Saturday, August 16, 2014

PARADIGM BYTES

Newsletter for Paradigm 97
July/ August 15, 2014
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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THREE SNIPPETS
Plastic and Reconstructive Surgery - Global Open:
doi: 10.1097/GOX.0b013e318294e41d

Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction

ABSTRACT
Background: Compromised perfusion in autologous breast reconstruction results in fat necrosis and flap loss. Increased flap weight with fewer perforator vessels may exacerbate imbalances in flap perfusion. We studied deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps to assess this concept.
Methods: Data from patients who underwent reconstruction with DIEP and/or MS-TRAM flaps between January 1, 2010 and December 31, 2011 (n = 123) were retrospectively reviewed. Patient demographics, comorbidities, intraoperative parameters, and postoperative outcomes were collected, including flap fat necrosis and donor/recipient site complications. Logistic regression analysis was used to examine effects of flap weight and perforator number on breast flap fat necrosis.
Results: One hundred twenty-three patients who underwent 179 total flap reconstructions (166 DIEP, 13 MS-TRAM) were included. Mean flap weight was 658 ± 289 g; 132 (73.7%) were single perforator flaps. Thirteen flaps (7.5%) developed fat necrosis. African American patients had increased odds of fat necrosis (odds ratio, 11.58; P < 0.001). Odds of developing fat necrosis significantly increased with flap weight (odds ratio, 1.5 per 100 g increase; P < 0.001). In single perforator flaps weighing more than 1000 g, six (42.9%) developed fat necrosis, compared to 14.3% of large multiple perforator flaps.
Conclusions: Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

Reconstruction with autologous tissue remains a sound option for many women following mastectomy.1,2 Among the strengths of autologous reconstruction is achievement of a natural consistency and pleasing aesthetic outcome. However, the main limitation can be donor site morbidity following flap harvest.3 Modifications in surgical technique and flap design using the muscle-sparing transverse rectus abdominus myocutaneous (MS-TRAM) flap and the deep inferior epigastric perforator (DIEP) flap have decreased donor site morbidity.4–8 However, advancements in preserving the integrity of the rectus muscle in the abdominal wall, that is, by focusing on single perforator dissection, may result in compromised flap vascularity and an increase in perfusion-related flap complications.5,9
Fat necrosis is a consequence of either inadequate arterial inflow or relatively poor venous outflow in a DIEP flap. Development of fat necrosis requiring reoperation can result in significant aesthetic deformity and emotional and financial costs: treatment often requires breast imaging studies, tissue biopsy, and/or excision and may cause significant anxiety in patients with a history of breast cancer. ...
http://click.email.mylwwjournals.com/?qs=1f890412c7459ab3eab5f971d7c0de252c82b5ab4c81fb305d62e49b9f000934
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Don’t wait until it’s too late: Learn how to SPOT Skin Cancer™ (Good patient teaching info)
SCHAUMBURG, Ill. (May 1, 2014) — American Academy of Dermatology teaches potentially life-saving behavior in recognition of Melanoma Monday®

It is estimated that one in five Americans will be diagnosed with skin cancer in the course of their lifetime, and one person dies from melanoma – the deadliest form of skin cancer – every hour.

In recognition of Melanoma/Skin Cancer Detection and Prevention Month® in May and Melanoma Monday®, observed on May 5, the American Academy of Dermatology (Academy) is encouraging the public to learn how to SPOT Skin Cancer™. The campaign aims to save lives by emphasizing the importance of early detection.

“When caught early, skin cancer is highly treatable,” said board-certified dermatologist, Brett M. Coldiron, MD, FAAD, president of the Academy. “Despite this, many people don’t know how to be their own detective when it comes to skin cancer, including what to look for on their skin or when they should see a dermatologist.”

To increase people’s chances of spotting skin cancer early, the Academy recommends everyone learn the ABCDE rule, which outlines the warning signs of melanoma:
  • A – is for Asymmetry: One half of the mole does not match the other half
  • B – is for Border irregularity: The edges are ragged, notched or blurred.
  • C – is for Color that varies from one area to another.
  • D – is for Diameter: While melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller.
  • E – is for Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.
“Although skin cancer is more common among people with light or fair skin, everyone is at risk of getting this life-threatening disease,” said Dr. Coldiron. “SPOT Skin Cancer™ encourages people to invest in their health and spot skin cancer early, when it is most treatable. If you see anything on your skin that is changing, itching or bleeding, you should make an appointment to see a board-certified dermatologist.”

To further learn how to spot skin cancer, visit the Academy’s SPOT Skin Cancer™ website – www.SpotSkinCancer.org – for valuable information and resources on skin cancer prevention and detection, including:

 
SPOT Skin Cancer™ is the Academy’s campaign to create a world without skin cancer through public awareness, community outreach programs and services, and advocacy that promote the prevention, detection and care of skin cancer. The Academy designates the first Monday in May as Melanoma Monday® as a way to raise awareness of melanoma and encourage early detection through self-exams.

