PARADIGM BYTES
Newsletter for Paradigm 97
December 10, 2015
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
Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPET
A boost in neurodevelopment
The umbilical cord blood serves as the baby’s life blood until birth as it contains many wonderfully precious cells, like stem cells, red blood cells and white blood cells (including cancer-fighting T-cells) to help fight disease and infection.
However, the common practice is to quickly cut off this source of valuable cells at the moment of birth. But recently, there have been studies emerging regarding the benefit of delayed cord clamping.
According to a study, a couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later. Those children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. However, the results showed no differences in IQ.
Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom, states that "there is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth."
By delaying the clamping of the cord more blood is allowed to transfer from the placenta to the infant, sometimes increasing the infant's blood volume by up to a third. The iron in the blood increases infants' iron storage, and iron is essential for healthy brain development.
Rabe adds, “the extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world. Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly."
Studies supporting the delay of cord clamping
Several studies have shown higher levels of iron and other positive effects later in infancy among babies whose cords were clamped after several minutes, but few studies have looked at results past infancy.
In one study, researchers randomly allocated half of 263 healthy Swedish full-term newborns to have their cords clamped more than three minutes after birth. The other half were clamped less than 10 seconds after birth.
Four years later, the children underwent a series of assessments for IQ, motor skills, social skills, problem-solving, communication skills and behavior. Results revealed that those with delayed cord clamping showed modestly higher scores in social skills and fine motor skills. When separated by sex, only the boys showed statistically significant improvement.
Risks
Despite these benefits, the American Congress of Obstetricians and Gynecologistshas not yet endorsed the practice, citing insufficient evidence for full-term infants and the World Health Organization recommends delayed cord clamping of not less than one minute.
Some studies have found a higher risk of jaundice, a buildup of bilirubin in the blood from the breakdown of red blood cells. Another potential risk is a condition called polycythemia, according to Dr. Scott Lorch, an associate professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and director of the Center for Perinatal and Pediatric Health Disparities Research at Children's Hospital of Philadelphia.
According to him, "Polycythemia can have medical consequences for the infant, including blood clots, respiratory distress and even strokes in the worst-case scenario.”
There are also studies which have found higher levels of red blood cells in babies with delayed cord clamping, but there were no complications.
As of the moment, studies on delayed cord clamping have excluded infants born in distress, such as those with breathing difficulties or other problems. But according to Rabe, these infants may actually profit most from the practice since these babies often need more blood volume to help with blood pressure, breathing and circulation problems.
"Also, the placental blood is rich with stem cells, which could help to repair any brain damage the baby might have suffered during a difficult birth," she added. "Milking of the cord would be the easiest way to get the extra blood into the baby quickly in an emergency situation."
Sources:
- http://www.bellybelly.com.au/birth/cord-clamping-delaying-cord-clamping/ or http://tinyurl.com/nphdfog
- http://www.npr.org/sections/health-shots/2015/05/26/409697568/delayed-umbilical-cord-clamping-may-benefit-children-years-later or http://tinyurl.com/p6wbf32
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Publication
What’s in a name?
Editor’s note: The information below was provided by United States Pharmacopeial Convention (USP). It may be freely reproduced and distributed, for non-commercial use only. The American Nurses Association is a voting member of the USP Convention.
If you eat jelly instead of jam you would get a slightly different version of the same thing. Jelly, jam, and preserves are all made from fruit mixed with sugar and pectin. The difference between them comes in the form that the fruit takes: fruit juice, fruit pulp or crushed fruit, or chunks of fruit respectively. But, not all things that sound and look alike are as easily — or safely — switched. ok-alike/sound-alike drugs can create increased potential for harm. In fact, inadvertent switches of hydromorphone for morphine, or vice versa, are among the most common and serious errors that can occur between two high-alert drugs. These two medications are considered “high-alert” because they bear a heightened risk of causing significant patient harm. The very real danger of confusing these drugs is the crux of the Stimuli article in the United States Pharmacopeia (USP) Pharmacopeial Forum (March-April 2014), “Name Confusion Between Hydromorphone and Morphine: Safety in Patient Care”.
The article indicates that “[a] recent analysis of wrong-drug errors involving hydromorphone showed that 70% of these mistakes (129 of 185) occurred when hydromorphone was given instead of morphine, or vice versa”, and further observes that “[t]he potential for patient harm may be greatest when the wrong drug is given at the correct dosage for the other drug.” It goes on to describe a variety of risk-control strategies which have been employed to prevent these errors, but which have not been sufficiently effective in preventing patient harm.
What should be done to reduce these medication errors?
One possible solution is to change the name of hydromorphone. Changing the nonproprietary name of a medication is a very rare occurrence, but it has happened before. A nonproprietary name change is considered a last resort for protecting patient safety, and the USP Nomenclature, Safety, and Labeling Expert Committee (NSL EC), which is responsible for USP’s naming decisions, is aware of the significant and prolonged impact this action could have on the healthcare community, industry, and consumers. The article is an effort to stimulate discussion about the seriousness of the reported errors and solicit input on the effects of a name change on practitioners, industry, governmental agencies, and the international community. Should the drug hydromorphone undergo a name change? Are there other innovative ideas that could be effective in reducing medications errors involving hydromorphone and avert the need for a name change?
Who should comment?
