

WELCOME TO:

CPR3537@gmail.com (Joey) August 14, 2013

bamontgomery@valdosta.edu (Brandi) August 26, 2013

IEWilliams@Valdosta.edu   (Ivy)   August 26, 2013

jqlawson@bellsouth.net   (Joan)   September 10, 2013

Carmenrj2003@hotmail.com (Carmen) September 10, 2013

pklebosits@bellsouth.net (Pam) September 11, 2013

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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. So, be certain to let me know when you change your address. 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. **~~**~~**~~**~~**~~

THOUGHT FOR THE DAY

THOUGHT FOR THE DAY

The best and most beautiful things in the world cannot be seen
or even touched. They must be felt with the heart.
~Helen Keller

Hope to hear from you..... Frankie

RNFrankie@AOL.com

Answer to Quiz Time:
Correct answer: b. Insulin therapy is the standard treatment for glucocorticoid-induced hyperglycemia. This may include rapid-acting or NPH insulin, with dosage based on the patient’s weight. In patients requiring high glucocorticoid dosages, such as post-transplant patients, an insulin infusion protocol may be the best choice.

Learn more by reading the continuing education program "Managing glucose levels in hospital patients."

The Paradigm Bytes Newsletter is published once a month and placed on our website. If you no longer enjoy receiving my notices about the publication, you may stop at any time by contacting me ( RNFrankie@AOL.com ) or just hitting reply when my notice to you appears in your inbox. We'll be sad to see you go, but your request will be honored immediately.

PARADIGM97

Blog Archive

About Me

Wednesday, September 11, 2013

September PARADIGM BYTES

Safety concerns

What about residual volume?

Searching for evidence

Is it the correct dose?

Best technique

Addressing antibiotics

Other concerns

Advancing practice