June Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 June 12, 2012 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. ***~~~***~~~***~~~*** SNIPPETS Compassion and fatigue January 3, 2012 -- Recent press items have highlighted the devastating effects of nurse under-staffing on patients and nurses alike. Today, Laura Landro's "Informed Patient" column in The Wall Street Journal discussed compassion fatigue among nurses, especially those who regularly care for terminally ill patients. Landro's Health Blog provided additional information about the problem, which may contribute to burnout and high turnover, which in turn add to compassion fatigue. That cycle can lead to worse patient care. The Wall Street Journal pieces include expert comment from several nurses, and the items convey that nurses play an important role in care, though they might have focused more on the danger that impaired nurses pose to patients because of the critical nature of nursing. And on December 31, 2011, the Daily Mail (UK) ran a piece by Sam Greenhill about a woman who, though not a nurse, had "nursed" her 89-year-old grandmother back to health at a hospital, after the physicians and other health professionals had apparently written the patient off. The woman reportedly fed, washed, and advocated for her grandmother while the hospital's actual nurses were too overworked to do so. We're generally critical of media accounts that suggest lay people have acted as "nurses" by providing unskilled care, since that suggests nursing requires no special education or skills. But here it sounds like the lay person did a better job than the real nurses. Of course, despite the happy ending, the piece also presents a distressing picture of what happens when nurses are so overworked that they cannot do the most basic part of their jobs--saving lives. We thank those responsible for these pieces. ... (Try to read all of this...very good) http://www.truthaboutnursing.org/news/2012/jan/wsj.html#ixzz1x9WYff8x ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS (This was sent in by Kurt Ullman, a member of Paradigm97) Thirty-six percent of physicians are not accepting new Medicaid patients, and 26% see no Medicaid patients at all, according to a new survey from a staffing company called Jackson Healthcare. The firm's online survey of 2232 physicians in April found that dermatologists are the least likely (34%) among all specialists to accept new Medicaid patients, followed by endocrinologists and plastic surgeons (36% each), general internists (42%), and physical medicine and rehabilitation specialists (43%). The specialists most willing to make an appointment for a new Medicaid patient are pediatric subspecialists (95%), pathologists (90%), radiologists (86%), anesthesiologists (83%), and general surgeons (81%). The numbers also reveal a lesser degree of physician disenchantment regarding Medicare. Seventeen percent of physicians said they are not accepting new Medicare patients, and 10% said they have closed their practice to Medicare entirely. The specialists least inclined to see new Medicare patients are adult psychiatrists (57%), plastic surgeons (68%), general internists (73%), family physicians (75%), and obstetricians-gynecologists (76%). In contrast, rates of accepting new Medicare patients top 90% among cardiologists, hematologists/oncologists, general surgeons, anesthesiologists, and neurologists. **************** ( I wrote to Kurt): If Medicare paid much more promptly, perhaps those facts would improve. Baby Boomers are going to have to lobby for this to happen . Frankie (This is Kurt's answer): This is only going to get worse. Under the healthcare reform act, much of the money savings come from providers, allegedly (that's another thread altogether), but even if it gets chucked by the Supremes, the 1997 Medicare Sustainability Act calls for something like 30% cuts (allegedly). Kurt ************ NON-MEDICAL NEWS: We have all heard of phishing (if not sure, go to: http://us.norton.com/transactsafely/phishingfaq.jsp for more info) Now, I just learned about Pharming ! How to Protect Against Pharming Pharming is an attempt to defraud Internet surfers by hijacking a Web site’s domain name, or URL, and redirecting users to an imposter Web site where fraudulent requests for information are made. To protect yourself against pharming, follow these basic guidelines: Check the URL of any site that asks you to provide personal information. Make sure your session begins at the known authentic address of the site, with no additional characters appended to it. Maintain effective, up-to-date virus protection. Symantec recommends Norton AntiVirus. Use a trusted, legitimate Internet Service Provider. Rigorous security at the ISP level is your first line of defense against pharming. Check the certificate. It takes just a few seconds to tell if a site you land on is legitimate. On the latest version of Internet Explorer and on many other commonly available Web browsers, go to "File"" in the main menu and select "Properties",or right click your mouse anywhere on the browser screen and, from the menu that pops up, click on"Properties. When the "Properties" box pops up, click on "Certificates" and check if the site carries a secure certificate from its legitimate owner. Block suspicious Web sites automatically. Norton Internet Security detects and blocks fake Web sites, making it easier for you to be confident most of the sites you are using are legitimate. http://us.norton.com/transactsafely/prevention.jsp?om_em_cid=hho_email_clubnorton_apr12_nam_us_A ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days As America's waistline expands, costs soar (Reuters) - U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960. The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows. Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops. ... http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430?feedType=RSS&feedName=healthNews *********************** RANDOM FACT: A report by the American Journal of Epidemiology states that long term job stress is worse for your heart than gaining 40 pounds or aging 30 years. ********************** How to Control 4 Common Body Odors The Skunk Ape of the Everglades announces its arrival with an aroma that’s part chicken coop, part outhouse, and the creature certainly grabs our imagination. But there’s nothing captivating about our own body odor. Luckily, we have a fix for the fumes! Here are 4 common body odors and tips to control them: Smelly feet: If the 250,000 sweat glands in your feet cause excessive sweating or if you wear damp socks or shoes for too long, your feet can stink. The solution? Zap the overgrowth of stinky bacteria: After washing and drying your feet, apply a diluted solution of lemongrass oil or verbena oil. Underarm odor: Anxiety, hormones, and armpit hair can turn your sweat sour. Wildly overactive sweat glands (i.e., hyperhidrosis) can also cause underarm odor. Most folks need deodorants, not antiperspirants, but if you really suffer from armpit odor, try a boric acid or tannic acid solution. Still dripping? Put on 20% aluminum at night and wash it off in the morning, or try antibiotic creams to kill multiplying bacteria. If you have hyperhidrosis, Botox turns off the faucet. Beta-blockers (high blood pressure medication) can help relieve chronic, stress-related sweating. Bad breath and flatulence: What you eat fuels bad breath and flatulence. Food odors -- onions, garlic, and curry, for example -- pass into your bloodstream and the aromas are exhaled from your lungs. The intestines pump out methane when you can’t cope with carbs or don’t have good bacteria in your guts. Remedy bad breath by flossing, brushing teeth and tongue, and drinking plenty of water. For flatulence, try Beano and probiotics (spore forms). http://www.realage.com/beauty-skin-care/how-to-control-4-body-odors?eid=1010657395&memberid=4687812 ************************** RANDOM FACT: On Oct. 22, 1987 a Japanese buyer, Eiichi Kobayashi, purchased the Old Testament portion of a Gutenberg Bible for $5.4 million dollars at a Christie's Auction. The last sale of a complete version took place nine years before, again at a Christie's, for $2.2 million. Today, single pages from the first-edition Bibles fetch $25,000 each. In addition to providing their well-known Bibles in hotel rooms, the Gideons also distribute Bibles to militaries of various countries, to hospitals, nursing homes, and prisons. ******************* AORN study highlights benefits of double-gloving Double-gloving with inner indicator gloves may protect nurses’ skin from needle sticks, according to results of a 24-month study published by the Association of periOperative Registered Nurses. The study in the March issue of AORN Journal examined the effect of double-gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. Denise Korniewicz, RN, PhD, FAAN, senior associate dean of research at the University of Miami School of Nursing & Health Studies, and Maher El-Masri, RN, PhD, associate professor and research leadership chairman at the University of Windsor in Canada, found that healthcare providers observed blood on their hands after surgery less frequently when they wore two pairs of gloves than when they wore a single pair. The researchers also found the frequency of changing gloves during surgery was significantly higher among healthcare providers who wore dark-colored gloves under light-colored gloves than among those wearing two pairs of gloves of the same color. The majority of healthcare providers in the study expressed favorable views about double-gloving, according to an AORN news release. The study is available via subscription or purchase at http://bit.ly/GYuDxj. http://news.nurse.com/article/20120409/NATIONAL01/304090021 ********************* RANDOM FACT: In its 2008 Death on the Job Report, the AFL-CIO ranked commercial fishing as the occupation with the highest fatality rate, with 150 deaths per 100,000 workers. ***************** U.S. gives nod to Eli Lilly's brain plaque test Reuters - U.S. regulators gave the nod to an imaging test from Eli Lilly and Co. that can for the first time help doctors detect brain plaque tied to Alzheimer's disease, the company said. The U.S. Food and Drug Administration approved the radioactive dye, called Amyvid, to help doctors rule out whether patients have Alzheimer's, the most common form of dementia, Lilly announced late on Friday. The dye binds to clumps of a toxic protein called beta amyloid that accumulates in the brains of patients with Alzheimer's. Doctors can then see the plaque light up on a positron emission tomography, or PET, scan. Patients with Alzheimer's always have some brain plaque, so its absence in the test would tell doctors to look for other causes of mental decline, such as depression or medications, Lilly has said. ... http://www.reuters.com/article/2012/04/07/us-fda-lilly-amyvid-idUSBRE8360C220120407?feedType=RSS&feedName=healthNews *********************** Nurses’ assessments of individualised care in long-term care institutions Journal of Clinical Nursing (full text available) Aims.  The aims of this study were to explore nurses’ assessments of individualised care in long-term care wards and to examine how their sociodemographic variables were associated with their views of such care. Background.  Although the importance of individualised care is highlighted both by nurses and by older people, there is a limited amount of research about individualised care, especially in the long-term care of older people. Design.  An exploratory design was employed. Methods.  Data were collected using questionnaires [Individualised Care Scale (ICS)-Nurse] from nurses (n = 283, n = 215, response rate 76%) working in the long-term care wards (n = 19) of four institutions in 2009. Data were analysed statistically. Results.  Overall, nurses perceived that they supported patient individuality during nursing activities but the care they provided was not so individualised. Nurses perceived that they supported older peoples’ individuality in the clinical situation and in decisional control over care well but supported older peoples’ individual life situation to a lesser extent. The higher the nurses’ age, the longer the working experience in health care or experience in the current ward, the more positive views they had about the support of individuality. Conclusions.  This study identified some shortcomings in the realisation of individuality in the care of older people. Nurses seem to think they generally provide individualised care but this was not necessarily realised in the current evaluations of the care they delivered. Relevance to clinical practice.  There is need to identify issues that may help in developing individualised care in clinical practice. Nurses’ attitude to older people in the geriatric care settings needs exploration. Nurses may focus on physiological needs that may hinder the recognition of older patient’s individuality. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2011.03855.x/abstract;jsessionid=287B14BCA8D9C27F28454B634EA07DA9.d01t02 ************************* Childbirth takes longer now than 50 years ago: study Many tasks can be tackled more quickly now than 50 years ago, but delivering a baby naturally it seems is not one of them, according to a U.S. government study. Compared with the 1960s, U.S. women have in recent years spent two to three hours longer in labor, according to researchers at the U.S. National Institutes of Health, who said the findings suggest doctors may need to rethink the definition of "normal" labor. The extra time is spent in the first stage of labor - the longest part of the process, before the "pushing" stage, according to findings published in the American Journal of Obstetrics & Gynecology. Mothers are different as well. On average, they're older and weigh more, and their newborns are bigger too. ... http://www.reuters.com/article/2012/04/02/us-childbirth-idUSBRE82T16M20120402?feedType=RSS&feedName=healthNews ***************************** RANDOM FACT: A solar flare is an enormous explosion in the solar atmosphere, involving sudden bursts of particle acceleration, plasma heating, and bulk mass motion. It is believed to result from the sudden release of energy stored in the magnetic fields that thread the solar corona in active regions around sunspots. The largest of solar flares can be equal to billions of one-megaton nuclear bombs! ********************* Thanks to the ACA, insurers cannot drop or deny coverage because of pre-existing conditions, children up to the age of 26 are now allowed to stay on their parent’s insurance plans, and Seniors are protected from the Medicare “Donut Hole” that threatened so many of our most vulnerable citizens. These are just some of the initial life-changing benefits that are cause for celebration today. •Take a look at our quick Summary of Benefits and Protections -- Do your Patients know what the ACA is already doing for them? http://www.nursingworld.org/HCR-Brief.aspx •Visit http://www.healthcareandyou.org/-- ANA partnered with organizations that represent consumers, physicians, hospitals and pharmacists to create this website, which provides easy-to-understand information about the health care law. Find out what’s happening in your state and what Health Care Reform means for you! ************************* Diagnosis and treatment of osteopenia Gulay Karaguzel and Michael F. Holick Osteopenia is a term to define bone density that is not normal but also not as low as osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score −1 to −2.5. There are many causes for osteopenia including calcium and vitamin D deficiency and inactivity. Genetics plays an important role in a person’s bone mineral density and often Caucasian women with a thin body habitus who are premenopausal are found to have osteopenia. Correction of calcium and vitamin D deficiency and walking 3 to 5 miles a week can often improve bone density in the hip and spine. There are a variety of pharmaceutical agents that have been recommended for the treatment of osteopenia and osteoporosis including hormone replacement therapy, selective estrogen receptor modulator therapy, anti-resorptive therapy. In addition patients with osteoporosis who have failed anti-resorptive therapy can have a significant improvement in their bone density with anabolic therapy. (The full article is in PDF form. You can get it at following link: http://www.springerlink.com/content/t68034062172t010/ ************************ RANDOM FACT: By 2010, no state had a prevalence of obesity less than 20%. 