PARADIGM BYTES
Newsletter for Paradigm 97
November 8, 2008

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/

MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPETS
Cranberry Juice for Urinary Tract Infections Not Just Myth: Israeli Scientist

Have a urinary tract infection, or bladder infection? You’ll probably hear it from every second person you mention it to- “Drink lots of cranberry juice. As much as you can. It really helped me. Cranberry juice.”
Who says? What is this, some kind of folk remedy, an Urban Legend, or has someone actually studied this and found it to work? One man really has looked at this sweet/sour berry, and made it the focus of the last 20 years of his professional life. He has even found the molecule that causes the mythical antibiotic effect.
Professor Itzhak Ofek, a researcher at Tel Aviv University, isolated the molecule, which he named non-dialyzable material or NDM. It seems to coat some bodily surfaces with Teflon-like efficiency, preventing infection-causing agents from taking root., NDM surprisingly appears to have little effect on the good bacteria in our bodies, according to Prof. Ofek.
E. Coli-Proof Proanthocyanidins
In a 1991 paper in the The New England Journal of Medicine [1], he described cranberry juice’s property of preventing certain E. coli bacteria from sticking to the bladder's lining. Other fruit juices such as orange, pineapple, guava, mango, and grapefruit did not have the anti-adhesion effect. This followed an earlier 2001 paper in the Federation of American Societies for Experimental Biology Journal [2] in which Rutgers University researchers found that that cranberry proanthocyanidins are absorbed in the body and may possibly be the compounds behind the anti-adhesion of E. coli in the urinary tract.
Women Only
This research, interestingly, only holds true for women. “The whole thing with cranberries seems to be female-oriented,” admits Prof. Ofek.
He continues, “The take-home message is that God created this fruit with a polyphenolic material. We still don't know its chemical formula, but it seems to target a fraction of bacteria and viruses.” Studies in 2001, 2002 and 2003 focused in women [3] [4] [5], and confirmed the beneficial results. Much of the research has been funded by Ocean Spray Cranberries, Inc.
When you consider that up to 60% of women will experience a urinary tract infection some time in their lives, and a third of them will have several recurrences [6], you start to wonder about the results a little. But don’t worry, men, you haven’t been left out. Recently, it was found that cranberry NDM may also act as an anti-cancer agent, and studies have also looked at cranberries’ effects as a mouthwash.
“We found that NDM inhibits adhesion of oral bacteria to tooth surfaces and as a consequence reduced the bacterial load that causes cavities in the mouth,” says Prof. Ofek. “And after a clinical trial, we formulated a mouthwash based on cranberries which was patented by Tel Aviv University.”
Prof. Ofek has also collaborated with Dr. Haim Shmuely, physician and lecturer at Tel Aviv University, to find that cranberry also inhibits two-thirds of the “unhealthy” bacteria that clings to gastric cells, which lead to ulcers.
“The results were very interesting,” says Prof. Ofek. “Cranberry helped reduce the load of this bacteria, Helicobacter pylori, in the gut. In combination with antibiotics, it reduced repeat ulcers from approximately 15 percent to about 5 percent.”
References
1. Ofek I, Goldhar J, Zafriri D, Lis H, Adar R, Sharon N. Anti-Escherichia coli adhesion activity of cranberry and blueberry juices. New England Journal of Medicine 1991; 324: 1599.
2. Howell AB, Leahy M, Kurowska E, Guthrie N. In vivo evidence that cranberry proanthocyanidins inhibit adherence of p-fimbriated E. coli bacteria to uroepithelial cells. Federation of American Societies for Experimental Biology Journal 2001; 15: A284.
3. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. British Medical Journal 2001; 322: 1571-1575.
4. June 2002 - Stothers L. A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. The Canadian Journal of Urology 2002; 9: 1558-1562.
5. Kontiokari T, Laitinen J, Jarvi L, Pokka T, Sundqvist K, Uhari M. Dietary factors protecting women from urinary tract infection. American Journal of Clinical Nutrition 2003; 77: 600-604
6. Foxman B, Barlow R, D'Arcy H, Gillespie B, Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol 2000; 10: 509-515
http://www.medopedia.com/cranberry-juice-urinary-tract-infections
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It certainly looks like yet another of granny's remedies has some good scientific backing. Although much of it is still theory and research is still ongoing, there are several possible ways in which cranberry juice may help in cystitis.
Acidifying or alkalinising urine
Some people believe that making the urine more acid can help cystitis, while others say that doing the opposite - making it more alkaline - is better.
There's some evidence that either approach calms the pain and discomfort of cystitis and controls levels of bacteria.
Acidifying the urine also prevents the formation of kidney and bladder stones.
One way to do this is to take ascorbic acid or vitamin C supplements. Drinking cranberry juice has been suggested as a natural way to acidify the urine, but to get the best effect you need a lot of cranberry, which means finding a juice with a high concentration of cranberries (more than 50 per cent - most commercial brands are only half this strength) or drinking large amounts of weaker juice.
Alkalinising urine seems to be more effective in reducing symptoms, especially for women who are 'culture negative' - that is, no harmful bacteria can be detected in their urine.
This can be done by drinking treatments based on potassium or sodium citrate, which you can buy at the chemists. It's not clear how alkalinising the urine helps but it can quickly get rid of symptoms often without the need for antibiotics.
Inhibiting bacteria
Cranberry juice contains chemicals which inhibit the activity of E. coli - the bacteria most often responsible for cystitis. The chemicals - condensed tannins or proanthocyanidins - stop the bacteria sticking to mucosal surfaces lining the bladder and gut.
This helps to clear bacteria from the urinary tract and recent research shows these may be the most important effect of cranberry juice.
The chemicals in cranberry juice may have this effect on other bacteria too. It's now being recommended as a way to reduce the risk of dental decay and stomach ulcers causes by Helicobacter pylori.
An important part of treating cystitis is drinking lots of fluid to flush out the urinary tract.
Keeping infection at bay
Two glasses of cranberry juice a day can help to prevent urine infections, especially in people who are more vulnerable, including those who have to use catheters.
Another bonus is that it can help reduce problems with the smell of urine that are a nuisance, especially for people with permanent catheters. http://www.bbc.co.uk/health/ask_the_doctor/cystitiscranberry.shtml

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FROM A MEMBER

The following is from Sue (GalloRN@AOL.com) Please share ! She writes:
"Just a quick note to see if any of you have specific wake up assessments (from sedation) protocols in the ICU. If so, would you be willing to share? We want to look at developing a protocol and presently don't have one written. Please share with your contacts as well so I can gather some info. If you can email it to me, that would be great. Thanks." Sue (Gallorn@AOL.com)
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I wrote Cindi ( CLWigston@osmh.on.ca )—our newest member-- and asked the following: I heard from a health care (EMT) "worker" that MRSA has mutated and now has no problems with anti-bacterial cleansing solutions of any kind. Is this true? I also wonder if health care workers-- to due their care of a MRSA or VRE patient-- could become carriers and have no idea that they are carriers? Should all nurses,etc. be tested for this? Just as we are protected with PPD and Hep B prevention ?
Her answer : " As for the mutation – any environmental cleaner that has activity against staph/enterococci (and all licensed here in Canada do) will work against MRSA/VRE. They have not, at least to my knowledge, become resistant to this type of agent. We must remember during the cleaning process that contact time and adequate cleaning (ie. Get all the stuff off the bed rails ) is the most important step in the process. Many of our facilities are now using accelerated hydrogen peroxide based products (i.e. Virox®) for several reasons. More environmentally friendly, good kill time etc.
The persistant carrier state in HCW’s, and again, this is Canadian in perspective, is not well documented. That may not be true south of the border. What I tell staff here is that generally they do not meet the criteria for developing colonization/infection as they are not hospitalized, not on massive abx therapy etc . . . I will attach our provincial BPG for your enjoyment. ( She did attach a copy ...if you are interested, ask her for a copy of their Policies and Procedures on this subject ) The title is:
Best Practices For Infection Prevention and Control of Resistant Staphylococcus aureus and EnterococciMethicillin-resistant Staphylococcus aureus (MRSA)Vancomycin-intermediate Staphylococcus aureus (VISA)Vancomycin-resistant Staphylococcus aureus (VRSA)Vancomycin-resistant Enterococcus
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The following was sent in by Bacello (Barbara) who regularly contributes to the Newsletter. Thank You. This page has simple handouts on a gazillion subjects. Although they were designed for patient teaching, they are also very appropriate (or easily modified) if you need something specific for CNA classes or inservices. (Or for the CNAs who are receiving this email who are looking for useful information for themselves or patients/residents.) If you want to check one, take a look at Dermatology, skin turgor. If you want to use these as written, you can download them in pdf format. If not, just read them online.Free registration is required ............... Bacello (Barbara) http://www.modernmedicine.com/patienteducation
http://listmgr.advanstar.com/t/8073524/81505816/782057/0/ - Library of over 3,600 illustrated handouts- Printable & customizable- Add instructions & practice info- Search over 1,600 diseases & conditions
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Birdijo@AOL.com (Cary) sent me a letter she had written to a newspaper in protest to their published article. Here is what she wrote: "Here is an excerpt from the letter I actually sent including the nursing comments: Some of your health care coverage has been good, but I often find it lacking simply because you tend to talk only to doctors, and in reality there are far more nurses caring for patients than doctors and we know much more in general about how patients are getting by, how hospitals work, home health and community health issues, etc., than docs often do. It seems your writers do not understand what nurses do. When you are hospitalized, it is for nursing care, not medical care. In addition, your paper has a nasty habit of calling everyone who isn't a doctor, a nurse, whether they are CNAs, unlicensed assistants, etc. which does a HUGE disservice to nurses. I suggest whenever you cover a healthcare topic, you consult nurses as well as your other sources and don't give a degree to someone until you know they actually have it. An excellent organization for information is the Center for Nursing Advocacy, although there are many individual nurses in the Chicagoland area who would be excellent sources for information. That is my nursing toot-I hope you will pass the information on and take it in the educational spirit in which it is intended.I very much appreciate your offer to come downtown and have a look-see and meet writers. I would love to do it. Unfortunately, I have a health issue of my own right now which prevents me from taking you up on that offer.Thank you again for your interest in subscriber's comments! It was unexpected. I look forward to seeing the new format and hope the changes are positive". Cary Jo Cook, RN, BSN
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INTERESTING READING

