Sunday, February 14, 2016

Happy Valentines February 14, 2016

PARADIGM BYTES

Newsletter for Paradigm 97
February 14, 2016

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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SNIPPET

 
Zika virus set to spread across Americas, spurring vaccine hunt

GENEVA/LONDON (Reuters) - The mosquito-borne Zika virus, which has been linked to brain damage in thousands of babies in Brazil, is likely to spread to all countries in the Americas except for Canada and Chile, the World Health Organization said on Monday.

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Zika Virus: What You Need to Know 
Zika virus is transmitted to humans primarily through the bite of an infected Aedesspecies mosquito (also a vector for dengue fever, chikungunya and yellow fever viruses). The mosquito typically breeds in domestic water-holding containers; they are aggressive daytime biters and feed both indoors and outdoors near dwellings. There is no vaccine to prevent or medicine to treat Zika. The virus is NOT spread person to person.  
Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito (also a vector for dengue fever, chikungunya and yellow fever viruses). The mosquito typically breeds in domestic water-holding containers; they are aggressive daytime biters and feed both indoors and outdoors near dwellings.  There is no vaccine to prevent or medicine to treat Zika. The virus is NOT spread person to person.
About 1 in 5 people infected with Zika virus become symptomatic. Characteristic clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctivitis. Other commonly reported symptoms include myalgia and headache. Clinical illness is usually mild with symptoms lasting for several days to a week. Severe disease requiring hospitalization is uncommon and case fatality is low. There have been cases of Guillain-Barre syndrome reported in patients following suspected Zika virus infection.
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See also:  Zika the Pandemic virus
http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/55915?xid=nl_mpt_DHE_2016-01-30&eun=g379846d0r
and:
CDC recommends Zika testing for at-risk newborn infants 
The CDC issued new guidance recommending newborns undergo testing for Zika virus infection if their mothers tested positive or inconclusive for the virus, or have reported symptoms of the disease while living abroad in an affected region or within two weeks of travel to such a region. The CDC's Cynthia Moore said one reason for the recommendation is that the full spectrum of problems related to the Zika virus is not known, so screenings are used out of an abundance of caution. The New York Times (free-article access for SmartBrief readers)   
 http://www.nytimes.com/2016/01/27/health/zika-testing-is-urged-for-some-newborns.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl&_r=0

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     FROM A MEMBER 

 

Thank you Barbara:   From Barbara  Acello   msedrn@gmail.com     

 She wrote: "You mentioned recycling in the newsletter. These are great."
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INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days
 
 
  
Compassion fatigue: Are you at risk?

For many of us, nursing isn’t just what we do; it’s who we are. Most of us became nurses because we care about people and want to make a difference in their lives.
Over time, nurses develop a nursing intuition and a working knowledge of disease and trauma. Our intuition, knowledge, and caring don’t automatically shut off when we leave work. For example, have you ever seen a worrisome mole on a complete stranger? Have you felt concern about a friend’s weight or a neighbor’s smoking habits? Have you ever been in a public place when you heard someone coughing—and wondered at what point you might intervene? These experiences are common among nurses. Yet, inability to shut off our knowledge and caring may leave us feeling emotionally saturated and raise our risk for compassion fatigue. ...    http://www.americannursetoday.com/compassion-fatigue/
 
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                                                                             LITTLE KNOWN FACTS:  

 Babies can breathe and swallow at the same time until they are six months old.
  
J is the only letter that does not appear in the periodic table of elements.
Of
 
fice desks have 400 times more bacteria than toilet seats.
If it takes less than five minutes to fall asleep it is likely linked to sleep deprivation.  A healthy sleeper takes about 15 minutes.

Researchers have found that imagining doing exercises actually increases muscle strength.

So far, man has survived on earth for 2 million ears.  The dinosaurs lasted 150 million years.

Most lip balm is made to be addictive.  The more you put it on the more you need it.

The oldest living thing is a mushroom/fungus located in Malheur National Forest in Easter Oregon.  It Covers 2,200 acres and is between 2,000 and 8,000 years old.  h 
ttp://abcnews.go.com/Technology/story?id=120049&page=1
 
 


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Worldwide Boost in Breast-Feeding Could Save 800,000 Lives: Study

THURSDAY, Jan. 28, 2016 (HealthDay News) -- If nearly all women worldwide breast-fed their infants and young children, there would be about 800,000 fewer children's deaths and 20,000 fewer breast cancer deaths a year, researchers report.
That decrease in children's deaths is equivalent to 13 percent of all deaths in children younger than 2 years of age, the study authors reported in a two-part series published online Jan. 28 in The Lancet.
The researchers also said that current breast-feeding practices cost the world's economy hundreds of billions of dollars a year.
"There is a widespread misconception that the benefits of breast-feeding only relate to poor countries. Nothing could be further from the truth," series author Cesar Victora, of Federal University of Pelotas in Brazil, said in a journal news release.
"Our work for this series clearly shows that breast-feeding saves lives and money in all countries, rich and poor alike. Therefore, the importance of tackling the issue globally is greater than ever," Victora added.
Only one in five children in high-income countries is breast-fed for 12 months, the researchers said. And, only one in three children in low- and middle-income countries is exclusively breast-fed for the first 6 months.
This means that millions of children and women don't receive the full benefits offered by breast-feeding, which has been shown to be healthy for both mothers and children, the study authors said.   ...  

https://www.nlm.nih.gov/medlineplus/news/fullstory_156952.html

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STATISTICS:

80 seconds
Heart disease and stroke cause 1 in 3 deaths among women each year, killing approximately 1 woman every 80 seconds.