36 states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more. Historically, obesity primarily afflicted adults, but this has changed in the last 2 decades. 15-25% of American children and adolescents are now obese. Children and adolescents who are obese are likely to be obese in adulthood and to develop obesity-related health problems. *********************** Half of Stroke Victims Don't Call 911, Research Shows Public needs more education about telling symptoms, experts say FRIDAY, March 16 (HealthDay News) -- Slightly more than half of Americans with stroke symptoms call 911, a rate that hasn't changed since the mid-1990s, a new study finds. The study highlights the need for more public education about stroke symptoms and the importance of early treatment, said the researchers from New York-Presbyterian Hospital/Weill Cornell Medical Center. "People do not always recognize the seriousness of stroke symptoms, or instead of calling 911 they may call their primary-care physician for an appointment and lose valuable time as the damage becomes irreversible," study leader Dr. Hooman Kamel, a neurologist at New York-Presbyterian Hospital/Weill Cornell, said in a medical center news release. The researchers examined data from more than 1,600 stroke cases collected by the National Hospital Ambulatory Medical Care Survey between 1997 and 2008. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_123037.html ************************** RANDOM FACT : U.S. citizens are not legally permitted to come in contact with extraterrestrials or their vehicles, according to the Code of Federal Regulations, implemented in 1969. RANDOM FACT #2: In July of 1947, the U.S. Army Air Force announced that they had recovered a flying saucer that crashed near Roswell Air Field in New Mexico. Within hours, however, the Army dismissed the statement, claiming the saucer was a misidentified weather balloon. ***************** Reducing Bloodstream Infections in an Outpatient Hemodialysis Center - New Jersey, 2008 - 2011 The Centers for Disease Control and Prevention's March 16, 2012 Morbidity and Mortality Weekly Report featured a New Jersey hemodialysis clinic's use of recommended interventions and dialysis event surveillance data to reduce the number of bloodstream infections in the facility. http://www.cdc.gov/mmwr/pdf/wk/mm6110.pdf ************* (Thank you, Barbara ) : DENTAL X-RAYS LINKED TO COMMON BRAIN TUMOR (Reuters Health) - A new study suggests people who had certain kinds of dental X-rays in the past may be at an increased risk for meningioma, the most commonly diagnosed brain tumor in the U.S. http://www.reuters.com/article/2012/04/10/us-dental-x-rays-idUSBRE8390GM20120410?DCMP=NWL-pro_healthlawpulse ***************** U.S. News - Nurse sentenced to life for killing patients by injecting ... Apr 2, 2012 – A Texas jury on Monday sentenced a former nurse to life in prison after ... patients by injecting bleach into their kidney dialysis lines, the Lufkin ... http://tinyurl.com/6tcvfjq http://www.usatoday.com/news/nation/story/2012-04-02/nurse-bleach-injection-dialysis/53952548/1 ******************** GENE STUDIES BEGIN TO UNRAVEL AUTISM PUZZLE (Reuters) - A sweeping study of hundreds of families with autism has found that spontaneous mutations can occur in a parent's sperm or egg cells that increase a child's risk for autism, and fathers are four times more likely than mothers to pass these mutations on to their children. http://www.reuters.com/article/2012/04/04/us-autism-usa-genes-idUSBRE83312820120404?DCMP=NWL-pro_healthlawpulse&&& Related Resources Autism research may be about to bear fruit http://news.lp.findlaw.com/ap_stories/other/1500/04-09-2012/20120409145000_14.html?DCMP=NWL-pro_healthlawpulse *********************** Health care groups respond to proposed ICD-10 extension The CMS plan to delay the ICD-10 compliance date for a year has received mixed reaction from industry stakeholders. The Medical Group Management Association applauded the move but expressed concerns that the ICD-10 implementation process remains flawed. Meanwhile, the American Health Information Management Association reiterated its stance against ICD-10 delay and advised health groups to stay focused on their implementation efforts. http://r.smartbrief.com/resp/dBsjCPaXbgeududlImko ************** HHS panel updates HIV treatment guidelines The HHS Panel on Antiretroviral Guidelines for Adults and Adolescents has released new guidelines for the treatment of patients with HIV. The new guidance includes revisions in the recommendations on starting antiretroviral therapy, drug interactions tables, co-infection and prevention of secondary transmission. Medscape (free registration) (4/10)      Study examines end-of-life cancer care http://r.smartbrief.com/resp/dBsjCPaXbgeuduaJJGGW ************ A study in Health Affairs said no particular type of hospital provided better cancer care for patients when considering National Quality Forum measures such as ICU admissions, chemotherapy usage or hospice care at the end of life. Researchers from the Dartmouth Institute for Health Policy & Clinical Practice found a large number of inpatient services were provided to terminally ill patients and said hospitals need to examine such care and "question its alignment with patient preferences -- whether they be for early supportive care or aggressive treatment in the last days of life." Modern Healthcare (free subscription required) (4/9)      http://r.smartbrief.com/resp/dBsjCPaXbgeuduaVNfNJ *************** Study looks at maternal-fetal Staphylococcus aureus transmission Maternal methicillin-resistant Staphylococcus aureus colonization at 34 to 37 weeks of gestation or at delivery increased the risk of babies carrying the bacteria, according to a study in the journal Pediatrics. Researchers also found that infant Staphylococcal colonization peaked at 2 months of age, with a rate of 20.9%. PediatricSuperSite.com (4/11) http://r.smartbrief.com/resp/dBsjCPaXbgeudubhRZwk ************** An Evidence-Based Approach to COPD: Part 1 Corbridge, Susan PhD, APN, ACNP, AE-C; Wilken, Lori PharmD, TT-S, AE-C, BCACP; Kapella, Mary C. PhD, RN; Gronkiewicz, Cindy MS, RN, ACNS-BC, AE-C OVERVIEW: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting as many as 24 million Americans and resulting in 1.5 million ED visits, 700,000 hospital admissions, and 124,000 deaths annually. This article, the first in a two-part series on COPD, outlines current guidelines and other evidence-based recommendations on diagnosing and managing stable COPD in the outpatient setting. Part 2 will appear in a future issue of AJN and will focus on managing acute exacerbations of COPD. AJN, American Journal of Nursing: March 2012 - Volume 112 - Issue 3 - p 46–57 doi: 10.1097/01.NAJ.0000412639.08764.21 Feature Articles http://journals.lww.com/ajnonline/Fulltext/2012/03000/An_Evidence_Based_Approach_to_COPD___Part_1.22.aspx?WT.mc_id=EMxj08x20120416xL14 ~~**~~**~~**~~**~~**~~ HUMOR SECTION "The Supreme Court has ruled that anybody can be strip-searched for any kind of arrest. That's something to think about the next time you bring 12 items into a 10-item-or-less lane." -Jay Leno A couple in their nineties are both having problems remembering things. During a checkup, the doctor tells them that they're physically okay, but they might want to start writing things down to help them remember Later that night, while watching TV, the old man gets up from his chair. 'Want anything while I'm in the kitchen?' he asks. 'Will you get me a bowl of ice cream?' 'Sure..' 'Don't you think you should write it down so you can remember it?' she asks. 'No, I can remember it..' 'Well, I'd like some strawberries on top, too. Maybe you should write it down, so as not to forget it?' He says, 'I can remember that. You want a bowl of ice cream with strawberries.' 'I'd also like whipped cream. I'm certain you'll forget that, write it down?' she asks. Irritated, he says, 'I don't need to write it down, I can remember it! Ice cream with strawberries and whipped cream - I got it, for goodness sake!' Then he toddles into the kitchen. After about 20 minutes, the old man returns from the kitchen and hands his wife a plate of bacon and eggs.. She stares at the plate for a moment. 'Where's my toast ?' ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Complete Your CE Now-Less than $6 per hour ANCC & State Board approved ; Instant certificates - no waiting No tests required (excluding Florida) ; High-quality, evidence-based course material http://advprjo61.securesites.net/CMEResource20111012Nurse.php 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/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. Sentinel Events.........Joint commission. http://www.jointcommission.org/sentinel_event.aspx This is an excellent nursing site, check it out: http://nursingpub.com/ Back issues of the ISMP 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/ 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 Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Roche Diagnostics Operations Elecsys Troponin I and Elecsys Troponin I STAT Immunoassays: Recall – With certain types of plasma samples, doctors may receive a falsely low result (up to a maximum of 50% lower than the actual concentration of Troponin I). These incorrect results may cause serious adverse health consequences, including death. The affected lot numbers are 163176 and 163177. Elecsys Troponin I and Elecsys Troponin I STAT Immunoassays are used to determine heart damage as an aid in the diagnosis of a heart attack. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm301483.htm ************************ Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume The affected product is a prefilled glass cartridge for use with the Carpuject Syringe system. The affected lot number is 10830LL, with an expiration date of April 1, 2013. Morphine Sulfate Carpujects 4 mg/mL are packaged in Slim-Pak tamper detection packages with each box containing 10 Carpujects (NDC 0409-1258-30). The affected lot was distributed in January 2012. It was initially distributed to wholesalers and a limited number of hospitals in Arizona, Colorado, Hawaii, Illinois, Indiana, Michigan, Minnesota, Ohio, Texas and Virginia. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm300852.htm *********************** Thoratec Corporation, HeartMate II Left Ventricular Assist System (LVAS): Class 1 Recall- Outflow Graft May Kink or Deform FDA is notifying health care professionals of a Class 1 Recall due to detachment of the bend relief from its intended position around the proximal outflow graft may allow the graft to kink or deform, resulting in reduction of blood flow from the HeartMate II LVAS pump, pump/graft thrombosis, or perforation of the outflow graft. Additionally, the metal end of the bend relief may be sharp and cause erosion and cutting of the outflow graft. This product may cause serious adverse health consequences, including death. Model numbers affected: 103393, 103695, 104692, 104911, 104912. The HeartMate II LVAS is indicated for use as a bridge to transplantation in heart transplant candidates at risk of imminent death from non-reversible left ventricular failure. It is also indicated for use in patients with New York Heart Association (NYHA) Class IIB of IV end-stage left-ventricular failure who have received optimal medical therapy for at least 45 of the last 60 days and who are not candidates for heart transplantation. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm298710.htm *********************** Thoratec Corporation Issues Update on Worldwide Medical Device Correction Notification Relating to Sealed Outflow Graft Used With HeartMate II® Left Ventricular Assist System Thoratec Corporation initiated a voluntary worldwide medical device correction notification of all serial numbers of the HeartMate II® Left Ventricular Assist Systems (HM II LVAS) having Catalog No. 104692, 103393, 104911, or 104912. Thoratec took this action based upon reports of the sealed outflow graft bend relief not being properly connected to the HeartMate II LVAS. The reported incidence of the defect, disconnected outflow graft bend relief, is 0.91% (29/3,200). Of these 29 incidents, 24 were observed in x-ray images or during surgical procedures, and were thus unlikely to be related to patient symptoms. However, in at least one reported case, it is noted that the disconnected bend relief may have contributed to the need for reoperation. The bend relief is designed to prevent kinking of the outflow conduit that connects the HeartMate II pump to the ascending aorta. ... http://www.fda.gov/Safety/Recalls/ucm296981.htm?source=govdelivery ********************** Dialysate Concentrates Used in Hemodialysis: Safety Communication - Alkali Dosing Errors FDA is notifying health care providers to consider the presence and quantity of acetate, citrate, and/or acetic acid in dialysate concentrates when determining the patients’ dialysate prescription. The FDA received a complaint describing alkali dosing errors that occurred during hemodialysis using dialysate concentrates containing acetic acid and acetate. When metabolized, these potential sources of alkali can contribute to elevated bicarbonate levels in patients undergoing hemodialysis. This can contribute to metabolic alkalosis, which is a significant risk factor associated with cardiopulmonary arrest, low blood pressure, hypokalemia, hypoxemia, hypercapnia, and cardiac arrhythmia. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm305630.htm ************************ Baxa Corporation Abacus Total Parenteral Nutrition (TPN) Calculation Software: Class I Recall - Potential Dosing Errors A number of errors have been reported by Abacus software users as a result of ordering salt based parenteral nutrition ingredients on an ion based ordering template. Abacus TPN Calculation Software is designed and intended to allow the ordering of electrolytes in only one of two ways: as a salt (such as calcium gluconate 10%) or as an elemental ion (such as calcium). However, if a dosage is entered into the system based on one method, when the template is configured for the other method, a dosing error can occur. The problem associated with mix-ups related to salt-based or ion-based ordering of electrolytes is not exclusive to calcium gluconate. Affected catalogue numbers include: 8300-0045: Abacus Calculator Only (Abacus CE) 8300-0046: Abacus Single Work Station (Abacus SE) 8300-0047: Abacus Multi-Work Station (Abacus ME) : http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm305762.htm ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: hollie_lynne@yahoo.com (Hollie) April 27, 2012 tami.berube@yahoo.com (Tami) June 5, 2012 cathie.grant@sgmc.org (Cathie) June 7, 2012 dbusseyRN@gmail.com (Darcy) June 7, 2012 ~~**~~**~~**~~**~~**~~ 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 ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY I am a most unhappy man. I have unwittingly ruined my country. A great industrial nation is now controlled by its system of credit. We have come to be one of the worst ruled, one of the most completely controlled and dominated Governments in the world -- no longer a government by free opinion, no longer a government by conviction and the vote of the majority, but a government by the opinion and duress of a small group of dominant men. -- Woodrow Wilson 1919 Hope to see you online/ or better yet....write me..... Frankie RNFrankie@AOL.com