Pharmacists, consumers and/or consumer groups, physicians, manufacturers, pharmacy and/or medical students, and the public may all have valuable insights and worthwhile feedback and all are encouraged to share thoughts and comments with the NSL EC by sending comments to dzb@usp.org. Much more detailed information about this challenge is available in the Stimuli article, which can be accessed by registering for the free forum (if not already), clicking on the “ACCESS PF NOW” button, and using the term “Hydromorphone and Morphine” in the search field.
http://www.americannursetoday.com/whats-in-a-name/
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Dense Breasts May Be Linked to Cancer Recurrence THURSDAY, March 22, 2012
(HealthDay News) —
Breast cancer is more likely to recur in women over 50 who have denser breast tissue, researchers report, noting that doctors should take breast density into account when making initial treatment decisions.
The Swedish study found that women with denser breasts had nearly twice the risk of recurrence, either in the same breast or in the surrounding lymph nodes, than women with less dense breasts.
"We found that if you have a PD [percentage density] at diagnosis of 25 percent or more, you have an almost twofold increased risk of local recurrence in the breast and surrounding lymph nodes than women with a PD of less than 25 percent," said Dr. Louise Eriksson and colleagues from the Karolinska Institute in Stockholm.
"However, density does not increase the risk of distant metastasis [spread] and has no effect on survival," Eriksson said.
Breast density, which can be determined through mammography, varies among women and decreases with age, especially at menopause, the researchers noted. ...
http://www.everydayhealth.com/cancer/breast-cancer/0322/dense-breasts-may-be-linked-to-cancer-recurrence.aspx?xid=aol_eh-gen_11_20151130_&aolcat=HLT
or
http://tinyurl.com/opduk5g
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As nurses, there are things that should be kept within the four walls of the hospital and need not be posted online. Below are do’s and don’ts when it comes to using social media sites:
- DON’T discuss or disclose sensitive or Protected Health Information (PHI).
Respect the patient’s privacy at all times, even when you’re off duty. Never post anything that relates to identifying patient information, including the patient’s name, social security number and address, as well as details about his or her condition. Also, do not take a photo of your patient and post it online (no matter how good looking your patient is). That is a violation of privacy.
It should also be noted that something as simple as adding the patient as a “friend” on Facebook or answering a health care question in a public forum such as Twitter can be a violation of patient privacy.
If you want to post about your day, make it as vague as possible.
- DO think twice before posting something.
Don’t just carelessly post anything on social media. Consider your audience, as well as the content of your post.
- DO present yourself in a respectable and professional manner online.
You may want to keep your profile on the highest privacy setting. A curious patient may look you up online and see pictures of wild party nights, or even simple family thingamajigs.
Also, act responsibly and professionally when posting on social media sites. Maintain professional boundaries with your patients.
If there is respect and a relationship of trust and professional boundaries, it is easier to work with a patient in deeply personal ways. Keeping your private life private maintains that boundary and a sense of professionalism. Also, keep in mind that it is not encouraged to maintain contact with a patient through social media.
- DO utilize social media on your own time and your own device.
You shouldn’t be facebooking/instagramminng/tweeting while working. When on duty, your focus must be on your tasks and nursing responsibilities. Also, there are certain policies enforced by organizations against the use of company time or resources for non-work activities like social media, even if you are posting about the industry.
- DON’T post if you have doubts about the content
Even if you deleted something, someone might have scree captured your post. Expect the worst when posing on social media. Not everything can remain private as your private post will always find a way to become shared with random strangers. So, if you’re not sure about what you’re posting, better not post at all.
Sources:
- http://www.fortis.edu/blog/nursing/the-nursing-professional-and-social-media-dos-and-donts/
- http://www.nursebuff.com/2015/07/social-networking-for-nurses/
- http://www.nursetogether.com/ethics-nursing-social-media-dos-and-donts#comments
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I, of course, had heard of this Syndrome, but never took the time to learn about it, so here it is just for you.
Marfan Syndrome:
is a genetic disorder that affects the body’s connective tissue. Connective tissue holds all the body’s cells, organs and tissue together. It also plays an important role in helping the body grow and develop properly.
Because connective tissue is found throughout the body, Marfan syndrome can affect many different parts of the body, as well. Features of the disorder are most often found in the heart, blood vessels, bones, joints, and eyes. Some Marfan features – for example, aortic enlargement (expansion of the main blood vessel that carries blood away from the heart to the rest of the body) – can be life-threatening. The lungs, skin and nervous system may also be affected. Marfan syndrome does not affect intelligence.
http://www.marfan.org/about/marfan
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Investigational Drug May Prevent Life-Threatening Muscle Loss in Advanced Cancers NOVEMBER 24, 2015
Data from a preclinical study show that AR-42, an experimental drug, may stop cachexia associated with advanced cancers and restore muscle health, according to a study in the Journal of the National Cancer Institute. Read more and read the study abstract.
Columbus, Ohio – New data describes how an experimental drug can stop life-threatening muscle wasting (cachexia) associated with advanced cancers and restore muscle health. The experimental agent, known as AR-42 while in testing, was developed and tested in preclinical studies at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).
AR-42 is part of a class of drugs known as HDAC (histone deacetylase) inhibitors, which are designed to block proteins that play a key role in mediating skeletal muscle breakdown. In cancer, HDAC proteins also tend to drive the pathways in cancer cells that lead to aggressive cancers. AR-42 is unique among HDAC inhibitors because it appears to have beneficial effects on muscle health and function, according to this new OSUCCC – James research.
In this new preclinical study, Tanios Bekaii-Saab, MD, and colleagues report data illustrating that orally administered AR-42 can significantly preserve body weight and prolong survival while simultaneously preventing the loss of muscle and fat tissue mass and preserving the health/strength of muscle.