34%
Percent fewer women who die from heart disease since Go Red for Women started 10 years ago.

43 million
Estimated number of women in the United States affected by heart disease.

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Patient Blood Management Certification Now Available 
Now Available January 27, 201
 By: Elizabeth Eaken Zhani, Media Relations Manager 
AABB Magda Yang (301) 215-6526
Call: (301) 215-6526 publicrelations@aabb.org

(OAKBROOK TERRACE, Illinois, January 27, 2016) – Applications for Patient Blood Management Certification are now being accepted by The Joint Commission. The certification is an evidence-based approach to optimizing care of patients who might need transfusion. It is based on the AABB Standards for a Patient Blood Management Program and can help hospitals and critical access hospitals realize the maximum benefits of establishing a comprehensive patient blood management program.
Blood transfusion is the most common procedure performed during hospitalization,1 but research shows 50 percent of red blood cell transfusions are found to be inappropriate.The voluntary Patient Blood Management Certification encompasses all aspects of patient evaluation and clinical management surrounding the transfusion decision-making process. It can reduce the need for allogenic blood transfusions and reduce health care costs, while ensuring that blood components are available for the patients who need them.
“It’s not easy to implement a cross-functional patient blood management program that is sustainable. The goal of this certification is to help hospitals implement practices to help with several issues, including eliminating unnecessary transfusions and adverse outcomes,” said Mark G. Pelletier, COO, Accreditation and Certification Operations, The Joint Commission. ”We are pleased to partner with AABB on this very important initiative to help hospitals better help their patients.”
The Patient Blood Management Certification promotes patient safety and quality by combining an internationally accepted quality management system structure with appropriate patient blood management technical requirements. The certification review will be a minimum of one day and certification is valid for two years. ...   
 http://www.jointcommission.org/patient_blood_management_certification_now_available/
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Posted: Jan 25, 2016 - The Joint Commission Awards First Integrated Care Certification - The Joint Commission’s Hospital Accreditation Program announced today that Parrish Medical Center, a public, not-for-profit facility in Titusville, Florida, is the first hospital in the United States to be awarded Integrated Care Certification.
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    Ofatumumab   for CLL

    FDA approved ofatumumab (Arzerra Injection, Novartis Pharmaceuticals Corporation) for extended treatment of patients who are in complete or partial response after at least two lines of therapy for recurrent or progressive chronic lymphocytic leukemia (CLL). Ofatumumab was previously approved for the treatment of previously untreated patients with CLL for whom fludarabine-based therapy was considered inappropriate and also for patients with CLL refractory to fludarabine and alemtuzumab. January 19, 2016.  


     
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    Bloodstream infections from peripheral lines: An underrated risk 
     

    Author: Michelle DeVries, MPH, CIC, and Mary Jo Valentine, MSN, RN, CNS
    Analytics—the study of data to reveal meaningful patterns—is remaking large swaths of our culture, from business to sports to politics. In health care, applying analytics toward the goal of preventing bloodstream infections (BSIs) reveals a surprising truth: A hospital is likely to have nearly as many BSIs associated with peripheral I.V. (PIV) lines as with central lines.
    Yet, because we’re trained to focus on the perils of central lines (mainly central venous catheters and peripherally inserted central catheters), we’re likely to overlook PIV perils, with potentially dangerous consequences for both patients and hospital finances. Recognizing this often-underappreciated risk, Methodist Hospitals in Gary and Merrillville, Indiana, now mandate the same kinds of technology for PIVs that central lines require. We take the BSI threat from PIVs seriously.
    Several preliminary studies suggest that nearly as many BSIs are linked to PIVs as to central lines. How can that be? Certainly, the BSI risk associated with central lines far exceeds that of PIVs. According to the Centers for Disease Control and Prevention (CDC), the pooled mean inpatient ward rate for central line–associated BSIs was 1.14 infections per 1,000 central-line days as of 2009 (the latest year for which statistics are available). For PIVs, the aggregate infection rate is less than half that—an estimated 0.5 per 1,000 peripheral-line days.
    But far more PIVs are placed each year than central lines. In the United States, roughly 150 million PIVs are inserted annually, compared to only about 3 million central lines. Even taking into account central lines’ much longer dwell times, you can easily see how the total number of BSIs linked to PIVs could approach or even surpass that of central lines.
    A PIV resembles a central line in one crucial respect—it’s an invasive device through which life-threatening bacteria can penetrate the bloodstream. Then consider that 70% to 80% of hospital patients have PIVs at some time during their stay. No matter which kind of line is involved, preventing BSIs is crucial because infected patients have a 12% to 25% chance of dying from the infection.
    BSIs also can hurt a hospital’s finances, making it harder to provide the best care possible. ...

     http://www.americannursetoday.com/piv/?utm_source=BenchmarkEmail&utm_campaign=Nurse_Today_Newsletter_012616&utm_medium=email

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    Some facts about women’s health 

    14.3% Percent of woman without health insurance (compared to 18.3% for men).
    11.6% Percent of woman unable to get or delayed in getting care during the past 12 months (compared to 9.4% for men).

    5  In 2012, the rate of hospital admissions with hypertension for black women was more than five times the rate for white women.

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    Less than 20% of nurses comply with standard precautions for infection prevention 
     (SCARY STATISTICS)

    Just 17.4 percent of ambulatory care nurses reported that they comply with all nine standard precautions for infection prevention, according to a study in the American Journal of Infection Control. Researchers from Northwell Health in Great Neck, N.Y., surveyed 116 registered nurses working in ambulatory care settings about their compliance with standard precautions, knowledge of hepatitis C virus and behavioral factors that influence compliance.

