May 2010

PARADIGM BYTES
Newsletter for Paradigm 97
May 16, 2010

PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.

MISSION STATEMENT

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

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SNIPPETS
(This is from Kurt Ullman-- thanks)
Eating and Drinking During Labour: Let Women Decide

Women should be allowed to eat and drink what they want during labour, say Cochrane Researchers. The researchers carried out a systematic review of studies examining the traditional practice of restricting food and fluid intake during labour and found no evidence for any risk or benefit for women at low risk of complications.

Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated “nil by mouth” policies or restricted what women in labour were allowed to eat and drink, regardless of women’s preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by “Mendelson’s syndrome”, where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour.

The Cochrane Systematic Review, which included five studies and a total of 3130 women, looked at the evidence for restricting food and drink in women who were considered unlikely to need anaesthesia. They found no evidence of any risk or benefit associated with eating or drinking, whether in studies comparing eating and drinking at will or just water with complete restriction, or in studies comparing specific foods, fluids, or carbohydrate drinks with water.

“Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications,” said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. “Women should be able to make their own decisions about whether they want to eat or drink during labour, or not.”

The researchers did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anaesthesia. Therefore, further research is need before specific recommendations can be made for this group.

However, Singata concludes that there may be better ways to approach studies of eating and drinking during labour. “While it is important to try to prevent Mendelson’s syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it,” she said.

Work on this review was supported by a grant from the National Institute for Health Research (NIHR), UK.

Full citation: Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2.

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MEDICAL NEWS

Top Story in Medscape Nurses is Stokowski's Article, "Will We Have a National Nurse?" Nurses around the country are weighing in and overwhelmingly agree that the time has come for the United States to have a National Nurse. Of the dozens of emails the NNNO received, only three were of a negative nature (one nurse thought this was a left/liberal idea; one nurse felt we should be putting the fire that was already in the hospital out before we moved to prevention; and another nurse thought this would cost too much, not realizing that HR 4601 asks that a position already funded through taxpayer dollars be known as the National Nurse).
The National Nursing Network Organization (NNNO) agenda is to have a National Nurse to promote prevention. The NNNO is not a union and is not affiliated with the CNA/NNOC of AFL-CIO. The NNNO is a 501(c)4 non-profit legislative advocacy organization. Read the bill: HR 4601: The National Nurse Act of 2010 http://www.nationalnurse.org

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INTERESTING READING

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

The Calcium Side Your Bones Crave Keep your skeleton strong and fracture-free by serving that calcium supplement with a salad on the side.

Salad? Yep, salad. A 4-year study found that older adults with the highest intakes of carotenoids -- think tomatoes, carrots, and leafy greens for major sources -- retained more bone mineral density than folks eating fewer fruits and veggies.... http://www.realage.com/tips/the-calcium-side-your-bones-crave

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People get hungrier when they're starved for sleep (Reuters 4/9) - People who are trying to stay trim may want to make sure they get plenty of sleep. In a study, researchers found that normal-weight young men ate a Big Mac's-worth of extra calories when they'd gotten four hours of sleep the night before compared to when they slept for eight hours.
Given the findings, and the fact that people have been sleeping less and getting fatter over the past few decades, "sleep restriction could be one of the environmental factors that contribute to the obesity epidemic," they write in the American Journal of Clinical Nutrition.... http://www.reuters.com/article/idUSTRE63854120100409

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April 10 (HealthDay News) -- Severe peripheral vascular disease may be much more common in younger American adults and women than previously suspected, according to a new study.

The disease causes a narrowing in blood vessels that carry blood to the arms, legs, kidney and stomach and leads to symptoms that include pain and cramping in the legs during exercise.

Researchers analyzed data on 994 men and women, age 55 and younger, treated in the Wake Forest University School of Medicine Vascular Center between 1998 and 2009. They found that most of them had premature atherosclerosis (hardening of the arteries). Severe premature arterial disease of the legs (64 percent) was the most common finding.... http://healthday.com/Article.asp?AID=637753

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RANDOM FACT: What is called a "French kiss" in the English speaking world is known as an "English kiss" in France.
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Spanish for You: Bridging the Language Gap in Healthcare With more than 32 million Hispanics in the United States, half of whom speak only Spanish, healthcare professionals today are faced with a number of challenges on the job. The biggest obstacle many U.S. healthcare providers face is the obvious language barrier that exists with patients who don’t speak English. It’s a problem of particular relevance, as the US has the third-largest Hispanic population anywhere in the world! Hispanics make up 15% (2007 U.S. Census Bureau) of our population and that number is projected to grow exponentially. One of every eight American is of Hispanic descent and the number is projected to steadily increase to 98 million. ... http://w3.rn.com/News/news_features_details.aspx?Id=33600

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Progress Toward Ovarian Cancer Early Detection: Strategies, Guidelines, and Clinical Trials Drescher CW et al. – Women at high risk for ovarian cancer based on gene mutations or a significant family history are candidates for ovarian cancer screening using CA–125 and TVS and/or risk reduction surgery. Routine population–based screening is not currently recommended. Early results from randomized trials demonstrate that screening detects many ovarian cancers prior to clinical diagnosis. The impact of screening on ovarian cancer mortality requires additional study. ... http://www.femalepatient.com/html/arc/sig/Gyn/articles/035_04_022.asp
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(Reuters 4/21) - Shutting off a single gene can help stop the cascade of damage that can paralyze people with spinal cord injuries, U.S. researchers reported on Wednesday. They propose using a common, generic diabetes drug in combination with a gene-silencing technique to stop spine injuries from getting any worse, and believe the approach may also work in people with stroke and traumatic brain injuries. Their experiment, published in the journal Science Translational Medicine, shows it is possible to stop the bleeding that can cause the damage from an injured spinal cord to spread and worsen.... http://www.reuters.com/article/idUSTRE63K4VB20100421?feedType=nl&feedName=ushealth1100
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April 14, 2010 -- Today, Voice of America ran "Nurse, I Need a Reality Check: Hollywood shapes many perceptions of medical professionals but that's a problem for real-life nurses," a helpful, in-depth piece about Hollywood's portrayal of nursing by Faiza Elmasry. The piece featured extensive quotes from Truth executive director Sandy Summers and nurses at Johns Hopkins Hospital. see the article and hear the radio report... http://www1.voanews.com/english/news/american-life/Nurse-I-Need-a-Reality-Check-90822599.html

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FDA turns attention to radiation therapy devices The U.S. Food and Drug Administration said on Thursday it has received nearly 1,200 complaints in the last decade about devices that deliver radiation treatments to cancer patients and has called on manufacturers to help improve safety.
The FDA sent letters to 93 makers of radiation treatment devices, urging them to attend a workshop to address concerns about patient exposure to excess radiation from medical treatments and procedures.

Companies sent letters include Varian Medical Systems, Siemens, Philips, GE Healthcare, Hitachi Ltd and several private firms.

Radiation exposure became a major concern in October after the FDA said it was investigating 206 cases of patients being exposed to toxic doses of radiation during CT scans of the brain at Cedars-Sinai Medical Center in Los Angeles.... http://www.reuters.com/article/idUSTRE6374IP20100408?feedType=nl&feedName=ushealth1100

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RANDOM FACT: Forest fires move faster uphill than downhill.
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Factors associated with safe patient handling behaviors among critical care nurses Lee S–J et al. – More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort–reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior. Safe work behaviors are best understood as socio–cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury. http://www3.interscience.wiley.com/journal/123362984/abstract

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A once-a-day pill helped completely rebuild bone in rodents with severe osteoporosis, a finding that could lead to a new class of drugs to treat the brittle-bone disease in humans, U.S. researchers said. The team tested a compound that blocks the production of serotonin produced in the gut in mice and rats with a severe form of the disease and found they completely recovered their bone density.
"If you break the bone, it looks like a normal bone," said Dr. Gerard Karsenty of Columbia University Medical Center in New York, whose study appears in the journal Nature Medicine.

Using the findings, he said the team is working to develop this type of treatment for human patients with osteoporosis, in which bones become fragile and porous, increasing the risk of fracture.

"There is an urgent need to identify new, safe therapies that can increase bone formation on a long-term basis," Karsenty said.... http://www.reuters.com/article/idUSTRE6170QN20100208?feedType=nl&feedName=ushealth1100

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Fruit, veggies, exercise -- they all make the heart-healthy list. And now, according to a new study, so does this breakfast staple: cereal.