Please remember that the REUTERS articles are often good for only 30 days

WASHINGTON (Reuters 9/11 ) - Avoid Chinese-made baby formula: Baby formula from China is illegal in the United States and should not be used, U.S. regulators warned on Thursday after Chinese officials blamed tainted formula for the death of an infant.
U.S. Food and Drug Administration officials said it was possible that some formula from China may have slipped into markets serving Chinese consumers in the United States even though its sales are prohibited.
The agency advised consumers not to purchase or use baby formula from China if they do see it.
"We have some concerns that there may be some supplies of infant formula that may have gotten into the country illegally and may be in specialty markets that serve the Chinese community," Janice Oliver, deputy director of the FDA's Center for Food Safety and Applied Nutrition, said in an interview... http://www.reuters.com/article/healthNews/idUSN1130903520080911?feedType=nl&feedName=ushealth1100
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UPDATE: BEIJING (Reuters 10/3) - Nearly 10,700 Chinese infants and children were still in hospital after drinking toxic milk and milk formula, China said on Thursday, but urged foreign customers to take a "scientific" approach to the safety of its products.
The country is still wrestling with a tainted milk scandal that has killed four babies, made tens of thousands more ill and affected products around the world.
But it has rushed to assure buyers abroad and at home that the government is back in control and has closed the loopholes that allowed the industrial chemical melamine, used in making plastics and in pesticides, to get into milk.
"Every country has to ensure the food safety and the health of its domestic consumers," foreign ministry spokesman Qin Gang told a regular briefing on Thursday. But we also need to find an objective, scientific approach to handle and analyze this problem," he said, adding that foreign customers would recover their confidence in Chinese food exports as control measures are strengthened".... http://www.reuters.com/article/healthNews/idUSTRE4980A420081009?feedType=nl&feedName=ushealth1100
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RANDOM FACT... The time spent deleting SPAM costs United States businesses $21.6 billion annually.

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For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral aspect of the thigh. Prevention & Control of Influenza - Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2008 MMWR 2008 Jul 17; Early Release:1-60. (Also available as PDF, 586K).
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HONG KONG (Reuters) - Delivering flu vaccines straight into the lungs instead of through routine injections could trigger a far stronger immune response, a study has found.
The world is expected to be extremely short of vaccines in the event of a flu pandemic, so the search for the best way to deliver vaccines is important because it would economize on the quantity of each dose.
The Australian study, published in Mucosal Immunology, showed that lower doses of a seasonal flu vaccine delivered into the lungs of sheep gave better protection against flu than a higher standard dose that was injected into another group of sheep.
"Our results suggest that delivery by the lung may allow a much lower ... dose to be used in the influenza vaccine, while inducing equivalent or perhaps even improved protection. This would mean more people would quickly be able to receive the vaccine," associate professor Philip Sutton of the Center for Animal Biotechnology at the University of Melbourne wrote in an email to Reuters.
The scientists delivered three different doses of flu vaccines (15, 5 and 1 micrograms) into the lungs of three groups of sheep using a bronchoscope, or tube. A fourth group of sheep was injected with standard 15-microgram flu vaccines.... http://www.reuters.com/article/healthNews/idUSTRE48O1LC20080925?feedType=nl&feedName=ushealth1100
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RANDOM FACT... The name "pumpkin" comes from the Greek word "pepon," meaning a large melon.

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NEW YORK (Reuters Health) - Testing lung fluid samples for levels of surfactant protein D (SP-D), which is thought to have a protective effect on the lungs, may help identify patients with a high risk of lung cancer, Canadian researchers report.
"The only proven way to cure lung cancer is to detect it early," lead author Dr. Don D. Sin, of the University of British Columbia in Vancouver, told Reuters Health. Finding a method to predict who will and will not develop lung cancer would permit screening for high-risk patients and initiation of therapies to reduce lung cancer risk, he noted.
To this end, Sin and colleagues measured SP-D levels in 71 individuals (72 percent male) who participated in a lung cancer prevention study, the researchers report in the medical journal Chest. Low levels of SP-D in lung fluid have been associated with abnormal or precancerous cells, referred to as "dysphasia."
The study group consisted of former and current (73 percent) smokers with bronchial dysplasia. The patients underwent bronchoscopy, a diagnostic procedure that inspects the windpipe and lungs, at the start of the study and 6 months later. All of the patients received inhaled budesonide therapy to lower their risk of lung cancer.... http://www.reuters.com/article/healthNews/idUSTRE48N7QY20080924?feedType=nl&feedName=ushealth1100
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RANDOM FACT... Wearing headphones for just an hour will increase the bacteria in your ear by 700 times.

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LONDON (Reuters 10/09 ) - A protein in the inner ear helps people differentiate between sounds and understand speech, French researchers reported on Wednesday in a finding that could help treat the hard of hearing.
The study also helps explain why some people have difficulty hearing in crowded restaurants or other noisy places, said Paul Avan, a researcher at the University of Auvergne in Clermont-Ferrand, France.
"This won't help cure deafness but will help diagnose why some people have hearing problems, especially in noisy places," Avan, who worked on the study, said in a telephone interview.
The study, which used genetically engineered mice, looked at the part of the inner ear called the cochlea, which contains two types of sensory cells to detect sounds.
Scientists often study mice because of the biological similarities between the animals and humans.
Until now people had thought that structures called ion channels found in the cells -- which work like a microphone to transform sound into electrical messages to the brain -- were mainly responsible for distorting sound in the inner ear.
Distortion is important because it allows people to pick out the correct sounds from a mixture of noises whether it be competing conversations at a cocktail party or other kinds of background noise, Avan said.
But the researchers showed how a protein called stereocilin -- not the ion channels -- was keeping sensory cells intact and allowing the inner ear to properly distort sounds, Avan said.... http://www.reuters.com/article/healthNews/idUSTRE4978SH20081009?feedType=nl&feedName=ushealth1100
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RANDOM FACT... The biggest pumpkin in the world tipped the scales at a whopping 1,446 pounds. This gigantic gourd was weighed in October 2004 at a pumpkin festival in Port Elgin, Ontario, Canada.

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RANDOM TIDBITS ...... The Statue of Liberty (“Liberty Enlightening the World”) is a 225-ton, steel-reinforced copper female figure, 151 ft 1 in. in height, facing the ocean from Liberty Island in New York Harbor. The right hand holds aloft a torch, and the left hand carries a tablet upon which is inscribed: “July IV MDCCLXXVI.”

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The statue was designed by Frederic Auguste Bartholdi of Alsace as a gift to the United States from the people of France to memorialize the alliance of the two countries in the American Revolution and their abiding friendship. The French people contributed the $250,000 cost.

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The 150-foot pedestal was designed by Richard M. Hunt and built by Gen. Charles P. Stone, both Americans. It contains steel underpinnings designed by Alexander Eiffel of France to support the statue. The $270,000 cost was borne by popular subscription in this country. President Grover Cleveland accepted the statue for the United States on Oct. 28, 1886. The Statue of Liberty was designated a National Monument in 1924 and a World Heritage Site in 1984.

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On Sept. 26, 1972, President Richard M. Nixon dedicated the American Museum of Immigration, housed in structural additions to the base of the statue. In 1984 scaffolding went up for a major restoration and the torch was extinguished on July 4. It was relit with much ceremony July 4, 1986, to mark its centennial.