Findings were reported online ahead of print in the Journal of the National Cancer Institute. The study will appear in the December 2015 issue of the journal....
http://cancer.osu.edu/news-and-media/news/investigational-drug-may-prevent-life-threatening-muscle-loss-in-advanced-cancers
or http://tinyurl.com/nbpgwj7
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Statistics:
December 1 is World AIDS Day.
1.2 million:
More than 1.2 million people in the United States are living with HIV infection.
1 in 8: Number who are unaware of their infection
50,000: Estimated number of new HIV infections per year
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A brief checklist may help determine whether Lewy body pathology is contributing to dementia, new research suggests.
The new tool could go a long way to finding answers for patients and families, who now wait up to 18 months to get a correct diagnosis, according to the test’s developer, James E. Galvin, MD, associate dean for clinical research, Florida Atlantic University, Boca Raton.
Recent disclosure by Susan Schneider, wife of comedian Robin Williams, who was diagnosed with depression and Parkinson’s disease (PD) before committing suicide last year, that he had signs on autopsy of Lewy body dementia (LBD) has put the disease squarely in the public eye.
Dr James E. Galvin
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LBD includes both dementia with Lewy bodies (DLB) and Parkinson’s disease dementia. The new test, called the Lewy body composite risk score (LBCRS), was derived from clinical features in autopsy-verified cases of healthy controls, Alzheimer’s disease (AD), DLB, and PD with and without dementia.
It was recently tested and validated in a cohort of 256 patients, the results of which were published in the September issue of Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.
http://www.medscape.com/viewarticle/854577
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Anaphylaxis Risk Highest With IV Iron Dextran
All iron intravenous (IV) products are associated with anaphylaxis risk, but the risk with iron dextran is significantly higher than with other formulations, and the risk is lowest with iron sucrose, according to a study of almost 700,000 Medicare nondialysis patients.
More than twice as many older recipients of iron dextran experienced anaphylaxis as those receiving other formulations, with an odds ratio of 2.6 (95% confidence interval [CI], 2.0 - 3.3; P <.001), after adjusting for age, indication, history of coronary heart disease, and hypertension.
"Dextran may be immunogenic, even to patients who have not been previously exposed, because of cross-reactivity of dextran to native polysaccharide antibodies," write Cunlin Wang, MD, PhD, director, Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Sprint, Maryland, and colleagues in an article published in the November 17 issue of JAMA. ...
http://www.medscape.com/viewarticle/854645
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Thank you Roz for this article.. (Rozalfaro@AOL.com)
In the most complete tally yet, scientists have identified nearly 1,500 genes that are connected to how we age
Almost every process in our body changes, however quickly or slowly, as we age. And it’s not just genes that are affected by aging, but the ways we live our lives: the things we’re exposed to, the things we eat and how much we exercise among them.
That’s why pinpointing the genes involved in this complex process is a formidable challenge.... While previous studies compared the genes themselves to find out which genes differed among people who lived longer and those who did not, Andrew Johnson, the study’s senior author from the Division of Intramural Research at the National Heart, Lung and Blood Institute, says they focused on the activity of the genes instead to get a better picture of which genes are changing with age. To measure that, they focused on RNA, the genetic product that our genes produce when they’re active. ...
time.com/4083380/genes-linked-to-aging/
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Thank you, Barbara ( msedrn@gmail.com)
New long-term care nursing group to debut in 2016 Leaders of an association for nurse assessment coordinators have announced they will be rolling out a new organization for long-term care directors of nursing in 2016. A “soft” opening will occur in March, with a full rollout expected to occur at a conference in September, they told McKnight's.
The effort is being led by leaders of the American Association of Nurse Assessment Coordination (AANAC), which in July announced that it had acquired the assets of the American Association of Long-Term Care Nursing (AALTCN).
“It makes sense. We have the staff and the infrastructure,” said AANAC President and CEO Diane Carter, RN, MSN, RAC-CT, C-NE, FAAN. “We have 15,000 members in AANAC and about half of them are directors of nursing.”
Carter said that AANAC also recently attempted to acquire the National Association of Directors of Nursing in Long Term Care (NADONA) but the offer was rebuffed. Attempts to obtain comment from NADONA's executive director on Friday were unsuccessful. ... http://tinyurl.com/nhjqpnk
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Quiz Time:
A patient who still has hypotension after initial fluid resuscitation most likely has which form of sepsis?
a. Systemic inflammatory response syndrome
b. Moderate sepsis
c. Severe sepsis
d. Septic Shock…
Answer at end of Newsletter:
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Sickle Cell Disease: Potential Biomarkers for Chronic Pain -
Pain crises are common in those with sickle cell disease, but now new research may have identified biomarkers for patients whose pain becomes chronic. Nina Kuei, BS, from Georgia Regents University, and colleagues analyzed potential characteristics and biomarkers of chronic pain in sickle cell disease. Kuei will discuss the findings at the 57th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida. Chronic pain was defined as pain more than 50% of days over a six month period. The analysis included 12 patients with sickle cell disease and chronic pain, 17 patients with sickle cell disease without chronic pain, and 9 African American healthy controls. Notably, those of African descent make up the majority of sickle cell disease in the United States – one out of every 13 African American children is born with the sickle cell trait and one out of every 365 are born with sickle cell disease, according to the National Institutes of Health. ...
http://www.hcplive.com/conference-coverage/ash-2015/sickle-cell-disease-potential-biomarkers-for-chronic-pain
or http://tinyurl.com/ohwl7ck
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This virus you never heard of may be causing birth defects in Brazil A little-known virus new to the Americas is spreading and may be causing deadly birth defects, health officials say.