The public can help raise awareness of melanoma and other types of skin cancer by using the hashtag #SPOTskincancer when sharing Academy resources on social media and encouraging friends and family members to take advantage of the Academy’s free skin cancer screenings in their area. Individuals who have been affected by skin cancer can share their personal stories on SpotSkinCancer.org and provide support and inspiration for others fighting skin cancer, as well as communicate the importance of prevention and early detection.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology) or Twitter (@AADskin).

http://www.aad.org/stories-and-news/news-releases/learn-how-to-spot-skin-cancer

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Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees).
Ebola HF is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. When infection occurs, symptoms usually begin abruptly. The first Ebolavirus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River. Since then, outbreaks have appeared sporadically.
There are five identified subspecies of Ebolavirus. Four of the five have caused disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused disease in nonhuman primates, but not in humans.
The natural reservoir host of ebolaviruses remains unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic (animal-borne) with bats being the most likely reservoir. Four of the five subtypes occur in an animal host native to Africa.
A host of similar species is probably associated with Reston virus, which was isolated from infected cynomolgous monkeys imported to the United States and Italy from the Philippines. Several workers in the Philippines and in US holding facility outbreaks became infected with the virus, but did not become ill.
Symptoms of Ebola HF typically include:
  • Fever
  • Headache
  • Joint and muscle aches
  • Weakness
  • Diarrhea
  • Vomiting
  • Stomach pain
  • Lack of appetite
Some patients may experience:
  • A Rash
  • Red Eyes
  • Hiccups
  • Cough
  • Sore throat
  • Chest pain
  • Difficulty breathing
  • Difficulty swallowing
  • Bleeding inside and outside of the body
Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.
Some who become sick with Ebola HF are able to recover, while others do not. The reasons behind this are not yet fully understood. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.
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Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S.
HospitalsStandard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola hemorrhagic fever (Ebola HF), also referred to as Ebola Viral Disease (EVD) (See Table below). Note that this guidance outlines only those measures that are specific for Ebola HF; additional infection control measures might be warranted if an Ebola HF patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.).
Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients. This guidance is not intended to apply to persons outside of healthcare settings.
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Eye Tests Might Help ID Alzheimer's
Eye tests could be used to identify people in the early stages of Alzheimer's disease, two new studies suggest. In one study, early results from 40 participants who used a certain eye test found a significant association between levels of beta-amyloid plaques in the retina of the eye and levels of the plaques in the brain. Beta-amyloid plaques in the brain are associated with Alzheimer's disease.
This type of eye test could be used in conjunction with the brain scans and clinical tests currently relied on to diagnose Alzheimer's, study author Shaun Frost, of the Commonwealth Scientific and Industrial Research Organization in Australia, said in a news release from the Alzheimer's Association.
The eye test could also be used to monitor the progression of Alzheimer's and a patient's response to treatment, Frost added. ...
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From BAcello (Barbara): I just discovered CDC has 2 newish posters that show handwash/alcohol
rub that include thumbs:

http://www.cdc.gov/handhygiene/Basics.html
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You are what you eat: Nutrition patterns in the U.S.:
›50%:
More than half of the U.S. population consume sugar-sweetened beverages on any given day
11.3%:
On average, adults consume 11.3% of their total daily calories from fast food.
49%:
Percent of adults who take a dietary supplement
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Attention everyone who hates to run: Turns out, you only need to torture yourself for about five minutes a day to reap some important health benefits like adding years to your life.
According to a new study published Monday in the Journal of the American College of Cardiology, those who jogged or ran for as little as five minutes a day reduced their risk of premature death by about three years.
USA Today quotes the study's lead author, who says those who run for less than an hour a week reap the same health benefits as those who run more, regardless of age, gender or health conditions. "More [running] may not be better in relation to health benefits."
To get these results, researchers studied the exercise habits of more than 55,000 adults between the ages of 18 and 100 over the course of 15 years. ...
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Group advises against routine pelvic exams for most women
The American College of Physicians has released new guidelines advising against routine pelvic exams for women who are not pregnant and who don't have symptoms of a potential health problem. The group said there is not sufficient evidence that the screening exams benefit most women, but cervical cancer screening should be continued. The guidelines appear in Annals of Internal Medicine. HealthDay News(6/30)
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FDA approves MannKind's inhaled insulin for diabetes
MannKind has obtained the FDA's approval to market its fast-acting, inhaled insulin Afrezza as a treatment for type 1 and type 2 diabetes. The drug comes in powder form and is delivered using a cartridge. Due to its potential risks in patients with asthma and chronic obstructive pulmonary disease, the drug will carry a boxed warning on its label. Bloomberg Businessweek(6/28)
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August Facts:
August is named after Augustus, first Emperor of Rome who chose it as it was the month of his greatest triumphs. He died in August AD14.

Until 8BC, the Romans called August 'Sextilis' as it was the sixth month of their year.
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Bonus Fact:

The birthstone in August is the peridot or sardonyx; the flower is the gladiolus or poppy.

August is also: (My birthday !!)

National Family Fun Month
National Peach Month
National Golf Month
National Picnic Month
Romance Awareness Month
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August is Children’s Eye Health and Safety Month:
12:
Children 12 and younger should never ride in the front seat of a car.
6:
Number of reported eye injuries related to boxing or wrestling in children up to age 14 (2012 data)
1,023:
Number of reported eye injuries related to football in children up to age 14 (2012 data).
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THREE HINTS
When you get out a new roll of toilet paper, place a few drops of your favorite essential oil in the cardboard tube of the toilet paper. This will release the scent of the oil each time the paper is used.

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Hint 1: Here is one of the best uses for apple cider vinegar.

Rinse freshly bought produce in 4 tablespoons cider vinegar dissolved in a gallon of cold water. This wash will remove dirt, pesticides, and insects. (and MarGerlach added:
And rinsing strawberries and raspberries in this keeps them from getting moldy so they stay fresh in the fridge longer.
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Hint 2:

Glue a rock to the top of a empty pill bottle, bury the bottle so that only the rock shows. A spare key is hidden inside! So smart!
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Thank you, Barbara (BAcello) who writes:
Experts advise healthcare facilities to avoid a “heavily marketed” soap in updated hand hygiene guidelines published Wednesday.