    Overview http://tinyurl.com/gqx4m89
    Full text http://www.ajicjournal.org/article/S0196-6553(15)01035-4/pdf
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    Skin cancer more deadly when caught during pregnancy

    (Reuters Health) - Melanoma may be even more dangerous when it's diagnosed in women during pregnancy or within a year of giving birth, a U.S. study suggests.
    Among women under 50 with malignant melanoma, those diagnosed during or soon after pregnancy were significantly more likely to have tumors spread to other organs and tissues, and were also much more likely to have the cancer recur after treatment, the study found.
    Women diagnosed around the time of pregnancy were also more likely to die, though the risk increase wasn't big enough to rule out the possibility it was due to chance.
      "This study demonstrated that women who are diagnosed with melanoma during pregnancy or in the post-gestation period have higher risk melanomas," said Dr. Jeffrey Farma, co-director of the cutaneous oncology and melanoma program at Fox Chase Cancer Center in Philadelphia, of the study, which was based on review of medical records for 462 women. ...
    http://www.aol.com/article/2016/01/20/skin-cancer-more-deadly-when-caught-during-pregnancy/21300218/
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     Rate of Severe Stomach Birth Defect Increased Over Two Decades: CDC 
    Gastroschisis, a hole in the abdominal wall, more common in babies born to teen mothers. 

    THURSDAY, Jan. 21, 2016 (HealthDay News) -- A birth defect involving the stomach called gastroschisis has been increasing among U.S. infants for decades, and more than doubled among young, black mothers over an 18-year period, federal health officials report.
    Babies with gastroschisis have a hole in the stomach wall at birth through which the intestines, and sometimes other organs such as the liver, protrude. The condition requires immediate surgery. Most babies do well after the operation, experts from the U.S. Centers for Disease Control and Prevention said.
    "We don't know why gastroschisis is increasing," said Suzanne Gilboa, team leader and an epidemiologist in the CDC's National Center on Birth Defects and Developmental Disabilities.
    Despite the increase, the disorder is still rare. About 2,000 babies in the United States are born each year with gastroschisis, the CDC said.
    What causes the condition isn't known, Gilboa said. However, some possible risk factors have been identified. These include smoking, illegal drug use, alcohol use, and being underweight before getting pregnant. "But we don't know if these are the explanation for what we are seeing," Gilboa said. ... 
    http://consumer.healthday.com/disabilities-information-11/misc-birth-defect-news-63/severe-stomach-birth-defect-has-doubled-over-past-two-decades-cdc-says-707289.html
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     California Voters Will Have Their Say on Drug Prices   Measure would require state to bargain harder with drug companies
    California voters will weigh in this November on a high-stakes ballot proposition intended to help control the cost of prescription drugs – the latest attempt to limit soaring prices that have prompted public criticism nationwide.
    The proposition would require the state to drive a harder bargain with drug companies so it doesn't pay more for medications than the Department of Veterans Affairs. ...
    http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/55924?xid=nl_mpt_DHE_2016-02-01&eun=g379846d0r
     
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     Position statement regarding use of informally shared human milk

    Sharing human milk among family members and between families is a timeless practice. In recent years, there has been an increased governmental investment in breastfeeding, and more families are aware of the evidence supporting the improved health outcomes of infants from human milk and breastfeeding. Thus, there has been a resultant resurgence in informal milk sharing (arranged privately between families and facilitated by social media networks). Formalized networks to facilitate milk sharing recommend including health care professionals in the decision-making and risk-benefit analysis. ...

    The American Academy of Nursing on policy.

    http://www.nursingoutlook.org/article/S0029-6554(15)00336-XCHealth%20Policy


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     Folic Acid Consumption in First Trimester Linked to GDM Risk Much higher risk for women with prepregnancy BMI of ≥25 kg/m² taking FA supplements

    MONDAY, Feb. 8, 2016 (HealthDay News) -- Folic acid (FA) consumption in the first trimester is associated with increased risk of gestational diabetes mellitus (GDM), according to research published online Jan. 28 in Diabetes Care.
    Beibei Zhu, from the Anhui Medical University in Hefei, China, and colleagues used data from the prospective China-Anhui Birth Cohort Study to examine the correlation between FA supplement consumption and the risk of GDM.
    The researchers diagnosed GDM in 12.8 percent of the 1,938 women who had either used FA supplements or never used any vitamin supplements. The risk of GDM was increased in association with daily FA supplement consumption in the first trimester (adjusted odds ratio, 2.25). The risk of GDM was much higher for women with a prepregnancy body mass index (BMI) of ≥25 kg/m² and taking FA supplements daily in the first trimester versus women with a prepregnancy BMI of <25 5.63="" alone="" and="" before="" fa="" font="" gdm.="" had="" in="" increased="" kg="" m="" no="" not="" odds="" of="" or="" pregnancy="" ratio="" risk="" second="" supplements="" taking="" the="" trimester="" using="" women="">
    "Our study, for the first time, suggests that daily FA supplement consumption in early pregnancy increases the risk of GDM, and further larger cohort studies are warranted to examine this adverse effect," the authors write.


    http://www.physiciansbriefing.com/Article.asp?AID=707836

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    Caesarean delivery is associated with higher risk of depressive symptoms, pain and sexual dysfunction 

    Chang SRChen KHHo HNet alDepressive symptoms, pain, and sexual dysfunction over the first year following vaginal or cesarean delivery: a prospective longitudinal studyInt J Nurs Stud 2015;52:143344

    http://ebn.bmj.com/content/early/2016/02/09/eb-2015-102267?papetoc
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    Quiz Time

    Which of the following suggests your patient is experiencing opioid-induced respiratory depression (OIRD)?
    a. Respiratory rate of 11 breaths/minute
    b.  Pulse oximetry (Spo2) of 92%
    c.  Oxygen saturation of 95%
    d. End-tidal carbon dioxide (ETco2) of 26 mm Hg
    Answer at end of Newsletter. 