It's called Zika virus, and it's moving across much of Brazil and north into Central America, carried by the same mosquitoes that carry other viruses such as dengue and yellow fever.
Health officials thought Zika was pretty harmless, causing a pesky fever and muscle aches, but Brazilian health officials say it may be causing a birth defect called microcephaly, too. The Pan American Health Organization, an arm of the World Health Organization, has issued an alert about it. Viruses such as German measles, chickenpox or cytomegalovirus can cause it if the mother's infected during pregnancy, and there is no cure.
The rate of cases has doubled in Brazil this year over previous years, PAHO says. ("As of 30 November 2015, 1,248 cases of microcephaly, including seven deaths, have been reported in 14 states of Brazil, which are under investigation." PAN AMERICAN HEALTH ORGANIZATION )
"The number is increasing day by day," virologists Silvia Sardi and Gubio Soares Campos of Brazil's Federal University of Bahia, who have been tracking the virus, said in an email to NBC News.
"It is becoming a serious problem, principally in poor areas, where the control of mosquitoes is a hard task," they added. ...
. http://www.aol.com/article/2015/12/06/this-virus-you-never-heard-of-may-be-causing-birth-defects/21279155/
or http://tinyurl.com/oq42suj
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Hydroxyurea: An Option for Preventing Sickle Cell Stroke Oral drug offers alternative to transfusion to pediatric patients
ORLANDO -- A drug that eases some of the painful symptoms of sickle cell anemia in children might also help prevent one of the worst symptoms, stroke.
In a 2-year, phase III randomized clinical trial, the off-label use of hydroxyurea was non-inferior to standard therapy (monthly transfusions) in normalizing a marker of stroke risk for children with sickle cell, according to Russell Ware, MD, PhD, of the Cincinnati Children's Hospital Medical Center. Stroke is a "huge problem" for children with sickle cell anemia, Ware told reporters at the American Society of Hematology (ASH) meeting.
But the advent of transcranial Doppler (TCD) screening has allowed clinicians to identify children at the highest risk, and to take effective counter-measures, such as monthly transfusions, combined with chelation therapy to treat iron build-up, he said.
Still, the treatment is not optimal, and "treating a 3-year-old child with chronic transfusions lifelong is a very big undertaking," he said.
Ware and colleagues hypothesized that daily oral hydroxyurea, currently approved to treat the painful crises that characterize the disease, might lower the velocity of blood in cranial vessels as well as transfusions.
The drug prevents red blood cells from developing the sickle shape that is characteristic of the disease. ...
http://www.medpagetoday.com/MeetingCoverage/ASHHematology/55075?xid=nl_mpt_DHE_2015-12-08&eun=g379846d0r
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Randomised controlled trial:
Intermittent pneumatic compression is effective in reducing proximal DVT
Evid Based Nurs ebnurs-2015-102265Published Online First: 30 November 2015
Intermittent pneumatic compression is effective in reducing proximal DVT
Evid Based Nurs ebnurs-2015-102265Published Online First: 30 November 2015
implications for practice and research
- Intermittent pneumatic compression (IPC) is effective in reducing proximal deep vein thrombosis and should be used for all immobile patients with stroke, unless cost is a major concern.
- The cost-effectiveness of IPC in different types of medical patients remains uncertain; future randomised controlled trials on IPC should be powered by cost-effectiveness.
Context
Venous thromboembolism (VTE) is a common complication in hospitalised patients, and is associated with significant morbidity and mortality. Although pharmacological thromboprohylaxis is effective in reducing VTE, …
http://ebn.bmj.com/content/early/2015/11/30/eb-2015-102265.extract
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(This study was done in 2013....why don't the hospitals listen and apply ?)
Increased RN Staffing Hours Are Correlated with Higher Quality Patient Care
increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse (LPN) or nursing assistant (NA) hours.
The study's authors -- Gestur Davidson, Ira Moscovice and Kathy Belk -- posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a new research brief on the Robert Wood Johnson Foundation website. ...
The study's authors -- Gestur Davidson, Ira Moscovice and Kathy Belk -- posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a new research brief on the Robert Wood Johnson Foundation website. ...
http://inqri.blogspot.com/2013/12/increased-rn-staffing-hours-are.html
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Most MRI-Detected Breast Tumors Aren't Significant: Study
Magnetic resonance imaging (MRI) can detect multicentric breast cancers that are not identified on mammography, but approximately three-quarters of the MRI-detected lesions in a single-center series were ductal carcinoma in situ (DCIS) or invasive cancers of less than 1 cm, researchers reported.
In a review of records from 2001 to 2011, 14% or 2,021 patients with newly diagnosed breast cancer who underwent biopsy after preoperative MR imaging had an additional cancer detected on MRI that was occult on mammography, according to Chiara Iacconi, MD, of USL1 Massa-Carrara in Italy, and colleagues from the Memorial Sloan-Kettering Cancer Center in New York City, writing in Radiology. ...
http://www.medpagetoday.com/HematologyOncology/BreastCancer/54933?xid=nl_mpt_DHE_2015-12-01&eun=g379846d0r
or: http://tinyurl.com/q6zut8g
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A data analysis of more than 2.2 million mammograms for US women aged 40 to 74 years found that the 10-year risk of breast cancer was 39% higher among those who had false-positive results and were referred for additional imaging, compared with those who had true-negative results. The study, reported in the journal Cancer Epidemiology, Biomarkers & Prevention, suggests that breast cancer risk-prediction models should incorporate a history of false-positive mammograms. The reason behind the link is not known. HealthDay News (12/2),MedPage Today (free registration) (12/2)
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Women with positive mammography screens ultimately judged to be false were still at significantly increased likelihood for developing invasive breast cancer within the next 10 years, a study involving 1.3 million women showed.