PARADIGM BYTES Newsletter for Paradigm 97 May 11, 2012 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. ***~~~***~~~***~~~*** SNIPPETS Nurses and Substance Abuse Anne Heuser, R.N. LNCC Happy Nurses Week to all. To celebrate and recognize nurses this week at my hospital, we had many presentations; from Mary Kay to SPAN. SPAN is a program through NYSNA which assists nurses who are struggling with substance abuse. Through reaching out to this organization, the addicted nurse can receive help and support and may not have to lose their license. Let’s not remain silent on this epidemic anymore. Let’s be proactive and take a hard look at ourselves and our colleagues. The SPAN presentation I attended really touched my heart. The presenter talked about substance abuse issues with nurses and our individual struggles. Maybe it is you or a colleague…. It reminded me of how human and affected we are. Please follow the below link to learn more. http://www.nysna.org/images/pdfs/span/span_spg12.pdf It would be really great to have more contributors to the SNIPPET column. Please contact me if you are interested, write to:. RNFrankie@AOL.com. ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS The following is from MarGerlach (Marlene) who writes: I totally agree with the concept of sitting down for a patient "consultation"/whatever is a much better way to do it than standing. Puts you on their level and you do not give the impression of being intimidating, superior, disinterested or hurried. You surely appear much more interested in them if you are willing to sit down with them . When I was going through chemo 19 years ago, my oncologist was a total love! After the usual checkup, he would lean way back in his chair, put his hands behind his head and sincerely ask "What else can I do for you today?" "What do you need?" "Do you need to talk about anything?" That meant so much to me that he was willing to take as much time as I needed. ***************************** The following is a well written editorial by one of our members; this was written for Nurse's Week of May 6 through May 12. Please read and enjoy The quiet—and not-so-quiet—courage of nurses. The Best People I Know The more I learned about what nurses did, the more I felt nursing was a good choice: the work changed constantly and was important. (I did think about becoming a physician for about a minute—but the education was long and costly, and the profession seemed not nearly as exciting by Cherry Ames standards.) ... Kennedy, Maureen Shawn MA, RN ( AKA shawn.kennedy@wolterskluwer.com ) http://journals.lww.com/ajnonline/Fulltext/2012/05000/The_Best_People_I_Know.1.aspx ; ~~**~~**~~**~~**~~**~~ MEDICAL NEWS U.S. cites Assurant unit over health premium hike (Reuters) - U.S. officials on Monday cited two health insurers for excessive premium increases, under consumer protection rules of President Barack Obama's healthcare reform law that could soon be nullified by the Supreme Court. The Department of Health and Human Services called on Assurant Inc's Time Insurance Co and Bedford Park, Illinois-based United Security Life and Health Insurance Co to either offer rebates to customers in six states or rescind premium hikes ranging up to 24 percent. ... http://www.reuters.com/article/2012/04/16/us-usa-healthcare-insurers-idUSBRE83F1B020120416?feedType=RSS&feedName=healthNews ~~**~~**~~**~~**~~**~~ INTERESTING READING RANDOM FACT: The Dalai Lama of Tibet, Tenzin Gyatso, is both the spiritual leader and head of the state of Tibet. Born on July 6, 1935, he was just 2 years old when he was recognized as the reincarnation of the 13th Dalai Lama, Thubten Gyatso. He took the throne at age 4 and became a monk at age 6. Bonus Fact: The Dalai Lama has a range of pastimes including meditating, gardening, and repairing watches. ************************** Discussing Death With Pediatric Patients: Implications for Nurses Communicating about end-of-life issues with a pediatric patient and their families can be difficult and uncomfortable for many nurses. The purposes of this article are to provide nurses a foundational overview of the child's understanding of death through the lens of awareness, development, and experience and to provide effective ways for nurses to implement this knowledge as they approach the topic of death with patients and their families. ( the full article price is 14 USD.........one can register and receive articles for the year.) http://www.pediatricnursing.org/article/PIIS0882596311007068/abstract?rss=yes ***************************** The '5 S's': Easing baby pain after vaccine shots For most parents - even the strongest believers in the benefits of vaccines - anticipating how their newborns' facial expressions will turn from curious to shock before they burst into tears from the needle stick, can make the next well-baby check-up something they would love to skip. But doctors at Children's Hospital of the King's Daughters in Norfolk, Virginia, have found an easy way - actually five easy ways - to help calm a baby's pain (and anxiety), without any medication. It's called the "5 S's": swaddling (tightly wrapping a baby in a blanket almost like a burrito), side/stomach position, shushing sounds, swinging and sucking. If babies were doing four out of five of these "S's," they would usually stop crying within 45 seconds after the shot, according to a new study published in the journal Pediatrics. ... http://thechart.blogs.cnn.com/2012/04/16/the-5-ss-easing-baby-pain-after-vaccine-shots/ ************************** Doctors call for end to five cancer tests, treatments (Reuters) - In a move that threatens to further inflame concerns about the rationing of medical care, the nation's leading association of cancer physicians issued a list on Wednesday of five common tests and treatments that doctors should stop offering to cancer patients. The list emerged from a two-year effort, similar to a project other medical specialties are undertaking, to identify procedures that do not help patients live longer or better or that may even be harmful, yet are routinely prescribed. As much as 30 percent of health-care spending goes to procedures, tests, and hospital stays that do not improve a patient's health, according to a 2008 analysis by the nonpartisan Congressional Budget office. ... http://www.reuters.com/article/2012/04/04/us-cancer-idUSBRE83305020120404?feedType=RSS&feedName=healthNews *********************** RANDOM FACTS: (1) The word "toast" is a wish of good health. It started in ancient Rome, where a piece of toasted bread was dropped into wine. (2) The word alcohol is derived from the Arabic word 'al-kuhl', meaning "finely divided", in reference to the distillation process. ***************** How Added Sugar In Diet Leads To Obesity, Diabetes - New Clues About Fructose A new animal study published on Monday in the Proceedings of the National Academy of Sciences, offers new clues about the mechanism through which a diet high in fructose, such as from added sugar and high fructose corn syrup, may contribute to the development of obesity and diabetes. Previous studies have already shown that fructose intake from added sugar is linked with the epidemic rise in obesity, metabolic syndrome, and nonalcoholic fatty liver disease. Metabolic syndrome is a group of risk factors that raises a person's risk for diabetes, heart disease, stroke, and other health problems. It currently affects more than one in four Americans. There is also evidence that fructose intake causes features of metabolic syndrome in animals and humans. This suggests, for instance, if you compared two diets of similar calorie intake, the one with more fructose, as opposed to more starch, will lead to greater accumulation of fat around organs and higher insulin resistance. ... http://www.medicalnewstoday.com/articles/242259.php ************************* Atrial fibrillation plays role in later dementia Dr. Koon Teo, lead author from the Population Health Research Institute at McMaster University in Ontario, noted that dementia, admission to long term care facilities, and loss of independence, occurred in 34 percent of atrial fibrillation patients as compared to only 26 percent who did not have the heart arrhythmia. During the study, researchers reviewed data from two randomized controlled trials, including ONTARGET and TRANSCEND, which involved more than 31,000 patients. Participants were at least 55 years old and came from 733 medical centers in 40 countries. About 70 percent were men. All had heart disease or diabetes, with some organ damage from the diseases. ... http://www.dailyrx.com/news-article/atrial-fibrillation-plays-role-later-dementia-17736.html (how many of us have thought about Afib in this context?) ********************* Five uses for Vegetable oil besides cooking: KEY LOCK HELPER Does the lock on your front door never want to give up your house key? Try wiping your key down with some vegetable oil. It acts as a lubricant, helping the key to get into the lock more freely. HAIR MOISTURIZER You can use vegetable oil as a deep conditioning treatment. Just take about half a cup of oil and warm it at 50% power in the microwave until it's just above room temperature. Massage the vegetable oil into your hair, shampoo and then rinse. CAR CLEANER Whether you are trying to get rid of the brake dust that accumulates on your tires and hub caps, or the bugs, dirt or pollen that always stick to your car's grill and wind shield, skip the special auto cleaners and use vegetable oil instead. Pour a tiny bit onto a paper towel or a rag, and wipe down these surfaces. The vegetable oil helps wipe the gunk away while creating a car-safe coating that future debris won't stick to. NON-STICK SHOVELS With all the spring/summer gardening and yard work, you can use vegetable oil to coat your shovels and trowels. This helps prevent dirt from clumping on your tools. You can also do this trick to your lawnmower blades so grass doesn't stick to them. If you are in a pinch, you can also coat the "working parts" of your hand tools with vegetable cooking spray. SEASON YOUR POTS AND PANS This might not be the most groundbreaking of tips, but you can use vegetable oil to season a new skillet. A light coating of vegetable oil helps protect the pan. Although there are very many different ways to season it, this is my preferred: After washing the pan for the first time, rub a little bit of vegetable oil over the surface of the pan and the sides. You don't have to worry about the bottom. ***************** Implementation of Evidence-Based Practice Susan L. Adams PhD, RN Laura Cullen MA, RN, FAAN Expectations for evidence-based healthcare are growing, yet the most difficult step in the process, implementation, is often left to busy nursing leaders who may be unprepared for the challenge. Selecting from the long list of implementation strategies and knowing when to apply them are a bit of an "art," matching clinician needs and organizational context. This article describes an application-oriented resource that nursing leaders can use to plan evidence-based practice implementation in complex healthcare systems. Nurses in leadership positions have responsibility for provision of evidence-based healthcare that meets the expectations of patients, families, regulators and others.1-3 Research shows that use of evidence is inconsistent. Basic practices from hand hygiene to early ambulation are difficult to implement. Nursing leaders are expanding use of evidence-based care delivery to improve patient and organizational outcomes by developing the infrastructure, defining the processes, strategically planning for implementation, and reporting results. http://www.nursingcenter.com/evidencebasedpracticenetwork/JournalArticle.aspx?Article_ID=1323359 JONA: Journal of Nursing Administration April 2012 Volume 42 Number 4 Pages 222 - 230 ************************* Progesterone might relieve menopause symptoms..