     
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     STATISTICS

    An AHRQ report released last month reported the following facts about hysterectomy as a treatment for benign uterine fibroids from 2005 to 2013:
    20%
    Percent drop in hysterectomies to treat benign uterine fibroids.
    5
    Hysterectomies performed in hospital-based ambulatory surgery settings increased more than fivefold.

    50%
    Hysterectomies performed in hospitals decreased by half.

    175%
    Percent increase in the rate of uterine fibroid embolization in both ambulatory surgery and inpatient settings.
     
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    Zika: The Unexpected Pandemic   World remains unprepared as novel pathogens just keep coming
    No one really saw Zika virus coming or cared much if it did.
    In general, it has been regarded "clinically inconsequential," Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told MedPage Today -- so much so that it wasn't even on a recent World Health Organization list of pathogens that need urgent research to prevent epidemics.  
    And -- absent its apparent association with a spike in cases of microcephaly in Brazil -- it probably still would be thought of as a minor nuisance, experts toldMedPage Today.
    But Zika virus illustrates a worrisome fact -- the pace of emerging infectious diseases is both increasing and unpredictable.  Zika is a flavivirus, discovered in 1947, that is carried mainly by the mosquito Aedes aegypti. It causes a mild, self-limiting febrile illness in 20% to 25% of the people it infects; most people would never know they had it.
    Until recently, it was pretty much confined to its ancestral home in Africa. Then in 2007 it was found in Micronesia and in 2013 ongoing transmission was documented in French Polynesia. ...

    http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/55915?xid=nl_mpt_DHE_2016-01-30&eun=g379846d0r
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     Interim Guidelines for Pregnant Women during a Zika Virus Outbreak
     
    CDC has developed interim guidelines for health care providers in the United States caring for pregnant women during a Zika virus outbreak. These guidelines include recommendations for pregnant women considering travel to an area with Zika virus transmission and recommendations for screening, testing, and management of pregnant returning travelers. Updates on areas with ongoing Zika virus transmission are available online (http://wwwnc.cdc.gov/travel/notices/). Health care providers should ask all pregnant women about recent travel. Pregnant women with a history of travel to an area with Zika virus transmission and who report two or more symptoms consistent with Zika virus disease (acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis) during or within 2 weeks of travel, or who have ultrasound findings of fetal microcephaly or intracranial calcifications, should be tested for Zika virus infection in consultation with their state or local health department. Testing is not indicated for women without a travel history to an area with Zika virus transmission. In pregnant women with laboratory evidence of Zika virus infection, serial ultrasound examination should be considered to monitor fetal growth and anatomy and referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended. There is no specific antiviral treatment for Zika virus; supportive care is recommended. ...
     http://www.cdc.gov/mmwr/volumes/65/wr/mm6502e1.htm?s_cid=mm6502e1_w
      
    However, due to concerns of microcephaly associated with maternal Zika viral infection, fetuses and infants of women infected with Zika virus during pregnancy should be evaluated for possible congenital infection and neurologic abnormalities. In December 2015, Puerto Rico reported its first confirmed Zika virus case.  More recently, the mother of a newborn delivered in Hawaii with microcephaly likely was exposed to the Zika virus while she was residing in Brazil in May 2015. ...  

    http://www.nursingworld.org/HomepageCategory/NursingInsider/Zika-Virus-What-You-Need-to-Know.html?utm_source=BenchmarkEmail&utm_campaign=Nurse_Today_Newsletter_012616&utm_medium=email
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    CDC recommends Zika testing for at-risk newborn infants 

    The CDC issued new guidance recommending newborns undergo testing for Zika virus infection if their mothers tested positive or inconclusive for the virus, or have reported symptoms of the disease while living abroad in an affected region or within two weeks of travel to such a region. The CDC's Cynthia Moore said one reason for the recommendation is that the full spectrum of problems related to the Zika virus is not known, so screenings are used out of an abundance of caution. The New York Times (free-article access for SmartBrief readers) (1/26) 

     http://www.nytimes.com/2016/01/27/health/zika-testing-is-urged-for-some-newborns.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl&_r=0

    or     http://tinyurl.com/zv3gsqr


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     Researchers find new Zika clues to birth defect in fetus study

    Slovenian researchers found evidence of severe abnormalities in a fetus from a pregnant woman who showed signs of Zika virus infection at 13 weeks of gestation but had normal ultrasounds in the 14th and 20th weeks. Severe abnormalities became apparent in an ultrasound at 29 weeks. Results of a fetal autopsy, reported in the New England Journal of Medicine, revealed evidence of high levels of the Zika virus in brain tissue, providing compelling evidence of a link between the virus and brain defects, experts said.
     Reuters (2/10)  

     http://www.reuters.com/article/us-health-zika-science-idUSKCN0VJ2M7

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    In Brazil, it was found that  Deformed babies also suffering eye damage linked to Zika  