The 10-year breast cancer risk was higher by 39% in women who had false-positive mammograms and additional breast imaging as compared with women who had true-negative mammograms, Louise M. Henderson, PhD, of the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, and co-authors reported in the December issue of Cancer Epidemiology, Biomarkers & Prevention. Moreover, the risk increase reached 76% in the subgroup of women who had breast biopsies after false-positive mammograms, and was independent of breast density, a known risk for breast cancer.
The reasons for the association remain unclear, but the results suggest that a history of false-positive screening mammography should be incorporated into breast cancer risk-prediction models, the researchers said. ... http://www.medpagetoday.com/HematologyOncology/BreastCancer/54978?xid=nl_mpt_DHE_2015-12-03&eun=g379846d o
r http://tinyurl.com/pngpk2m
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The following won't cooperate. short of rewriting!
Energy-Dense Walnuts Tied to Better Diets
Tuesday, November 24, 2015
'Uniquely nutritious' says author of randomized trial. Walnuts significantly improved diet quality, endothelial function, and cholesterol without negatively affecting blood pressure or glucose levels in a new study.
In a randomized trial of 112 participants who either spent 6 months eating walnuts followed by 6 months on a diet with no walnuts, or vice versa, the walnut group had a significantly better diet both with dietary counseling and without it.
In addition, endothelial function and total and low-density lipoprotein (LDL) cholesterol improved from baseline with the walnut diet of about 56 g of walnuts per day -- about a handful -- though these measures didn't significantly vary when the two arms were directly compared, according to lead author David Katz, MD, at the Yale University School of Medicine.
They published their findings in BMJ Open Diabetes Research & Care on Monday. ... http://www.everydayhealth.com/news/energy-dense-walnuts-tied-better-diets/?xid=aol_eh-endo_3_20151130_&aolcat=APS
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THE APPLE
An apple is a very nutritional fruit which contains protein, carbohydrates, fats, ashes, fibers,and a long lists of vitamins and minerals . Its peel contain more nutrients than its flesh. The peels of apples, in particular, are high in phenolics. The total phenolic and flavonoid contents were highest in the peels.The peels has more vitamin C and had significantly higher total antioxidant activities than the flesh.
The same can apply for consuming the entire seed-- not just pressing them.
The experts at Rain understand seed technology. They know the entire seed is like a nugget of gold.
First of all, the oil is cold pressed out of the seeds. Then the rest of the seed is ground into a flour so that when it is reconstituted with the oil, all parts of the seed are in a form which makes the healing compounds bio-available to the body.
The inner flour and the husk, as well as the oil of the seed, contain different, powerful benefits, if your body can absorb them, which it can in this form.
The same can apply for consuming the entire seed-- not just pressing them.
The experts at Rain understand seed technology. They know the entire seed is like a nugget of gold.
First of all, the oil is cold pressed out of the seeds. Then the rest of the seed is ground into a flour so that when it is reconstituted with the oil, all parts of the seed are in a form which makes the healing compounds bio-available to the body.
The inner flour and the husk, as well as the oil of the seed, contain different, powerful benefits, if your body can absorb them, which it can in this form.
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Evid Based Nurs 2015;18:124 doi:10.1136/eb-2015-102058
- Nursing issues
- Randomised controlled trial
A checklist-based tool for postoperative complications may improve and standardise patient care
+Author Affiliations
- Correspondence to: Dr Naina Mohan, Croydon Health Services NHS Trust, Croydon University Hospital, 430 London Road, Thornton Heath, London CR7 7YE, UK; naina.mohan@croydonhealth.nhs.uk
Commentary on:
Implications for practice and research
- The use of checklists improved the management of postoperative complications by providing a standardised, evidence-based approach to clinical scenarios. They also improved communication and teamwork within multidisciplinary teams.
- As these improvements were observed in a simulated environment, clinical implementation studies are required to validate the results.
Context
The postoperative phase of gastrointestinal surgery is fraught with complications, with significantly high morbidity rates. The management of these complications is extremely variable, being affected by a number of factors such as time constraints, staffing and adherence to best-practice guidelines. Checklists have successfully been introduced into other areas of …
[Full text of this article] http://ebn.bmj.com/content/18/4/124.extract
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Drug Information Update -
FDA approves new drug for patients with previously treated multiple myeloma
| 11/16/2015 |
Today the U.S. Food and Drug Administration granted accelerated approval for Darzalex (daratumumab) to treat patients with multiple myeloma who have received at least three prior treatments. Darzalex is the first monoclonal antibody approved for treating multiple myeloma.
Multiple myeloma is a form of blood cancer that occurs in infection-fighting plasma cells (a type of white blood cell) found in the bone marrow. These cancerous cells multiply, produce an abnormal protein and push out other healthy blood cells from the bone marrow. The disease may result in a weakened immune system and cause other bone or kidney problems. The National Cancer Institute estimates there will be 26,850 new cases of multiple myeloma and 11,240 related deaths in the United States this year.