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On a tablet inside the pedestal is engraved a sonnet called The New Colossus, written by Emma Lazarus (1849–1887).
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Migraines cut breast cancer risk 30 percent: study CHICAGO (Reuters 11/6) - In a puzzling twist, women who have a history of migraine headaches are far less likely to develop breast cancer than other women, U.S. researchers said on Thursday.
The study is the first to look at the relationship between breast cancer and migraines and its findings may point to new ways of reducing a woman's breast cancer risk, they said.
"We found that, overall, women who had a history of migraines had a 30 percent lower risk of breast cancer compared to women who did not have a history of such headaches," said Dr. Christopher Li of the Fred Hutchinson Cancer Research Center in Seattle, whose findings appear in the journal Cancer Epidemiology, Biomarkers and Prevention.... http://www.reuters.com/article/healthNews/idUSTRE4A518L20081106?feedType=nl&feedName=ushealth1100
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RANDOM FACT... Add up opposing sides of a dice cue and you will always get seven ******************

The following was written by a nurse (Janine) who is a member of Paradigm97 and who works in the Outback of Australia.... and we think we have it hard. She writes:" The wound care course is being taught by a CNS from a big Sydney hospital. She is a great teacher. I found it inspiring to sit there and contemplate that this is what a CNS can do. The other students are from health centres all over the outback.The teacher was going through two bags of dressings and explaining what type of wound each one was used for. She'd nearly finished when a student said, 'But we don't have any of these dressings.' Everyone else agreed. The CNS looked stunned. 'But these are best practice. You must have them.' No. None of us had ever heard of any of them before. I thought of our dressing cupboard on the ward, looking more empty each week, and how we make do with what we have. The CNS suggested we go with our list of best practice dressings and present it to our Wound Care Committee. She couldn't believe there was no such entity.Later the CNS was discussing pain management and said 'in these cases you call in the pain management team.' When we told her we don't have such a team she asked who we call on. 'The nurse looking after the patient. If they don't know they ask another nurse. Then they try to convince the doctor to prescribe it.'She asked whether our wound care specialist ever does inservices so we told her we don't have one of those either.She was too polite to say what she thought of our wound assessment forms. These have a little area for nurses drawings of bits of anatomy with a spot marking where the wound is. Next to it is an area to write the size of the wound. Beneath it you list the dressing you're using. That's it. From the conversation today it seems staff have been trying to bring in a new wound chart for about ten years. For the last few years the excuse has been that we are adopting another health service's chart, but it hasn't happened. No wonder nurses keep giving up."
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LONDON (Reuters 10/13) - Scientists have found two new genetic variations that appear to increase the risk of the most common skin cancer among people of European descent. The variations play no role in skin color but people with both of them are nearly three times more likely to develop basal cell carcinoma compared with people without the changes, researchers from Iceland's Decode Genetics said on Sunday.
Darker skin is traditionally regarded as an important protection against skin cancer.
"Here we have two variants that have no impact on pigmentation and only affect the risk of basal cell carcinoma," Kari Stefansson, Decode's chief executive, who led the study, said in a telephone interview. "We don't know why that is."
Basal cell carcinoma is the most common form of cancer worldwide, and in the vast majority of cases are thought to be caused by exposure to ultraviolet rays of the sun, according to the American Academy of Dermatology.... http://www.reuters.com/article/healthNews/idUSTRE49B2SS20081013?feedType=nl&feedName=ushealth1100 (I just had a 1 cm X 1/2 cm area removed from the bridge of my nose...and I get checked every 6 months)
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WASHINGTON (Reuters 10/12) - Researchers trying to find ways to transform ordinary skin cells into powerful stem cells said on Sunday they found a shortcut by "sprinkling" a chemical onto the cells.
Adding the chemical allowed the team at the Harvard Stem Cell Institute in Massachusetts to use just two genes to transform ordinary human skin cells into more powerful induced pluripotent stem cells or iPS cells.
"This study demonstrates there's a possibility that instead of using genes and viruses to reprogram cells, one can use chemicals," said Dr. Doug Melton, who directed the study published in the journal Nature Biotechnology.
Melton said Danwei Huangfu, a postdoctoral researcher in his lab, developed the new method. "The exciting thing about Danwei's work is you can see for the first time that you could sprinkle chemicals on cells and make stem cells," Melton, a Howard Hughes Medical Institute Investigator, said in a statement. http://www.reuters.com/article/healthNews/idUSTRE49B2M320081012?feedType=nl&feedName=ushealth1100
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RANDOM FACT... Rats multiply so quickly that in 18 months, two rats could have over a million descendants.

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CHICAGO (Reuters 10/13) - A long-term analysis of people who took the arthritis drug Vioxx confirms it doubles the risk of strokes and heart attacks, researchers said on Monday, but this risk goes away a year after people stop taking it. And other drugs in the same class of painkillers known as Cox-2 inhibitors may cause similar harm, they said.
"The good news is the data suggests that the risk doesn't persist forever. The risk goes back toward normal after a year of follow up," said Dr. Robert Bresalier of the M.D. Anderson Cancer Center at the University of Texas, whose study appears in the journal Lancet.
Safety data from this same study in 2004 set off alarms that Vioxx increased the risks of heart attacks and stroke, prompting drug maker Merck & Co Inc to withdraw the popular painkiller from the market.
Merck last year inked a $4.85 billion deal to settle thousands of claims for heart attacks, strokes and deaths allegedly caused by the drug. The original study, funded by Merck, was meant to determine whether Vioxx could prevent polyps that raise the risk of colon cancer.... http://www.reuters.com/article/healthNews/idUSTRE49C84M20081013?feedType=nl&feedName=ushealth1100
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Health experts say that a pediatric vaccine against Streptococcus pneumoniae, introduced in 2000, has done a good job protecting young children but that progress has stalled as a new highly drug-resistant strain is increasing cases of Serotype 19A infection, leading to meningitis, pneumonia and other life-threatening illnesses in children. Vaccine maker Wyeth is expected to present study results later this month on an updated vaccine designed to beat Sterotype 19A and five other pneumococcal variations. The New York Times (10/13) http://www.nytimes.com/2008/10/14/health/14vacc.html?_r=1&ref=health&oref=slogin
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The Standing Heel-Rise Test: Relation to Chronic Venous Disorders and Balance, Gait, and Walk Time in Injection Drug Users Mobility impairment is an unintentional and largely unrecognized consequence of injection drug use (IDU). This impaired mobility in combination with other potential pathologic changes to the veins, muscles, and joints of the lower legs from IDU may lead to the dev- elopment of chronic venous disorders (CVD). Chronic venous disorders of the lower extremities may cause swelling, varicose veins, skin damage, refractory ulcers, and pain1 — progressive and debilitating sequelae. Injection drug users with CVD often complain of mobility problems such as difficulty with walking, stair climbing, and working.2,3 Previous research4 found evidence of CVD in 87% of persons in a methadone maintenance treatment program; by contrast, additional research found CVD affects 7% to 9% of the general population and occurs late in life.3,4 http://www.o-wm.com/content/the-standing-heel-rise-test-relation-chronic-venous-disorders-and-balance-gait-and-walk-time
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Cancer Risk on the Night Shift; Experts say it’s too early to panic In December 2007, the World Health Organization’s International Agency for Research on Cancer declared that shift work involving disruption of the body’s natural circadian rhythm is “probably carcinogenic to humans.”• Artificial light exposure at night may initiate the suppression of melatonin, which is believed to inhibit cancer growth.• Vitamin D deficiency because of a lack of sun exposure may lead to a higher risk of cancer in night-shift workers. • Sleep deprivation may negatively impact the immune system and the body's ability to mitigate the production of cancer cells. • Scientists question whether the timing of light exposure is more important than the duration. • It is questioned whether working the night shift or other attributes such as body mass index and lack of exercise increase the risk of breast cancer. • It is most important to address controllable factors proven to increase cancer risk, such as maintaining a lean body weight, physical activity, eating well, quitting smoking, getting regular physical exams and mammograms, and minimizing alcohol consumption... this was sent in by Melva (MJSolon@AOL.com) Thank you !
http://include.nurse.com//apps/pbcs.dll/article?AID=/20081006/NATIONAL01/110060129/
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I tried to tell some nurses about better wound care....check out the following !

Burn Treatment Cream May Delay Healing A cream commonly used to treat burns may actually delay healing. In addition, despite the wide range of wound dressings available for burns, there is no consensus on the most effective alternative treatment, say Cochrane Researchers who carried out a systematic review of existing data.

Increased understanding of the wound healing process means that there are now a large number of different ways to treat burns. Films, gels, artificial skins and fibre dressings may all help to heal wounds, but doctors still often turn to traditional gauze dressings, as well as silver sulphadiazine (SSD) cream (Silvadene). Healthcare providers have used SSD cream since the 1960s to minimize the risk of burns becoming infected, although concerns have recently been raised about its toxic effects on skin cells. (in my opinion, removing SSD is almost impossible to avoid causing the patient pain....I completely agree with this article).

The Cochrane Team who carried out the research found 26 relevant trials. Although each trial was relatively small they concluded that SSD cream increases the time taken for a wound to heal, as well as increasing the number of dressing applications required.

“We think that the use of SSD cream on burn wounds needs to be reconsidered,” says lead researcher, Jason Wasiak, who works for the Victorian Adult Burns Service at the Alfred Hospital in Melbourne, Australia.

Trials showed that a number of different dressing types, including polyurethane films, hydrocolloid gels and biosynthetic dressings, can be more effective for treatment of moderate burns than SSD or standard chlorhexidine impregnated gauze dressings. As well as reducing healing times, some alternative dressings also reduced pain associated with burns.

Many of the trials, however, failed to adequately assess the depth of burns suffered, so the data was less easy to interpret. The researchers say there is a strong case for larger and better designed trials that will help inform doctors about the most appropriate treatments for burns of different severities.

“There is a need to clearly estimate burn depth in order to make proper recommendations as to the best products for treating burns,” says Wasiak.

Wasiak J, Cleland H, Campbell F. Dressings for superficial and partial thickness burns. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD002106. DOI: 10.1002/14651858.CD002106.pub3.
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Honey Helps To Heal Wounds Honey may reduce healing times in patients suffering mild to moderate burn wounds. A systematic review by Cochrane Researchers concluded that honey might be useful as an alternative to traditional wound dressings in treating burns.

“We’re treating these results with caution, but it looks like honey can help speed up healing in some burns,” says lead researcher Dr Andrew Jull, of the Clinical Trials Research Unit at the University of Auckland, New Zealand.

Honey has been used in wound treatment since ancient times. The mechanism of action is unclear. While honey may help the body remove dead tissue and provide a favourable environment for the growth of new, healthy tissue, current interest in medicinal honey focuses largely on its antibacterial effects.