    Children born with abnormally small heads and brain defects linked to the outbreak of Zika virus in Brazil are also suffering serious damage to their eyesight and possibly their hearing, doctors said on Thursday.
    Half of the 135 babies being evaluated at a rehabilitation center in the northeastern Brazilian city of Recife have limited vision due to deformed optic nerves and retinas, and many are cross-eyed, ophthalmologist Camila Ventura said.
    "Their eyes are scarred for life," said Ventura. "Between 40 and 50 percent of them have serious eyesight defects."
    The babies are some of the 3,700 cases reported in Brazil since last year of newborns with a neurological condition called microcephaly that is associated with the mosquito-borne Zika virus sparking a health scare across the Americas.
    The surge in cases of the rare condition is unprecedented and scientists have yet to prove categorically it is caused by Zika. But they know the condition will handicap the development of the children who will have to struggle with learning disabilities and impaired motor functions.
    Doctors at Recife's Altino Ventura rehab center are testing the babies' vision and hearing to determine what they are able to see and hear, before giving them therapy to stimulate their brains. ...

    http://www.reuters.com/article/us-health-zika-eyesight-idUSKCN0V703U?feedType=nl&feedName=healthNews
     
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    Companies and scientists are racing to create a Zika vaccine as concern grows over the mosquito-borne virus that has been linked to severe birth defects and is spreading quickly through the Americas.
    Zika is now present in 23 countries and territories in the Americas. Brazil, the hardest-hit country, has reported around 3,700 cases of the devastating birth defect called microcephaly that are strongly suspected to be related to Zika.
    The Geneva-based World Health Organization (WHO), stung by criticism that it reacted too slowly to West Africa's Ebola epidemic, convenes an emergency meeting on Monday to help determine its response to the spread of the virus.
    The U.S. Centers for Disease Control and Prevention has activated an emergency operations center staffed around the clock to address Zika, agency officials told Reuters.
    On Thursday, the WHO said as many as 4 million people in the Americas may become infected by Zika, adding urgency to the research efforts. Vaccine developers made clear a vaccine for widespread public use is at least months, if not years, away. ...
    http://www.reuters.com/article/us-health-zika-who-idUSKCN0V61JB?feedType=nl&feedName=healthNews 
     
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     This is very old...accidentally found it.  the link works...but there is no new info on the subject that I could find.

    Researchers have developed a microfluidic chip that can capture rare clusters of circulating tumor cells, which could yield important new insights into how cancer spreads. The work was funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), part of the National Institutes of Health.
    Circulating tumor cells (CTCs) are cells that break away from a tumor and move through a cancer patient’s bloodstream. Single CTCs are extremely rare, typically fewer than 1 in 1 billion cells. These cells can take up residence in distant organs, and researchers believe this is one mode by which cancer spreads.
    Even less common than single CTCs are small groups of CTCs, or clusters. While the existence of CTC clusters has been known for more than 50 years, their prevalence in the blood as well as their role in metastasis has not been thoroughly investigated, mostly because they are so elusive. However, recent advances in biomedical technologies that enable researchers to capture single CTCs have renewed interest in CTC clusters, which are occasionally captured along with single CTCs. ...   http://www.nih.gov/news-events/news-releases/microchip-captures-clusters-circulating-tumor-cells-nih-study 
     
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     Submit your paper to Journal of Research in Nursing
    
    Co-Editors in Chief:
    Professor Andree Le May, Formerly Professor of Nursing, University of 
    Southampton, UK
    Dr Ann McMahon, Honorary Research Fellow, University of Glasgow, UK
    
    The Journal of Research in Nursing is a leading peer reviewed journal that 
    blends good research with contemporary debates about policy and practice. The Journal 
    of Research in Nursing contributes knowledge to nursing practice, research and local, 
    national and international health and social care policy. Each issue contains a variety 
    of papers and review commentaries within a specific theme. 
     ****************************
     
    Britain and Bill Gates pledge 3 billion pounds to fight malaria
    LONDONSubmit your paper to Journal of Research in Nursing
    Co-Editors in Chief:
    Professor Andree Le May, Formerly Professor of Nursing, University of 
    Southampton, UK
    Dr Ann McMahon, Honorary Research Fellow, University of Glasgow, UK
    
    The Journal of Research in Nursing is a leading peer reviewed journal that 
    blends good research with contemporary debates about policy and practice. The Journal 
    of Research in Nursing contributes knowledge to nursing practice, research and local, 
    national and international health and social care policy. Each issue contains a variety  
    of papers and review commentaries within a specific theme.  
    (Reuters) - Britain will spend 500 million pounds ($700 million) per year for the next five years to try and end deaths caused by malaria, the government said on Monday, announcing a partnership with Microsoft founder Bill Gates worth a total of 3 billion pounds.

     ****************** 
     
     RANDOM TIDBITS:  The rockets mentioned in "The Star Spangled Banner" were less effective than bombs. They had a shorter range and were so inaccurate that they had to be abandoned as weapons after the War of 1812. Not until World War II did rockets become important.

    ***

    Bonus Fact:  The Pentagon is the world's largest office building, a city in itself. With an area of 6,500,00 square feet the Pentagon has a Main Street lined with shops, restaurants and its own post office.
                                                                                   **** 

     Bonus Fact: On November 19, 1863, at the dedication of a military cemetery at Gettysburg, Pennsylvania, during the American Civil War, President Abraham Lincoln delivers one of the most memorable speeches in American history. In just 272 words, Lincoln brilliantly and movingly reminded a war-weary public why the Union had to fight, and win, the Civil War. 


     

                                                                   ~~**~~**~~**~~**~~**~~
    HUMOR SECTION

    Are you ready for some bizarre colonoscopy humor?  
                           