The most common side effects of Darzalex were infusion-related reactions, fatigue, nausea, back pain, fever and cough. Darzalex may also result in low counts of infection-fighting white blood cells (lymphopenia, neutropenia, and leukopenia) or red blood cells (anemia) and low levels of blood platelets (thrombocytopenia). ...
For more information, please visit: Darzalex
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FDA takes action to protect consumers from potentially dangerous dietary supplements
The U.S. Food and Drug Administration, in partnership with other government agencies, yesterday announced the results of a yearlong sweep of dietary supplements to identify potentially unsafe or tainted supplements. The sweep resulted in civil injunctions and criminal actions against 117 various manufacturers and/or distributors of dietary supplements and tainted products falsely marketed as dietary supplements. Among the cases announced today is a criminal case charging USPlabs LLC and several of its corporate officers. USPlabs was known for its widely popular workout and weight loss supplements, which it sold under names such as Jack3d and OxyElite Pro.
Led by the U.S. Department of Justice, the sweep included the FDA, the Internal Revenue Service’s Criminal Investigation Division, the Federal Trade Commission, the U.S. Postal Inspection Service, the Department of Defense and the U.S. Anti-Doping Agency.
An 11-count indictment was unsealed earlier today against USPlabs, a Dallas, Texas company that formerly manufactured highly popular workout and weight loss supplements. The indictment charges USPlabs, S.K. Laboratories Inc. and their operators with a variety of charges related to the sale of those products. The defendants were arrested/surrendered to the U.S. Marshal’s Service today. Along with the arrests, FDA and IRS special agents seized assets in dozens of investment accounts, real estate in Texas, and a number of luxury and sports cars. ...
For more information, please visit: USPlabs
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FDA moves quickly to approve easy-to-use nasal spray to treat opioid overdose 11/19/2015
Yesterday the U.S. Food and Drug Administration approved Narcan nasal spray, the first FDA-approved nasal spray version of naloxone hydrochloride, a life-saving medication that can stop or reverse the effects of an opioid overdose. Opioids are a class of drugs that include prescription medications such as oxycodone, hydrocodone, and morphine, as well as the illegal drug heroin.
Drug overdose deaths, driven largely by prescription drug overdoses, are now the leading cause of injury death in the United States – surpassing motor vehicle crashes. In 2013, the Centers for Disease Control and Prevention reported the number of drug overdose deaths had steadily increased for more than a decade. When someone overdoses on an opioid, it can be difficult to awaken the person, and breathing may become shallow or stop – leading to death if there is no medical intervention. If naloxone is administered quickly, it can counter the overdose effects, usually within two minutes.
The use of Narcan nasal spray in patients who are opioid dependent may result in severe opioid withdrawal characterized by body aches, diarrhea, increased heart rate (tachycardia), fever, runny nose, sneezing, goose bumps (piloerection), sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, and increased blood pressure.
For more information, please visit: Narcan
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December is the 12th and last month of the year in the Julian and Gregorian Calendars, but if you know your Latin you know that decem means "ten".
As it turns out, December was also the tenth month in the Roman calendar until a monthless winter period was divided between January and February. RANDOM FACTS: Nobel Prizes are awarded on December 10, the anniversary of Alfred Nobel's death. Bonus Fact: December is the month with the shortest daylight hours of the year in the Northern Hemisphere and the longest daylight hours of the year in the Southern Hemisphere. *********************** |
RANDOM FACT:
(Why not night shift ?)
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Bristol-Myers Squibb Co said the U.S. Food and Drug Administration had approved the expanded use of its cancer drug, Opdivo, to treat an additional form of advanced skin cancer.
Opdivo, first approved in December 2014, raked in worldwide revenue of $467 million in the nine months ended Sept. 30.
The drug has been approved for five other indications in the past 12 months.
The company said on Tuesday the approval allows for the drug's use in patients with a previously untreated, advanced form of melanoma and is based on data from a late-stage study comparing the drug with chemotherapy.
Opdivo, already in use in patients with forms of lung cancer and with advanced melanoma who have received treatment, belongs to a promising new class of drugs designed to help the body's immune system fight cancer by blocking a protein called programmed death receptor (PD-1). ...
Read more www.reuters.com/article/2015/11/24/us-bristol-myers-fda-idUSKBN0TD1EF20151124#bLwVKTUE28DGfFF5.99
or: http://tinyurl.com/qbddpev
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RANDOM FACTS: A team of Korean scientists set up some traps to catch viruses and bacteria floating in the air. They set up their traps in Seoul, in an industrial complex in western Korea, and in a forest. Based on their collection, they came up with the following estimates...
In each cubic meter of air, there are between 1.6 million and 40 million viruses.
Given that we breathe roughly .01 cubic meters of air each minute, a simple calculation based on these results suggests we breathe in a few hundred thousand viruses every minute.
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Bonus Fact: Viruses are by far the most abundant biological entities on Earth and they outnumber all the others put together. They infect all types of cellular life including animals, plants, bacteria and fungi.
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Metals are an important part of our world. So important we mark epochs in our history after them; such as the Bronze Age and the Iron Age. The Bronze Age goes back as far as 3600 BC, however, interestingly enough, it wasn't until 1735 that a metal, cobalt, was discovered that was completely unknown to the ancients.
Since that time some truly bizarre metals have been discovered, such as...
RANDOM FACTS: Mercury, which becomes solid at -40 degrees F, is the only metal that is liquid at room temperature.