The review brings together data from 19 clinical trials involving 2554 patients with a range of different wounds. Honey was more effective in reducing healing time compared to some gauze and film dressings that are often used to treat moderate burns. However, the researchers were unable to show any clear benefits for the healing of grazes, lacerations, surgical wounds and leg ulcers.

The researchers don’t advise using honey to treat other types of wounds. “Health services should invest in treatments that have been shown to work,” says Dr Jull. “But, we will keep monitoring new research to try and establish the effect of honey.” Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD005083. DOI: 10.1002/14651858.CD005083.pub2.
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I think the following is the understatement of the year ! The report identified a disconnect between nurse dissatisfaction and hospital executives’ perception of it, with leaders believing nurse dissatisfaction occurs but not in their facilities. The hospital execs ranked nursing shortages as a lower priority than reimbursement, government regulations, clinical quality and uncompensated care. ... http://www.amnhealthcare.com/News/news-details.aspx?Id=4002
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You know those infomercial gadgets that do 10 jobs in one? Well, there's a fruit that tops them all. It's the pomegranate. And it puts on quite a show when it comes to fighting disease. We're talking everything from cancer to high blood pressure. The All-Purpose Pomegranate The pomegranate -- a tough, leathery fruit packed with delicious, edible seeds -- has been used medicinally since ancient times. When present-day researchers recently took a closer look, reviewing over 90 pomegranate-related studies, what did they find? Pomegranates have antioxidant, anticarcinogenic, anti-inflammatory, and even antimicrobial properties. Whew! Our ancestors were onto something. Here's a short list of what pomegranates may help tackle:
Cancer: In lab studies, pomegranate extract triggered the death of both prostate and breast cancer cells. (When's the best age for prostate cancer screening to begin? Read this article for answers.)
Blood pressure: Pomegranate juice dropped systolic numbers in hypertensive patients. (Try these 6 tips for getting the best blood pressure readings.)
Blood sugar: Pomegranate improved blood sugar levels in animal studies. (Here's another tasty way to get steadier blood sugar.)
References:
Anticancer activities of pomegranate extracts and genistein in human breast cancer cells. Jeune, M. A. et al., Journal of Medicinal Food 2005 Winter;8(4):469-475. Therapeutic applications of pomegranate (Punica granatum L.): a review. Jurenka, J. S., Alternative Medicine Review 2008 Jun;13(2):128-144.
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Olive oil for a Flat Belly ( buy only the Extra Virgin Cold Pressed Olive oil-- in a dark bottle preferably) That bagel? It could go right to your gut. Literally. But a bit of olive oil each day may help keep your middle little. That's what researchers are saying after testing two diets -- one high in carbs and the other based on healthy fats from olive oil. The "fat" diet kept bellies flatter. Why Belly Fat Is So Bad Besides making you sad when you zip up your pants, excessive abdominal fat increases your risk for high blood sugar and many other health problems. But in a recent study of overweight people, a Mediterranean-style diet -- where approximately 30 percent to 40 percent of the calories came from unsaturated fats, like those in olive oil -- seemed to help prevent tummy-expanding over time. Another bonus: The fat-focused diet helped people maintain better insulin sensitivity, too. Not so with the high-carb diet, which seemed to encourage body fat to relocate to people’s bellies. (Read this to find out how much Mediterranean eating it takes to reduce heart disease.)

Reference: Monounsaturated fat-rich diet prevents central body fat distribution and decreases postprandial adiponectin expression induced by a carbohydrate-rich diet in insulin-resistant subjects. Paniagua, J. A. et al., Diabetes Care 2007 Jul;30(7):1717-1723.
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Wouldn't it be great to have balance-beam-worthy body control? This nutrient could help: vitamin D. Vitamin D may not turn you into Shawn Johnson, but as you age, it may give you a leg up when it comes to keeping your balance, your grip strength, and your foot speed. Dangers of D-ficiency A lack of vitamin D is actually fairly common in the United States; up to 40 percent of people may not be getting enough. And shortfalls increase with age. Not good, because a study recently revealed that people 65 and older who are low on D do poorly on tests of handgrip strength, walking speed, balance, and the ability to stand up from a seated position. More research is needed, but scientists feel there is already enough evidence of vitamin D’s positive effect on muscle strength to warrant being on D alert. (Get the lowdown on all of D's benefits with this tool.) Get 400 international units of vitamin D and 1,200 milligrams of calcium per day
Reference: Activation of NF-E2-related factor-2 reverses biochemical dysfunction of endothelial cells induced by hyperglycemia linked to vascular disease. Xue, M. et al., Diabetes 2008 Oct;57(10):2809-2817.
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HUMOR SECTION

Thanks to Laregis for the following-- not exactly humorous-- but I found it very interesting.
The Human Body
The human body is a machine that is full of wonder. This collection of human body facts will leave you wondering why in the heck we were designed the way we were.

1.. Scientists say the higher your I.Q., the more you dream.

2.. The largest cell in the human body is the female egg.

3.. The smallest cell is the male sperm.

4.. You use 200 muscles to take one step.

5. The average woman is 5 inches shorter than the average man.

6.. Your big toes have two bones each while the rest have three.

7.. A pair of human feet contain 250,000 sweat glands.

8.. A full bladder is roughly the size of a soft ball.

9.. The acid in your stomach is strong enough to dissolve razor blades.

10.. The human brain cell can hold 5 times as much information as the Encyclopedia Britannica. 11.. It takes the food seven seconds to get from your mouth to your stomach.

12.. The average human dream lasts 2-3 seconds.

13.. Men without hair on their chests are more likely to get cirrhosis of the liver than men with hair. (testosterone?)

14.. At the moment of conception, you spent about half an hour as a single cell.

15.. There are about one trillion bacteria on each of your feet.

16.. Your body gives off enough heat in 30 minutes to bring half a gallon of water to a boil.
17.. The enamel in your teeth is the hardest substance in your body.

18.. Your teeth start developing (in your gums) 6 months before you are born.

19.. When you are looking at someone you love, your pupils dilate. They do the same when you look at someone you hate.

20.. Blondes have more hair than dark-haired people.

21.. Your thumb is the same length as your nose.

22.. At this very moment, I know you are putting this last fact to the test. Now remove your thumb from your nose and pass this on to the f riends you think might be interested in comparing their thumbs to their noses as well. You did it -- I KNOW you did !!!!! Eat Dessert First, Life Is Short!
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise......... If you have a favorite site ... and it isn't here.
Please send it in to me. RNFrankie@AOL.com

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

Can either pay $8 / course OR pay $26.99 for a year for all the CE courses you want to take
.
www.nurse.com Pay Only $34.99 for a full year of CONTACT HOURS

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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.

This website (for registering the CELL PHONES) was sent in by Laregis@AOL.com (Laura) who sends in a prodigious amount of articles for the Newsletter. Thank you !
https://www.donotcall.gov/

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

Very interesting website on analyzing handwriting and finding those who lie:
http://www.aolhealth.com/healthy-living/handwriting-personality?icid=200100397x1212557405x1200829748

the National Nurse's new website: http://nationalnurse.org/

Any time you want to check a rumor ... this is the link: http://www.snopes.com/

This is fun! See if you can place the state:
http://www.sheppardsoftware.com/states_experiment_drag-drop_Intermed_State15s_500.html

This site has passed the Snopes.com test
http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

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MEDICAL RECALLS
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ReliOn Insulin Syringes for use with U-100 Insulin (Tyco Healthcare - Covidien) Covidien and FDA notified patients and healthcare professionals of a recall of ReliOn sterile, single-use, disposable, hypodermic syringes with permanently affixed hypodermic needles. The mislabeled syringe may result in patients receiving an overdose of as much as 2.5 times the intended dose, with serious health consequences, low blood sugar, and even death. These syringes are sold only by Wal-Mart or Sam's Club pharmacies under the ReliOn name. The recall applies only to lot number 813900. The product was distributed from Aug. 1, 2008 until Oct. 8, 2008, and includes 471,000 individual syringes in 4,710 boxes. FDA urges patients and health care professionals to check syringe packaging carefully for products with this lot number, not to use the product, and return the product to the pharmacy for replacement. The lot number can be found on the back panel of the 100 count syringe carton, or on the white paper backing of each individual syringe “peel-pack”. http://www.fda.gov/medwatch/safety/2008/safety08.htm#ReliOn
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Vibe Technologies Vibrational Integrated Bio-photonic Energizer Machine Multi-Frequency Field Generator FDA notified healthcare professionals of a Class I Recall of the Vibe Technologies Vibrational Integrated Bio-photonic Energizer Machine Multi-Frequency Field Generator. This device has not been approved by FDA, lacks safety and effectiveness data, and is not manufactured under current good manufacturing practices. The manufacturer has submitted no evidence to FDA to support any of their claims that the product could treat or cure such diseases as cancer, depression, infection and pain. Individuals with the device should stop using it immediately and contact the manufacturer to make arrangements to return the device. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Vibe
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Thoratec Corporation notified healthcare professionals of a worldwide correction of the HeartMate II Left Ventricular Assist System (HM II LVAS), of all serial numbers (having Catalogue No. 1355 or 102139), distributed since the beginning of clinical studies in November 2003. Over time, wear and fatigue of the percutaneous lead connecting the HeartMate II LVAS blood pump with the System Controller may result in damage that could interrupt pump function, require reoperation to replace the pump, and potentially result in serious injury or death. The estimated probability of the need for pump replacement due to percutaneous lead damage is 1.3% at 12 months, 6.5% at 24 months, and 11.4% at 36 months. Healthcare professionals with patients supported by a HeartMate II LVAS should assess the wear and fatigue of the percutaneous lead and provide proper instruction to patients on the management and care of the lead. http://www.fda.gov/medwatch/safety/2008/safety08.htm#HeartMate
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NURSING HINTS CORNER

Taped for Comfort
(This process could be used on anyone with IV catheters--- perhaps would help keep them from being pulled out by dementia patients, hopefuly) A dialysis patient may have sensitive skin and, if he takes minoxidil, excessive hair growth. So I try to avoid taping dialysate infusion lines to his wrists. Instead, I ask him (or his family) to bring in a clean sweatband, which I place on his wrist. Then, I tape the lines to the band. This will eliminate unnecessary discomfort. Sue S. McRae, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.60, Springhouse Corporation/www.springnetcom.