But we're not talking about Cocoa Puffs. We're talking about whole-grain cereals -- like steel-cut oats, shredded wheat, or muesli. Men in a study who noshed at least once a week on whole-grain cereals were significantly less likely to experience heart failure.... http://www.realage.com/tips/a-breakfast-staple-that-blocks-heart-failure

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WASHINGTON (Reuters) - People who drink two or more sweetened soft drinks a week have a much higher risk of pancreatic cancer, an unusual but deadly cancer, researchers reported on Monday.
People who drank mostly fruit juice instead of sodas did not have the same risk, the study of 60,000 people in Singapore found. Sugar may be to blame but people who drink sweetened sodas regularly often have other poor health habits, said Mark Pereira of the University of Minnesota, who led the study.

"The high levels of sugar in soft drinks may be increasing the level of insulin in the body, which we think contributes to pancreatic cancer cell growth," Pereira said in a statement. Insulin, which helps the body metabolize sugar, is made in the pancreas.

Writing in the journal Cancer Epidemiology, Biomarkers & Prevention, Pereira and colleagues said they followed 60,524 men and women in the Singapore Chinese Health Study for 14 years.... http://www.reuters.com/article/idUSTRE6170NY20100208?feedType=nl&feedName=ushealth1100

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The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used world wide. A plant-based diet protects against chronic oxidative stress-related diseases. Dietary plants contain variable chemical families and amounts of antioxidants. It has been hypothesized that plant antioxidants may contribute to the beneficial health effects of dietary plants. Our objective was to develop a comprehensive food database consisting of the total antioxidant content of typical foods as well as other dietary items such as traditional medicine plants, herbs and spices and dietary supplements. This database is intended for use in a wide range of nutritional research, from in vitro and cell and animal studies, to clinical trials and nutritional epidemiological studies.... http://www.nutritionj.com/content/9/1/3
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What’s In The Health Care Reform For Nurse Practitioners And Their Patients?
A preliminary analysis of the final Health Care Reform legislation includes: a nondiscrimination provision that includes nurse practitioners, recognition of nurse practitioners as primary care providers and leaders in public and home care medical home pilots and demonstrations, funding for nurse managed clinics; funding for graduate nurse education and post graduate experience demonstrations, inclusion in primary care Medicare payment increases, and inclusion in ACOs (Accountable care organizations). The bill language is replete with provider neutral language that will facilitate the utilization of nurse practitioners in many venues.... http://www.aanp.org/AANPCMS2/LegislationPractice/What%92s%2BIn%2BThe%2BHCR%2BFor%2BNurse%2BPractitioners%2BAnd%2BTheir%2BPatients.htm


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NEW YORK (Reuters April 26) - U.S. Department of Health and Human Services Secretary Kathleen Sebelius has called on health insurer WellPoint to stop dropping coverage for patients recently diagnosed with breast cancer, calling the practice "deplorable."
http://www.reuters.com/article/idUSTRE63M2YM20100423?loomia_ow=t0:s0:a49:g43:r2:c0.093023:b33334166:z0
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Care model strives for efficiency As a nurse practitioner at the CareMore Health Plan center in Modesto, Calif., Heather Del Villar is trying to keep Medicare patients with chronic diseases from going back to hospitals by remotely monitoring their health and providing immediate treatment. "We prevent their conditions from getting worse. It makes sense from the patient's standpoint, the medical standpoint and the business standpoint," Del Villar said. The Modesto Bee (Calif.) http://www.modbee.com/2010/04/26/1142432/care-model-strives-for-efficiency.html
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RANDOM TIDBIT: REM sleep may help developing brains mature. Premature babies have 75 per cent REM sleep, 10 per cent more than full-term babies. Similarly, a newborn kitten puppy rat or hampster experiences only REM sleep, while a newborn guinea pig (which is much more developed at birth) has almost no REM sleep at all.
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Child abuse drops sharply in U.S. Study: Incidents declined by 26% from 1993 to 2006 NEW YORK - A massive new federal study documents an unprecedented and dramatic decrease in incidents of serious child abuse, especially sexual abuse. Experts hailed the findings as proof that crackdowns and public awareness campaigns had made headway.
An estimated 553,000 children suffered physical, sexual or emotional abuse in 2005-06, down 26 percent from the estimated 743,200 abuse victims in 1993, the study found... http://www.msnbc.msn.com/id/35205114/ns/health-kids_and_parenting/ (personally, I believe that child abuse is now hidden better)

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Now here is something we all need to know......hmmm

RANDOM FACT: After eating, a housefly regurgitates its food and then eats it again.
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NEW YORK (Reuters 4/28) - Sticking to a strict diet of mom's milk during the first 4 months of life may reduce a child's risk of developing asthma by their eighth birthday, according to a new study.

"Breast milk is the optimal food for infants during the first months of life," lead researcher Dr. Inger Kull of the Karolinska Institute in Stockholm, Sweden, told Reuters Health in an email. "But whether or not breastfeeding reduces the risk of asthma has been debated."

Through her milk, a mother transfers "good" bacteria, antibodies and proteins that can help thwart infection. But the evidence for how breastfeeding might influence the later development of asthma remains confusing, with various studies suggesting protective, neutral and even detrimental effects.... http://www.reuters.com/article/idUSTRE63R4TL20100428?feedType=nl&feedName=ushealth1100

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FDA probes risks of HIV, prostate, other (Reuters 5.3) The Food and Drug Administration said on Monday it was probing reports of liver toxicity with patients who used Kaletra to prevent HIV infection after exposure to the AIDS virus.

The agency also said it was investigating cases of male breast cancer in patients treated with Avodart as well as Merck & Co's prostate drug Proscar and baldness treatment Propecia.

The FDA releases a quarterly list of safety probes to inform the public about early investigations of potential side effects that have been reported. The list released on Monday covered issues identified between October and December 2009.

Being on the list does not mean the FDA has concluded the drug causes the specific risk, the agency said. http://www.reuters.com/article/idUSTRE6424DA20100503

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BMI is not an accurate measure of obesity Obesity may be far more of a problem than experts realize because body mass index is an insensitive measure of excess body fat, researchers said. A study of more than 1,200 patients found 66% of those deemed obese based on dual-energy X-ray absorptiometry scans had BMI values in the non-obese range. ... http://abcnews.go.com/Health/Wellness/bmi-underestimates-prevalence-obesity/story?id=10521712
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43 OTC drugs for infants, children are recalled Johnson & Johnson's McNeil Consumer Health care unit voluntarily recalled batches of 43 nonprescription drugs for children and babies, including liquid formulations of Tylenol and Benadryl, because of manufacturing problems at the company's facility in Fort Washington, Pa., that were cited by the FDA. ... http://www.washingtonpost.com/wp-dyn/content/article/2010/05/01/AR2010050103051.html
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Issue Date: October 2006 Vol. 1 No. 1 Author: Ira Gene Reynolds, BSN, RN, PCCN-CMC Calculating I.V. drip rates with confidence While you're working your shift on the progressive care unit, the physician phones in an order to start a patient's I.V. dopamine infusion at 5 mcg/kg/minute. As you hang up the phone, your mind starts to race: How fast should I set the infusion pump to deliver 5 mcg/kg/minute? Will I be able to remember the complex drip rate equation I learned in nursing school? Will I have to mix the solution or will it come premixed? Will I have to titrate the drug myself, or will I get a regular physician's order? If I need to titrate it myself, can I do this on my unit?
Many nurses are expected to deliver and titrate I.V. drugs regularly. Such factors as unit protocols, titration policies, and the specific drug ordered determine exactly how you'll deliver and titrate an I.V. drug.

Today, with an emphasis on patient safety, the pharmacy staff customarily mixes the majority of drug solutions and also may calculate infusion pump rates. Many pharmaceutical companies have gotten in on the act, too, providing a drip rate matrix.

Although many I.V. infusion pumps calculate drip rates automatically, these rates must be double-checked to ensure patient safety. So chances are you'll need to calculate I.V. drip rates and titration scales yourself.

If you feel uneasy when performing these critical tasks, you're not alone. To boost your confidence, this article presents simplified equations to help you breeze through selected I.V. drip rate calculations.

NOTE TO READER: For the sake of accuracy, the rest of this article is available in PDF format only: http://www.americannursetoday.com/assets/0/434/436/440/6182/6184/6190/6208/0d39b2a0e79043daa 93d29d73cf4681a.pdf

http://www.americannursetoday.com/Article.aspx?id=6208&fid=6182
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Your heart disease risk could probably be lower with a little more of this nutrient on board: vitamin D. Older adults who had the highest blood levels of vitamin D enjoyed a 33 percent lower risk of developing heart disease in a recent study. And supplements are a fine source. You can also look to sunshine and fortified dairy products to get your fill of D.

Beyond Bone Health Vitamin D has long been touted for its benefits to bone health. But more and more research is showing a bigger role in health. In a study, adults who had the highest levels of D had the lowest level of "cardiometabolic disorders" -- the family of conditions that includes heart disease, diabetes, and metabolic syndrome. ... http://www.realage.com/tips/take-this-supplement-for-heart-health

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Get more nutrition with every bite when you choose chickpeas that are dark in color. Black, red, purple -- chickpeas come in more colors than basic beige. And a recent study indicates that dark-hued chickpeas may have as much as 13 times more polyphenols in each serving.

Your True Colors With 6 grams of protein, 5 grams of fiber, and a scant 140 calories per half-cup serving, chickpeas are a dieter's dream. And not only will you get more polyphenols in the darker varieties, but those extra polyphenols pack 31 times more antioxidant power compared to the lighter colored legumes, research shows. In fact, the antioxidant powers of dark chickpeas power right past those of dried fruit, most nuts, and many other legumes.... http://www.realage.com/tips/choose-this-color-chickpea

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RANDOM FACT: Almonds are part of the peach family.
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Study Shows RN Ratios Save Lives A new study provides evidence that California’s RN-to-patient staffing law reduces patient mortality, assures nurses spend more time with patients and promotes retention of experienced RNs. The study, published by Health Services Research, was conducted by University of Pennsylvania researchers led by Linda Aiken, RN, PhD, director of the Center for Health Outcomes and Policy Research at the school of nursing.

Surveying more than 22,000 RNs in California and two comparable states, Pennsylvania and New Jersey, the researchers found New Jersey hospitals would have 14% fewer patient deaths and Pennsylvania 11% fewer deaths if they matched California’s 1:5 ratios in surgical units.

Fewer California RNs miss changes in patient conditions because of their workload than New Jersey or Pennsylvania RNs, the researchers said.... (My daughter, a Florida nurse on a step-down cardiac unit, has a minimum of 7 patients !) http://news.nurse.com/article/20100423/NATIONAL02/105030017/-1/frontpage

(I think this article is "preaching to the choir"........the hospital administrations need to digest these facts).
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Trepp R et al. –Knowledge of diabetes is mediocre among medical and nursing house staff. For physicians, the knowledge level depends on the speciality (internal medicine better than surgery and gynaecology) and correlates with the comfort level in dealing with diabetes, but is not higher in attending physicians than in residents. Nurses have a high comfort level, which, however, does not correlate with knowledge, which is similar in medicine, surgery and student nurses, but low in gynaecology.... Free full text pdf http://www.smw.ch/docs/PdfContent/smw-12974.pdf
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Popular Diet Plans Can Unclog Arteries Low-fat, low-carbohydrate and Mediterranean diets ( http://www.healthday.com/Article.asp?AID=636488) all can help to reverse thickening of the artery walls that can lead to heart attack and stroke, Israeli researchers said. They found that even if weight loss is only moderate, sticking to the diets long-term can reverse atherosclerosis. HealthDay News http://www.healthday.com/Article.asp?AID=636488
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Your body might be able to break down fat better if you do this one simple thing: stand more. A small study suggests that when people sit around too much, enzymes that help break down fat are practically turned off. Bad news not just for your waist but also for your heart and artery health. The solution? Fidget, pace, get up, get down. Do whatever you have to do to move those legs of yours. Often.... http://www.realage.com/tips/lose-fat-just-by-standing

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Fundamental Patterns of Knowing in Nursing: the Challenge of Evidence-Based Practice Porter et al. – This article reconsiders the fundamental patterns of knowing in nursing in light of the challenge of narrow empirics in the form of evidence–based practice. Objections to the dominance of evidence–based practice are reviewed, and the reasons for it are examined. This ineffability can be countered only by introducing a wider form of empirics than countenanced by evidence–based practice into all patterns of knowing, to demonstrate their salience and to make their use in practice transparent. ... http://journals.lww.com/advancesinnursingscience/Abstract/2010/01000/ Fundamental_Patterns_of_Knowing_in_Nursing__The.3.aspx
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RANDOM FACT: Antarctica has as much ice as the Atlantic Ocean has water.
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Inkjet'like device 'prints' cells right over burns WINSTON-SALEM, North Carolina (Reuters 4/8) - Inspired by a standard office inkjet printer, U.S. researchers have rigged up a device that can spray skin cells directly onto burn victims, quickly protecting and healing their wounds as an alternative to skin grafts....
http://www.reuters.com/article/idUSTRE63657520100408?feedType=nl&feedName=ushealth1100
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RANDOM FACT: Your body is creating and killing 15 million red blood cells per second!
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New Drug Shows Promise for Curing Hepatitis C Antiviral telaprevir works when previous treatments failed, trial results show WEDNESDAY, April 7 (HealthDay News) -- Adding the antiviral drug telaprevir to a second-round treatment for hepatitis cures about half the people who were not helped in the first round, new research shows.

"This is the first large study in patients who had not responded to standard treatment," said Dr. John G. McHutchison, associate director of the Duke Clinical Research Institute and lead author of a report in the April 8 issue of the New England Journal of Medicine.... http://www.healthday.com/Article.asp?AID=637811

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TODAY'S THRIFTY TIP: After heating and cooling, water heating is typically the largest energy user in the home because it is necessary for so many domestic activities. So it pays to keep your water heater working as efficiently as possible like lowering the water temperature thermostat by ten degrees and wrapping the water tank in an insulating blanket. But there is a simple and very important part of maintenance that many people ignore or don't even know about.

In the course of normal use, minerals and natural sediment in your water condense and settle to the bottom of your water heater. This sediment can seriously impede the efficiency of your water heater and can eventually cause it to malfunction, not to mention the fact that the sediment will eventually start to get into your tap water.

Learning how to clean hot water heater sediment is easy: First turn off the power so you don't risk electrical shock or burn out your element. Then turn off the cold water valve to the tank. Attach a garden hose to the tank drain valve and then drain a few gallons of the hot water in the tank through the hose. Then close the drain valve and open the cold water valve and you're ready to use the tank again.
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RANDOM FACT: The average human head has about 100,000 hairs
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“Over my 20 years in neonatal nursing, I’ve seen an evolution of change to a more baby-driven approach, rather than a nurse-driven or parent-driven one,” said Kim Guglielmo, RN, (at left in photo) a clinical nurse at UNC Health Care’s Newborn Critical Care Center in Chapel Hill, NC.

The trend of cue-based feeding in the NICU has nurses paying more attention than ever to signals young patients provide about their hunger. A recent study links hunger-based feeding with shorter lengths of stay. ... http://nursing.advanceweb.com/Regional-Articles/Features/Promoting-Early-Discharge-in-NICU.aspx?prg=15



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HUMOR SECTION


An elderly man was on the operating table awaiting surgery. He had insisted that his son, a renowned surgeon, perform the operation. As he was about to receive anesthesia, he asked to speak to his son.

"Yes, Dad, what is it?"

" Don't be nervous. Do your best. And just remember, if something happens to me, your mother is going to come to live with you and your wife."


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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

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

This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !


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

Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.

Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org

Decubqueen's website: www.accu-ruler.com

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

http://nursenetworkers.com/ Check this site out....it's new and seems interesting

http://www.nationalnurse3.blogspot.com/

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

The Nursing Site http://thenursingsite.com .

http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website

http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

National Do Not Call Registry

If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Critical Thinking is More Than Problem Solving Critical Thinking: Not Usually Rapid Fire

Should Clinical Courses Get a Letter Grade?

Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/
** http://www.chegg.com/ Cheap textbook rentals. Best way to rent books for college

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MEDICAL RECALLS
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LIFEPAK 15 Monitor/Defibrillator by Physio-Control Inc. FDA notified healthcare professionals of a Class I recall of LIFEPAK 15 Monitor/Defibrillator manufactured and distributed between Marcy 26, 2009 and December 15, 2009. There is a potential for the device to unexpectedly:
Power Off then On by itself.
Power Off then NOT turn On.
Power Off by itself requiring the operator to turn it back On.
Stay powered On and not allow itself to be turned Off.
Healthcare professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm209467.htm

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Coviden Initiates Voluntary Recall of Certain Shiley™ Tracheostomy Tubes FDA and Coviden notified healthcare professionals of a recall of certain lots of its cuffed ShileyTM tracheostomy tubes and Custom/Specialty tracheostomy tubes due to the product’s cuff not holding air as a result of leaks in the pilot balloon inflation assembly. With respect to the affected units, if a cuff does not hold air, ventilation will be adversely affected since the ability to generate positive pressure in the airway could be compromised by lack of cuff seal. This could result in a sudden decrease in the amount of oxygen in the blood or a sudden increase in the amount of carbon dioxide in the blood, especially if the patient requires assisted mechanical ventilation. In some instances, this could result in serious injury, including death.
The voluntary recall only affects lot numbers from a specific period of time. Only Shiley tracheostomy tubes from lot numbers listed in the firms' press release are affected by this action. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts

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Cardiac Science Automated External Defibrillators - Powerheart, Cardiovive, NK, Responder models: Class I Recall [UPDATED 04/27/2010] This update alerts users that Nihon Kohden (NK) and GE Responder models are also affected although they were not identified in earlier communications about this recall. In addition, Cardiac Science issued a software upgrade for the devices’ self tests on 02/24/10 for the Powerheart automatic external defibrillators (Models 9390A and 9390E) and is planning on issuing a similar software upgrade for other affected devices. However, FDA’s review of the updated software indicates that it detects some but not all electrical component defects. Updated recommendations and complete list of affected models can be found in the 04/27/2010 Medical Device Update. http://www.fda.gov/Safety/MedWatch/SafetyInformation /SafetyAlertsforHumanMedicalProducts/ucm205165.htm

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McNeil Consumer Healthcare Over-the-Counter Infants’ and Children’s Products: Recall including Tylenol, Motrin, Zyrtec, and Benadryl products McNeil Consumer Healthcare and FDA notified healthcare professionals of a voluntary recall of certain over-the-counter (OTC) Children’s and Infants’ liquid products manufactured in the United States, including Tylenol, Motrin, Zyrtec, and Benadryl products. Some of these products may not meet required quality standards. This recall is not being undertaken on the basis of adverse medical events. However, as a precautionary measure, parents and caregivers should not administer these products to their children. These products were distributed in the United States, Canada, Dominican Republic, Dubai (UAE), Fiji, Guam, Guatemala, Jamaica, Puerto Rico, Panama, Trinidad & Tobago, and Kuwait. See the company Press Release for a list of products affected by this recall. Consumers can contact the company at 1-888-222-6036 and also at www.mcneilproductrecall.com . http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm210442.htm

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Camolyn eye drops, Fisiolin nasal drops: Voluntary recall due to non-sterility US Oftalmi and FDA notified healthcare professionals of the nationwide recall of all over-the-counter eye drops and nasal drops, initiated due to conditions at the manufacturing facility that cannot assure the sterility of the products. Products that are non-sterile have the potential to cause eye infections, which may be sight threatening. Products are packaged in 15mL plastic bottles and were distributed nationwide to food and drug distributors. The products affected by this recall with lot numbers, expiration dates and UPC codes are noted below. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlerts forHumanMedicalProducts/ucm207794.htm
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Stud Capsule For Men: Product contains Undeclared Drug Ingredient Kanec USA and FDA notified healthcare professionals of a nationwide recall of Stud Capsule For Men [Lot #060607-01/060108-01, Exp 6-2013], after being informed by FDA that laboratory analysis of a sample found the product to be adulterated with sildenafil, an FDA approved drug. The products are sold as a blister pack containing one capsule per unit of use 24-packs in a Box. Lot number and expiration date appears on the seal. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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FDA notified healthcare professionals of the Class 1 recall of certain lots of the BD Q-Syte Luer Access Split Septum device and other finished products, including kits and trays, sold by other companies in which the Q-Syte Luer Access device is a component. This device is used with other infusion therapy products to administer therapies, such as chemotherapy, blood and fluids into the intravenous system. The affected BD products were distributed from August 1, 2008 through February 1, 2010.

These lots of the BD Q-Syte Luer Access Split Septum devices are defective, which may result in air bubbles leaking into the infusion system and into the patient’s bloodstream, resulting in an air embolism. In addition, these defective devices may result in leakage of therapy being infused and result in incomplete inadequate administration of therapy. There is also a potential for blood leakage through this defect. These problems may result in serious injuries or death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlerts forHumanMedicalProducts

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Boston Scientific Implantable Cardioverter Defibrillators: Recall FDA notified healthcare professionals that FDA has been notified by Boston Scientific that it has stopped shipment and started recalling all of its implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) that have not yet been implanted.

FDA is advising practitioners that they should not use these devices unless and until the agency reviews and approves the changes the company has made. FDA is not aware of new safety concerns and, therefore, does not recommend that any of the devices subject to the recall be explanted. Product families included in this advisory include Boston Scientific’s Cognis, Confient, Livian, Prizm, Renewal, Teligen and Vitality. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm205409.htm

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Natural Wellness and FDA notified consumers that MasXtreme, a product sold as a dietary supplement contains aildenafil close in structure to sildenafil and is expected to possess a similar pharmacological and adverse event profile as well as the drug phentolamine which is an alpha-adrenergic blocker. This may pose a threat to consumers because aildenafil may interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. Common side effects of phentolamine include arrhythmia (abnormal heart rhythm) and tachycardia (rapid heart beat).

MasXtreme is sold in blister packs containing one (1) capsule. The product is distributed nationwide by Natural Wellness Inc. Consumers who have purchased MasXtreme capsules are urged to immediately discontinue their use. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm206791.htm

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NURSING HINTS CORNER

(why don't you send in your hints? ...I would appreciate it)

Smooth Move: When I need to transfer an obese patient from one bed to another, I slide the patient and his mattress onto the new bed. Mattress handles make this easy to accomplish. This method reduces strain and discomfort for both the patient and the nurse. It also works well with patients who have difficulty moving. Fay Stout, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 41, 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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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:

Our newest member: jessicafreeman4@yahoo.com (Jessica) April 28, 2010


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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; 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 views.

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THOUGHT FOR THE DAY


What a cruel thing is war: to separate & destroy families
and friends, and mar the purest joys and happiness God has
granted us in this world; to fill our hearts with hatred
instead of love for our neighbors, and to devastate the
fair face of this beautiful world.

Robert E. Lee, to his wife, 1864


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

Paradigm Bytes

PARADIGM BYTES
Newsletter for Paradigm 97
April 11, 2010

PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.

MISSION STATEMENT

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

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SNIPPETS
The following was sent to me by a friend of mine, JANNA .. Please send me your response.

Hi
Here's the scenario...it's way too long I'm afraid, but if there is something here you think you can use, carte blanche, my friend, LOL !

Topic: Temp or no temp ?

Mandated Protocol: Influenza screening in school setting
Oral Temp 100.4, frequent productive or non-productive cough, sore throat, body aches, nausea and or diarrhea.
Mask and isolate student, contact parent and request pick up from school.
Temp must be normal for 48 hrs and cough resolved before they can be permitted back in school.

Scenario: Student presents w/ an ORAL temp of 99.8, frequent non-productive cough, c/o sore throat, body aches, nausea, and fatigue. Mom is contacted and consults w/ a PA who states 99.8 is NOT considered a fever. I verbalized my disagreement in light of the fact that it was an ORAL temp and was most likely closer to 100.8 had it been taken per rectum. She then conceded my point, and the student was sent home where she remained for 7 days, febrile x 4 days and was diagnosed + for Influenza A.

While attending a conference on Influenza A, given by an MD who reviewed the same protocol, I presented the above case to him and informed him that I sent the student home w/ an oral temp of 99.8 for the very reasons I cited above. He, too, stated that this was not considered a fever and therefore posed little risk of being contagious. I asked him if he considered a rectal temp of 100.8 a fever and he said "yes, low grade".
With that, I informed him of a long standing nursing practice of mentally adding 1 degree to oral temps because the rectal temp is a more accurate reflection of the core body temp and is generally 1 degree higher than po. Therefore, the student's temp was actually 100.8, met the criteria and was sent home where indeed her temp escalated that very day and Influenza A was confirmed by her PMD. ( He wasn't too happy with me after that but, the RN applauds spoke volumes. Ever since that time, I've been considering running for Senator, LOL ! Just kidding !!! )

Question:
If the rectal temp is more accurate and pretty close to 1 degree higher than the oral route, should emerging, resting oral temps in the 99 + region be dismissed as "normal" in the presence of additional symptoms ?

Since when is someone only contagious if a fever is present?

Are there any other RNs who were taught the 1 degree variable principle ?

Please note: Before I do any po temps I always ask if the patient has had any food or fluids within the past 15 minutes to avoid inaccurate results. Please send me the response and I will forward it to her...thanks.

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FROM THE MEMBERS


Received this from Bacello (Barbara) Thank you !

Do you wish that your nurse had a gag order preventing her from speaking up on behalf of patients? Should RNs be fired for reporting on hospital safety errors? What about prosecuted for blowing the whistle on quack doctors or heartless healthcare corporations?

Unfortunately this is exactly what too many hospitals are trying to do in our nation today. While the healthcare bill may have passed, there remain life and death patient safety and care issues that we as a nation need to address.

If you are a supporter of America’s nurses, please read what we’re talking about, below, and then offer your solidarity with RNs. We believe this story will outrage you. http://seminal.firedoglake.com/diary/38073
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The following was sent in by whowland1@mac.com (Wendie)....thank you:
Why Certify? The Benefits of Nursing Certification In celebration of Certified Nurses Day, March 19, ANCC believes it is important for all nurses to understand the value of nursing certification. Congratulations to all the nurses who have achieved this important career milestone, and for those still considering it, here are some excellent reasons to pursue specialty nursing certification.... http://www.medscape.com/viewarticle/717805?src=mp&spon=24&uac=104232AV
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In response to the above website from Wendie......I wrote:

I agree with you.........however, I believe that the schools for the Certification should offer some financial help ! To be certified as a Wound Specialist (at the right school).......the charge was about $4000 . Needless to say, I could not afford it then, and absolutely couldn't afford it now. There is a week end school....but it was one I ignored.

Wendie's answer: Usually and to be credible, the certification course is separate from the cert EXAM. Beware the "certification" whose main (or only) promoter is the entity that profits when you take their prep course, buy all your materials from them, and then charges you for the the exam and all recertifications. I walked in to such an exam, scheduled immediately after the "course." I passed it on the basis of my own common sense and a few handounts lying on the floor while people were on break. I did not ever use that certification in my credentials and did not pay to re-up when it expired three or four years later. This was from a veery big name in the industry.


Of my present professional credentials, I took a comprehensive review course for one (ten weeks, twice a week, a real college-level class in a new field for me) and did free self-study for the others. No legitimate credentialling agency tells the any test-prep course the content of the exam, so the test-prep companies find out the way the rest of us do: they take it and try to remember for the next exam. No guarantee at all of specific content. I would encourage people to look into that.
<<<<<<<<>>>>>>>>

Oneacre454@msn.com wrote: We need an economic plea for RNs , the hospitals are hiring LPNs and placing them on Med/Surg floor and Having one RN cover them under their license, Lots of RNs are out of work. (the local hospital in this little town is laying off RNs.......hospital CEOs etc. all seem to have the mistaken belief that Nurses are Overhead ! )
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days

Americans of all races don't get enough sleep The National Sleep Foundation's annual Sleep in America Poll shows Americans are not getting enough sleep and that cultural differences can play a role in habits. The poll found only about 40% of respondents said they got a good night's sleep on most nights, with African-Americans reporting the least amount of sleep.... http://www.usatoday.com/news/health/2010-03-08-sleepsurvey08_ST_N.htm

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Shingles of the eye tied to stroke risk NEW YORK (Reuters 3/3 ) - People who have had an attack of shingles involving the eyes may have a heightened risk of stroke for a year afterward, a study published Wednesday suggests....
http://www.reuters.com/article/idUSTRE62259U20100303?feedType=nl&feedName=ushealth1100
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Facilitation as a Role and Process in Achieving Evidence-Based Practice in Nursing Dogherty EJ et al. – Further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence–based practice in nursing. Research is needed to clarify how facilitation may be used to implement change in nursing practice along with evaluation of the effectiveness of various approaches.... http://www3.interscience.wiley.com/journal/123295670/abstract?CRETRY=1&SRETRY=0
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RANDOM FACT: In 1980, a Las Vegas hospital suspended workers for betting on
when patients would die!
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This book was recommended by Rozalfaro (roz@alfaroteachsmart.com)

Critical Conditions The essential Hospital Guide to Get Your Loved One Out Alive
http://www.criticalconditions.com/about_book.htm
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Anemia drugs help end-stage anemic kidney patients Aggressive treatment with blockbuster anemia drugs may offer the best approach for kidney dialysis patients with severe anemia, U.S. researchers said on Tuesday.
But aggressive treatment only made things worse for patients in the final stages of kidney disease with mild anemia, they reported in the Journal of the American Medical Association.

The findings may help guide regulators as they weigh new restrictions on erythropoiesis-stimulating agents or ESAs, such as Amgen Inc's Epogen. ESAs are used by 95 percent of patients with chronic kidney disease. http://www.reuters.com/article/idUSTRE6214PK20100302?feedType=nl&feedName=ushealth1100

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CHICAGO (Modern Healthcare) - Reducing patients' risk of unnecessary readmission to the hospital after discharge is a lot like untangling the spaghetti of wires tucked behind most people's television/sound systems. At least that has been the experience at Rush University Medical Center inChicago....
http://www.reuters.com/article/idUSTRE62S26720100329?feedType=nl&feedName=ushealth1100
(There must be a checking of all the patients' meds....the old ones and the new ones --this one step may prevent re-admission..in my opinion)

There’s a map of the 100 hospitals here http://www.reuters.com/news/infographic?type=channelName&infographicId=top100hospitals (they missed: John Hopkins in MD, NY Presbyterian, UCLA Medical, University of Michigan Medical, and Massachusetts General.)
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RANDOM FACT: Crocodiles swallow stones to help them dive deeper.

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AAHSA Testimony Urges Senate Panel to Speed Pain Relief for Nursing Home ResidentsWASHINGTON, March 24 /PRNewswire-USNewswire/ -- In written testimony to the U.S. Senate Special Committee on Aging as part of a hearing entitled, "The War on Drugs Meets the War on Pain: Nursing Home Residents Caught in the Crossfire," the American Association of Homes and Services for the Aging (AAHSA) urged the committee to support legislation designed to recognize "chart orders" and the functional role of nurses as the de facto agent of physicians whose patients reside in nursing facilities.

In its testimony, AAHSA outlined the effect that the U.S. Drug Enforcement Administration's (DEA) outdated and overly cumbersome regulations have on nursing homes residents' quality of care and life. The regulations prohibit pharmacists from filling prescriptions for controlled substances like many pain medications unless the pharmacy has a signed prescription from a physician. This additional step means that nursing home residents may be forced to wait hours, or even days, to receive medication for pain,seizures, psychiatric and end-of-life symptoms at times when physicians are hard to reach.
http://www.prnewswire.com/news-releases/aahsa-testimony-urges-senate-panel-to-speed-pain-relief-for-nursing-home-residents-89036907.html
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RANDOM FACT: The poison-arrow frog has enough poison to kill about 2,200 people.
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DHA (Docosahexaenoic acid) May Prevent Age-Related Dementia The Journal of Nutrition, 03/01/10 Cole GM et al. – Clinical trials suggest that the (n–3) fatty acid docosahexaenoic acid (DHA) or fish oil alone can slow early stages of progression, but these effects may be apolipoprotein E genotype specific, and larger trials with very early stages are required to prove efficacy. The authors advocate early intervention in a prodromal period with nutrigenomically defined subjects with an appropriately designed nutritional supplement, including DHA and antioxidants.... http://jn.nutrition.org/cgi/content/abstract/jn.109.113910v1
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Overview: Docosahexaenoic acid (DHA) is an omega-3 fatty acid. It is found in cold water fatty fish and fish oil supplements, along with eicosapentaenoic acid (EPA). Vegetarian sources of DHA come from seaweed. DHA is essential for the proper functioning of our brains as adults, and for the development of our nervous system and visual abilities during the first 6 months of life. In addition, omega-3 fatty acids are part of a healthy diet that helps lower risk of heart disease. Our bodies naturally produce small amounts of DHA, but we must get the amounts we need from our diet or supplements. Most people in the Western world do not get enough omega-3 fatty acids in their diet....
http://www.umm.edu/altmed/articles/docosahexaenoic-acid-000300.htm
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Depression in the Elderly InnovAiT, 03/23/10 Funnell E – Depression is the most common mental illness in the elderly, with an estimated 15% of the elderly population living in the community having clinically significant depressive symptoms. It is of medical and social importance as it is associated with increased morbidity and mortality, poor quality of life and increased social dependence. Recognition of depression in this age group has been found to be poor, with more patients presenting with somatic physical symptoms. Treatment can also be difficult compared with younger patients, with increased prevalence of side effects of medication, polypharmacy and poor compliance. Primary care practitioners are therefore crucial in the detection and early instigation of appropriate treatment. This article looks at the risk factors, presentation and treatment options for depression in the elderly agegroup.

http://rcgp-innovait.oxfordjournals.org/cgi/content/abstract/3/4/199
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A course for nurses to handle difficult communication situations. A randomized controlled trial of impact on self'efficacy and performance.
Patient Education and Counselling, 03/22/10 Doyle D et al. – A short course for nurses on handling difficult communication situations achieved significant improvements in self–efficacy but not in performance. Teaching communication skills in community–based settings is important for the safety and effectiveness of patient care. Sponsoring organizations should weigh trade–offs between feasibility and achievement of measurable improvements in performance. One possible approach is to focus on specific communication skills rather than a full suite of skills....
http://www.pec-journal.com/article/PIIS0738399110000479/abstract?rss=yes
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RANDOM FACT: A lump of pure gold the size of a matchbox can be flattened into a sheet the size of a tennis court
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Choose this fat-burning Condiment: It's perfect on potatoes, very good on veggies, and divine in salad dressings. And the best news yet? It may help with fat burning. The magic condiment in question: vinegar.

Obese people who took in 1 to 2 tablespoons of apple cider vinegar daily in a study melted significantly more body fat and belly fat than a group taking a placebo -- despite being on the same diet and exercise plan.... http://www.realage.com/tips/choose-this-fat-burning-condiment

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LONDON (Reuters) - New imaging technology suggests an experimental drug for Alzheimer's reduces clumps of plaque in the brain by around 25 percent, lifting hopes for a medicine that disappointed in clinical tests two years ago. Bapineuzumab -- being developed by Pfizer Inc, Irish drugmaker Elan Corp and Johnson & Johnson -- is a potential game-changer because it could be the first drug to treat the underlying cause of the degenerative brain disease.
Investor confidence in the antibody medicine, however, took a big hit in July 2008 when it failed to meet its main goal in a mid-stage trial and caused brain swelling at higher doses. The new study, which only involved 28 patients, is modest fillip.... http://www.reuters.com/article/idUSTRE62001A20100301?feedType=nl&feedName=ushealth1100

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RANDOM FACT: At a party, 40% of all the guests snoop in your medicine cabinet.
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Women "on the Pill" live longer: Study One of the world's largest studies of the contraceptive pill has found that women who have taken it can expect longer lives and are less likely to die from any cause, including cancer and heart disease....
http://www.reuters.com/article/idUSTRE62B01R20100312?feedType=nl&feedName=ushealth11
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Scientists have found the "mother," or origin, of all skin cells and say their discovery could dramatically improve skin treatments for victims of serious wounds and burns. Hans Clevers and a team of Dutch and Swedish researchers conducted a study in mice and found that the stem cell that gives produces all the different cells of the skin actually lives in hair follicles.
The findings, which they say will translate for human use, mean it may be possible to harness these stem cells to help with wound repair or skin transplants for burns victims, they said in a study in the Science journal on Thursday.... http://www.reuters.com/article/idUSTRE62A4KQ20100311?feedType=nl&feedName=ushealth1100

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New Emphasis on Glucometer Cleaning/ Disinfection F-Tag 441 of the CMS State Operations Manual addresses the new infection control guidelines related to glucometer cleaning and disinfection. The American Society of Consultant Pharmacists (ASCP) has researched individual glucometer manufacturers' cleaning recommendations, along with the guidelines of the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA) and American Diabetes Association
(ADA). Click here to access ASCP's glucometer cleaning summary document.
http://tinyurl.com/yfo6ab8

If a manufacturer does not provide specific cleaning recommendations for glucometers, facilities might want to consider cleaning them with high-level disinfectants. Become familiar with the amount of time the disinfectant solution has to be in contact with the equipment or how long active cleaning should be performed to ensure complete disinfection. Simply wiping equipment with a disinfectant-soaked swab may not be adequate. Wiping for a specific length of time or ensuring the equipment is "wet" or saturated for a specific length of time may be required.
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RANDOM FACT: Lobsters can live up to 50 years. (not with humans in their world)
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Have Your Blueberries This Way-- It's Better Get more nutrition from your blueberries by tossing them into a steamy bowl of oatmeal instead of cold cereal and milk.

Why? Because a recent study revealed that combining blueberries and milk in the same meal could block your body's absorption of the antioxidant goodness in the berries.

The ABCs of Antioxidant Absorption
Blueberries are packed with powerful phenolic antioxidants that help keep you young by combating oxidative stress. ... http://www.realage.com/tips/have-your-blueberries-this-way-its-better

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Psychoeducation for bipolar disorder Smith D et al. – Bipolar disorder is a complex disorder of mood and behaviour that requires a multimodal treatment approach. In the past 10 years there has been growing interest in psychoeducational interventions delivered as adjuncts to conventional management. Several studies have tested the effectiveness of psychoeducational treatments delivered in a variety of formats. http://apt.rcpsych.org/cgi/content/abstract/16/2/147

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Smith A et al. – Triage decision making is an essential skill for nurses. Through initial assessment, a nurse must be able to prioritize patient care on the basis of appropriate decision making. The purpose of this article is to present pilot study data on the Triage Decision–Making Inventory, which measures the identification of critical thinking, cognitive characteristics, intuition, and experience when making triage decisions. Establishing reliability and validity of the instrument in a sample of nurses with diverse specialties allows staff development experts to use the inventory to tailor training for new graduates and practicing nurses. ... http://journals.lww.com/jnsdonline/Abstract/2010/01000/Triage_Decision_Making_ Skills__A_Necessity_for_all.17.aspx
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Healthy at Home Nurse practitioners are helping revive the old-fashioned house call, which is gaining popularity as evidence shows it can lead to better outcomes for less money. Advanced, portable technology allows NPs to diagnose and manage patient conditions in a home setting, which helps people stay in their community and out of nursing homes. ...
http://nurse-practitioners.advanceweb.com/editorial/content/editorial.aspx?cc=218528
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RANDOM FACT: Diet Coke was only invented in 1982.
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Unfortunately, you must register to read the entire study) The Role of Nursing in the Rehabilitation of Stroke Survivors: An Extended Theoretical Account Kirkevold M – These developments provide significant new insights that may refine and extend the original understanding of the role of nursing in stroke rehabilitation. This article proposes an extended theoretical framework of the role of nursing in stroke recovery and rehabilitation. ...
http://journals.lww.com/advancesinnursingscience/Abstract/2010/01000/The_Role_of_Nursing_in_ the_Rehabilitation _of.11.aspx
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(This is another article which requires one to register) Polypharmacy in Schizophrenia Purpose of review: Although most guidelines recommend monotherapy in schizophrenia, the combined application of multiple psychotropic agents is very common, especially in treatment-refractory cases. We review the empirical basis supporting these attempts and their relevance for clinical practice. ...
http://journals.lww.com/co-psychiatry/Abstract/2010/03000/Polypharmacy_in_schizophrenia.6.aspx
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Stents, surgery both prevent strokes; study (Reuters 2/26/10)
For many years, surgery has been the preferred way to clear away dangerous fatty deposits in neck arteries that can cause strokes.

But newer, less invasive approaches using angioplasty and stents have been approved for use in higher-risk patients, stirring debate over which approach is best.

Carotid artery stenting involves threading a wire mesh coil called a stent in the neck artery to widen the blocked area and capture any dislodged plaque that could travel to the brain and cause a stroke.

They compared the treatment with surgery, in which doctors cut open the neck, scrape away the fatty deposits in the artery, and sew it back up.

Several medical device makers sell carotid stents, including Boston Scientific Corp, Abbott Laboratories, Johnson & Johnson, Ev3 Inc and C.R. Bard Inc.... http://www.reuters.com/article/idUSTRE61P2N420100226?feedType=nl&feedName=ushealth1100

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RANDOM FACT: Refrigerating apples can help them last up to 10 times longer than those left at room temperature.
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Thank you, Melva (HealthDay News) -- Any one of three heart-healthy diets -- low-fat, low-carbohydrate, Mediterranean -- can reverse the thickening of artery walls that can lead to heart attack and stroke, an Israeli study indicates.
"Once one adheres to a sensible diet, even though you experience only a moderate weight loss, if you stick to it long enough you can cause regression of atherosclerosis," explained Iris Shai, a nutritional epidemiologist at Ben-Gurion University of the Negev, and lead author of a report to be published in the March 16 print issue of the journal Circulation.

Atherosclerosis involves a thickening and narrowing of blood vessels. When narrowing leads to a full blockage of blood flow, heart attacks or strokes are the result.... http://www.healthday.com/Article.asp?AID=636488

http://www.mayoclinic.com/health/mediterranean-diet/CL0 **********************
105 convicted burglars were interviewed for a book and here is some of what they said. Things Your burglar Won't Tell You:

1. Of course, I look familiar. I was here just last week cleaning your carpets, painting your shutters, or delivering your new refrigerator.

2. Hey, thanks for letting me use the bathroom when I was working in your yard last week. While I was in there, I unlatched the back window to make my return a little easier.

3. Love those flowers. That tells me you have taste...and taste means that there are nice things inside. Those yard toys your kids leave out always make me wonder what type of gaming system they have.

4. Yes, I really do look for newspapers piled up on the driveway, and I might leave a pizza flyer in your front door to see how long it takes you to remove it.

5. If it snows while you are out of town, get a neighbor to create car and foot tracks into the house. Virgin drifts in the driveway are a dead give away.

6. If decorative glass is part of your front entrance, don't let your alarm company install the control pad where I can see if it is set--- that makes it too easy.

7. A good security company alarms the window over the sink and also the windows on the second floor which often access the master bedroom and your jewelry. It's not a bad idea to put motion detectors up there, too.

8. It's raining, you are fumbling with your unbrella, and you forget to lock your door--understandable. 'But understand this: I don't take a day off because of bad weather.

9. I always knock first. If you answer, I'll ask for directions somewhere or offer to clean your gutters..(don't take me up on it).

10. Do you really think I won't look in your sock drawer? I always check dresser drawers, the bedside table, and the medicine cabinet.

11. Here's a helpful hint: I almost never go into kids' rooms.

12. You are right: I won't have enough time to break into that safe where you keep your valuables. But if it's not bolted down, I will take it with me.
13. A loud TV or radio can be a better deterrent than the best alarm system. If you're reluctant to leave your TV on while you're out of town, you can buy a $35 device that works on a timer and simulates the flickering glow of a real television.. (Find it at faketv.com.)

8 more things a burglar won't tell you:

1. Sometimes, I carry a clipboard. Sometimes, I dress like a lawn guy and carry a rake. I do my best to never, ever look like a crook.

2. The two things I hate the most: loud dogs and nosy neighbors.

3. I'll break a window to get in, even if it makes a little noise. If your neighbor hears one loud sound, he'll stop what he is doing and wait to hear it again. If he doesn't hear it again, he will just go back to what he was doing. It's human nature.

4. I'm not complaining, but why would you pay all that money for a fancy alarm system and leave your house without setting it?

5. I love looking in your windows. I'm looking for signs that you're home, and for flat screen TVs or gaming systems I'd like. I'll drive or walk through your neighborhood at night before you close the blinds just to pick my targets.

6. Avoid announcing your vacation on your Facebook page. It's easier than you think to look up your address.

7. To you, leaving that window open just a crack during the day is a way to let in a little fresh air. To me it's an invitation.

8. If you don't answer when I knock. I try the door. Occasionally, I hit the jackpot and walk right in.

Sources: Convicted burglars in North Carolina, Oregon, California, and Kentucky; security consultant Chris McGoey, who runs crimedoctor.com; and Richard T. Wright, a criminology professor at the University of Missouri-St. Louis, who interviewed 105 burglars for his book Burglars on the Job

Don't be a victim. Practice Crime Prevention
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RANDOM FACT: The average ice berg weighs 20,000,000 tons
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This tip is from Marlene (Margerlach@AOL.com) Thank you !
ZIP LOCK BAG
We went with friends on Sunday for breakfast and sat in the patio section beside the house. We happened to notice zip lock baggies pinned to a post and a wall. The bags were half filled with water, each contained 4 pennies, and they were zipped shut. Naturally we were curious! Ms. ______ told us that these baggies kept the flies away! So naturally we were even more curious! We actually watched some flies come in the open window, stand around on the window sill , and then fly out again. And there were no flies in the eating area! Below is an explanation on this fly control idea.

Regarding the science behind zip log bags of water? My research found that the millions of molecules of water presents its own prism effect and given that flies have a lot of eyes, to them it's like a zillion disco balls reflecting light, colors and movement in a dizzying manner. When you figure that flies are prey for many other bugs, animals, birds, etc., they simply won't take the risk of being around that much perceived action. I moved to a rural area and thought these guys were just yanking my city boy chain but I tried it and it worked immediately! We went from hundreds of flies to seeing the occasional one, but he didn't hang around long.
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New York (Reuters 3/25) Adults and teenagers who suffered physical abuse as children may have a heightened risk of migraines, two new studies suggest. In one study, Canadian researchers found that migraines were twice as common among adults with a history of childhood abuse, compared to those who reported no such abuse.

Similarly, the second study, of nearly 4,000 Taiwanese teenagers, found a higher prevalence of migraine among those who said that they had ever been beaten by a family member. And the more frequesnt the abuse, the greater the chances of suffering migraines. ... http://www.reuters.com/article/idUSTRE62O3X620100325?feedType=nl&feedName=ushealth1100
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Reuters (3/25) Gene test helps select breast cancer chemotherapy Scientists have found a new and simple way to identify breast cancer patients who are likely to respond well to treatment with a common class of chemotherapy drugs, and predict who is unlikely to see any benefit.
The findings presented by researchers at the European Breast Cancer Conference in Spain on Thursday, mean doctors should be able to test patients, tailor treatment to them and avoid giving them toxic drugs that will not help.

By conducting a study called a meta-analysis of four large breast cancer trials including nearly 3,000 patients, the researchers found that an abnormality on chromosome 17, called CEP17, is a "highly significant indicator" that the tumor will respond to chemotherapy drugs called anthracyclines. ... http://www.reuters.com/article/idUSTRE62O3W620100325?feedType=nl&feedName=ushealth1100
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HUMOR SECTION
An 89-year-old man goes for a physical. All of his tests come back with normal results.
The doctor says, " George , everything looks great. How are you doing mentally and emotionally ? Are you at peace with God?"

George replies, "God and I are tight. He's taking care of me. He knows I have poor eyesight, so he's fixed it so when I get up in the middle of the night to go to the bathroom, POOF.... the light goes
on. When I'm done, POOF... the light goes off."

"Wow, that's incredible," the doctor says. A little later in the day, the doctor calls George's wife, Ethel.

"Hello Ethel," the doctor begins. " George is doing fine. But I had to call you because I'm in awe of his relationship with God. Is it true that he gets up during the night and POOF.... the light goes on
in the bathroom, and when he's done, POOF..... the light goes off ?"

"Oh, Dear God !!" 'Ethel exclaims. "He's peeing in the fridge again !"

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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

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

This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !

Measles: Not just a childhood rash CME Free Full Text
Cleveland Clinic Journal of Medicine http://www.mdlinx.com/NurseLinx/newsl-article.cfm/3070667/ZZ5603146585149290157159/?news_id=467

Treating silent reflux disease does not improve poorly controlled asthma CME Free Full Text http://www.mdlinx.com/NurseLinx/newsl-article.cfm/3070660/ZZ5603146585149290157159/?news_id=467
Cleveland Clinic Journal of Medicine

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WEBSITES/ LINKS

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

Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)

Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org

Decubqueen's website: www.accu-ruler.com

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

http://www.nationalnurse3.blogspot.com/

The Emergency Email & Wireless Network Alerting us to scams/phishing, etc.
http://www.emergencyemail.org/newsemergency/anmviewer.asp?a=489&z=43

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

The Nursing Site http://thenursingsite.com .

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

http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website


http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

National Do Not Call Registry https://www.donotcall.gov/default.aspx

If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Critical Thinking is More Than Problem Solving Critical Thinking: Not Usually Rapid Fire

Should Clinical Courses Get a Letter Grade?

Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/

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MEDICAL RECALLS
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Teleflex Incorporated notified healthcare professionals of the recall of all lots of Arrow Select IV Tubing Sets, accessories, and certain lots of arterial embolectomy catheters because it has been determined that product sterility cannot be guaranteed. Testing revealed pin holes in some of the pouches in which the products are packaged, and if product sterility has been compromised, there is a potential for infection, which could lead to serious injury or death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts

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FDA is recommending that healthcare professionals temporarily suspend the use of Rotarix, a vaccine used to prevent rotavirus disease. FDA’s recommendation is a precaution taken while the agency learns more about the situation.

FDA has learned that DNA from porcine circovirus type 1 (PCV1) is present in Rotarix. PCV1 is not known to cause disease in humans. There is no evidence at this time that this finding poses a safety risk. Because available evidence supports the safety of Rotarix, no medical follow-up is needed for patients who have been vaccinated with Rotarix.

There are two licensed vaccines for rotavirus in the United States: RotaTeq and Rotarix. For children who have received one dose of Rotarix, CDC advises that clinicians can complete the series with RotaTeq for the next two doses. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm205640.htm

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FDA and Baxter notified healthcare professionals of a Class I recall of the HomeChoice and HomeChoice PRO Automated Peritoneal Dialysis Systems, which are prescription medical devices used to treat pediatric and adult patients with kidney failure. Reports of serious injuries and at least one death have been associated with increased Intraperitoneal Volume (IIPV), also known as overfill of the abdominal cavity. IIPV may result in serious injury or death from conditions including but not limited to: abdominal wall and/or diaphragmatic hernias, hydrothorax, heart failure, acute hypertension, pulmonary edema, decreased pulmonary function, pericardial effusion, and peritonitis.

Children and non-verbal patients may be at increased risk because of their smaller size or inability to communicate. Increased monitoring of these patients is recommended. Other vulnerable populations include critically ill patients and patients with pulmonary and hemodynamic instability.

Patients and caregivers should watch for the potential signs of IIPV. If patients or caregivers notice any of the signs of IIPV, stop the device, initiate manual drain, and contact your doctor immediately. Clinicians should weigh the risks and benefits to continued use of these devices by their patients versus other forms of dialysis therapy. Clinicians should also review the prescription settings for patients who continue to use these devices. See the Recall Notice for a listing of affected models/product code numbers. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm202885.htm

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FDA and Thomas Medical Products notified healthcare professionals of a Class I recall of the Transseptal Sheath Introducer Kit (also under the trade names: HeartSpan, CHANNEL FX, Torflex, Braided Guiding Introducer Kit), which are prescription medical devices used to to pass heart catheters from the right to the left side of the heart. The sheath tip may break off and separate during heart procedures. If this occurs, the fragment could move through the heart and arteries to vital organs, causing a blockage anywhere, including the brain or heart. This could lead to unplanned open heart surgery, permanent injury, such as a stroke or heart attack, and/or death. These devices were manufactured and distributed from October 1, 2006 through December 27, 2009. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts
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Counterfeit Polypropylene Surgical Mesh: Initial Communication Counterfeit flat sheets of polypropylene surgical mesh, used in the repair of hernias and chest wall defects, are being marketed in the United States, labeled with the C. R. Bard/Davol brand name. These products are not Bard-manufactured products. Healthcare professionals and facilities should carefully examine all manufacturers’ polypropylene surgical mesh products for their lot numbers and anything unusual that might indicate they are counterfeit. The product codes, sizes and lot numbers of the counterfeit product identified, to date, are noted in the linked Initial Communication, and recommendations/actions for healthcare professionals, healthcare facilities, and patients are provided. MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm204224.htm
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Abiomed AB5000 Circulatory Support System: Class I Recall FDA notified healthcare professionals of the Class 1 recall of the AB5000 Circulatory Support System, a product that supplies power to disposable blood pumps used to support the left and/or right sides of the heart. The computer may shut down (stop pumping) without an alarm and this defect may cause serious injuries or death. These products were manufactured and distributed between May 2003 and December 2009. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm203956.htm
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Baylis Medical Torflex Transseptal Guiding Sheath: Class I Recall FDA notified healthcare professionals of the Class 1 recall of Torflex Transseptal Guiding Sheath, a medical device used to pass heart catheters from the right to the left side of the heart. The sheath tip may break off and separate during heart procedures. If this occurs, the fragment could move through the heart and arteries to vital organs, causing a blockage anywhere, including the brain or heart. This could lead to unplanned open heart surgery, permanent injury, such as a stroke or heart attack, and/or death. This product was manufactured from April 11, 2007 through March 3, 2008 and distributed from April 2007 through May 2009. Recalled model and lot numbers are noted in the Recall Notice. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm204177.htm
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Beckman Coulter UniCel DxC Synchron Clinical System--Ion Selective Electrode Flow Cell: Class I Recall FDA notified healthcare professionals of the Class I recall of UniCel DxC Synchron Clinical System – Ion Selective Electrode (ISE) Flow Cell. These systems are computer-controlled clinical chemistry analyzers used to determine different types of blood chemistries and other chemistries from blood samples collected from an individual. There may be excessive build-up of protein, bacteria, and sample tube additives in the instrument’s ion selective electrode flow cell which may cause incorrect sodium results. This product has been manufactured and distributed since November 2004. See Recall Notice for the serial numbers affected.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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WinRho SDF (Rho(D) Immune Globulin Intravenous (Human): Risk of Intravascular Hemolysis
Cangene, Baxter and FDA notified healthcare professionals that cases of intravascular hemolysis (IVH) and its complications, including fatalities, have been reported in patients treated for immune thrombocytopenic purpura (ITP) with WinRho SDF. IVH can lead to clinically compromising anemia and multi-system organ failure including acute respiratory distress syndrome. Serious complications including severe anemia, acute renal insufficiency, renal failure and disseminated intravascular coagulation have also been reported. Fatal outcomes associated with IVH and its complications have occurred most frequently in patients of advanced age (age over 65) with co-morbid conditions. The Boxed Warning informs healthcare professionals that:
Patients should be closely monitored in a health care setting for at least eight hours after administration
A dipstick urinalysis should be performed at baseline, 2 hours, 4 hours after administration and prior to the end of the monitoring period
Patients should be alerted to and monitor for signs and symptoms of IVH, including back pain, shaking chills, fever, and discolored urine or hematuria. Absence of these signs and/or symptoms of IVH within eight hours do not indicate IVH cannot occur subsequently.
If signs and/or symptoms of IVH are present or if IVH is suspected after WinRho administration, post-treatment laboratory tests should be performed including plasma hemoglobin, urinalysis, haptoglobin, LDH and plasma bilirubin (direct and indirect).
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm203739.htm


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NURSING HINTS CORNER

No Mess Mouth Care

Giving mouth care to a patient who must lie flat in bed isn't easy--especially the rinsing and spitting. But here is a way to avoid the mess:
After the patient's teeth are brushed, offer him/her mouthwash or water through a straw. Then have the patient use the same straw to expel the mouthwash or water into an emesis basin.
Although using a straw may be a bit awkward at first, patients usually master it quickly and become proficient in the ins and outs of rinsing and spitting with straws. Kathy Scheeve, SN

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.128, 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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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

No new members this time.

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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; 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 views.

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THOUGHT FOR THE DAY


A general dissolution of the principles and manners will
more surely overthrow the liberties of America than the
whole force of the common enemy.


--Samuel Adams


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