Bonus Fact: The rare metal gallium melts at 86 degrees F. It is safe to touch. If you hold a piece of it in your hand and wait, your body heat will melt it.
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POPCORN TRIVIA:
Popcorn wasn’t introduced to the general public as a snack food until around 1840, when it first made appearances at fairs, carnivals, and rallies.
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When the portable popcorn machine was invented in 1885, the salty, buttery snack gained popularity. Popcorn vendors were quick to set up shop and introduce newbies to this tasty snack.
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The popcorn boom happened at the same time as dime theaters came into existence. Vendors seized the opportunity and sold their treats outside of movies. However, the mess left behind irritated movie theater owners, especially when the fancier theaters of the 1910s and 20s were built.
When the Great Depression began, desperate theater owners installed their own popcorn machines inside. Soon after, concession stands were part of the designs of theatres, and a movie and a bucket of popcorn became a main form of entertainment for Americans well into the 1930s.
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The introduction of TV threatened the movie business once more, and concession stands became a vital part of a theater's existence. When sugar rations occurred during World War II and candy wasn't an option at the movies, popcorn sales skyrocketed.
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Today, concession stand sales account for a whopping 40 percent of movie theatres’ net revenue.
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HUMOR SECTION
Our dog suddenly began barking almost every night at around 3 a.m.
Irritated and sleepy, my husband, Larry, searched the back yard for what might have disturbed this otherwise peaceful animal.
For three days he found nothing amiss. When the dog woke up the neighborhood a fourth night at 3 a.m. with frantic barking, Larry finally sneaked around the house through the alley only to discover our quiet neighbor, the last man you'd suspect of wrongdoing, throwing pebbles over the fence at the dog.
My husband demanded to know what he was doing.
"My mother-in-law is visiting," the embarrassed neighbor explained. "If she gets awakened in the middle of the night one more time, she says that she will leave."
Irritated and sleepy, my husband, Larry, searched the back yard for what might have disturbed this otherwise peaceful animal.
For three days he found nothing amiss. When the dog woke up the neighborhood a fourth night at 3 a.m. with frantic barking, Larry finally sneaked around the house through the alley only to discover our quiet neighbor, the last man you'd suspect of wrongdoing, throwing pebbles over the fence at the dog.
My husband demanded to know what he was doing.
"My mother-in-law is visiting," the embarrassed neighbor explained. "If she gets awakened in the middle of the night one more time, she says that she will leave."
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and one of my favorites:
While visiting Annapolis, a lady tourist noticed several students on their hands and knees assessing the courtyard with pencils and clipboards in hand.
"What are they doing?" she asked the tour guide.
"Each year," he replied with a grin, "the upperclassmen ask the freshmen how many bricks it took to finish paving this courtyard."
When they were out of earshot of the freshmen, the curious lady asked the guide: "So, what's the answer?"
The guide replied, with a grin: "One."
"What are they doing?" she asked the tour guide.
"Each year," he replied with a grin, "the upperclassmen ask the freshmen how many bricks it took to finish paving this courtyard."
When they were out of earshot of the freshmen, the curious lady asked the guide: "So, what's the answer?"
The guide replied, with a grin: "One."
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Go to www.sharedgovernance.org for access to a 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.
Go to www.sharedgovernance.org for access to a free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.
Please follow me on Twitter as Dr Robert Hess.
Pay Only $34.99 for a full year of CONTACT HOURS
www.nurse.com for CNE offerings.
www.nurse.com for CNE offerings.
Free CEs http://www.myfreece.com/welcome.asp
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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/
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
Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Compounded Multivitamins by Glades Drugs: Voluntary Recall - High Amounts of Vitamin D3 (Cholecalciferol)
ISSUE: The U.S. Food and Drug Administration is alerting health care professionals and patients of a voluntary recall of compounded multivitamin capsules containing high amounts of Vitamin D3 (Cholecalciferol), distributed nationwide by Glades Drugs in Pahokee, Florida. FDA has received reports of several adverse events potentially associated with these compounded capsules made by Glades Drugs. Consumption of this product may result in vitamin D toxicity, which may be severe and may lead to life-threatening outcomes if leftuntreated. Patients suffering adverse effects from high Vitamin D levels (Cholecalciferol) may not initially show symptoms. Therefore, patients who have received these compounded capsules should stop taking this medication and immediately seek medical attention.
Symptoms of short-term vitamin D toxicity are due to high calcium levels (also known as hypercalcemia) and include confusion, increased urination, increased thirst, loss of appetite, vomiting, and muscle weakness. Acute hypercalcemia may intensify tendencies for heart arrhythmias and seizures and may increase the effects of certain heart drugs. Long-term toxicity may cause kidney failure, increase in calcium deposits in the blood and soft tissue, bone demineralization and pain. Patients with conditions such as liver disease or chronic kidney failure may be at increased risk for developing vitamin D toxicity.
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Intravascular Medical Devices: FDA Safety Communication - Lubricious Coating Separation
(I think this is so important that I included the entire article)
Including medical devices such as intravascular catheters, guidewires, balloon angioplasty catheters, delivery sheaths, and implant delivery systems
[Posted 11/23/2015]
AUDIENCE: Risk Manager, Cardiology, Surgery, Radiology, Pathology
ISSUE: The FDA wants to make health care providers aware of the possibility that hydrophilic and/or hydrophobic coatings may separate (e.g., peel, flake, shed, delaminate, slough off) from medical devices and potentially cause serious injuries to patients. Coating separation can be caused by a number of factors, ranging from the difficulty of the procedure and the patient’s anatomy to practitioner technique or using the wrong device for the procedure, to improper preconditioning of the device and improper storage conditions as well as issues with device design or manufacturing processes. Based on current information, the FDA believes the overall benefits of these devices continue to outweigh the risks. However, health care providers should be aware of potential problems and consider certain actions prior to use.