(Reuters Health) - A hormone called progesterone helps reduce how frequently and how severely women experience hot flashes and night sweats after menopause somewhat, according to a new study."There are certainly some people for whom estrogen is not an appropriate therapy and other people who wish to avoid it for other reasons. And progesterone offers a choice," Hitchcock, a researcher at the University of British Columbia, told Reuters Health. Estrogen had been a popular hormone therapy to treat menopausal symptoms until some large studies raised concerns about a possible increased risk of stroke and cancer among women who were taking it (see Reuters Health reports of October 19, 2010 and January 31, 2011). Progesterone has been used in hormone replacement therapy to treat menopausal symptoms, but it is typically thought of as an add-on to estrogen therapy to help protect the uterus from abnormal thickening. It is approved by the Food and Drug Administration to for that use, and for abnormal menstrual bleeding symptoms. ... http://articles.chicagotribune.com/2012-04-25/lifestyle/sns-rt-us-progesterone-menopausebre83o13l-20120425_1_menopausal-hot-flashes-progesterone *********************** FDA approves the Glaxo Cancer drug Votrient (Reuters) - U.S. regulators gave the nod to GlaxoSmithKline Plc's Votrient for a type of sarcoma on Thursday, following a positive advisory panel vote last month. The U.S. Food and Drug Administration approved the pill for people with soft-tissue sarcoma who have already received chemotherapy. Soft-tissue sarcoma is a rare but aggressive form of cancer that afflicted about 11,000 Americans last year, 4,000 of whom died from the disease, according to the National Cancer Institute. The cancer begins in the muscles, fat or other tissues. http://www.reuters.com/article/2012/04/26/us-glaxosmithkline-idUSBRE83O0O220120426?feedType=RSS&feedName=healthNews *************************** Informatics & the Future of Nursing Practice Technology is being integrated into every area of healthcare. What does that portend for nursing? From meaningful use to accountable care, healthcare trends are transforming nurses' roles, responsibilities and career trajectories. Key to being part of this change is nursing informatics. The field has already begun to flourish. The American Nurses Association has developed standards for nursing informatics. The American Organization of Nurse Executives has endorsed principles to enhance clinical outcomes by leveraging technology. Another guidepost is the Technology Informatics Guiding Education Reform (TIGER) Initiative Foundation, which recommends educators adopt informatics competencies for all levels of nursing education and practice, and reform the nursing curriculum by integrating healthcare information technology. Achieving success in developing nursing informatics will also require collaboration between hospital executives, nursing leaders, nursing management, nursing staff and nursing schools. ... http://nursing.advanceweb.com/Features/Articles/Informatics-the-Future-of-Nursing-Practice.aspx ; ***************************** Pendulum Swing We were all taught that the period of a pendulum is proportional to the square root of the length of the line suspending the weight - i.e., the longer the pendulum, the slower it swings. You are probably wondering what class this was in. Well it’s not important; just read, click and enjoy. Harvard students built a device with a series of 15 pendulums in a row, each one slightly longer than its neighbor, then set them in motion and filmed the result. The resulting patterns in this short video are fascinating to watch: http://sciencedemonstrations.fas.harvard.edu/icb/icb.do?keyword=k16940&pageid=icb.page80863&pageContentId=icb.pagecontent341734&state=maximize&view=view.do&viewParam_name=indepth.html#a_icb_pagecontent341734 ******************* Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease Who Is at Risk of Shocks? Background—The value of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) is unknown. We investigated the long-term outcome after ICD implantation and developed a simple risk stratification score for ICD therapy. ... http://circep.ahajournals.org/content/5/1/101.full?WT.mc_id=EMxj02x20120427xL1 *********************** Periodontal disease...... An American Heart Association expert committee of cardiologists, dentists and infectious disease specialists found no conclusive scientific evidence that periodontal disease causes atherosclerotic heart disease or stroke, and that treating gum disease prevents heart disease or stroke. Risk factors that gum and heart disease have in common, including smoking, age and diabetes, may be the reasons why the diseases often occur in the same person. To download a PDF of the study, which appeared in the AHA journal Circulation. ... http://circ.ahajournals.org/content/early/2012/04/18/CIR.0b013e31825719f3.abstract ************************ RANDOM FACT: When threatened, the hairy frog, or 'horror frog,' intentionally breaks its own bones to produce claws that protrude from its toe pads. (Yee Gods and little fishes !!! ) ************* Thank you, Cherie (ckppk) for this great hint: Berries are delicious, but they're also kind of delicate. Raspberries in particular seem like they can mold before you even get them home from the market. There's nothing more tragic than paying $4 for a pint of local raspberries, only to look in the fridge the next day and find that fuzzy mold growing on their insides. Well, with fresh berries just starting to hit farmers markets, we can tell you that how to keep them fresh! Here’s a tip I’m sharing on how to prevent them from getting there in the first place: When you get your berries home, prepare a mixture of one part vinegar (white or apple cider probably work best) and ten parts water. Dump the berries into the mixture and swirl around. Drain, rinse if you want (though the mixture is so diluted you can't taste the vinegar,) and pop in the fridge. The vinegar kills any mold spores and other bacteria that might be on the surface of the fruit, and ... Voila! Raspberries will last a week or more, and strawberries go almost two weeks without getting moldy and soft. So go forth and stock up on those pricey little gems, knowing they'll stay fresh as long as it takes you to eat them. ***************** Another excellent article from AJN....I agree wholeheartedly with the premise. Please send in your opinions about this topic, I know there is a lot of discussion about 12 hour shifts, esp when they are back to back with no real rest between. Long Work Hours for Nurses Roxanne Nelson But is working 12 consecutive hours in a high-stress setting that's physically, mentally, and emotionally demanding a good idea? And should we be helping students to get used to the idea earlier despite the evidence that long hours affect patient safety and nursing judgment? ... http://journals.lww.com/ajnonline/Fulltext/2012/05000/Long_Work_Hours_for_Nurses.16.aspx ************************ (The following was sent to me by Sandy Summers, thank you. I consider the hospital's actions wimpy- just because a surgeon is deprived of an expected income and throws a tantrum, they cave.) To quickly summarize, Amanda Trujillo is an RN, MSN, earning a doctoral degree, who took the time to educate her patient about the omplications of having a transplant. The patient decided she'd rather go to hospice, so Amanda put in for a referral, at the request of the patient. Next morning the surgeon threw a fit over the canceled surgery and demanded she be fired. (!) The extremely weak and pathetic nurse managers at Banner Health Del E. Webb in Sun City Arizona fired her and she was reported to the board of nursing for what--doing her job--being a good nurse? So the board has been dithering with Amanda's license forever as she's been out of work because no one will hire her when her license is under investigation. I'm trying to find out the latest on this incredible injustice rooted in ignorance about who nurses are and what they really do to save lives and improve patient outcomes. Further reading here: http://vdutton.posterous.com/94287821 *********************** Aspirin tied to lower lung cancer risk in women (Reuters Health) - In a new study of more than 1,200 Asian women, those who took aspirin at least a couple of times a week had a much lower risk of developing lung cancer -- whether or not they had ever smoked. The findings, which link regularly taking aspirin to a risk reduction of 50 percent or more, do not prove lung cancer. There may be other explanations for the connection. But the study backs up a number of previous ones linking regular aspirin use to lower risks of certain cancers, including colon, prostate and esophageal cancers. Still, experts say it's too early to recommend widespread aspirin use for cutting cancer risk. ... http://www.reuters.com/article/2012/04/23/us-aspirin-cancer-idUSBRE83M0ZQ20120423?feedType=RSS&feedName=healthNews ******************* Social media policies from 196 health care facilities http://www.socialmediagovernance.com/policies.php?f=4#axzz1oY5XsZj9 ******************* RANDOM FACT: The Pacific Ocean, the world's largest water body, occupies a third of the Earth's surface. The Pacific contains about 25,000 islands (more than the total number in the rest of the world's oceans combined), almost all of which are found south of the equator. ************* (This was sent in by Marlene...Thank you) Learn Sarver Heart Center's Continuous Chest Compression CPR Every three days, more Americans die from sudden cardiac arrest than the number who died in the 9-11 attacks. You can lessen this recurring loss by learning Continuous Chest Compression CPR, a hands-only CPR method that doubles a person’s chance of surviving cardiac arrest. It’s easy and does not require mouth-to-mouth contact, making it more likely bystanders will try to help, and it was developed at the University of Arizona College of Medicine. (Video) http://medicine.arizona.edu/spotlight/learn-sarver-heart-centers-continuous-chest-compression-cpr ************************** Dissolvable Heart Artery Stents Appear Safe in Study ; Biodegradable stents might lower risk of heart attack, Japanese researchers suggest MONDAY, April 16 (HealthDay News) -- New long-term research now suggests that fully biodegradable stents are safe to use in heart arteries. Reporting in the April 16 issue of Circulation, Japanese researchers said a 10-year study has shown the biodegradable Igaki-Tamai stent, made of a cornstarch-based material, dissolves into the artery wall, leaving no permanent foreign material in an artery and reducing the occurrence of an in-stent blood clot. According to the study, survival rates from all causes was 87 percent and rates of major heart-related complications were similar to those seen with metal stents. Stents, the tiny mesh tubes inserted into heart arteries to keep open and allow blood to flow to the heart, are far from fail-safe. New blockages can -- and do -- occur. So scientists have been trying to develop new stents, including ones coated with blood-thinning medications. Metal stents, sometimes coated with drugs, remain in the body where they can reclog. The Igaki-Tamai stent, developed by Kyoto Medical Planning Co., is used in nine European Union countries and Turkey to treat peripheral artery disease, or blocked arteries in the legs. It is not used to treat blocked heart arteries in any country.... http://consumer.healthday.com/Article.asp?AID=663804 ************************* RANDOM FACT: A mouthful of seawater may contain millions of bacterial cells, hundreds of thousands of phytoplankton and tens of thousands of zooplankton. *********** HIV Raises Anal Cancer Risk in Women, Study Says ; Findings indicate gay men aren't only ones who need screening MONDAY, April 16 (HealthDay News) -- Women with HIV are at increased risk for anal cancer, a new study finds. Researchers at Montefiore Medical Center in New York City looked at 715 HIV-infected women and found that 10.5 percent had some form of anal disease and about one-third of those women had precancerous disease. "Anal cancer was widely associated with HIV-infected men who have sex with men. But now, this study reveals anal precancerous disease in a high proportion of women with HIV," Dr. Mark Einstein, director of clinical research in the division of gynecologic oncology and a professor at Albert Einstein College of Medicine, said in a Montefiore news release. ... http://consumer.healthday.com/Article.asp?AID=663729 ******************* RN whistle-blowers summon moral courage If only whistle-blowing were as simple as taking a deep breath and making a lot of noise. In reality, any nurse who, according to the profession’s ethical obligations, detects wrongdoing and decides to pursue all avenues necessary to correct it probably is facing a grueling and complicated task. Whistle-blowing is much like being alone in the wilderness, said John S. Murray, RN, PhD, FAAN, a member of the American Nurses Association’s Center for Ethics and Human Rights Advisory Board. As an officer in the Air Force, he raised ethical concerns about academic and research practices in his workplace. He was reassigned. Colleagues shunned him. ... http://news.nurse.com/article/20120402/NATIONAL01/104020020 ; (I equate the whistle blowing by nurses with the Good Samaritan act protection for nurses). ******************** Nanostars Deliver Cancer Drugs Direct To Nucleus Scientists at Northwestern University in the US have developed a simple, specialized, star-shaped gold nanoparticle that can deliver drugs directly to the nucleus of a cancer cell. They write about their work in a paper published recently in the journal ACS Nano. Senior author Dr Teri W. Odom, said in a statement released on Thursday: "Our drug-loaded gold nanostars are tiny hitchhikers." "They are attracted to a protein on the cancer cell's surface that conveniently shuttles the nanostars to the cell's nucleus. Then, on the nucleus' doorstep, the nanostars release the drug, which continues into the nucleus to do its work," she added. ... http://www.medicalnewstoday.com/articles/243856.php ************************* Fake cancer drug surfaces again from overseas It is just about the worst kind of fraud you can imagine -- fake cancer drugs, not much more than a vial of water with a drug label on it. CBS News previously reported on this, but it's happened again: A number of clinics received counterfeit vials of cancer drugs. CBS News chief investigative correspondent Armen Keteyian has traced the source overseas. This week, the Food and Drug Administration alerted healthcare professionals that 120 vials of fake Altuzan -- which contained no active ingredient -- had entered the U.S from distributors in the U.K. after being purchased from wholesalers in Turkey. ... http://www.cbsnews.com/8301-18563_162-57409553/fake-cancer-drug-surfaces-again-from-overseas/ ~~**~~**~~**~~**~~**~~ HUMOR SECTION The district attorney was cross-examining the murderess on the witness stand. "And so after you had poisoned the coffee and your husband sat at the breakfast table partaking of the fatal dosage, didn't you feel any qualms? Didn't you feel the slightest pity for him knowing that he was about to die and was wholly unconscious of it?" "Yes," she answered. "Come to think of it...there was just a moment when I sort of felt sorry for him." "And, when was that?" "When he asked for the second cup." ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ While visiting Annapolis, a lady tourist noticed several students on their hands and knees assessing the courtyard with pencils and clipboards in hand. "What are they doing?" she asked the tour guide. "Each year," he replied with a grin, "the upperclassmen ask the freshmen how many bricks it took to finish paving this courtyard." When they were out of earshot of the freshmen, the curious lady asked the guide: "So, what's the answer?" The guide replied: "One." ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Complete Your CE Now-Less than $6 per hour ANCC & State Board approved ; Instant certificates - no waiting No tests required (excluding Florida) ; High-quality, evidence-based course material http://advprjo61.securesites.net/CMEResource20111012Nurse.php ---------- 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/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com. Sentinel Events.........Joint commission. http://www.jointcommission.org/sentinel_event.aspx This is an excellent nursing site, check it out: http://nursingpub.com/ Back issues of the ISMP 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/ 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 Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** There are many more recalls in medicines...please check them out at : http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm299000.htm?source=govdelivery Also, more important to know recalls....please check them out at: http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm301838.htm?source=govdelivery Acetylcysteine Solution, USP, 20%, packaged in 3 x 30 mL vials per carton, Rx only; NDC 0054-3026-02; Item # 0233-53-1877093. Recall # D-1278-2012 CODE Lot #1877093, Exp. Date 06/30/2013 RECALLING FIRM/MANUFACTURER Ben Venue Laboratories Inc., Bedford, OH, by letters on December 19, 2011, by press release on February 2, 2012 and letters dated February 3, 2012. Firm initiated recall is ongoing. REASON Presence of Particulate Matter; glass particle identified during review of retain samples. VOLUME OF PRODUCT IN COMMERCE 4,911 cartons DISTRIBUTION Nationwide **************************** GE Responderand, Responder Pro, Cardio Life, Cardio Vive, Cardiac Science Powerheart, and Nihon-Kohden Automated External Defibrillators (AEDs): Class I Recall - Defective Component Affected Models include: Powerheart 9300A, 9300E, 9300P, 9390A, and 9390E CardioVive 92532, 92533 CardioLife 9200G and 9231 GE Responder and Responder Pro Nihon-Kohden AEDs FDA notified healthcare professionals and medical care organizations of the Class 1 recall of the listed AEDs which contain a component that may fail unexpectedly due to a defect. If the component were to fail during a rescue attempt, the AED may not deliver defibrillation therapy, causing serious adverse health consequences, including death. The unit’s self test may not detect the failure or impending failure of the component. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm294538.htm ************************* Victrelis (boceprevir) and Ritonavir-Boosted Human Immunodeficiency Virus (HIV) Protease Inhibitor Drugs: Drug Safety Communication - Drug Interactions FDA notified healthcare professionals that the Victrelis drug label has been revised to state that co-administration of Victrelis (boceprevir), a hepatitis C virus (HCV) protease inhibitor, along with certain ritonavir-boosted human immunodeficiency virus (HIV) protease inhibitors, is not recommended. The findings of a drug-drug interaction study and clinical trial showed that co-administration increased of the possibility of reducing the effectiveness of the medicines, permitting the amount of HCV or HIV virus in the blood to increase. Ritonavir-boosted HIV protease inhibitors include ritonavir-boosted Reyataz (atazanavir), ritonavir-boosted Prezista (darunavir), and Kaletra (lopinavir/ritonavir). FDA notified healthcare professionals and patients that drug interactions between the hepatitis C virus (HCV) protease inhibitor Victrelis (boceprevir) and certain ritonavir-boosted human immunodeficiency virus (HIV) protease inhibitors (atazanavir, lopinavir, darunavir) can potentially reduce the effectiveness of these medicines when they are used together. A drug interaction study showed that taking boceprevir (Victrelis) with ritonavir (Norvir) in combination with atazanavir (Reyataz) or darunavir (Prezista), or with Kaletra (lopinavir/ritonavir) reduced the blood levels of the HIV medicines and boceprevir in the body (see Data Summary below). FDA will be updating the Victrelis drug label to include information about these drug interactions. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm291144.htm ~~**~~**~~**~~**~~**~~ NURSING HINTS CORNER Spot check Here is another way to get rid of those seemingly indelible ink spots that adorn your pockets-- the products of uncapped pen points. Just saturate the spot with hairspray, then wash with your usual detergent. The result is a truly "spotless" (scrub)/ uniform. Cheryl Diorio, LPN. Spotless suggestion For spotless shoes, try wiping them with an alcohol prep pad. This removes dirt and smudges instantly. Kathryn L. R. Bowling, Capt., USAF, NC Shoe biz Now that you shes are clean, what about the laces? To clean them, place them in a bowl or jar of warm water and add some dishwasher detergent. Agitate the laces in the solution, let them soak for 1 or 2 hours, then rinse and sir-dry. Your laces will be white and as clean as your shoes. Janet Widman, RN Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, pp. 216 and 217, Springhouse Corporation/www.springnetcom. ; ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: hollie_lynne@yahoo.com April 27, 2012 Ctaryane@media.com (Cyndi) April 28, 2012 ~~**~~**~~**~~**~~**~~ 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 OLD ADDRESS: Gingermyst@AOL.com NEW ADDRESS: lglnrse@gmail.com (Anne) ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: lglnrse@gmail.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY I am a most unhappy man. I have unwittingly ruined my country. A great industrial nation is now controlled by its system of credit. We have come to be one of the worst ruled, one of the most completely controlled and dominated Governments in the world -- no longer a government by free opinion, no longer a government by conviction and the vote of the majority, but a government by the opinion and duress of a small group of dominant men. -- Woodrow Wilson 1919 Hope to see you online... even better e-mail me .... Frankie RNFrankie@AOL.com

April PARADIGM BYTES

PARADIGM BYTES
Newsletter for Paradigm 97
April 10, 2012

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
Nurses’ assessments of individualised care in long-term care institutions Journal of Clinical Nursing (full text available)
Aims.  The aims of this study were to explore nurses’ assessments of individualised care in long-term care wards and to examine how their sociodemographic variables were associated with their views of such care.
Background.  Although the importance of individualised care is highlighted both by nurses and by older people, there is a limited amount of research about individualised care, especially in the long-term care of older people.
Design.  An exploratory design was employed.
Methods.  Data were collected using questionnaires [Individualised Care Scale (ICS)-Nurse] from nurses (n = 283, n = 215, response rate 76%) working in the long-term care wards (n = 19) of four institutions in 2009. Data were analysed statistically.
Results.  Overall, nurses perceived that they supported patient individuality during nursing activities but the care they provided was not so individualised. Nurses perceived that they supported older peoples’ individuality in the clinical situation and in decisional control over care well but supported older peoples’ individual life situation to a lesser extent. The higher the nurses’ age, the longer the working experience in health care or experience in the current ward, the more positive views they had about the support of individuality.
Conclusions.  This study identified some shortcomings in the realisation of individuality in the care of older people. Nurses seem to think they generally provide individualised care but this was not necessarily realised in the current evaluations of the care they delivered.
Relevance to clinical practice.  There is need to identify issues that may help in developing individualised care in clinical practice. Nurses’ attitude to older people in the geriatric care settings needs exploration. Nurses may focus on physiological needs that may hinder the recognition of older patient’s individuality. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2011.03855.x/abstract;jsessionid=287B14BCA8D9C27F28454B634EA07DA9.d01t02
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Counting Nurses, Nurses Counting

Even before last year's Future of Nursing report from the Institute of Medicine highlighted the need for better data on the number of working nurses, people were beginning to pay serious attention to how nurses are counted. Cyclic nursing shortages and surpluses have piqued interest in just how many nurses we have—and how many are needed.

Most of the estimates of nursing supply come from state licensure files. These sources are problematic for various reasons, including the inability to link across states. There's no standard set of data collection questions about nurse employment and, in general, scant information specifying actual site of practice or specialty, except by type of institution or setting. Finally, if nurses don't maintain their licensure—and many who work outside of direct care don't—they aren't captured in these data, even though they may be applying nursing intelligence in their various jobs. ...
http://journals.lww.com/ajnonline/Fulltext/2012/01000/Counting_Nurses,_Nurses_Counting.2.aspx
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Registered nurses’ attention to and perceptions of pressure ulcer prevention in hospital settings
(please note this is the abstract...purchase of full document offered. Also, note the very small participation)
Aim.  To describe how registered nurses perform, document and reflect on pressure ulcer prevention in a specific nurse–patient care situation, as well as generally, on hospital wards.
Background.  Registered nurses should provide safe and qualified pressure ulcer prevention, but pressure ulcers remain a problem. Compliance with evidence-based guidelines impedes pressure ulcer formation.
Design.  A descriptive design with a multimethods approach.
Method.  Nine registered nurses at three wards and hospitals participated. The registered nurses were observed in a specific nurse–patient care situation with patients at risk for pressure ulcers. Interviews followed and patients’ records were reviewed. Quantitative and qualitative data analysis methods were used.
Results.  Pressure ulcer prevention performed by the registered nurses was dependent on the cultural care, which ranged from planned to unplanned prevention. Diversity was found in compliance with evidence-based guidelines across the wards. Although all patients involved were at risk and the nurses described pressure ulcer prevention as basic care, the nurses’ attention to prevention was lacking. Few prevention activities and no structured risk assessments using risk assessment tools were observed, and few care plans were identified. The lack of attention was explained by registered nurses’ trust in assistant nurses’ knowledge, and prevention was seen as an assistant nurse task.
Conclusion.  Registered nurses paid little attention to pressure ulcer prevention among patients at risk. The planned and unplanned care structures affected the prevention. The nurses trusted and largely delegated their responsibility to the assistant nurses.
Relevance to clinical practice.  Evidence-based pressure ulcer prevention is fundamental to patient safety. Care quality is created in situations where patients and care providers meet. How registered nurses work with pressure ulcer prevention, their role and communication, particularly with assistant nurses, should be of major concern to them as well as to healthcare managers.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2011.04000.x/abstract


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MEDICAL NEWS

FDA Calls on Tobacco Companies to List Harmful Ingredients (looking forward to this !)
FRIDAY, March 30 (HealthDay News) --The U.S. Food and Drug Administration announced Friday that it will require the tobacco industry to report on a range of toxic chemical ingredients, and to also back up any claims for "safer" tobacco products.
Both actions are preliminary at this point, and subject to a period of public comment.
While there are more than 7,000 chemicals in tobacco and tobacco smoke, the FDA has a working list of 93 chemicals that cause or may cause harm to smokers or non-smokers. These include formaldehyde, nicotine, arsenic, cadmium, ammonia and carbon monoxide. Tobacco companies will be required to list quantities of 20 different ingredients associated with cancer, lung disease and other health problems on consumer-friendly packaging by April 2013. ... http://consumer.healthday.com/Article.asp?AID=663306

++++++++++++++++++
Supreme court rules against Nestle unit on patent (Reuters) -
The Supreme Court ruled on Tuesday that Prometheus Laboratories could not patent a diagnostic method to observe changes in a patient's body to determine the best drug dosage for certain diseases, a decision that may affect the future of personalized medicine.
The justices unanimously overturned a ruling by a U.S. appeals court allowing the patent for Nestle SA unit Prometheus for using synthetic thiopurine compounds to treat gastrointestinal disorders such as Crohn's disease and other auto-immune illnesses.
Doctors are told to monitor patients taking the compounds for certain metabolites in red blood cells, with the goal of hitting certain levels to ensure the best treatment with the fewest side effects. Prometheus markets a diagnostic test that uses the technology covered by the two
patents. ...
http://www.reuters.com/article/2012/03/20/us-mayo-prometheus-patent-idUSBRE82J0NV20120320?feedType=RSS&feedName=healthNews

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INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days (but, if I offer an "old one", I have verified the availability of the article).

Hepatitis B program helps cut infant infections (Reuters Health) A program to prevent chronic hepatitis B infection in newborns seems to be working, according to a new study from researchers at the Centers for Disease Control and Prevention.
They found that more babies exposed to hepatitis B through their moms have gotten vaccinated right away, and fewer have ended up with chronic infections, since the program started in 1990.
That's important because the virus can be passed between mother and child during birth, and over the long run chronic infection increases the risk of liver failure and cancer. ...

http://www.reuters.com/article/2012/03/27/us-hepatitis-idUSBRE82Q18M20120327?feedType=RSS&feedName=healthNews
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RANDOM TIDBIT:
The game of jacks started out as dibstones and was played using pebbles or even sheep's knuckles. When a player captured a piece, he would call out "I've got dibs!" which led to the contemporary usage of the expression.
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Evaluation of a Suicide Prevention Training Program for Mental Health Services Staff
Abstract

Training for health services staff often focuses on improving individual practitioner’s knowledge and skills, with less emphasis given to the broader organizational context, in particular those elements that support successful implementation of changes post-training. This paper compares the effectiveness of a standard training model for suicide prevention to an enhanced training model. The training involved the public mental health workforce throughout the State of Queensland, Australia and was developed in collaboration with the State health department and as such took place within a policy and practice context. The standard training involved participation in a one-day training workshop, which provided information on evidence-based suicide prevention strategies. The enhanced model took an organizational development approach and incorporated a focus on creating and strengthening networks to enhance the capacity of mental health service staff to undertake preventive strategies. Findings suggest that multi-component organizational approaches for suicide prevention produces benefits that should now be trialled through experimental approaches.
(Can be read in full at this link: http://www.springerlink.com/content/j8h0134031705m4r/
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Hydrogen Peroxide (corrected)


Toothbrushes hold a lot of bacteria, so once a week or so you should let your toothbrush take a dip to get disinfected.
Dip your toothbrush in a 3% solution of hydrogen peroxide solution to help kill bacteria on the brush after brushing.

***
A tablespoon of 3% hydrogen peroxide solution in a cup of water can be used as a mouthwash -
swish for up to 60 seconds once a day; but don't swallow and be sure to rinse your mouth out afterwards. This can
also help whiten teeth.
***
Hydrogen peroxide in a 3% solution applied to a rag can be used to clean bench tops and cutting boards to help kill
salmonella and other bacteria.
*********
FDA approves generic Boniva for osteoporosis (Reuters)
Ibandronate is in a class of medications called bisphosphonates, which help increase bone mass and reduce the chance of having a


Boniva, known generically as ibandronate, is taken once a month to treat or prevent osteoporosis in women after menopause.

Mylan Pharmaceuticals Inc and privately held Apotex Inc and Orchid Healthcare are the manufacturers that have gained approval to make generic 150-milligram ibandronate tablets, the FDA said. ...


http://www.reuters.com/article/2012/03/19/us-boniva-idUSBRE82I10I20120319?feedType=RSS&feedName=healthNews
**************

Nurse study finds patients like it better when providers sit

One study concluded what many nurses already believed to be true. Patients feel more satisfied when clinicians sit at the bedside versus standing. “It was a simple position change,” said Jennifer Moran, RN, BSN, CNRN and clinical nurse educator at the University of Kansas Hospital.Moran collected data as research assistant on the Effect of sitting vs. standing on perception of provider time at bedside: A pilot study, led by Kelli Swaden, RN. The study compared the actual duration of 120 consultations and concluded that patients perceive a clinician has spent more time at their bedside when they sit rather than stand. Moran said she was amazed to find that patients believed the clinician spent anywhere from five minutes to as much as 15 more minutes when sitting versus standing, though the time spent was the same in both scenarios.“Most of the patients were alert and oriented,” she said. “It was shocking.” ... http://www.kccommunitynews.com/kc-nursing-news/30636412/detail.html

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Hospital Saved Millions by Keeping Close Eye on Antibiotic Use ;
Seven-year program eliminated overuse without compromising care

THURSDAY, March 15 (HealthDay News) -- Reducing unnecessary use of antibiotics could save hospitals millions of dollars a year, a new study suggests.

Researchers evaluated a seven-year antibiotic stewardship program at the University of Maryland Medical Center, and found that it led to a $3 million reduction in the hospital's annual budget for antibiotics by its third year.

After seven years, the program had slashed antibiotic spending per patient day by nearly half. The savings occurred in departments including the cancer center, trauma center, surgical and medical care intensive care units and transplant service.

After the program was canceled in 2008 in favor of providing more infectious disease consultations, antibiotic costs increased 32 percent (almost $2 million) within two years, according to the study in the April issue of the journal Infection Control and Hospital Epidemiology.

Reducing unnecessary use of antibiotics is encouraged as a way to protect against the spread of drug-resistant infections. This study shows that it also offers financial benefits. ...

http://www.nlm.nih.gov/medlineplus/news/fullstory_122984.html

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Endoscopy May Be Better Than Surgery for Severe Pancreatic Infection; Small, early study found lower risk of death and complications with less invasive procedure (HealthDay News) -- Patients with infected severe
pancreatitis fare better if they undergo a less invasive endoscopic
procedure rather than surgery, a new study finds.

The small, preliminary trial of 20 patients with infected necrotizing pancreatitis found that those who underwent endoscopic transgastric necrosectomy (removal of the pancreatic tissue) were less likely to die or experience major complications than those who had surgical necrosectomy.
Five of the 20 patients died -- 10 percent of those in the endoscopy group compared with 40 percent of those in the surgery group. All deaths were caused by multiple organ failure.
Major complications occurred in 20 percent of patients in the endoscopy group and 80 percent of those in the surgery group, according to the researchers.
"Acute pancreatitis is a common and potentially lethal disorder. In the United States alone, more than 50,000 patients are admitted with acute pancreatitis each year," wrote Dr. Olaf Bakker, of University Medical Center Utrecht in the Netherlands, and colleagues. "One of the most dreaded complications in these patients is infected necrotizing pancreatitis that leads to sepsis and is often followed by multiple organ failure."
Most patients with infected necrotizing pancreatitis require necrosectomy. Surgical necrosectomy causes inflammation and has a high complication rate, the researchers said in a journal news release. http://www.nlm.nih.gov/medlineplus/news/fullstory_122891.html
*****************************
Health panel: Pap tests needed only every 3 years (Reuters Health) - Women only need to get a Pap test once every three years to check for cervical cancer, and don't need to be screened until age 21 - even if they're sexually active earlier, according to new guidelines from a government-backed panel.
The statement from the United States Preventive Services Task Force, released on Wednesday, aligns closely with guidelines from three U.S. cancer groups that were also announced on Wednesday.
Once they hit 30, women also have the option of getting screened once every five years if they choose to do Pap tests together with human papillomavirus (HPV) testing every time, the committees agreed.
"The bottom line is, we strongly recommend screening," said Dr. Virginia Moyer, chair of the USPSTF and a pediatrician at Baylor College of Medicine and Texas Children's Hospital in Dallas. ...

http://www.reuters.com/article/2012/03/15/us-cancer-idUSBRE82D1CE20120315?feedType=RSS&feedName=healthNews

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An Educational Intervention to Increase “Speaking-Up” Behaviors in Nurses and Improve Patient Safety Abstract
“Speaking up” is a critical component in improving patient safety. Studies indicate, though, that most registered nurses prefer using behaviors of avoidance or accommodation in conflict situations. The purpose of this quasi-experimental study was to determine whether an educational intervention using scenarios, personal reflection, and peer support in small groups could improve speaking-up behaviors in registered nurses. Results showed a significant difference in speaking-up behaviors and scores in the intervention group (P < .001).

http://journals.lww.com/jncqjournal/Abstract/2012/04000/An_Educational_Intervention_to_Increase.9.aspx ;

(You could be reading the full-text of this article now...

if you become a subscriber
if you purchase this article

If you have access to this article through your institution, you can view this article in OvidSP.
Journal of Nursing Care Quality: April/June 2012 - Volume 27 - Issue 2 - p 154–160
doi: 10.1097/NCQ.0b013e318241d9ff Articles )
**************************

Vascular dementia is the second most common type of dementia, accounting for approximately 15 to 20% of all cases of dementia.1 Vascular dementia is defined as the loss of cognitive function resulting from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions as a result of cerebrovascular disease and cardiovascular pathological changes.2 Most studies that investigated the genetics of dementia have focused on Alzheimer disease, the most common type of dementia. ...

http://stroke.ahajournals.org/content/43/2/315.full?WT.mc_id=EMxj02x20120316xL1
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Bacterium H. Pylori May Undermine Blood Sugar Control The presence of Helicobacter pylori (H. pylori), a bacterium, has been linked to higher levels of HbA1c, a diabetes biomarker which is used for measuring blood sugar levels in patients with diabetes. For people with higher BMIs (body mass indexes), the association was even higher. Researchers from the NYU School of Medicine, part of NYU Langone Medical Center reported their findings in the Journal of Infectious Diseases. Researchers said the bacterium may alter the levels of glucose-regulating hormones and that antibiotics could benefit older type 2 diabetes patients as well as obese people who have H. pylori infection. ...

http://www.medicalnewstoday.com/articles/242899.php
*********************

Monthly shots of Amgen drug slash cholesterol up to 66 percent (Reuters)-

Monthly injections of an experimental drug from Amgen Inc slashed levels of cholesterol by up to an additional 66 percent in patients already
taking statins, researchers said on Sunday, making it a potential strong rival to a similar drug being developed by Regeneron Pharmaceuticals
Inc.

Amgen and Regeneron are racing to develop medicines that cut cholesterol through a new strategy, by blocking a protein called PCSK9.

In earlier studies, both drugs cut levels of "bad" LDL cholesterol by up to two thirds, although Amgen's AMG 145 had been tested in healthy
volunteers taking no other cholesterol medicines, while Regeneron's REGN 727 was tested in patients with high cholesterol that also took
statins. ...
http://www.reuters.com/article/2012/03/25/us-amgen-cholesterol-idUSBRE82O0CR20120325?feedType=RSS&feedName=healthNews

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Warfarin Helps Cut Stroke Risk, Researchers Report TUESDAY, March 27 (HealthDay News) -- The anti-clotting drug warfarin
reduces stroke risk in patients with a heart rhythm disorder called atrial fibrillation, research shows. The investigators found that stroke risk
was higher among women, the elderly, patients who had a previous stroke or mini-stroke (TIA), and patients who had never taken anti-
clotting vitamin K antagonists. Cleveland Clinic researchers led by Dr. Shikhar Agarwal examined data from more than 32,000 people who
took part in eight studies that compared Warfarin (coumadin) with newer anti-clotting medications.

The study was released online March 26 in advance of publication in an upcoming print issue of the Archives of Internal Medicine.

http://www.nlm.nih.gov/medlineplus/news/fullstory_123432.html
*******************


U.S. autism rates reach new height: CDC (Reuters) - About one in 88 children has autism or a related disorder, the highest
estimate to date and one that is sure to revive a national argument over how the condition is diagnosed and treated. The estimate released
on Thursday by the Centers for Disease Control and prevention represents and overall increase of 25% since the last analysis in 2006
and a near-doubling of the reported rate in 2002.

Among boys, the rate of autism spectrum disorders is one in 54, almost five times that of girls in whom the rate is one in 252. ...

http://www.reuters.com/article/2012/03/29/us-autism-idUSBRE82S0P320120329?feedType=RSS&feedName=healthNews


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Man hugs doctors after seeing face transplant in mirror (Reuters) - (The change is astonishing....wonderful)

Surgeons from the University of Maryland Medical Center on Tuesday detailed what they said was the world's most comprehensive
face transplant- allowing a 37-year-old man to emerge from behind a mask 15 years after a gun accident almost killed him. ...

http://www.reuters.com/article/2012/03/27/us-usa-health-face-idUSBRE82Q15O20120327?feedType=RSS&feedName=healthNews

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Controversial Arizona late-term abortion bill advances (Reuters) - A controversial Arizona bill that bans most abortions performed after 20 weeks of pregnancy moved closer to becoming law on Wednesday in the Republican-controlled state legislature after clearing the state Senate. The bill, which would still allow abortions after 20 weeks in the case of medical emergency, was passed by a mostly party- line 20-to-10 vote in the Senate on Tuesday. Only a small number of abortions are performed in Arizona after 20 weeks. State Representative, Kimberly Yee, a Republican who sponsored the bill, said she has the votes needed for the late-term abortion bill to pass the House and head for Arizona Governor Jan Brewer to sign. ...

http://www.reuters.com/article/2012/03/28/us-arizona-abortion-idUSBRE82R1D020120328?feedType=RSS&feedName=healthNews


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

HUMOR SECTION

A lawyer was speaking to his client about the potential for a lawsuit.
"Sir," the lawyer said, "you have the best case I have ever heard." At that, the man thanked him and headed for the door.

"Where are you going?" the lawyer asked, astonished.

"I'm going to settle this out of court," the man replied.

"Why? I told you that you have the best case I have ever heard."

"It probably is, but not for me. I was telling you the other guy's story."

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

Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess.

Pay Only $34.99 for a full year of CONTACT HOURS

www.nurse.com for CNE offerings.

http://w3.rn.com/nursing-education/education_main.aspx?cs_section=2

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.

This is an excellent nursing site, check it out: http://nursingpub.com/

An interesting website: http://www.uptodate.com/home/clinicians/index.html

Back issues of the ISMP 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/

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

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
The following is the last time it will be in the newsletter:
12 lead EKG Interpretation Part #1
http://nursingpub.com/12-lead-ekg-explained-part-1
12 Lead EKG Interpretation Part #2 http://nursingpub.com/12-lead-ekg-interpretation-part-2
12 Lead EKG Interpretation Part #3
http://nursingpub.com/12-lead-ekg-interpretation-part-3


This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/

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MEDICAL RECALLS
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FDA Enforcement Report... (There are too many recalls for blood, platelets, blood products....please read at website)

1) Enoxaparin Sodium Injection, USP, 100 mg/mL, 1 mL pre-filled Single Dose Syringe in a blister (NDC 0781-3500-05) packaged in 10-count Syringes in a blister per carton (NDC 0781-3500-69), Rx Only. Recall # D-1274-2012;

2) Enoxaparin Sodium Injection, USP, 30 mg/0.3 mL, 0.3 mL pre-filled Single Dose Syringe in a blister, NDC 0781-3133-01, packaged in 10-count Syringes in a blister per carton, NDC 0781-3133-63, Rx Only. Recall # D-1275-2012
CODE
1) Lot #: 917713, Exp 08/13;
2) Lot #: 917995, Exp 08/13

Recalling Firm: Sandoz Inc., Broomfield, CO, by letters on February 13, 2012.
Manufacturer: Baxter Pharmaceuticals Solutions, LLC, Bloomington, IN. Firm initiated recall is ongoing.

Defective Container: Small defects with stopper ribs. 100 mg: 27,059 cartons; 30 mg: 15,051 cartons
DISTRIBUTION
Nationwide and PR

http://www.fda.gov/Safety/Recalls/EnforcementReports/ucm297823.htm?source=govdelivery
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Celexa (citalopram hydrobromide) - Drug Safety Communication: Revised Recommendations,
Potential Risk of Abnormal Heart Rhythms

Citalopram is not recommended for use at doses greater than 40 mg per day because such doses cause too large an effect on the QT interval and confer no additional benefit.
Citalopram is not recommended for use in patients with congenital long QT syndrome, bradycardia, hypokalemia, or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure.
Citalopram use is also not recommended in patients who are taking other drugs that prolong the QT interval.
The maximum recommended dose of citalopram is 20 mg per day for patients with hepatic impairment, patients who are older than 60 years of age, patients who are CYP 2C19 poor metabolizers, or patients who are taking concomitant cimetidine (Tagamet) or another CYP2C19 inhibitor, because these factors lead to increased blood levels of citalopram, increasing the risk of QT interval prolongation and Torsade de Pointes.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm297624.htm
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Proton Pump Inhibitors (PPIs) - Drug Safety Communication: Clostridum Difficile-Associated Diarrhea (CDAD) Can be Associated With Stomach Acid Drugs

AcipHex (rabeprazole sodium)
Dexilant (dexlansoprazole)
Nexium (esomeprazole magnesium)
Omeprazole (omeprazole) Over-the-Counter (OTC)
Prevacid (lansoprazole) and OTC Prevacid 24hr
Prilosec (omeprazole) and OTC
Protonix (pantoprazole sodium)
Vimovo (esomeprazole magnesium and naproxen)
Zegerid (omeprazole and Sodium bicarbonate) and OTC

FDA notified the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve. The FDA is working with manufacturers to include information about the increased risk of CDAD with use of PPIs in the drug labels.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm290838.htm
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FDA Med Watch-Salter Labs 7600 Bubble Humidifier Used with Supplemental Oxygen Therapy: Class I Recall-Humidifier Lids Fail to Pop Off at the Intended Pressure
Special order patient kits were sold under the following brand names:

Salter Labs
AdvaCare
Allcare Medical
Memorial Home Services
Therapy Support Inc.
Mendo-Lake Home Respiratory Services
MedAssurance Inc.
Abundant Home Care

The 7600 Bubble Humidifier is used for supplemental oxygen therapy. The humidifier is used to provide additional humidity to supplemental oxygen therapy. This product is a single-use device used in health care facilities and home health care. Model numbers include 7600-0-50, E7600-0-50, NP7600-0-50 and special order patient kits that contain 7600 bubble humidifiers. Lot numbers: 091911 and 092611.

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm291820.htm


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NURSING HINTS CORNER
When seconds count... When suctioning an artificial airway, you should not apply suction for longer than 15 seconds at a time. But how do you know when the seconds have passed? Use this technique from the CPR procedure. During CPR, you count---" one, one thousand; two, one thousand; three, one thousand"-- to mark off the seconds. Similarly, in suctioning, you can count, "one, one thousand; two, one thousand" and so on until the seconds have elapsed. Then remove the suction catheter. (I believe the patient will be very grateful ---editorial comment) Robert Hutson, RRT, EdD

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.131, 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:

PDQOPERA@yahoo.com (Ann) March 28, 2012

TKriewald@bellsouth.ne (Theresa) March 29, 2012

June_Luke@Yahoo.com (June) March 29, 2012

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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. So please send me your new name/e-mail address, okay? RNFrankie@AOL.com

OLD ADDRESS: Gingermyst@AOL.com

NEW ADDRESS: lglnrse@gmail.com (Annie)



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EDITORIAL STAFF:
(GingerMyst) lglnrse@gmail.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

Justice has been described as a lady who has been subjected
to so many miscarriages as to cast serious reflections on her virtue.

--William Prossner, Lawyer

<<<<>>>>

"What people say, what people do, and
what they say they do, are entirely different things"

-Margaret Mead

QUIZ ANSWER: d. A Signs and symptoms of generalized (dysesthetic) vulvodynia may be diffuse or may occur in different areas at different times. Pain may occur in the labia majora, labia minora, and/or vestibule. Some women experience pain in the clitoris, mons pubis, perineum, or inner thighs. The pain is constant or intermittent.


Hope to get your e-mail..... Frankie (Frances)
RNFrankie@AOL.com