    [A physician claims these are actual comments from his
    patients made while he was performing colonoscopies.]
    
    1. "Take it easy, Doc, you're boldly going where no man
    has gone before."
    
    2. "Find Amelia Earhart yet?"
    
    3. "Can you hear me NOW?"
    
    4. "Oh boy, that was sphincterrific!"
    
    5. "Are we there yet? Are we there yet? Are we there yet?"
    
    6. "You know, in Arkansas, we're now legally married."
    
    7. "Any sign of the trapped miners, Chief?"
    
    8. "You put your left hand in, you take your left hand out.
    You do the Hokey Pokey...."
    
    9. "Hey! Now I know how a Muppet feels!"
    
    10. "If your hand doesn't fit, you must acquit!"
    
    11. "Hey, Doc, let me know if you find my dignity."
    
    12. "You used to be an executive at Enron, didn't you?"
    
    13. "Could you write me a note for my wife, saying that my
    head is not, in fact, up there?"
                                                                                   ****************
    
    
    
    This is a little 'off color", but I am embarrassed to say....I laughed.     
     A wife, being the romantic sort, sent her husband a text;

    "If you are sleeping, send me your dreams. 

    If you are laughing, send me your smile.

     If you are eating, send me a bite. 

    If you are drinking, send me a sip. 

    If you are crying, send me your tears.

     I love you." 
    He replied, "I am in the bathroom. Please advise."

       
    ~**~**~~**~~**~~**~~**~~

    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. info@sharedgovernance.orgwww.sharedgovernance.org 

    Pay Only $34.99 for a full year of CONTACT HOURS 
    www.nurse.com for CNE offerings.

     
                                       
                                   
    Antibody Signals Adverse Pregnancy Outcome
    Lupus anticoagulant was the only antiphospholipid antibody linked with poor birth outcome ...  (Need to log into Medpage for this CME)   

    http://www.medpagetoday.com/Rheumatology/Lupus/55791?xid=nl_mpt_DHE_2016-01-23&eun=g379846d0r   
     

    ~~**~~**~~**~~**~~**~~
    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/

                                                               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

    *******************************************************
    ********************************************
    *
    MEDICAL RECALLS
    *
    *******************************************
    ******************************************************
     
     Magnesium Sulfate in Water for Injection by Hospira: Recall - Incorrect Barcode Labeling on the Primary Container

    Hospira, Inc. announced a voluntary recall of one lot of MAGNESIUM SULFATE IN WATER FOR INJECTION (0.325 mEq Mg**/mL) 40 mg/mL 2g total, 50 mL (NDC: 0409-6729-24, Lot 53-113-JT, Expiry 1NOV2016) to the user level due to a confirmed customer report of an incorrect barcode on the primary bag labeling. The product has a barcode identifying the product contents on both the overwrap and on the primary container. The barcode on the overwrap is correct; however, there is potential for the primary container barcode to be mislabeled with the barcode for HEPARIN SODIUM 2000 USP UNITS/1000 mL in 0.9% SODIUM CHLORIDE INJECTION. The product is labeled with the correct printed name on the primary container and overwrap. See thePress Release for product photos.
    If the incorrect barcode on Magnesium Sulfate in Water for Injection is not detected prior to dispensing or administration to a patient, and the product is administered based on the printed name, patient harm is unlikely since the barcode on the overwrap and readable text on the primary container and overwrap are correct. However, if detected, there is the potential for delay in treatment of Magnesium Sulfate in Water for Injection that can result in life-threatening seizures, stroke, cerebral hemorrhage and maternal death, and attendant risks to the fetus, including fetal demise. Administration of the magnesium sulfate drug product to a patient who is prescribed heparin and in whom the Magnesium Sulfate is contraindicated can result in serious adverse events related to the drug’s pharmacologic action and may require medical intervention. Although serious in nature, the likelihood of this risk to occur is low due to the high detectability of this nonconformance.
    BACKGROUND: Magnesium Sulfate in Water for Injection is indicated for the prevention and control of seizures in preeclampsia and eclampsia, respectively. The product is packaged 50 mL fill, in 100 mL container bags and sold 24 bags per carton (NDC: 0409-6729-24, Lot 53-113-JT, Expiry 1NOV2016). The lot was distributed nationwide in the U.S. to wholesalers, distributors and hospitals from September 2015 to November 2015. Hospira has initiated an investigation to determine the root cause and corrective and preventive actions.
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm480224.htm
    or   http://tinyurl.com/jg5fmdb 
    *****************
    Pleural and Pneumopericardial Drainage Sets by Stryker Fuhrman - Class I Recall - Catheter May Break During Insertion


    Stryker Sustainability Solutions received two reports that the catheter included in the Drainage Set broke off in the pleural cavity while inserting the device into the patient. Both cases resulted in the need for medical intervention. This issue could cause serious patient injury or death.
    See the Recall Notice for further information, including manufacturing dates, distribution dates, and lot numbers.
      The Fuhrman Pleural/Pneumopericardial Drainage Set is used to remove air from the sac (pericardium) surrounding the heart, or to drain air or fluid from thin covering (pleural cavity) that protects the lungs.
    Customers with questions should contact the Stryker Sustainability Solutions Complaint Hotline: 1(888) 888-3433 x5555.