Since Jan. 1, 2010, there have been 11 recalls from various manufacturers associated with these coatings peeling or flaking off of medical devices. The majority of the recalls were associated with guidewires, but there have also been recalls for other types of devices including sheaths, retrieval devices and embolization device delivery wires used in the vasculature.
In addition, since Jan. 1, 2014, the FDA has received approximately 500 Medical Device Reports (MDRs) describing separation of hydrophilic and/or hydrophobic coatings on medical devices such as guidewires, catheters, and introducers that had been used for cerebrovascular, cardiovascular and peripheral vascular procedures. The majority of the reports were submitted for vascular guidewires and over 75% of the reports describe device malfunctions.
Serious adverse events reported in these MDRs and in the scientific literature include pulmonary embolism, pulmonary infarction, myocardial embolism, myocardial infarction, embolic stroke, tissue necrosis, and death. Serious injuries associated with the peeling of coatings reported in MDRs included the persistence of coating fragments in patients, requiring surgical intervention to mitigate the consequences, adverse tissue reactions, and thrombosis.
BACKGROUND: The FDA has not concluded that any specific manufacturer or brand of these devices is associated with higher risks than others. The cause of coating separation is multifactorial, and can be associated with factors including device design, device manufacturing, and use. Current FDA analysis suggests that use-related issues may be mitigated through proper device selection, preparation, and other considerations noted below.
RECOMMENDATION: Based on current understanding of the benefits and risks of devices with these coatings, the FDA believes that the overall benefits of these devices continue to outweigh the risks. However, health care providers should consider the following information and actions to reduce the potential of serious adverse events:
- Be aware that many devices are designed, labeled and indicated for specific uses. For example, the coating and performance of a device meant to be used in the peripheral vasculature may be different than a device meant to be used in the cerebral vasculature.
- Follow manufacturer’s instructions for proper device storage (e.g., shelf life, temperature, exposure to light, etc.) as improper storage can impact the integrity of the coating.
- When using two devices together (e.g., catheter and introducer sheath), ensure there is sufficient room for one to pass safely within the other, taking into consideration the features of the device (e.g., curved tip), and that some coatings may swell during use. For example, consider using a slightly larger French size for the introducer sheath than the catheter so there is sufficient room between the devices. Review the device labeling or consult the device manufacturer for further information.
- Follow the manufacturer’s recommended preconditioning steps (if applicable) for the device. Preconditioning activates the lubricious properties of some device coatings for optimal use.
- During preconditioning of the coating, use only the recommended solution (e.g., normal saline, heparinized saline, sterile water, etc.). Solutions may not be interchangeable and may affect the hydrophilic and/or hydrophobic coatings differently.
- Avoid using alcohol, antiseptic solutions, or other solvents to pre-treat the device because this may cause unpredictable changes in the coating which could affect the device safety and performance.
- Avoid pre-soaking devices for longer than instructed, as this may impact the coating performance.
- Avoid wiping the device with dry gauze as this may damage the device coating.
- Use caution when manipulating, advancing and/or withdrawing these devices through needles, metal cannulas, stents, or other devices with sharp edges, or through tortuous or calcified blood vessels. Manipulation, advancement and/or withdrawal past sharp or beveled edges may result in destruction and/or separation of the outer coating which may lead to clinical adverse events.
- Be aware that attempting to alter the shape of devices by bending, twisting, or similar methods may compromise the coating integrity and that damage to the coating may not always be noticeable to the naked eye.
- Consider replacing a device if it does not move freely, is visibly kinked or otherwise damaged, or does not perform as expected.
- For further information on how to use a device safely, consult the labeling or contact the device manufacturer.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
- Complete and submit the report Online: www.fda.gov/MedWatch/report
- Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
[11/23/2015 - Safety Communication - FDA]
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G5 Ventilator by Hamilton: Class I Recall - Ventilation and Alarm Failure
The ventilator may stop working without sounding an alarm when the device operator presses the oxygen enrichment key to attach the ventilator mask to the patient (suctioning maneuver). This problem can occur during the following conditions:
- When pressing the oxygen enrichment key a second time within 50 milliseconds after the disconnection is detected, or,
- When disconnection is detected immediately before the oxygen enrichment period automatically ends, so that detection of disconnection and termination of O2-enrichment occur within 50 milliseconds of each other.
If the device operator does not intervene, the patient may not receive enough oxygen and could suffer serious adverse health consequences, including injury or death.
See the Recall notice for a listing of affected catalog numbers.
BACKGROUND: Recalled Device is the G5 Ventilator V2.00 and V2.31, distribution dates March 2007 to March 2014. The firm has received a total of 1 report of device malfunction. No injuries or deaths were reported.
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accuruler for 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
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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
Old Address: tkriewald@bellsouth.net
New Address: tmhartrn@gmail.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
Hope to hear from you..... Frankie
d. Septic shock is severe sepsis accompanied by persistent hypotension after fluid resuscitation.
Learn more by reading the continuing nursing education article “Reducing sepsis deaths: A systems approach to early detection and management.”