Triclosan antibacterial soaps have proved to be less safe and effective than recommended products such as chlorhexidine soap and alcohol-based hand rub, according to recommendations from the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America. Triclosan is often added to antibacterial soaps and body washes to reduce or prevent bacterial contamination.
http://tinyurl.com/mcjmz3a
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Researchers Say They've Found New Clues to Autism
 
A genetic mutation that increases the risk for a certain form of autism and causes specific physical traits and symptoms has been identified by researchers.
The finding may eventually enable doctors to do pre-birth testing for the CHD8 gene mutation in order to identify babies who are at risk for autism, according to the study authors.
"This is a big leap forward in our insight into the causes of autism," study leader Dr. Raphael Bernier, clinical director of the Autism Center at Seattle Children's Hospital and associate professor at the University of Washington, said in a hospital news release.
"It's possible we may be able to look at features in utero and determine a higher risk of autism, possibly even early detection," he added.
The findings were published July 3 in the journal Cell.
http://www.everydayhealth.com/news/researchers-say-theyve-found-new-clues-autism/?xid=aol_eh-emo_13_20140707_&aolcat=HLT&ncid=webmail5
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Medical Errors: Why Don't Nurses Speak Up?Nearly 9 out of 10 cases, a nurse is aware that a medical error is occurring AND THEY SAY NOTHING. Why do they stay quiet? nursetogether.com
Over 400,000 preventable deaths occur each year as a result of medical errors (Journal of Patient Safety, September 2013). That’s tantamount to killing the entire population of Miami, Florida in one year; Sacramento, California the next; and so on. Thousands die from medical errors annually. However, nurses don't speak up when these happen, even under their watch. Learn why it happens. ...
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Thank you, Barbara (BAcello).
Replacing horizontal violence in the nursing profession
By Keith Carlson
Nurse bullying and so-called "horizontal violence" are rampant in our profession. Nurses bully and harass one another, using intimidation and other tactics as they jockey for power in a healthcare system that does not proactively attempt to prevent such disruptive behavior. Yes, we hear tales of physicians intimidating and bullying nurses, but we also hear numerous examples of nurses treating one another with utter disrespect and a true lack of kindness.http://tinyurl.com/pd4o925
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Genetic testing recommended for colorectal cancer patients
A new guideline from the U.S. Multi-Society Task Force on Colorectal Cancer recommends genetic testing of tumors for all newly diagnosed colorectal cancer patients. Read more and read an abstract of the consensus statement.
FDA approves new drug for skin infections
On August 6, the U.S. Food and Drug Administration (FDA) approved Orbactiv (oritavancin), a new antibacterial drug to treat adults with skin infections. Read more.

FDA approves new drug for type 2 diabetes
On August 1, the U.S. Food and Drug Administration (FDA) approved Jardiance (empagliflozin) tablets as an addition to diet and exercise to improve glycemic control in adults with type 2 diabetes. Read more.
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FDA approves new treatment for COPD
On July 31, the U.S. Food and Drug Administration (FDA) approved Striverdi Respimat (olodaterol) inhalation spray to treat patients with chronic obstructive pulmonary disease. Striverdi Respimat is a long-acting beta-adrenergic agonist
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News Articles

  • Posted: Jul 1, 2014 - CMS Renews Joint Commission Hospital Accreditation Deeming Authority - The Centers for Medicare & Medicaid Services (CMS) announced it has renewed the approval of The Joint Commission’s deeming authority for the accreditation of hospitals that want to participate in the Medicare program. The continued recognition was awarded for a six-year period effective July 15, 2014, through July 15, 2020.
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Combination therapy effective against invasive bloodstream infection
A rescue therapy involving fosfomycin and imipenem was safe for 94% of patients with invasive bloodstream infections of methicillin-resistant Staphylococcus aureus, according to a study in the journal Clinical Infectious Diseases. Within 72 hours after the treatment was given, 69% of the patients in the study had responded. There were no relapses, and one MRSA-related death was reported.... Healio (free registration)/Infectious Disease News(8/1)
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Senate approves bill to reauthorize federal support for autism programs
The Senate on Thursday passed by unanimous consent a bill to authorize annual funding of $260 million for autism-related programs through 2019. The provisions of the Autism CARES Act include changes to the Interagency Autism Coordinating Committee and call for an autism point person at the HHS.... The Hill/Floor Action blog(7/31), Disability Scoop(8/1)
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Scientists claim that the most complicated and mysterious thing in the universe is the human brain. Scientists know more about stars exploding billions of light years away than they know about the brain.
Aristotle (384 BC-322 BC) believed that the center of thought was the heart and that the brain's function was merely to cool the heart. It was an early Greek physician, Alcmaeon of Croton (c. 6th century B.C.), who was the first to claim that the brain, not the heart, is the central organ of sensation and thought.
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RANDOM FACT:

In South America, scientist have discovered deliberately made 'skull holes' that may have been made to treat painful headaches, brain disease, or to let 'evil spirits' out of the head. Called 'trepanation,' the process of making those holes was incredibly painful. The high number of trepanized skulls suggests that this brain surgery was commonplace.

*** Bonus Fact:

Contrary to the popular belief that humans use just 10 percent of their brain capacity, humans actually use virtually every part of the brain, and most of the brain is active all the time.
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Not sleeping enough can shrink your brain, study says
Turns out, a good night's sleep can prevent more than just tired eyes: Duke researchers in Singapore studied 66 Chinese adults through sleep surveys and MRI scans and found those who got less sleep
showed a decline in cognitive function -- and smaller brains than when they first started the study.

Our brains already shrink as we age, but clocking in fewer hours on the pillow could cause that process to speed up. The scientists say this could be the reason behind the rise in dementia among older people.
Last year, there was an estimated 44 million people with dementia worldwide. According to Alzheimer's Disease International, that number is expected to increase to more than 75 million by 2030, and 135 million in 2050.