    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm481251.htm

    or  http://tinyurl.com/jo7r8ks

    ***************
    • Sunmark  
    • Rite-Aid  
    • Topcare  
    • Kroger  
    • GoodSense  
    • Dollar General
    • Care One  
    • CVS

    Perrigo Company announced that, following the recent recall of certain dosing cups by its supplier, it has initiated a voluntary product recall in the US to the retail level of 2 batches of its children's guaifenesin grape liquid (100mg/5 mL) and 3 batches of its children's guaifenesin DM cherry liquid (100mg guaifenesin and 5mg dextromethorphan HBr/ 5 ml) sold in 4 oz. bottles with dosage cup in a box under multiple store brand product names. Some packages contain an oral dosing cup with incorrect dose markings. See the press release for affected label and lot numbers.
    At risk populations such as those who are poor metabolizers of dextromethorphan may experience an overdose by a factor of 3, if incorrect measuring levels are used.
    Consumers should be aware that an overdose of Guaifenesin DM may cause hyper excitability, rapid eye movements, changes in muscle reflexes, ataxia, dystonia, hallucinations, stupor, and coma. Other effects have included nausea, vomiting, tachycardia, irregular heartbeat, seizures, respiratory depression, and death. Small children who are poor metabolizers of dextromethorphan and use the product regularly over a period of several days at the mistaken dose, may develop cumulative toxicity. Moreover, adverse reactions to guaifenesin when given in high or excessive dosage may include nausea/vomiting, diarrhea, and/or abdominal pain. Therefore, an extreme overdose in an at risk population may need medical intervention, but in most cases adverse health consequences are temporary and reversible.
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm481563.htm
    or  http://tinyurl.com/zwnxn5w
    ********************

     FDA MedWatch - Baxter IV Solutions: Recall - Potential Presence of Particulate Matter 
    • 0.9% Sodium Chloride Injection, USP, 250 mL VIAFLEX Plastic Container
    • 70% Dextrose Injection (2000 mL) USP

    AUDIENCE: Pharmacy
    ISSUE: Baxter International Inc. announced a voluntarily recall of two lots of intravenous (IV) solutions to the hospital/end user level due to the potential presence of particulate matter. The particulate matter in each case was determined to be an insect and was identified as a result of a customer complaint.
    The lots being recalled were distributed to customers and distributors in the United States between June 6, 2015 and December 16, 2015. See the Press Release for affected lot numbers.
    Injecting a product containing particulate matter, in the absence of in-line filtration, may result in blockage of blood vessels, which can result in stroke, heart attack or damage to other organs such as the kidney or liver. There is also the possibility of allergic reactions, local irritation and inflammation in tissues and organs.
    BACKGROUND: 0.9% Sodium Chloride Injection, USP, 250 mL VIAFLEX Plastic Container is intended for IV use as a source of water and electrolytes and may also be used as a priming solution in hemodialysis procedures. 70% Dextrose Injection (2000 mL) USP is indicated as a source of calories and water for hydration.
    RECOMMENDATION: Baxter is directing customers not to use the product from the recalled lots. Recalled product should be returned to Baxter for credit by contacting Baxter Healthcare Center for Service at 1-888-229-0001, Monday through Friday, between the hours of 7 a.m. and 6 p.m., Central Time. Unaffected lots of product are available for replacement. This recall is not expected to affect current supply and product remains available for current customers.
    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
    Read the MedWatch Safety Alert, including links to the press release at:
     
     **************

      FDA MedWatch - Magnesium Sulfate in Water for Injection by Hospira: Recall - Incorrect Barcode Labeling on the Primary Container

    AUDIENCE: Pharmacy
    ISSUE: Hospira, Inc. announced a voluntary recall of one lot of MAGNESIUM SULFATE IN WATER FOR INJECTION (0.325 mEq Mg**/mL) 40 mg/mL 2g total, 50 mL (NDC: 0409-6729-24, Lot 53-113-JT, Expiry 1NOV2016) to the user level due to a confirmed customer report of an incorrect barcode on the primary bag labeling. The product has a barcode identifying the product contents on both the overwrap and on the primary container. The barcode on the overwrap is correct; however, there is potential for the primary container barcode to be mislabeled with the barcode for HEPARIN SODIUM 2000 USP UNITS/1000 mL in 0.9% SODIUM CHLORIDE 

    INJECTION. The product is labeled with the correct printed name on the primary container and overwrap. See the Press Release for product photos.
    If the incorrect barcode on Magnesium Sulfate in Water for Injection is not detected prior to dispensing or administration to a patient, and the product is administered based on the printed name, patient harm is unlikely since the barcode on the overwrap and readable text on the primary container and overwrap are correct. However, if detected, there is the potential for delay in treatment of Magnesium Sulfate in Water for Injection that can result in life-threatening seizures, stroke, cerebral hemorrhage and maternal death, and attendant risks to the fetus, including fetal demise. Administration of the magnesium sulfate drug product to a patient who is prescribed heparin and in whom the Magnesium Sulfate is contraindicated can result in serious adverse events related to the drug’s pharmacologic action and may require medical intervention. Although serious in nature, the likelihood of this risk to occur is low due to the high detectability of this nonconformance.

    BACKGROUND: Magnesium Sulfate in Water for Injection is indicated for the prevention and control of seizures in preeclampsia and eclampsia, respectively. The product is packaged 50 mL fill, in 100 mL container bags and sold 24 bags per carton (NDC: 0409-6729-24, Lot 53-113-JT, Expiry 1NOV2016). The lot was distributed nationwide in the U.S. to wholesalers, distributors and hospitals from September 2015 to November 2015. Hospira has initiated an investigation to determine the root cause and corrective and preventive actions.