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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
Visit us at http://www.accu-ruler.com/.

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This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php

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

Welcome to: BassM@nfcc.edu (Marcia) 11/6/08

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NOTICE:
I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a corrected email address....so please don't forget to write : RNFrankie@AOL.com

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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)

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

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THOUGHT FOR THE DAY

Sent in by JuliaCR Thank you !

"If you don't read the newspaper you are uninformed,
if you do read the newspaper you are misinformed." Mark Twain


Hope to see you online..... Frankie
RNFrankie@AOL.com

Another from Raconte....Genevieve.

Medical tourism is a hot—and I mean hot—topic these days. Its coverage in newspapers, magazines and on television continues to attract a great deal of attention not only from the medical community, but also corporate America, including insurance companies, and the public at large. In many ways this coverage is beneficial, bringing to light the pros and cons of seeking intricate and often life-saving surgery thousands of miles from home.
The rise in popularity of medical tourism forces nurses to consider what kind of influence it might have on the future of our field. In the long term, the outcomes could prove far-reaching on what hospitals, doctors, nurses and patients expect in the ways of healthcare services and outcomes.
Historically, the United States has been a destination for people from foreign countries coming in search of treatment that was unavailable or in limited access in their home countries. This continues to be the case for both medically necessary and elective procedures. For example, with the Euro gaining strength against the U.S. dollar, many Europeans are coming here for cosmetic surgery not covered by their national healthcare plans.
What we’re seeing now is that many Americans are traveling outside the U.S. in search of low-cost, quality care. As foreign countries have upgraded, expanded and improved their homegrown and imported talent, they have developed hospitals that appear poised and ready to compete with the American care model. For example, many foreign hospitals have assertively adopted JCI (Joint Commission International) accreditation, which is the nonprofit, international arm of the Joint Commission.
A Significant Cost Difference
There are many reasons why a person would choose to participate in medical tourism instead of seeking treatment stateside. The most common reasons are cost, convenience (believe it or not), quality of care, and the ability to combine the procedure with a vacation. Some of the more popular destinations for medical tourism are (in no particular order of importance) Mexico, Costa Rica, Brazil, Argentina, South Africa, India, Thailand, Malaysia and Singapore.
The cost difference can be significant. For example, a heart bypass is around $100,000 in the U.S., $33,100 in France and $7,000 in India; a hip replacement is around $40,000 in the United States, $15,000 in France, and $5,800 in India; and a knee replacement costs around $35,000 in the U.S., $17,000 in France and $6,700 in India. Thus one can see why many individuals may find it attractive and sensible to seek treatment outside the United States.
Some countries have gone one step beyond in supporting medical tourism, where a patient might expect to find hospitals that are like luxury hotels, bringing state-of-the-art medical equipment alongside a feeling of being cared for at a spa or resort. In some cases, the patient can schedule a pre- or post-surgery tour of the country, organized by the same concierge team that arranged their medical care. Many of these specialized hospitals have an entire team that is devoted to a specific patient, staffed by a doctor who is available nearly 24/7, and Registered Nurses (no LVNs, CNAs or techs) dressed in the traditional starched white uniforms of the old days.
The Thai Eye Doctor
Many of us who have been privileged to either serve in the U.S. military or be the spouse of an active-duty service person have required medically necessary care while stationed in a far-off land. In most of these cases, our care was provided on a U.S. military installation and thus it is very much like being cared for on U.S. soil.
Unfortunately, there are times when even our U.S.-based military hospitals are not able to provide treatment, as was the case when my husband and our family were stationed in Bangkok, Thailand in the late ’60s. At that time the doctors at the 4th Army Field Hospital were not equipped to provided the corrective surgery that two of my children needed. Both were born with the congenital eye defect strabismus. My daughter’s case was less severe than my son’s, who was so crossed-eyed that it impaired his ability to do many age-appropriate behaviors.
It was at the base doctor’s suggestion that we consult with a local Thai eye specialist who had succeeded at surgically correcting this eye defect and who trained at Tulane Medical School in Louisiana. The Thai doctor assured us that he could easily correct my daughter’s eye defect, but expressed some trepidation at performing surgery on my son since he was under a year in age. After taking into consideration the educational delays that might stem from waiting, and assessing my skills as a nurse, he agreed to perform the surgery on my baby. Both children came through with flying colors. To this day many ophthalmologists marvel that the surgeon in Thailand was able to perform each correction with just one surgery.When Asked for Advice
As healthcare professionals, we are no strangers to having friends, family and business associates ask our opinion on issues concerning health and medicine. They may seek our advice on whether or not to have knee-replacement surgery at a hospital in Singapore or India.
If you find yourself being asked to provide an opinion on medical tourism, consider and possibly share the following: Though seeking medically necessary treatment in a foreign country appears to have many benefits, there are also risks. As potential patients, they need to do their own research and weigh the risk/benefit ratio instead of basing their decision solely on the information from a medical tourism brochure. Some important questions to ask are:
• Does that hospital participate in the JCI?
• Are its physicians board-certified (or that nation’s equivalent) in the procedure?
• Do they have staff members who are competent in your native language?
• How many procedures of this type do they perform each month/year? (Remember that with surgery, practice, practice, practice greatly increases the proficiency of the surgeons and generally improves the outcome for the patient.)
• What type of follow-up can you expect once you return to your home country? (Some American physicians are uncomfortable following up on a medical tourism patient.)
• What is the stability of the government where you will be receiving your medical treatment? And so forth.Remember that traveling to a foreign land means there will be differences to being treated in the States. Make sure that you are up to date on all necessary immunizations, that all your travel papers and documents are in order, that you sign in with the local U.S. embassy, and that you have all your ducks in a row prior to leaving.

Geneviève M. Clavreul, RN, PhD, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management.

PARADIGM BYTES

Newsletter for Paradigm97
October 8, 2008

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://www.blogger.com/

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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Please drop in . the Paradigm97 chatroom is always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends.

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SNIPPET

Physicians Warn Clostridium Difficile (C. Dif.) the Next MRSA? Dr. Ed Corboy had no idea what was afflicting his 80-year-old mother, Joan Corboy. All he knew for certain was that since being treated for what was a routine diarrheal infection, she seemed to be wasting away and none of her doctors or other health specialists could explain why."She lost almost 55 pounds between July Fourth and Christmas in 2006," said Corboy, a resident of Wilmette. "She was so sick, so weak and despite the best care of her doctors, she was getting weaker. It was clear she was in big trouble."Afraid that his mother was running out of time, Corboy called the Centers for Disease Control in Atlanta for advice. Dr. Clifford McDonald told him the infection his mother probably had was of the NAP1 type of the bacteria Clostridium difficile, a virulent strain of a common intestinal bacteria currently plaguing hospitals that now rivals the superbug Methicillin-resistant staphylococcus aureus (MRSA) as one of the top emerging disease threats to humans."Disease caused by Clostridium difficile can range from nuisance diarrhea to life-threatening colitis that could lead to the surgical removal of the colon, and even death," said Dr. Stuart Johnson, associate professor of medicine, division of infectious diseases, Loyola University Chicago Stritch School of Medicine. "It's a very hardy strain and it seems to persist."C-diff, as it is better known, is a bacterium that was discovered in 1978 to be the cause of antibiotic-associated diarrhea and colitis, said Johnson, one of the world's top C-diff researchers and physicians, and who successfully treated Joan Corboy's infection. Although C-diff sickens about 500,000 Americans a year and has reached epidemic proportions in 38 states including Illinois, most people have not yet heard of it."I don't think that people appreciate the urgency and severity of this disease," said Dr. Dale Gerding, professor of medicine, division of infectious diseases, Stritch School of Medicine, and associate chief of staff for Research, Hines VA Hospital. "In the past, it was thought to be a nuisance illness. Now it is a fatal illness and a lot of physicians have not figured that out as yet.""I don't think that people appreciate the urgency and severity of this disease," said Dr. Dale Gerding, professor of medicine, division of infectious diseases, Stritch School of Medicine, and associate chief of staff for Research, Hines VA Hospital. "In the past, it was thought to be a nuisance illness. Now it is a fatal illness and a lot of physicians have not figured that out as yet."Hospitals in Quebec have been particularly hard hit by C-diff. In the 12 hospitals affected, about 2,000 deaths were directly attributable to the antibiotic resistant strain between the 2003 and 2004. In the United Kingdom, deaths from C-diff leaped by 28% in 2007 to more than 8,000, according to the nation's Department of Health."What was surprising was not just the rates, but the number of severe cases," said Johnson, who helped treat Joan Corboy's illness.Similar to MRSA, C-diff is an infection that is mainly acquired in a hospital or nursing home, although like MRSA there is some evidence that a community-acquired strain may (?) be developing, according to the CDC."When a patient is in the hospital getting antibiotics for some type of infection, one of the potential complications is that the normal bacterium that lives in the colon is disturbed with that antibiotic. That makes you susceptible to an infection with Clostrium difficile," Johnson said. "The great majority of cases occur in people who have recently used antibiotics."When C-diff is not actively dividing, it forms very tough spores that can exist on surfaces for months and years, making it very difficult to kill, Johnson said. "Antibiotics are very effective against the growing form of the bacteria but it doesn't do anything to the spores," Johnson said. "If there are spores they can sit around like stealth bombs. Once the antibiotic is gone, these spores can germinate again and spread their toxins."Since its discovery, C-diff has grown increasingly resistant to antibiotics, according to Johnson and Gerding, who has been studying the bacteria since 1980. Though it is appearing more often in younger people, those 65 years and older face a greater risk of developing infection from C-diff and has more severe outcomes and higher death rates. Relapse is common with about 25 percent of patient experiencing a second bout of disease within two months after their first. Patients who have had two or more episodes of disease have a 30 percent to 65 percent risk of another bout.Symptoms of C-diff include profuse diarrhea and abdominal pain and distention of the abdomen. An infection is also frequently accompanied by fever, nausea and dehydration. In some rare cases blood may be present in the stool. The infection is spread by spores that contaminate the hospital environment and hands of healthcare workers who can transmit the spores to patients. The resistance of the spores to hospital cleaning agents and to alcohol hand disinfectants makes it extremely difficult to eradicate. http://www.newswise.com/articles/view/544346/?sc=rsmn http://www.cdc.gov/ncidod/dhqp/id_cdiff.htmlhttp://www.mayoclinic.com/health/c-difficile/DS00736 http://www.emedicine.com/med/TOPIC3412.HTMhttp://www.medscape.com/viewarticle/570064 http://content.nejm.org/cgi/content/short/353/23/2503 (New England Journal of Medicine NEJM)

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MEDICAL NEWS
This article was sent in by : (Anne) anne@wingusa.org Legislative Update on Safe Patient Handling September 26, 2008 HR 378 Nurse and Patient Safety and Protection Act Remains in Committee The national bill HR 378 “Nurse and Patient Safety and Protection Act of 2007” remains in committee. The bill for safe patient handling was originally introduced two years ago on September 26, 2006, as HR 6182 “Nurse and Patient Safety and Protection Act of 2006,” by U.S. Representative John Conyers, Jr., Democrat, Michigan District 14, calling for an amendment of the Occupational Safety and Health Act of 1970 to reduce injuries to patients, nurses, and other health care providers with a safe patient handling standard.Representative John Conyers, Jr., re-introduced the bill as HR 378 “Nurse and Patient Safety and Protection Act of 2007” on January 10, 2007. HR 378 would "direct the Secretary of Labor to issue an occupational safety and health standard to reduce injuries to patients, direct-care registered nurses, and other health care providers by establishing a safe patient handling standard."If HR 378 is successful, a Federal Safe Patient Handling Standard, calling for “all health care facilities” to comply, will be enacted “to prevent musculoskeletal disorders for direct-care registered nurses and other health care providers working in health care facilities. This standard shall require the elimination of manual lifting of patients by direct-care registered nurses and other health care providers, through the use of mechanical devices, except during a declared state of emergency.”The last action on HR 378 was over a year ago. HR 378 was referred on May 9, 2007, by two House Committees, the Committee on Education and Labor and the Committee on Workforce Protections, to the House Subcommittee on Workforce Protections. As of this date, September 26, 2008, HR 378 remains in the Subcommittee on Workforce Protections where it has not yet had a hearing, and no hearing is scheduled.There is one co-sponsor to date of the Nurse and Patient Safety and Protection Act. On June 3, 2008, U.S. Representative Joe Sestak, Democrat, Pennsylvania District 7, (202) 225-2011, joined Representative John Conyers, Jr., to co-sponsor HR 378 for the protection of healthcare workers and dependent persons in their care against devastating injuries directly caused by manual patient lifting..From a call this date, September 26, 2008, to the House Education and Labor Committee office, (202) 225-3725, the Subcommittee on Workforce Protections has not acted on HR 378. And, with Congress looking to adjourn for this session, the Nurse and Patient Safety and Protection Act is not likely to be acted on this year. The date for Congress to re-convene will be per call of the Chair.Legislators wanting to co-sponsor HR 378 Nurse and Patient Safety and Protection Act, or others wishing to express support, can contact Representative John Conyers, Jr., (202) 225-5126, John.Conyers@mail.house.gov, and Mr. Joel Segal, Legislative Assistant on Health Policy, (202) 225-5126, Joel.Segal@mail.house.gov. UPDATE: Gov. Schwarzenegger has just vetoed the Safe Handling bill (SB1151) for 5th time/year : SB1151 Links to wording and complete history. The veto message will be added soon through the "Veto Message" link: http://www.blogger.com/.
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INTERESTING READING
Please remember that the REUTERS articles are usually good for 30 days

Needle-Length Guidlines for Thigh and Shoulder Vaccines May Need Revision — Because of substantial risk for overpenetration of the intramuscular layer when using current recommendations for vaccination needle lengths, a revision of these needle-length guidelines for thigh and shoulder injections may be needed, according to the results of a study reported in the August 11 issue of Pediatrics."The US Centers for Disease Control and Prevention [CDC] has needle-length recommendations for intramuscular vaccinations in the thigh and shoulder on the basis of the age of the child," write William C. Lippert, BA, from Tulane University in New Orleans, Louisiana, and Eric J. Wall, MD, from Cincinnati Children's Hospital Medical Center in Ohio. "Underpenetration of the intramuscular layer with short needles has been documented; however, few studies have focused on the risk for overpenetration of the intramuscular level with needles that are too long. The purpose of this study was to determine the optimal needle length for intramuscular vaccination of children of various ages and sizes at the shoulder and thigh levels by using MRI [magnetic resonance imaging] and computed tomography [CT] scan measurements." ... http://www.medscape.com/viewarticle/579120
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Technology is evolving all the time, and so are Internet threats. It can be hard to keep track of how to cope with these challenges when things change so quickly. That's why we've come up with a list of 5 basic principles to help you keep surfing safely—now and in the future.... http://cdn.rsys1.net/ig.rsys1.net/responsysimages/tne/RS_CP/trendsetter_sept08_top5.html

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According to Lanette Anderson,( http://www.nursetogether.com/tabid/169/itemid/516/Lanette-L-Anderson-MSN-JD-BBA-RN.aspx) nurses can play an important role in the policies shaping the nursing profession today. She states "one of the easiest ways to get started with this endeavor is to seek out and become a member of the nursing association in your local area, the American Nurses Association, or both." Here is her three part series on the importance of the involvement of nurses, both individually and as a profession, in politics and policy development.Click here to read "The basic review of the lawmaking process"Click here to read, "Current laws and regulations affecting nurses today"Click here to read, "What individual nurses can do"
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Patient follow-up helps reduce suicide rate: report GENEVA (Reuters 9/1) - Health workers should follow up patients who try to commit suicide as an effective way to save lives, the World Health Organization (WHO) said in a study published on Monday.In its latest bulletin, the U.N. agency said 85 percent of suicide attempts took place in developing countries. Worldwide, it was among the top three causes of death among people aged between 15 and 34. New research showed telephone calls and other regular contact after patients were released from hospital dramatically reduced the likelihood of their attempting suicide again.... http://www.reuters.com/article/healthNews/idUSL142015020080901?feedType=nl&feedName=ushealth1100
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Everyone should have access to quality, evidenced-based mental health services — regardless of age, sex, religion, sexual preference, race, or ethnicity. Yet minority populations continue to have limited access to or underutilize mental health treatment and intervention. SAGE's CBMCS* Multicultural Training Program is the most powerful training tool available to help improve cultural competency among mental health practitioners. To review this revolutionary training program request your sample materials.
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Joint Commission Alert: Prevent Blood Thinner Deaths and Overdoses OAKBROOK TERRACE, Ill. – September 24, 2008) A number of recent high profile errors related to commonly used blood thinners highlight a safety issue that too frequently results in harm or even death to patients, according to a Joint Commission alert issued today that offers solutions to this medication safety issue.The Joint Commission’s new Sentinel Event Alert urges greater attention to the dangers associated with anticoagulants, life-saving medications that also present serious risks when administered incorrectly or in error. Patients being treated with these medications must be closely monitored and screened for drug and food interactions, given that commonly used anticoagulants such as heparin and warfarin have narrow therapeutic ranges and a high potential for complications. Adding to the problem is a lack of standardized naming, labeling and packaging of anticoagulants that create confusion and lead to devastating errors.Anticoagulant medication errors are such a serious patient safety issue that The Joint Commission addresses these types of errors in the 2008 National Patient Safety Goals, with full implementation of the requirements expected by January 1, 2009 for hospitals, outpatient clinics, home care and long term care organizations across the United States. In addition, The Joint Commission’s medication management standards require organizations to pay particular attention to high-risk drugs such as anticoagulants in order to improve safety.“Anticoagulants are vital to maximizing the effectiveness of many medical treatments and surgical procedures that benefit patients, but the systems necessary to ensure that these drugs are used safely are not adequate,” says Mark R. Chassin, M.D., M.P.P., M.P.H.., president, The Joint Commission. “The strategies contained in this Alert give health care organizations and caregivers the tools to make a difference in preventing anticoagulant medication errors.”The Joint Commission’s Alert highlights factors that contribute to anticoagulant medication errors, including lack of standardized labeling and packaging, failure to document and communicate patient instructions during hand-offs, and inappropriate dosing for pediatric patients. http://www.jointcommission.org/Library/WhatsNew/nr_09_24_08.htm
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RANDOM FACT... A duck's quack doesn't echo.
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This is a follow-up to the article in August Newsletter about prevention of AIDS ... Circumcision problems impair HIV prevention: study GENEVA (Reuters 9/1) - African health workers need more training and better tools to circumcise men and boys safely for HIV prevention, according to a World Health Organisation (WHO) study chronicling "shocking" rates of complications.As many as 35 percent of males circumcised by traditional practitioners in Kenya's Bungoma district suffered complications such as bleeding, infection, excessive pain and erectile dysfunction from the procedure, the WHO researchers found."Other common adverse effects reported were pain upon urination, incomplete circumcision requiring recircumcision, and laceration," they wrote, estimating 6 percent of patients had life-long problems as a result.... http://www.reuters.com/article/healthNews/idUSL140856520080901?feedType=nl&feedName=ushealth1100
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RANDOM FACT...During the Gold Rush in 1849, some people paid as much as $100 for a glass of water!
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FRIDAY, Aug. 29 (HealthDay News) -- Eating plenty of antioxidant-rich food such as blueberries, artichokes and pecans may help protect against macular degeneration, the leading cause of age-related blindness in the United States and other developed countries.U.S. researchers found that antioxidants disrupt a link between two processes in the retina that, in combination, contribute to macular degeneration. Antioxidants also extend the lifetime of irreplaceable photoreceptors and other retinal cells.The "destructive synergy" that causes macular degeneration occurs when a buildup of a compound called A2E disrupts energy production in mitochondria, the "power plants" in cells, the researchers said. The lack of energy interferes with daily cleaning and maintenance of photoreceptors and another type of retinal cell. This leads to more buildup of A2E and a continuing cycle that results in the destruction of the vital visual cells that can't be replaced.... http://healthday.com/Article.asp?AID=618674
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RANDOM FACT... Months that begin on a Sunday will always have a 'Friday the 13th'.
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WASHINGTON (Reuters 9/3) - Men with elevated levels of calcium in their blood may have a much higher risk of getting fatal prostate cancer, U.S. researchers said on Wednesday. The findings indicate that a simple blood test may identify men at high risk for the most dangerous prostate tumors, and there already are drugs available that cut calcium levels in the bloodstream, the researchers said.They tracked 2,814 men in a government health survey in which they gave blood samples that revealed calcium levels. The men in the top third of blood calcium levels had 2.68 times the risk of developing fatal prostate cancer later in life compared to those in the bottom third, the study found.... http://www.reuters.com/article/healthNews/idUSN0242123420080903?feedType=nl&feedName=ushealth1100
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Sex bias seen in control of cancer pain NEW YORK (Reuters 9/26) - How well pain is managed in people with cancer apparently differs between men and women, new research hints.Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic.Men and women did not differ significantly in terms of worst pain scores, least pain scores, or pain interference. However, average pain in the last week and pain right now were significantly higher in women.In addition, the average total daily dose of pain-killers was significantly greater for men (130 versus 66 milligrams morphine equivalent value).Women were also significantly less likely than men to receive prescriptions for high potency opioids (33 percent versus 51 percent).... http://www.reuters.com/article/healthNews/idUSTRE48P70E20080926?feedType=nl&feedName=ushealth1100
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RANDOM TIDBITS - RAINFORESTS (just in case you want to go on Jeopardy) Rainforests once covered 14% of the earth's land surface; now they cover 6%. One hundred and thirty seven plant, animal and insect species are being lost every single day due to rainforest deforestation. The howler monkey is the loudest animal living in the rainforests of South America.More than half of the world's estimated 10 million species of plants, animals and insects live in the tropical rainforests. One hectare of lowland rainforest in South America can contain as many frog species as in all of North America. The biggest rainforest in the world is in South America, along the banks of the Amazon River.
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Glucosamine and chondroitin don't slow arthritis (Reuters 9/29) - Two hugely popular supplements used to fight arthritis and joint pain, glucosamine and chondroitin sulfate, do not seem to work any better than placebo to slow the loss of knee cartilage in osteoarthritis, researchers reported on Monday.But the researchers said some of their findings were confusing and said more study was needed."At two years, no treatment showed what we determined to be a clinically important reduction in joint space width loss," said Dr. Allen Sawitzke of the University of Utah School of Medicine, who helped lead the study.The study, funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, confirms other findings showing the supplements have few or no effects.... http://www.reuters.com/article/healthNews/idUSTRE48S82820080929?feedType=nl&feedName=ushealth1100
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FDA: No Lou Gehrig's disease risk with statins (Reuters 9/29) - An analysis of dozens of studies found the widely used statin cholesterol drugs do not increase the risk of Lou Gehrig's disease, U.S. health officials said on Monday.The U.S. Food and Drug Administration said it reviewed 41 long-term controlled clinical trials after receiving a higher- than-expected number of reports of Lou Gehrig's disease, or amyotrophic lateral sclerosis, in patients who were treated with the cholesterol-lowering drugs. Millions of people around the world take statins, including Pfizer Inc's Lipitor and AstraZeneca Plc's Crestor.FDA researchers found that nine out of about 64,000 patients treated with statins were diagnosed with ALS, a fatal neurodegenerative disease, during long-term clinical trials. That compared with 10 of 56,000 patients who got placebos.... http://www.reuters.com/article/healthNews/idUSTRE48S8HA20080930?feedType=nl&feedName=ushealth1100
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RANDOM FACT... Scratch-and-sniff works by taking the aroma-generating chemical and encapsulating it in gelatin or plastic spheres that are a few microns in diameter. When you scratch the sticker, you rupture some of these spheres and release the smell.
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Omega-6 fatty acid intake tied to breast cancer NEW YORK (Reuters 9/26) - Substances called heterocyclic amines (HAs) found in cooked meat and fish don't appear to boost a woman's risk of developing breast cancer after menopause, Swedish researchers report.However, low intake of these substances combined with high consumption of omega-6 polyunsaturated fatty acids (PUFAs), which are found in most types of vegetable oil, may indeed increase the likelihood that postmenopausal women will develop breast cancer, Dr. Emily Sonestedt, of Lund University, Malmo, and her colleagues found."The interaction in the present study between omega-6 PUFAs and HAs is not easily explained, and points toward the importance of examining the impact of food patterns rather than the influence of single dietary factors," Sonestedt and her team state in the October 1 issue of the International Journal of Cancer.... http://www.reutershealth.com/archive/2008/09/26/eline/links/20080926elin003.html
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On-site nurse practitioners help with health of nursing home residents EUGENE, Ore. - With America growing older, concern is mounting over health care. But in Eugene, a program between some nursing homes and a local health plan is showing promise.Collaboration and thinking outside the box are the forces behind this idea. Here's the problem: doctors are hard pressed to visit patients in nursing homes locally, and patients are making trips too often to the hospital or the emergency room.Trillium Community Health Plans and the rehab center have teamed up to place on-site nurse practitioners in the center. http://www.kval.com/news/local/29434039.html
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WASHINGTON (Reuters 10/2) - .A CDC report, based on 2006 data, said about 1.1 million people in the U.S. are living with HIV/AIDS, a figure that is increasing as more people become infected and as patients survive longer. The report also estimated about 20% of that group were not aware they have the disease. http://www.reuters.com/article/healthNews/idUSTRE49166C20081002
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In an effort to reduce the student-to-school nurse ratio in public secondary schools and elementary schools, United States Representative Carolyn McCarthy, D-NY, and fellow Congress member Lois Capps, D-CA, introduced the Student-to-School Nurse Ratio Improvement Bill-H.R. 6201 in June 2008.If enacted, the first-of-its-kind bill would direct funding to district schools with substandard nurse-to-student ratios to help improve them, providing grants through the Centers for Disease Control and Prevention (CDC) to eligible states to help reduce the student-to-school nurse ratios. A report to Congress on the effectiveness of the grant program will also be required.... http://sdm3.rm04.net/ctt?kn=12&m=2201373&r=MTEzODI2Mjk5NTAS1&b=0&j=NTgzNjYzMTQS1&mt=1&rt=0.
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HUMOR SECTION
I was walking past the mental hospital the other day,and all the patients were shouting,'13....13....13' The fence was too high to see over, but I saw a little gap in the planks and looked through to see what was going on.Some bastard poked me in the eye with a stick.Then they all started shouting '14....14....14'...
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Ralph and Edna were both patients in a mental hospital. One day while they were walking past the hospital swimming pool. Ralph suddenly jumped into the deep end. He sank to the bottom of the pool and stayed there. Edna promptly jumped in to save him. She swam to the bottom and pulled him out. When the Head Nurse Director became aware of Edna's heroic act she immediately ordered her to be discharged from the hospital, as she now considered her to be mentally stable. When she went to tell Edna the news she said, 'Edna, I have good news and bad news. The good news is you're being discharged, since you were able to rationally respond to a crisis by jumping in and saving the life of the person you love. I have concluded that your act displays sound mindedness. The bad news is, Ralph hung himself in the bathroom with his bathrobe belt right after you saved him. I am so sorry, but he's dead.' Edna replied, 'He didn't hang himself, I put him there to dry. How soon can I go home?'
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
http://www.snopes.com/

http://www.nurse.com/ Pay Only $34.99 for a full year of CONTACT HOURS
CE4781.0 hrBridging the Generation Gaps
CE285-60d1.0 hrEmerging Infectious Diseases:
CE301-60c1.0 hrPolycystic Ovarian Syndrome:
CE130-60e1.0 hrPreventing Violence in the Healthcare Setting
CE195-60e1.0 hrImproving Patient Education for Poor Readers
CE4451.0 hrTreatment and Prevention of Anemia of Critical Illness
CE4341.0 hrBleeding in Early Pregnancy: When Is It an Emergency?
CE486 1.0 hrSchool RNs Lead Education Efforts for Students with Diabetes
CE485 1.0 hrNurses Critical as Reimbursement Dries Up for Catheter-Associated UTIs60157 3.0 hr sCentral Vascular Access Devices Workbook
Managing Older adults pain : https://nursing.advanceweb.com/CE/TestCenter/Course.aspx?CourseID=704&CreditID=1https://nursing.advanceweb.com/CE/TestCenter/Main.aspx
Can either pay $8 / course OR pay $26.99 for a year for all the CE courses you want to take
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com.

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

http://www.snopes.com%20/This site has passed the Snopes.com test

http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3
the National Nurse's new website: http://nationalnurse.org/

Nurse's TV........check out your city and the time of broadcast
http://www.nursetv.com/tv-showtimes/

Click here: Safe Staffing Saves Lives http://safestaffingsaveslives.org/

How ethical are you? Take this quiz....http://jobs.aol.com/quiz/ethics?ncid=AOLCOMMjobsDYNLprim0001&icid=200100397x1207917944x1200447018

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Title of "nurse" protection from individuals who profess to be nurses. Look for your state--- MINE ISN"T THERE!!! Therefore anyone can claim they are a nurse and getaway with it...ie. medical assistants, etc. http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/State/StateLegislativeAgenda/TitleNurse_1.aspxClick here to print out the list of CEU requirement for each of the 50 states.

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MEDICAL RECALLS
FDA notified healthcare professionals of a Class I Recall of the Nebion HLX-8 Magnetic Resonance Device. The manufacturer of the device made unsupported claims that the product could be used to treat many different medical conditions and diseases such as cancer (including breast, bone, lung, and pancreatic), carpel tunnel syndrome, migraines, premenstrual syndrome, rheumatoid arthritis, ruptured disks, shingles, and sports injuries and sprains. The device was not approved by FDA, lacked safety and effectiveness data, and was not manufactured under current good manufacturing practices. Individuals with the device should stop using it immediately and contact the manufacturer to make arrangements to return the device. Read the entire 2008 MedWatch Safety Summaries, including a link to the FDA Class I Recall notice regarding the above issue at:http://www.fda.gov/medwatch/safety/2008/safety08.htm#Nebion
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Medtronic and FDA notified healthcare professionals of the Class I Recall of several Medtronic intrathecal catheters and intrathecal catheter revision kits used with the implanted Medtronic SyncroMed II, SynchroMed EL, and IsoMed infusion pumps that store and deliver parenteral drugs to the intrathecal space. The products were recalled because of potential misconnections of the Medtronic Sutureless Connector Catheters from the catheter port on the pump. These misconnections have resulted in a blockage between the sutureless pump connector and the catheter port on the pump and disconnection from the pump connector. See the FDA Recall Notice for recommendations for healthcare professionals. Read the entire 2008 MedWatch Safety Summary, including a link to the FDA Class I Recall Notice regarding the above issue at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#INDURA
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Statin drugs and amyotrophic lateral sclerosis (ALS) An FDA analysis provides new evidence that the use of statins does not increase incidence of amyotrophic lateral sclerosis (ALS), a neurodegenerative disease often referred to as "Lou Gehrig's Disease." The FDA analysis, undertaken after the agency received a higher than expected number of reports of ALS in patients on statins, is based on data from 41 long-term controlled clinical trials. The results showed no increased incidence of the disease in patients treated with a statin compared with placebo. The FDA is anticipating the completion of a case-control or epidemiological study of ALS and statin use. Results from this study should be available within 6-9 months. FDA is also examining the feasibility of conducting additional epidemiologic studies to examine the incidence and clinical course of ALS in patients taking statins. Based on currently available information, health care professionals should not change their prescribing practices for statins and patients should not change their use of statins. Read the entire 2008 MedWatch Safety Summary, including a link to the FDA New Release, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Statin
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FDA has been made aware of preliminary safety findings from a clinical trial conducted in Germany investigating the use of epoetin alfa to treat acute ischemic stroke. The clinical trial utilized doses of epoetin alfa that were considerably higher than the doses recommended for the treatment of anemia as described in the FDA-approved labeling for the product. Over a period of ninety days after the start of the trial, there were more deaths in the group of patients who received epoetin alfa compared to patients who received the placebo (16% versus 9%). Roughly half of all deaths in both groups occurred within the first seven days after starting the drug, with death from intracranial hemorrhage (bleeding within the brain) occurring among approximately 4% of patients who received epoetin alfa compared to 1% of patients in the placebo group. FDA anticipates the receipt of additional data within the next several weeks. As soon as the review of these data is complete, FDA will communicate our conclusions and recommendations to the public. The finding of increased mortality in patients receiving epoetin alfa in the German trial suggests the need to closely monitor patients enrolled in other ongoing trials for adverse outcomes and to evaluate whether the potential benefits for enrolled patients outweigh the risks in these trials. Read the entire 2008 MedWatch Safety Summary, including a link to the FDA's Early Communication About An Ongoing Safety Review regarding this issue. http://www.fda.gov/medwatch/safety/2008/safety08.htm#ESA3
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Ammonul (sodium phenylacetate and sodium benzoate) Injection 10%/10% Ucyclyd Pharma, Inc. informed healthcare professionals of the detection of particulate matter in the Ammonul Injection product. This particulate matter may impact the safe use of Ammonul. To ensure optimal patient care, healthcare providers are being instructed to use a MilIex Durapore GV 33 mm Sterile Syringe Filter (0.22 µm ) during the admixture process when injecting Ammonul into the 10% Dextrose IV bag. Since this particulate matter may not be readily seen on visual inspection, a filter must be employed in all cases regardless of whether particulate matter is seen in the vial. Testing has confirmed the removal of this specific particulate when using this filter to admix Ammonul. Contact Ucyclyd Pharma, 1-888-829-2593, or 1-800-900-6389 -- a representative is available 24 hours, seven days a week. Read the entire 2008 MedWatch Safety Summary, including a link to the manufacturer's Dear Healthcare Provider Letter, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Ammonul.
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Tarceva (erlotinib) Tablets OSI and Genentech notified healthcare professionals that cases of hepatic failure and hepatorenal syndrome, including fatalities, have been reported during use of Tarceva, particularly in patients with baseline hepatic impairment. Patients with hepatic impairment receiving Tarceva should be closely monitored during therapy and the product should be used with extra caution in patients with total bilirubin >3x ULN. Dosing should be interrupted or discontinued if changes in liver function are severe, such as doubling of total bilirubin and/or tripling of transaminases in the setting of pretreatment values outside the normal range. New information from a pharmacokinetic study in patients with moderate hepatic impairment associated with significant liver tumor burden has been provided in the revised prescribing information, and other recommendations are included Read the entire 2008 MedWatch Safety Summary, including links to the manufacturer's Dear Healthcare Provider Letter and the revised prescribing information for Tarceva, http://www.fda.gov/medwatch/safety/2008/safety08.htm#Tarceva.
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Covidien and Mallinckrodt Inc. informed healthcare professionals of important new safety information in prescribing Phosphocol P 32. Phosphocol P 32 is approved for the intracavitary instillation for the treatment of peritoneal or pleural effusions caused by metastatic disease. Phosphocol P 32 may increase the risk for leukemia in certain situations. Two children (ages 9 and 14) with hemophilia developed acute lymphocytic leukemia approximately 10 months after intra-articular injections of Phosphocol P 32 (0.6 and 1.5 mCi total dose). This drug is not indicated in the intra-articular treatment of hemarthroses. Additionally, post marketing experience identified radiation injury (necrosis and fibrosis) to the small bowel, cecum, and bladder following administration of P 32 into the peritoneal cavity. Healthcare professionals should refer to the product's revised prescribing information for updated information regarding the appropriate use of Phosphocol P 32. Read the entire 2008 MedWatch Safety Summaries, including a link to the manufacturer's Dear Healthcare Provider Letter and the revised prescribing information for Phosphocol P 32. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Phospho

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NURSING HINTS CORNER
This one is from the ListServe.........

If you have a patient who "finger paints" or just has fecal matter under the nails.......the best way to clean them is with shaving cream. Leaves skin soft.....and very definitely clean.

Here's another one: For patients with contractures the skin in the folds of their contractures can get very smelly and is difficult to clean. Try using toothpaste- rub on your hands with a little water then gently rub into the contracture. It cleans out the dead skin, leaves a fresh minty smell and is comforting and less painful than trying to get a wash cloth in there to clean it. (Thanks to Kristi pd3rn@oh.rr.com for this hint)

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ADVERTISEMENTS
from the members

This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.
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This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php

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

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NOTICE:I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.......lol
So please send me your new name/address, ok? RNFrankie@AOL.com

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EDITORIAL STAFF:GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene)
and RNFrankie @AOL.com (Frankie)
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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's opinion.

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THOUGHTS FOR THE DAY

Fear defeats more people than any

other one thing in the world

.--Ralph Waldo Emerson*

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Until we stop harming all other living things,

we are still savages.

"Thomas A. Edison (1847-1931)

Hope to see you online..... Frankie
(RNFrankie@AOL.com)