So if you need an excuse to grab a few extra hours under the covers, that seems like a pretty good one. As for how much you should be aiming for on the reg, scientists say adults need 7-8 hours every night.
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Use these articles and CE related to Translating Evidence into Clinical Practice to help you implement evidence-based practice in your practice. We've organized the content by topic so you can easily find the evidence you need.
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Quiz Time
Risk factors for osteoporosis include all of the following except:
a. a history of fracture after age 40.
b. cigarette smoking.
c. excessive alcohol use.
d. a large frame.
See answer at end of newsletter
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HUMOR SECTION
A mother traveled 2,000 miles to be with her only son on the day he was to receive his Air Force wings and also get married.

"It was wonderful," she said later. "It isn't every day that a mother watches her son receive his wings in the morning and have them clipped in the evening."


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Having trouble with the doctor's notes on an emergency case which read, "Shot in the lumbar region," the new secretary--poor girl-- was flustered and at her wit's end.

At last she thought she had it figured out and brightened up as she typed up the record, "Wounded in the woods."  
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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.
Original Research: Local Anesthesia Before IV Catheterization
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.
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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.orgwww.sharedgovernance.org
Decubqueen's website: www.accuruler.com
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

 Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Soliris (eculizumab) Concentrated Solution for IV Infusion by Alexion: Recall - Visible Particulates
Alexion Pharmaceuticals, Inc. announced that it is initiating a voluntary recall of certain lots of Soliris (eculizumab) 300mg/30 mL concentrated solution for intravenous infusion. The administration of particulate, if present in a parenteral drug, poses a potential safety risk to patients in two general areas: immune reaction and blood clots. Particulates could cause blockage of flow of blood in vessels, which could be life-threatening. The single affected Soliris lot is #10007A. Although these lots currently remain in specification, Alexion is including the following remaining lots, which were produced with the same process component during vial filling, within the scope of the U.S. recall: 10002-1, 00006-1, 10003A, 10004A, 10005A, 10005AR, 10006A and 10008A.
BACKGROUND: Soliris is approved as a treatment for patients with paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), two ultra-rare and life-threatening disorders. Alexion and its distributors typically ship Soliris to healthcare providers in small quantities, which are timed to individual patient infusions, with the product being consumed before more is shipped. As product from the identified lots was last shipped on October 30, 2013, there is anticipated to be little, if any, material from these lots still remaining in commercial distribution.
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Medical Device Safety and Recalls: Fresenius NaturaLyte Liquid Bicarbonate Concentrate (Part Number: 08-4000-LB)
The U.S. Food and Drug Administration has issued a recall for the NaturaLyte Liquid Bicarbonate Concentrate, 6.4 Liter Bottle (Part Number: 08-4000-LB). The product may develop higher than expected bacteria levels during its shelf life. Lab testing identified the bacteria as Halomonas (species 1, 2, 3), a gram negative bacteria typically found in water with high salt concentration. The FDA has received one report of death and two reports of injury that may be related to use of this product. The use of affected product may cause serious adverse health consequences, including sepsis, bacteremia, and death. ... http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm399124.htm
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Gemstar Docking Station by Hospira, Inc: Class I Recall - Potential for Error or Failure to Power Up
Hospira, Inc., announced today a nationwide medical device correction of the GemStar Docking Station (list number 13075), used in conjunction with the GemStar infusion pump. When the docking station is used in conjunction with a GemStar Phase 3 pump (List 13000, 13100 or 13150) the potential exists for the GemStar Phase 3 pump to fail to power up while connected to the docking station. When a GemStar Phase 3 (List 13000, 13100 or 13150) or GemStar Phase 4 pump (List 13086, 13087 or 13088) is used in conjunction with both a docking station and an external battery pack accessory (List 13073), there is a possibility that the GemStar pump will display error code 11/003 and give an audible alarm, indicating excessive input voltage from the external sources. If the GemStar pump detects what is perceived to be more than 3.6 Volts as measured on the external voltage input, the pump will stop the infusion. This will trigger an audible alarm and the device will display alarm code 11/003.
If a GemStar fails to power up or the 11/003 error code stops an infusion, a delay of therapy may occur. A delay or interruption in therapy has a worst case potential to result in significant injury or death.
BACKGROUND: The GemStar Docking Station is a separately sold accessory to the GemStar infusion pump and provides an alternate power source to the GemStar pump. The products impacted by these issues are identified in a table in the Firm Press Release. http://go.usa.gov/kM9d
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Fisher and Paykel Healthcare, Ltd., Infant Nasal CPAP Prongs
A recall has been issued for the Fisher and Paykel Healthcare, Ltd., Infant Nasal CPAP Prongs. Fisher and Paykel Healthcare received 24 reports in which the device has malfunctioned. There were zero injuries and zero deaths. The firm received reports of the affected prongs detaching from the nasal tubing during use, especially when mucous and/or moisture are present. When the affected prongs detach from the nasal tubing, therapy is likely to be interrupted. This may cause low blood oxygen (hypoxemia). The detached prongs may enter an infant’s mouth and present a potential risk of choking and airway obstruction. The use of the affected product may cause serious adverse health consequences, including death. For more information, please see http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm398631.htm
 
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-Ruler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
Welcome to:
dmatkinson@valdosta.edu (Denise) July 2014
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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.
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THOUGHT FOR THE DAY
It's easier to build strong children than to repair broken men.
--Frederick Douglass
Correct answer: d. Risk factors that contribute to osteoporosis include a personal history of a fracture after age 40, a thin or small frame, a family history of osteoporosis, cigarette smoking, excessive alcohol use, inactivity, and advanced age.
Hope to hear from you..... Frankie

PARADIGM BYTES

Newsletter for Paradigm 97
July/ August 15, 2014
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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THREE SNIPPETS
Plastic and Reconstructive Surgery - Global Open:
doi: 10.1097/GOX.0b013e318294e41d

Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction

ABSTRACT
Background: Compromised perfusion in autologous breast reconstruction results in fat necrosis and flap loss. Increased flap weight with fewer perforator vessels may exacerbate imbalances in flap perfusion. We studied deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps to assess this concept.
Methods: Data from patients who underwent reconstruction with DIEP and/or MS-TRAM flaps between January 1, 2010 and December 31, 2011 (n = 123) were retrospectively reviewed. Patient demographics, comorbidities, intraoperative parameters, and postoperative outcomes were collected, including flap fat necrosis and donor/recipient site complications. Logistic regression analysis was used to examine effects of flap weight and perforator number on breast flap fat necrosis.
Results: One hundred twenty-three patients who underwent 179 total flap reconstructions (166 DIEP, 13 MS-TRAM) were included. Mean flap weight was 658 ± 289 g; 132 (73.7%) were single perforator flaps. Thirteen flaps (7.5%) developed fat necrosis. African American patients had increased odds of fat necrosis (odds ratio, 11.58; P < 0.001). Odds of developing fat necrosis significantly increased with flap weight (odds ratio, 1.5 per 100 g increase; P < 0.001). In single perforator flaps weighing more than 1000 g, six (42.9%) developed fat necrosis, compared to 14.3% of large multiple perforator flaps.
Conclusions: Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

Reconstruction with autologous tissue remains a sound option for many women following mastectomy.1,2 Among the strengths of autologous reconstruction is achievement of a natural consistency and pleasing aesthetic outcome. However, the main limitation can be donor site morbidity following flap harvest.3 Modifications in surgical technique and flap design using the muscle-sparing transverse rectus abdominus myocutaneous (MS-TRAM) flap and the deep inferior epigastric perforator (DIEP) flap have decreased donor site morbidity.4–8 However, advancements in preserving the integrity of the rectus muscle in the abdominal wall, that is, by focusing on single perforator dissection, may result in compromised flap vascularity and an increase in perfusion-related flap complications.5,9
Fat necrosis is a consequence of either inadequate arterial inflow or relatively poor venous outflow in a DIEP flap. Development of fat necrosis requiring reoperation can result in significant aesthetic deformity and emotional and financial costs: treatment often requires breast imaging studies, tissue biopsy, and/or excision and may cause significant anxiety in patients with a history of breast cancer. ...
http://click.email.mylwwjournals.com/?qs=1f890412c7459ab3eab5f971d7c0de252c82b5ab4c81fb305d62e49b9f000934
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Don’t wait until it’s too late: Learn how to SPOT Skin Cancer™ (Good patient teaching info)
SCHAUMBURG, Ill. (May 1, 2014) — American Academy of Dermatology teaches potentially life-saving behavior in recognition of Melanoma Monday®

It is estimated that one in five Americans will be diagnosed with skin cancer in the course of their lifetime, and one person dies from melanoma – the deadliest form of skin cancer – every hour.

In recognition of Melanoma/Skin Cancer Detection and Prevention Month® in May and Melanoma Monday®, observed on May 5, the American Academy of Dermatology (Academy) is encouraging the public to learn how to SPOT Skin Cancer™. The campaign aims to save lives by emphasizing the importance of early detection.

“When caught early, skin cancer is highly treatable,” said board-certified dermatologist, Brett M. Coldiron, MD, FAAD, president of the Academy. “Despite this, many people don’t know how to be their own detective when it comes to skin cancer, including what to look for on their skin or when they should see a dermatologist.”

To increase people’s chances of spotting skin cancer early, the Academy recommends everyone learn the ABCDE rule, which outlines the warning signs of melanoma:

  • A – is for Asymmetry: One half of the mole does not match the other half
  • B – is for Border irregularity: The edges are ragged, notched or blurred.
  • C – is for Color that varies from one area to another.
  • D – is for Diameter: While melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller.
  • E – is for Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.
“Although skin cancer is more common among people with light or fair skin, everyone is at risk of getting this life-threatening disease,” said Dr. Coldiron. “SPOT Skin Cancer™ encourages people to invest in their health and spot skin cancer early, when it is most treatable. If you see anything on your skin that is changing, itching or bleeding, you should make an appointment to see a board-certified dermatologist.”

To further learn how to spot skin cancer, visit the Academy’s SPOT Skin Cancer™ website – www.SpotSkinCancer.org – for valuable information and resources on skin cancer prevention and detection, including:

SPOT Skin Cancer™ is the Academy’s campaign to create a world without skin cancer through public awareness, community outreach programs and services, and advocacy that promote the prevention, detection and care of skin cancer. The Academy designates the first Monday in May as Melanoma Monday® as a way to raise awareness of melanoma and encourage early detection through self-exams.

The public can help raise awareness of melanoma and other types of skin cancer by using the hashtag #SPOTskincancer when sharing Academy resources on social media and encouraging friends and family members to take advantage of the Academy’s free skin cancer screenings in their area. Individuals who have been affected by skin cancer can share their personal stories on SpotSkinCancer.org and provide support and inspiration for others fighting skin cancer, as well as communicate the importance of prevention and early detection.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 17,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org. Follow the Academy on Facebook (American Academy of Dermatology) or Twitter (@AADskin).
http://www.aad.org/stories-and-news/news-releases/learn-how-to-spot-skin-cancer

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Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees).
Ebola HF is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. When infection occurs, symptoms usually begin abruptly. The first Ebolavirus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River. Since then, outbreaks have appeared sporadically.
There are five identified subspecies of Ebolavirus. Four of the five have caused disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused disease in nonhuman primates, but not in humans.
The natural reservoir host of ebolaviruses remains unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic (animal-borne) with bats being the most likely reservoir. Four of the five subtypes occur in an animal host native to Africa.
A host of similar species is probably associated with Reston virus, which was isolated from infected cynomolgous monkeys imported to the United States and Italy from the Philippines. Several workers in the Philippines and in US holding facility outbreaks became infected with the virus, but did not become ill.
Symptoms of Ebola HF typically include:
  • Fever
  • Headache
  • Joint and muscle aches
  • Weakness
  • Diarrhea
  • Vomiting
  • Stomach pain
  • Lack of appetite
Some patients may experience:
  • A Rash
  • Red Eyes
  • Hiccups
  • Cough
  • Sore throat
  • Chest pain
  • Difficulty breathing
  • Difficulty swallowing
  • Bleeding inside and outside of the body
Symptoms may appear anywhere from 2 to 21 days after exposure to ebolavirus though 8-10 days is most common.
Some who become sick with Ebola HF are able to recover, while others do not. The reasons behind this are not yet fully understood. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.
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Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S.
HospitalsStandard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola hemorrhagic fever (Ebola HF), also referred to as Ebola Viral Disease (EVD) (See Table below). Note that this guidance outlines only those measures that are specific for Ebola HF; additional infection control measures might be warranted if an Ebola HF patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.).
Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients. This guidance is not intended to apply to persons outside of healthcare settings.
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Eye Tests Might Help ID Alzheimer's
Eye tests could be used to identify people in the early stages of Alzheimer's disease, two new studies suggest. In one study, early results from 40 participants who used a certain eye test found a significant association between levels of beta-amyloid plaques in the retina of the eye and levels of the plaques in the brain. Beta-amyloid plaques in the brain are associated with Alzheimer's disease.
This type of eye test could be used in conjunction with the brain scans and clinical tests currently relied on to diagnose Alzheimer's, study author Shaun Frost, of the Commonwealth Scientific and Industrial Research Organization in Australia, said in a news release from the Alzheimer's Association.
The eye test could also be used to monitor the progression of Alzheimer's and a patient's response to treatment, Frost added. ...
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From BAcello (Barbara): I just discovered CDC has 2 newish posters that show handwash/alcohol
rub that include thumbs:

http://www.cdc.gov/handhygiene/Basics.html
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You are what you eat: Nutrition patterns in the U.S.:
›50%:
More than half of the U.S. population consume sugar-sweetened beverages on any given day
11.3%:
On average, adults consume 11.3% of their total daily calories from fast food.
49%:
Percent of adults who take a dietary supplement
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Attention everyone who hates to run: Turns out, you only need to torture yourself for about five minutes a day to reap some important health benefits like adding years to your life.
According to a new study published Monday in the Journal of the American College of Cardiology, those who jogged or ran for as little as five minutes a day reduced their risk of premature death by about three years.
USA Today quotes the study's lead author, who says those who run for less than an hour a week reap the same health benefits as those who run more, regardless of age, gender or health conditions. "More [running] may not be better in relation to health benefits."
To get these results, researchers studied the exercise habits of more than 55,000 adults between the ages of 18 and 100 over the course of 15 years. ...
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Group advises against routine pelvic exams for most women
The American College of Physicians has released new guidelines advising against routine pelvic exams for women who are not pregnant and who don't have symptoms of a potential health problem. The group said there is not sufficient evidence that the screening exams benefit most women, but cervical cancer screening should be continued. The guidelines appear in Annals of Internal Medicine. HealthDay News(6/30)
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FDA approves MannKind's inhaled insulin for diabetes
MannKind has obtained the FDA's approval to market its fast-acting, inhaled insulin Afrezza as a treatment for type 1 and type 2 diabetes. The drug comes in powder form and is delivered using a cartridge. Due to its potential risks in patients with asthma and chronic obstructive pulmonary disease, the drug will carry a boxed warning on its label. Bloomberg Businessweek(6/28)
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August Facts:
August is named after Augustus, first Emperor of Rome who chose it as it was the month of his greatest triumphs. He died in August AD14.

Until 8BC, the Romans called August 'Sextilis' as it was the sixth month of their year.
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Bonus Fact:

The birthstone in August is the peridot or sardonyx; the flower is the gladiolus or poppy.

August is also: (My birthday !!)

National Family Fun Month
National Peach Month
National Golf Month
National Picnic Month
Romance Awareness Month
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August is Children’s Eye Health and Safety Month:
12:
Children 12 and younger should never ride in the front seat of a car.
6:
Number of reported eye injuries related to boxing or wrestling in children up to age 14 (2012 data)
1,023:
Number of reported eye injuries related to football in children up to age 14 (2012 data).
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THREE HINTS
When you get out a new roll of toilet paper, place a few drops of your favorite essential oil in the cardboard tube of the toilet paper. This will release the scent of the oil each time the paper is used.

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Hint 1: Here is one of the best uses for apple cider vinegar.

Rinse freshly bought produce in 4 tablespoons cider vinegar dissolved in a gallon of cold water. This wash will remove dirt, pesticides, and insects. (and MarGerlach added:
And rinsing strawberries and raspberries in this keeps them from getting moldy so they stay fresh in the fridge longer.
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Hint 2:

Glue a rock to the top of a empty pill bottle, bury the bottle so that only the rock shows. A spare key is hidden inside! So smart!
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Thank you, Barbara (BAcello) who writes:
Experts advise healthcare facilities to avoid a “heavily marketed” soap in updated hand hygiene guidelines published Wednesday.

Triclosan antibacterial soaps have proved to be less safe and effective than recommended products such as chlorhexidine soap and alcohol-based hand rub, according to recommendations from the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America. Triclosan is often added to antibacterial soaps and body washes to reduce or prevent bacterial contamination.
http://tinyurl.com/mcjmz3a
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Researchers Say They've Found New Clues to Autism
A genetic mutation that increases the risk for a certain form of autism and causes specific physical traits and symptoms has been identified by researchers.
The finding may eventually enable doctors to do pre-birth testing for the CHD8 gene mutation in order to identify babies who are at risk for autism, according to the study authors.
"This is a big leap forward in our insight into the causes of autism," study leader Dr. Raphael Bernier, clinical director of the Autism Center at Seattle Children's Hospital and associate professor at the University of Washington, said in a hospital news release.
"It's possible we may be able to look at features in utero and determine a higher risk of autism, possibly even early detection," he added.
The findings were published July 3 in the journal Cell.
http://www.everydayhealth.com/news/researchers-say-theyve-found-new-clues-autism/?xid=aol_eh-emo_13_20140707_&aolcat=HLT&ncid=webmail5
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Medical Errors: Why Don't Nurses Speak Up?Nearly 9 out of 10 cases, a nurse is aware that a medical error is occurring AND THEY SAY NOTHING. Why do they stay quiet? nursetogether.com
Over 400,000 preventable deaths occur each year as a result of medical errors (Journal of Patient Safety, September 2013). That’s tantamount to killing the entire population of Miami, Florida in one year; Sacramento, California the next; and so on. Thousands die from medical errors annually. However, nurses don't speak up when these happen, even under their watch. Learn why it happens. ...
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Thank you, Barbara (BAcello).
Replacing horizontal violence in the nursing profession
By Keith Carlson
Nurse bullying and so-called "horizontal violence" are rampant in our profession. Nurses bully and harass one another, using intimidation and other tactics as they jockey for power in a healthcare system that does not proactively attempt to prevent such disruptive behavior. Yes, we hear tales of physicians intimidating and bullying nurses, but we also hear numerous examples of nurses treating one another with utter disrespect and a true lack of kindness.http://tinyurl.com/pd4o925
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Genetic testing recommended for colorectal cancer patients
A new guideline from the U.S. Multi-Society Task Force on Colorectal Cancer recommends genetic testing of tumors for all newly diagnosed colorectal cancer patients. Read more and read an abstract of the consensus statement.
FDA approves new drug for skin infections
On August 6, the U.S. Food and Drug Administration (FDA) approved Orbactiv (oritavancin), a new antibacterial drug to treat adults with skin infections. Read more.

FDA approves new drug for type 2 diabetes
On August 1, the U.S. Food and Drug Administration (FDA) approved Jardiance (empagliflozin) tablets as an addition to diet and exercise to improve glycemic control in adults with type 2 diabetes. Read more.
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FDA approves new treatment for COPD
On July 31, the U.S. Food and Drug Administration (FDA) approved Striverdi Respimat (olodaterol) inhalation spray to treat patients with chronic obstructive pulmonary disease. Striverdi Respimat is a long-acting beta-adrenergic agonist
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News Articles

  • Posted: Jul 1, 2014 - CMS Renews Joint Commission Hospital Accreditation Deeming Authority - The Centers for Medicare & Medicaid Services (CMS) announced it has renewed the approval of The Joint Commission’s deeming authority for the accreditation of hospitals that want to participate in the Medicare program. The continued recognition was awarded for a six-year period effective July 15, 2014, through July 15, 2020.
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Combination therapy effective against invasive bloodstream infection
A rescue therapy involving fosfomycin and imipenem was safe for 94% of patients with invasive bloodstream infections of methicillin-resistant Staphylococcus aureus, according to a study in the journal Clinical Infectious Diseases. Within 72 hours after the treatment was given, 69% of the patients in the study had responded. There were no relapses, and one MRSA-related death was reported.... Healio (free registration)/Infectious Disease News(8/1)
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Senate approves bill to reauthorize federal support for autism programs
The Senate on Thursday passed by unanimous consent a bill to authorize annual funding of $260 million for autism-related programs through 2019. The provisions of the Autism CARES Act include changes to the Interagency Autism Coordinating Committee and call for an autism point person at the HHS.... The Hill/Floor Action blog(7/31), Disability Scoop(8/1)
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Scientists claim that the most complicated and mysterious thing in the universe is the human brain. Scientists know more about stars exploding billions of light years away than they know about the brain.
Aristotle (384 BC-322 BC) believed that the center of thought was the heart and that the brain's function was merely to cool the heart. It was an early Greek physician, Alcmaeon of Croton (c. 6th century B.C.), who was the first to claim that the brain, not the heart, is the central organ of sensation and thought.
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RANDOM FACT:

In South America, scientist have discovered deliberately made 'skull holes' that may have been made to treat painful headaches, brain disease, or to let 'evil spirits' out of the head. Called 'trepanation,' the process of making those holes was incredibly painful. The high number of trepanized skulls suggests that this brain surgery was commonplace.

*** Bonus Fact:

Contrary to the popular belief that humans use just 10 percent of their brain capacity, humans actually use virtually every part of the brain, and most of the brain is active all the time.
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Not sleeping enough can shrink your brain, study says
Turns out, a good night's sleep can prevent more than just tired eyes: Duke researchers in Singapore studied 66 Chinese adults through sleep surveys and MRI scans and found those who got less sleep
showed a decline in cognitive function -- and smaller brains than when they first started the study.

Our brains already shrink as we age, but clocking in fewer hours on the pillow could cause that process to speed up. The scientists say this could be the reason behind the rise in dementia among older people.
Last year, there was an estimated 44 million people with dementia worldwide. According to Alzheimer's Disease International, that number is expected to increase to more than 75 million by 2030, and 135 million in 2050.

So if you need an excuse to grab a few extra hours under the covers, that seems like a pretty good one. As for how much you should be aiming for on the reg, scientists say adults need 7-8 hours every night.
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Use these articles and CE related to Translating Evidence into Clinical Practice to help you implement evidence-based practice in your practice. We've organized the content by topic so you can easily find the evidence you need.
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Quiz Time
Risk factors for osteoporosis include all of the following except:
a. a history of fracture after age 40.
b. cigarette smoking.
c. excessive alcohol use.
d. a large frame.
See answer at end of newsletter
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HUMOR SECTION
A mother traveled 2,000 miles to be with her only son on the day he was to receive his Air Force wings and also get married.

"It was wonderful," she said later. "It isn't every day that a mother watches her son receive his wings in the morning and have them clipped in the evening."


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Having trouble with the doctor's notes on an emergency case which read, "Shot in the lumbar region," the new secretary--poor girl-- was flustered and at her wit's end.

At last she thought she had it figured out and brightened up as she typed up the record, "Wounded in the woods."
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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.
Original Research: Local Anesthesia Before IV Catheterization
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.
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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.orgwww.sharedgovernance.org
Decubqueen's website: www.accuruler.com
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

 Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Soliris (eculizumab) Concentrated Solution for IV Infusion by Alexion: Recall - Visible Particulates
Alexion Pharmaceuticals, Inc. announced that it is initiating a voluntary recall of certain lots of Soliris (eculizumab) 300mg/30 mL concentrated solution for intravenous infusion. The administration of particulate, if present in a parenteral drug, poses a potential safety risk to patients in two general areas: immune reaction and blood clots. Particulates could cause blockage of flow of blood in vessels, which could be life-threatening. The single affected Soliris lot is #10007A. Although these lots currently remain in specification, Alexion is including the following remaining lots, which were produced with the same process component during vial filling, within the scope of the U.S. recall: 10002-1, 00006-1, 10003A, 10004A, 10005A, 10005AR, 10006A and 10008A.
BACKGROUND: Soliris is approved as a treatment for patients with paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), two ultra-rare and life-threatening disorders. Alexion and its distributors typically ship Soliris to healthcare providers in small quantities, which are timed to individual patient infusions, with the product being consumed before more is shipped. As product from the identified lots was last shipped on October 30, 2013, there is anticipated to be little, if any, material from these lots still remaining in commercial distribution.
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Medical Device Safety and Recalls: Fresenius NaturaLyte Liquid Bicarbonate Concentrate (Part Number: 08-4000-LB)
The U.S. Food and Drug Administration has issued a recall for the NaturaLyte Liquid Bicarbonate Concentrate, 6.4 Liter Bottle (Part Number: 08-4000-LB). The product may develop higher than expected bacteria levels during its shelf life. Lab testing identified the bacteria as Halomonas (species 1, 2, 3), a gram negative bacteria typically found in water with high salt concentration. The FDA has received one report of death and two reports of injury that may be related to use of this product. The use of affected product may cause serious adverse health consequences, including sepsis, bacteremia, and death. ... http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm399124.htm
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Gemstar Docking Station by Hospira, Inc: Class I Recall - Potential for Error or Failure to Power Up
Hospira, Inc., announced today a nationwide medical device correction of the GemStar Docking Station (list number 13075), used in conjunction with the GemStar infusion pump. When the docking station is used in conjunction with a GemStar Phase 3 pump (List 13000, 13100 or 13150) the potential exists for the GemStar Phase 3 pump to fail to power up while connected to the docking station. When a GemStar Phase 3 (List 13000, 13100 or 13150) or GemStar Phase 4 pump (List 13086, 13087 or 13088) is used in conjunction with both a docking station and an external battery pack accessory (List 13073), there is a possibility that the GemStar pump will display error code 11/003 and give an audible alarm, indicating excessive input voltage from the external sources. If the GemStar pump detects what is perceived to be more than 3.6 Volts as measured on the external voltage input, the pump will stop the infusion. This will trigger an audible alarm and the device will display alarm code 11/003.
If a GemStar fails to power up or the 11/003 error code stops an infusion, a delay of therapy may occur. A delay or interruption in therapy has a worst case potential to result in significant injury or death.
BACKGROUND: The GemStar Docking Station is a separately sold accessory to the GemStar infusion pump and provides an alternate power source to the GemStar pump. The products impacted by these issues are identified in a table in the Firm Press Release. http://go.usa.gov/kM9d
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Fisher and Paykel Healthcare, Ltd., Infant Nasal CPAP Prongs
A recall has been issued for the Fisher and Paykel Healthcare, Ltd., Infant Nasal CPAP Prongs. Fisher and Paykel Healthcare received 24 reports in which the device has malfunctioned. There were zero injuries and zero deaths. The firm received reports of the affected prongs detaching from the nasal tubing during use, especially when mucous and/or moisture are present. When the affected prongs detach from the nasal tubing, therapy is likely to be interrupted. This may cause low blood oxygen (hypoxemia). The detached prongs may enter an infant’s mouth and present a potential risk of choking and airway obstruction. The use of the affected product may cause serious adverse health consequences, including death. For more information, please see http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm398631.htm
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-Ruler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
Welcome to:
dmatkinson@valdosta.edu (Denise) July 2014
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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.
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THOUGHT FOR THE DAY
It's easier to build strong children than to repair broken men.
--Frederick Douglass
Correct answer: d. Risk factors that contribute to osteoporosis include a personal history of a fracture after age 40, a thin or small frame, a family history of osteoporosis, cigarette smoking, excessive alcohol use, inactivity, and advanced age.
Hope to hear from you..... Frankie

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