    RECOMMENDATION: Anyone with an existing inventory of the recalled lot should stop use and distribution and quarantine the product immediately. Customers should notify all users in their facility. Customers who have further distributed the recalled product should notify any accounts or additional locations which may have received the recalled product and instruct them if they have redistributed the product to notify their accounts, locations or facilities to the consumer level.
    Hospira is notifying its direct customers via a recall letter and is arranging for impacted product to be returned to Stericycle in the United States. For additional assistance, call Stericycle at 1-877-650-7695 between the hours of 8 a.m. to 5 p.m. ET, Monday through Friday.
    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
    Read the MedWatch safety alert, including a link to the press release, at:

    ***************

    Evita V500 and Babylog VN500 Ventilators by Dräger: Class I Recall - Issue with Optional PS500 Battery Power Supply May Cause Ventilators to Shut Down Unexpectedly

    AUDIENCE: Risk Manager, Surgery, Critical Care Medicine, Nursing, Pediatrics
    ISSUE: Dräger is recalling the PS500 battery power supply because a software issue causes shorter than expected battery run times. The software issue with the power supply also prevents the appropriate alarm from sounding 5 minutes before the battery runs out of power and the device shuts down. If the ventilator shuts down, a patient may not receive necessary oxygen. This could cause patient injury or death.
    The recalled device is the optional PS500 battery power supply for Dräger Evita V500 and Babylog VN500 ventilators, manufactured from June 1, 2011 to October 30, 2015 and distributed from June 1, 2011 to October 30, 2015. See the Recall Notice for further information, including catalog numbers and pictures.
    BACKGROUND: The PS500 is an optional battery power supply sold for use with the Dräger Evita and Babylog ventilators. The Evita V500 Ventilator provides constant breathing support for adults and children, including premature babies weighing at least 14 ounces. The Babylog VN500 provides constant breathing support for premature babies weighing at least 14 ounces. Both ventilators are used in hospitals or during patient transport.
    RECOMMENDATION: Dräger sent a letter to all customers with affected devices on December 3, 2015, informing them of this issue. The letter indicates that Dräger will contact customers with affected devices to update battery charging software, and replace batteries if necessary, free of charge.
    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.
    Read the MedWatch safety alert, including a link to the FDA Recall Notice, at:
     
    aturday.
    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
    Read the MedWatch safety alert, including a link to the firm press release, at:
     
     
    Multiple Products by R Thomas Marketing: Recall - Undeclared Drug Ingredient
    AUDIENCE: Consumer

    ISSUE: R Thomas Marketing LLC is voluntarily recalling all lots of the following products to the consumer level:

    •Black Ant: BIG BOX (20 small boxes / 4 capsules per box / 80 capsules total)
    •Herb Viagra: BIG BOX (20 small boxes / 4 capsules per box / 80 capsules)
    •Real Skill: BIG BOX (20 small boxes / 4 capsules per box / 80 capsules)
    •Stree Overlord: BIG BOX (20 small boxes / 4 capsules per box / 80 capsules)
    •Weekend Prince: BIG BOX (24 individual cards / 2 capsules per card/ 48 capsules)
    •African Black Ant: BIG BOX (8 small boxes / 6 capsules per box / 48 capsules)

    These products were tested by the FDA and found to contain sildenafil, a PDE-5 Inhibitor which is the active ingredient in an FDA-approved drug for erectile dysfunction (ED) making this tainted dietary supplement and unapproved drug. This undeclared active ingredient poses a threat to consumers because sildenafil may interact with nitrates found in some prescription drugs such as nitroglycerin and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. Additionally, the product may cause side effects, such as headaches and flushing.
    Out of an abundance of caution, R Thomas Marketing is also recalling all lots of various other products previously sold at the consumer level because these products were sourced from the same vendors as the above-mentioned products and may have resulted in similar misbranding or the likelihood for misbranding to occur in the future. See the Press Release for a list of all recalled products.
    BACKGROUND: These products were marketed as dietary supplements for male sexual enhancement. The products are packaged in accordance with the respective identifiers listed above. All lots of the specified products sold by R Thomas Marketing via internet sales from September 2013 to present are included in this recall.
    RECOMMENDATION: Consumers and retailers that have any of these above mentioned products should stop using and/or distributing this product immediately and arrange return of the products to: Attn: RECALL NOTICE, R Thomas Marketing LLC, 20 Passaic St., Trenton, NJ 08618
    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.
    Read the MedWatch Safety Alert, including a link to the firm press release, at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm481067.htm
     
                                                                 ~~**~~**~~**~~**~~**~~
    ADVERTISEMENTS
    from the members

    This ad is from Decubqueen (Gerry)..........AccuRuler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
    ~~**~~**~~**~~**~~**~~

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

    No new names for this issue 


    ~~**~~**~~**~~**~~**~~
    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 addressSo, be certain to let me know when you change your address. RNFrankie@AOL.com

    ~~**~~**~~**~~**~~**~~

    EDITORIAL STAFF:
    GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)

    ~~**~~**~~**~~**~~**~~

    PARADIGM 97 CO-FOUNDERS:
    MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)

    ~~**~~**~~**~~**~~**~~

    DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
    ~~**~~**~~**~~**~~**~~
    THOUGHT FOR THE DAY

    Government is not reason; it is not eloquence;
     it is force!  Like fire, it is a dangerous servant and a fearful master. 

      George Washington 
     
     



    Hope to hear from you..... Frankie

      
      Answer : d. OIRD usually manifests as a respiratory rate between eight and
    10 breaths/minute, Spo2 below 90%, and ETco2 below 30 mm Hg or above 50 mm Hg. However, OIRD may occur outside these parameters.

    No comments: