April PARADIGM BYTES Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 April 20,2013 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 Study: Nurse understaffing associated with infections in neonatal ICUs A study in JAMA Pediatrics found that nurse understaffing was associated with an increased risk for nosocomial infections in very low birth weight infants in neonatal ICUs Importance There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. Objective To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes. Design Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010). Setting Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs. Participants All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments. Exposures We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010. Main Outcomes and Measures An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection. Results Hospitals understaffed 32% of their NICU infants and 92% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.39 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.5% in 2008 and 13.9% in 2009. A 1 standard deviation–higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.39 (95% CI, 1.18-1.63; P < .001) in 2009. Conclusions and Relevance Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants. http://healthcommedia.benchmarkmails26.com/c/l?u=2237D5B&e=2997CD&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o **************** "How to help nurses practice at the top of their game" August 5, 2012 -- Recent press items report that new research has revealed critical aspects of nurse understaffing in the United States and the United Kingdom. On July 31, the Philadelphia Inquirer ran a generally good piece by Don Sapatkin (with Meeri Kim) about a study by researchers at the University of Pennsylvania that used 2006 data from 161 Pennsylvania hospitals to analyze the link between worse staffing and higher rates of infection. The study focused on the burnout associated with poor staffing, which researchers found played a critical role in higher infection rates, taking lives and costing money. The Inquirer article quotes two of the nurses responsible for the study, as well as nurses from the American Nurses Association and elsewhere as outside experts. Although its account of the study findings is not totally clear, the report does give a sense of why having enough skilled, engaged nurses plays such an important role in patient outcomes, particular because of good input from a Pittsburgh union leader. And on July 31, the Telegraph (U.K.) published a good article by Laura Donnelly about a new study of staffing at 46 National Health Service (NHS) hospitals by nursing researchers at Kings College London. That study found that nurses had an average of eight patients during the day and 11 at night (in some places 15 patients at night). Not surprisingly, most of the nurses did not have enough time to do their work. The Telegraph piece is more about the government's responsibility for the poor staffing amid an ongoing public inquiry into the 2009 Stafford Hospital scandal, and the piece does not quote the researchers, though it does include key findings and quote two nursing leaders. The article stresses that understaffing is closely linked to the growing use of less-qualified support staff. The piece could have done more to explain what nurses do to save lives (like detecting infections) that other staff cannot; instead, we hear mostly about custodial care and "compassion." But both the Telegraph and the Inquirer convey the importance of nurse staffing and show that nurses can be academic and health policy leaders. http://www.truthaboutnursing.org/news/2012/aug/staffing.html ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS These are responses to the March issue in which was the following: What would you have done? (Thank you Barbara (BAcello) for sending this ) This independent living facility does not permit staff to do CPR. The dispatch tape broke my heart. With all the negative press, the BNE will probably investigate. The whole situation is unconscionable & I am ashamed to call this nurse a peer.................Barbara A 911 dispatcher pleaded with a nurse at a Bakersfield, Calif., senior living facility to save the life of an elderly woman by giving her CPR, but the nurse said policy did not allow her to, according to a newly released audiotape of the call. “Is there anybody there who is willing to help this lady and not let her die?” the dispatcher asked in a recording of the 911 call released by the Bakersfield Fire Department. “Not at this time,” the nurse said. http://abcnews.go.com/blogs/headlines/2013/03/elderly-woman-dies-after-nurse-refuses-to-give-her-cpr/ ; MarGerlach (Marlene) writes: What would you have done?" Wow! I would have done CPR and so would any nurses I know and the facility be damned! And, Jenxl (Linda) writes: "There's more to the no CPR than was first reported or reported in Paradigm97.... The woman who died did not want any life saving measures which was part of why she went to that establishment. Family was perfectly happy with what happened." ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Do Women Need Bras? French Study Says Brassieres Are A 'False Necessity' Women who go braless may actually have the right idea, new research suggests. According to the results of a 15-year study in France published Wednesday, bras provide no benefits to women and may actually be harmful to breasts over time. "Medically, physiologically, anatomically, the breast does not benefit from being deprived of gravity," Jean-Denis Rouillon, a professor at the University of Franche-Comté in Besançon, told France Info. Conducting the study at the university's hospital, Rouillon measured and examined the breasts of more than 300 women, aged 18 and 35, taking note of how the additional support provided by bras affects the body over time. (It should be noted the study does not mention breast size.) Overall, he found that women who did not use bras benefited in the long term, developing more muscle tissue to provide natural support. As France's The Local notes, Rouillon also noticed that nipples gained a higher lift, in relation to the shoulders, on women who went braless. When bras are worn, the restrictive material prevents such tissue from growing, which may actually accelerate sagging, the study concluded. Capucine Vercellotti, a 28-year-old woman who participated in the research, found that she breathes easier without the constraints of a bra. "At first, I was a little reluctant to the idea of running without a bra, but I got started and after five minutes, I had no trouble at all," Vercellotti said, according to the Agence France-Presse. http://www.franceinfo.fr/societe/les-seins-se-portent-mieux-sans-soutien-gorge-947307-2013-04-10 ***************** Analysis: Emerging deadly virus demands swift sleuth work (Reuters) - The emergence of a deadly virus previously unseen in humans that has already killed half those known to be infected requires speedy scientific detective work to figure out its potential. Experts in virology and infectious diseases say that while they already have unprecedented detail about the genetics and capabilities of the novel coronavirus, or NCoV, what worries them more is what they don't know. The virus, which belongs to the same family as viruses that cause the common cold and the one that caused Severe Acute Respiratory Syndrome (SARS), emerged in the Middle East last year and has so far killed seven of the 13 people it is known to have infected worldwide. Of those, six have been in Saudi Arabia, two in Jordan, and others in Britain and Germany linked to travel in the Middle East or to family clusters. "What we know really concerns me, but what we don't know really scares me," said Michael Osterholm, director of the U.S.-based Center for Infectious Disease Research and Policy and a professor at the University of Minnesota. Less than a week after identifying NCoV in September last year in a Qatari patient at a London hospital, scientists at Britain's Health Protection Agency had sequenced part of its genome and mapped out a so-called "phylogenetic tree" - a kind of family tree - of its links. ... http://links.reuters.com/r/F367J/9BVV6/C49VUX/OJJXSR/B473WS/YT/h?a=http://links.reuters.com/r/F367J/9BVV6/C49VUX/OJJXSR/XBL43J/YT/h ****************** As amazing and complex as the human body is, we are blind and deaf to most of the world around us. Consider... RANDOM FACT: Humans can see less than 1 percent of the electromagnetic spectrum and hear less than 1 percent of the acoustic spectrum. *** Bonus Fact: The existence of the rainbow depends on the conical photoreceptors in your eyes. To animals without cones the rainbow does not exist. So you don't just look at a rainbow, you "create it". ******************** Screening might avert many lung cancer deaths: study (Reuters Health) - A calculation based on results from a large lung cancer screening trial projects that 12,000 deaths a year among the highest-risk smokers and ex-smokers in the U.S. could be avoided with a national screening program. The National Lung Screening Trial, published in 2010, found 20 percent fewer deaths from lung cancer in a group of people at highest risk for the disease when they were screened annually with CT scans, a form of high-resolution X-ray that can spot suspicious lung nodules. Based on the 8.6 million Americans who would fall into that high-risk category because of a decades-long history of smoking, researchers at the American Cancer Society say in a new study that 12,000 fewer people a year would die of lung cancer if national screening were put in place. ... http://links.reuters.com/r/X7E3V/8HVKX/QNGEAP/HDDZK4/MJQ0CD/YT/h?a=http://links.reuters.com/r/X7E3V/8HVKX/QNGEAP/HDDZK4/MJQOX4/YT/h ************************** FDA approves Biogen's oral MS drug, Tecfidera (Reuters) - U.S. regulators on Wednesday approved a new multiple sclerosis drug made by Biogen Idec Inc that is widely expected to become the No. 1 oral treatment for the disease, with annual sales topping $3 billion. The drug, Tecfidera, activates a chemical pathway in the body known as Nrf2 that helps protect nerve cells from damage and inflammation. Following Wednesday's approval by the Food and Drug Administration, Biogen said it will launch the drug within the coming days. Multiple sclerosis is a chronic condition that attacks the central nervous system and can lead to numbness, weakness, paralysis and blindness. It affects more than 2.1 million people worldwide, according to the National Multiple Sclerosis Society. ... http://links.reuters.com/r/CRB2Q/FV9HU/7AD8R7/JIIXCS/GYKFU1/YT/h?a=http://links.reuters.com/r/CRB2Q/FV9HU/7AD8R7/JIIXCS/3CO4CJ/YT/h ******************* The Cost of Collaboration Incorporating shared governance requires cooperation among all levels of staff as well as a comprehensive cost-benefit analysis The benefits of shared governance are recognized throughout the nursing community, but implementing the culture can be challenging when faced with the potential costs. "Nursing and non-nursing leaders are often concerned that shared governance is too costly, but that point of view is very short sighted given the increase in care quality and long-term savings this culture can bring," said Patricia Givens, DHA, EdM, RN, NEA-BC, associate chief nursing officer, Children's Hospital Colorado, Aurora. "Staff engagement at every level is necessary to ensure the highest level of care." While higher staff involvement can incur costs for facilities, when implemented with care and prior planning, shared governance is beneficial to patients, staff, leadership and the healthcare community as a whole. ... http://nursing.advanceweb.com/Archives/Article-Archives/The-Cost-of-Collaboration.aspx ******************** Statistics: 1.7 million: Number of people who sustain a traumatic brain injury (TBI) in the United States each year 475,000: Number of those people who are children 3.1 million: Number of individuals who live with life-long disability as a result of TBI 35%: Percentage of TBIs caused by falls; the highest percentage, 17% are caused by car crashes 30.5%: TBI is a contributing factor to 30.5% of all injury-related deaths in the United States.. Source: Brain Injury Association Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************** Early-onset baldness may predict prostrate cancer in black men. Going bald before age 60 and frontal baldness were significantly associated with high-stage and high-grade prostate cancer among black men, U.S. researchers found. They wrote in the journal Cancer Epidemiology, Biomarkers & Prevention that any form of baldness was linked to a greater likelihood of developing prostate cancer. MedPage Today (free registration) ************** Scientists find new gene markers for cancer risk NEW YORK (AP) -- A huge international effort involving more than 100 institutions and genetic tests on 200,000 people has uncovered dozens of signposts in DNA that can help reveal further a person's risk for breast, ovarian or prostate cancer, scientists reported Wednesday. It's the latest mega-collaboration to learn more about the intricate mechanisms that lead to cancer. And while the headway seems significant in many ways, the potential payoff for ordinary people is mostly this: Someday there may be genetic tests that help identify women with the most to gain from mammograms, and men who could benefit most from PSA tests and prostate biopsies. ... http://hosted.ap.org/dynamic/stories/U/US_MED_CANCER_GENES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2013-03-27-17-21-44 ******************** Quiz Time Which of the following is an advantage of a dry-suction chest drainage system? a. Lower levels of suction pressure b. Variable bubbling, which indicates proper functioning c. A steady bubbling sound, which indicates proper functioning d. Higher levels of suction pressure Answer at end of Newsletter...... Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ***************** FDA approves once-monthly Abilify for schizophrenia (Reuters) - Regulators on Thursday approved a once-monthly injectable form of Abilify, the blockbuster treatment for schizophrenia, which will be sold by Japanese drugmaker Otsuka and Danish drug group Lundbeck. In July 2012, the Food and Drug Administration declined to approve the medicine, Abilify Maintena, citing deficiencies from an inspection of a third-party supplier of sterile water. Otsuka and Lundbeck resubmitted their marketing application soon afterward, after working with an alternative supplier. About 1 percent of adults in the United States are believed to have schizophrenia, a disorder of thought processes that can involve hallucinations, delusions and poor emotional responsiveness. ... FDA approves once-monthly Abilify for schizophrenia *************************** (Reuters) - A baby girl in Mississippi who was born with HIV has been cured after very early treatment with standard HIV drugs, U.S. researchers reported on Sunday, in a potentially ground-breaking case that could offer insights on how to eradicate HIV infection in its youngest victims. The child's story is the first account of an infant achieving a so-called functional cure, a rare event in which a person achieves remission without the need for drugs and standard blood tests show no signs that the virus is making copies of itself. More testing needs to be done to see if the treatment would have the same effect on other children, but the results could change the way high-risk babies are treated and possibly lead to a cure for children with HIV, the virus that causes AIDS. "This is a proof of concept that HIV can be potentially curable in infants," said Dr. Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, who presented the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta. ... http://links.reuters.com/r/2XRTM/OXSOQ/U10J5T/UUU9H4/K9ICGQ/YT/h?a=http://links.reuters.com/r/2XRTM/OXSOQ/U10J5T/UUU9H4/Q3RM09/YT/h *********************** RANDOM FACTS : On November 19, 1863, at the dedication of a military cemetery at Gettysburg, Pennsylvania, during the American Civil War, President Abraham Lincoln delivers one of the most memorable speeches in American history. In just 272 words, Lincoln brilliantly and movingly reminded a war-weary public why the Union had to fight, and win the Civil War. ********************** Heart repair breakthroughs replace surgeon's knife SAN FRANCISCO (AP) - Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels. Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube. These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects - without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches. All rely on catheters - hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes into blood vessels. ... http://apnews.myway.com/article/20130324/DA57ILM80.html **************** Warfarin Communication Toolkit for Nurses This toolkit introduces a new set of training materials—presentations, exercises—as well as resources to help you adapt what you learn to your practice setting. The materials are based on the principles of effective standardized communication that includes these components: Situation, Background, Assessment, and Recommendation (SBAR). The materials will teach about how to use SBAR to improve communication about warfarin. The skills taught have applications for other clinical areas as well; SBAR has been used to address a variety of communication challenges in diverse settings. http://www.chainonline.org/practice-tools/warfarin-communication-toolkit-for-nurses/ ************* Word Origins: Atlanta*** Georgia's chief city came into being thanks to the railroad, which began to work its way through the area in 1836. A planned line from Chattanooga, Tennessee, to the northwest was to shunt at a place noted on the map simply as "Terminus." A few years later, a railroad official suggested naming the growing town around this point "Atlantica-Pacifica." The name stuck until 1847, when a resident suggested the shortened form "Atlanta," made official that year. ************* Improving Patient Safety in Nursing Homes: Resource List (Thank you, BAcello [Barbara] ) This document contains references to Web sites that provide practical resources nursing homes can use to implement changes to improve patient safety culture and patient safety. http://www.ahrq.gov/professionals/quality-patient-safety/surveys/nursing-home/2010/ ******************** FALLS TOOLKIT: Toolkit offers new ideas for preventing hospital falls (Thank you, BAcello [Barbara] ) http://www.ahrq.gov/legacy/research/ltc/fallpxtoolkit/ This 202-page public domain toolkit is written for hospitals but AHRQ is categorizing it under LTC. It contains a lot of good info, including these care plan approaches: 13 ways to prevent patient falls To reduce the risk of falls among all patients, health professionals in hospitals should: 1. Familiarize the patient with the environment. 2. Have the patient demonstrate call light use. 3. Maintain call light within reach. 4. Keep personal possessions within safe reach of the patient. 5. Have sturdy handrails in patient bathrooms, rooms and hallways. 6. Place the hospital bed in a low position when a patient is resting in bed; raise it to a comfortable height when the patient is getting out of bed. 7. Keep hospital bed brakes locked. 8. Keep wheelchair wheels in the locked position when it is stationary. 9. Keep nonslip, comfortable, well-fitting footwear on the patient. 10. Use night lights or supplemental lighting. 11. Keep floor surfaces clean and dry. Clean up all spills promptly. 12. Keep patient care areas uncluttered. 13. Follow safe practices when helping patients in and out of bed. Source: “Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care,” Agency for Healthcare Research and Quality, January. ************** Nine-year-old Awonder Liang of Madison, Wisconsin just became the youngest chess master in the United States. He earned the title Saturday while competing in the Midwest Open Team Chess Festival. RANDOM FACT: The United States Chess Federation (USCF) awards the Title of National Master to anyone who achieves a USCF rating of 2200, and the title of Senior Master to anyone who achieves a USCF rating of 2400. The USCF also awards the Life Master title to anyone who holds a 2200 rating for a total of 300 or more games in his or her lifetime The title Grandmaster is awarded to strong chess players by the world chess organization FIDE. Apart from World Champion, Grandmaster is the highest title a chess player can attain. Once achieved, the title is held for life. ********* Bonus Fact: Blindfold chess is real and documented in world records. It is as it sounds: a player makes all of his or her moves without looking at a board. Usually there is a 'middle man' of sorts to give and receive moves for the game. Blindfold chess is an impressive skill that many stronger chess players possess. It certainly requires a keen ability to see the board clearly, which can get difficult after many moves. The record was set in 1960 in Budapest by Hungarian Janos Flesch, who played 52 opponents simultaneously while blindfolded � he won 31 of those games. *************** U.S. funds 25 states to test new Medicaid models (Reuters) - The Department of Health and Human Services said on Thursday that it would provide 25 of the 50 states with funding to test new ways to lower costs and improve care within the national Medicaid program for the poor. The first states to receive State Innovation Model awards are Arkansas, Maine, Massachusetts,Minnesota, Oregon and Vermont, which will implement plans to transform their healthcare delivery system under President Barack Obama's healthcare reform law, which sets aside $300 million for the overall venture. Medicaid, jointly funded by federal and state funds, accounts for about one-quarter of state budgets nationwide and has taken on new urgency as a funding item since the recession expanded the program's enrollment in many areas. "I understand the real sense of urgency that states feel to improve the health of their populations, while also reducing total health care costs, and it's critical that the many elements of health care in each state - including Medicaid, public health, and workforce training - work together," Health and Human Services Secretary Kathleen Sebelius said in a statement. ... http://links.reuters.com/r/P65EH/JZXIO/2O5LEC/0GGF7B/K9IL6U/YT/h?a=http://links.reuters.com/r/ P65EH/JZXIO/2O5LEC/0GGF7B/VTU2MS/YT/h ************* ALI patients on ventilation vulnerable to PTSD (As one nurse stated: "I don't understand the disbelief that ICU patients would suffer PTSD. Sleep deprivation, narcotics, 24 hours of constant noice, interruptions, temperature changes (to cold, to hot), memory lapses etc. can cause anyone to experience major anxiety and bad dreams. Children are the same. We called it ICU psychosis. You can see it happening right before your eyes. I'm hopeful that we can prevent some of the anxiety that occurs during intense hospital stays d/t a life a/o death situation. What good is living if you can't survive the traumatic memories and not know which was real and which were not. Go research!")(This is not my interjection, however I agree with her) One in three patients with acute lung injury who survived stays in an ICU and required use of a mechanical ventilator showed substantial post-traumatic stress disorder symptoms that lasted for up to two years, according to a study. Because ALI is considered an archetype for critical illness, the researchers suspect PTSD is common among other ICU survivors as well. "We usually think of PTSD as something you develop if you go to war, are sexually assaulted or suffer a similar emotional trauma, " Dale Needham, MD, PhD, the study’s senior author and a critical care specialist at the Johns Hopkins University School of Medicine, said in a news release. ... The study appeared Feb. 26 on the website of the journal Psychological Medicine. The study abstract is available at http://bit.ly/Wg5fwA. ******************* To college graduates saddled with student debt, reaching a day when they don't have to make a monthly payment may seem far off, especially since U.S. Senators are still paying off their loans. However, Brian McBride, an associate producer at CNN and a 2010 graduate out of Arizona State University, managed to pay off $26,500 in debt in just two years. He explained his plan on CNN Money's website. http://www.huffingtonpost.com/2013/01/09/brian-mcbride-paying-off-26500-in-debt_n_2441339.html?ncid=webmail6 ******************** Bleeding, No Extra Ischemic Protection With High-Dose Aspirin Heartwire An analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial has shown that patients with ST-segment-elevation MI (STEMI) undergoing primary PCI discharged on high-dose aspirin have higher rates of major bleeding than those discharged on low-dose aspirin. The high-dose aspirin also failed to provide any additional protection against ischemic events [1]. "In the clinical guidelines, the recommended dose of aspirin ranges anywhere from 82 mg to 325 mg because we don't really have any prospective, randomized study showing which dose is actually best for these patients, which is kind of interesting given that we are now putting so much of our attention on the bleeding complications," Dr Roxana Mehran (Mount Sinai School of Medicine, New York), one of the study authors, told heart wire . "I think it's important that agents not only protect you against ischemia but also don't expose you to the harm of bleeding complications." ... http://www.medscape.com/viewarticle/776458 **************** Ever do the sugar-or-sweetener cha-cha-cha at the coffee shop? You know, when you dance between the sugar shaker and the pink, blue, and yellow packets? If this were a cartoon strip, the thought bubble over your head would read, "What’s the more healthful choice? The no-calorie fakes? The full-calorie hard stuff? Help!" It's like choosing between raising taxes and increasing the national debt. Pick your poison. Okay, neither sugar nor sweeteners are poison if they're eaten in reasonable quantities, but that's our point. There's nothing reasonable about the amount of sugars and syrups in all kinds of foods, from bagels to frozen veggie mixes. The effect of these added sugars? Imagine eating 22 teaspoons of sugar for breakfast every day. That's average for Americans. Canadians average 14 teaspoons of sugar a day. What that does to your health reads like a dirty laundry list. Research shows it lowers HDL (good) cholesterol and raises bad triglycerides. It also gloms onto proteins that create destructive substances called AGEs (short for advanced glycation end products). These set you up for heart disease, stiff joints, wrinkles, Alzheimer's, diabetes, kidney problems, bone fractures, and vision loss. Phew. (Follow these 4 steps to stop sugar cravings. ) ... http://www.realage.com/food/sugar-vs-artificial-sweeteners-which-is-healthier-and-safer?eid=1010665687&memberid=4687812 *********************** (Reuters Health) - Electronic alerts and other technology-based aids may help prevent costly missed or delayed diagnoses, according to a new review of past evidence. "I think there's a general feeling that we're probably going to need multiple strategies," said Dr. David Newman-Toker, who studies diagnostic errors at the Johns Hopkins University School of Medicine in Baltimore but was not involved in the study. He gave as examples computer programs that generate a list of possible diagnoses based on patient symptoms or policy initiatives that reward doctors for making correct diagnoses. For years researchers have known about the dangers of medication prescribing errors and mistakes in the operating room. And last week, another team of scientists reported that diagnostic errors are common in primary care and may put patients at risk for serious complications (see Reuters Health story of Feb 26, 2013 here: reut.rs/YxG9WC). But, according to the researchers behind the new analysis, most studies have not tracked whether patient safety efforts aimed at preventing such mistakes directly improve patient health down the line, or considered their costs and possible harms. ... http://links.reuters.com/r/JLVW3/7H23O/DWS21K/TPP9XU/FDWOYE/YT/h?a=http://links.reuters.com/r/JLVW3/7H23O/DWS21K/TPP9XU/FDWODK/YT/h ************************ New treatment benefits hemorrhagic stroke patients A minimally invasive procedure to remove blood clots in brain tissue after hemorrhagic stroke appears safe and may reduce long-term disability, according to late-breaking research presented Feb. 7 at the American Stroke Association’s international conference in Honolulu. Of the hundreds of thousands of Americans who have intracerebral hemorrhages each year, most are severely debilitated, noted Daniel Hanley, MD, the study’s lead author and professor of neurology at Johns Hopkins School of Medicine in Baltimore. ICH is the most common type of bleeding stroke. There has not been a specific evidence-based targeted treatment recommended for ICH nor any long-term randomized data on surgical treatment, according to the researchers. In one-year results of the Phase II study, researchers found that patients treated with surgery and recombinant tPA had less disability, spent less time in the hospital and were less likely to be in a long-term care facility than were other ICH patients. ... http://news.nurse.com/article/20130218/NATIONAL01/302180008 **************** Tips to Improve Your Caregiving Skills The opportunity to provide personal and attentive patient care is what draws many people to the nursing profession, yet the job itself can sometimes get in the way. Amid the myriad of tasks and responsibilities of each shift, nurses need to remember that caring for patients is always at the core. And caregiving is a skill that can be continually improved. “I think the biggest mistake nurses make in their caregiving is becoming ‘task-oriented’ and losing connection with the patient,” began Kathleen Lattavo, MSN, RN, CNS-MS, CMSRN, RNBC, ACNSBC, president, Academy of Medical-Surgical Nurses. “We run in to hang an IV piggyback and might ask the patient how they’re doing, but it can be obvious we just want to complete our task and get on our way. We are constantly thinking about everything else we need to do, when we should concentrate on the present encounter, give it our undivided attention and then move on from there.” ... http://www.nursezone.com/Nursing-News-Events/more-news/Tips-to-Improve-Your-Caregiving-Skills_41044.aspx ******************* Word Origins: Aztec *** The ethnographic term Aztec comes from the Nahuatl word Aztecatl, meaning "people of Aztlan," a place that archaeologists believe lies in present-day Arizona or New Mexico. Thousands of years ago, those people, who called themselves Nahua, moved to the site of present-day Mexico City. The Nahua are the most populous indigenous people in Mexico today, but we reserve the term "Aztec" for their forebears, whose empire collapsed with the Spanish conquest of Mexico. Greed *** "Greed" is one of the few words to enter English from the Gothic language, which was spoken in scattered pockets of eastern and northern Europe until the ninth century. Its original form, gredas, meant "hunger," a sense that later came to be applied to a kind of insatiable hunger of the soul. ***************** Study: Effects of childhood bullying persist into adulthood: A new study published in JAMA Psychiatry sheds light on the effects of childhood bullying in adults by assessing victims of bullying, those who were victims and bullies, and bullies. Victims of bullying had higher rates of psychological disorders, including generalized anxiety, panic disorder, and agoraphobia in adulthood. Those who were both victims and bullies had an increased risk for adult depression, panic disorder, and, in males only, suicide. Bullies were at risk for antisocial personality disorder. The researchers assessed participants four to six times between the ages of 9 and 16 years and in young adulthood (19, 21, and 21-26 years). ... http://healthcommedia.benchmarkmails26.com/c/l?u=20CA33D&e=281425&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ******************* Even for sperm, there is a season (Reuters) - Autumn is the time of year most associated with bumper crops of new babies, and according to an Israeli study there may be a scientific reason for it: human sperm are generally at their healthiest in winter and early spring. Based on samples from more than 6,000 men treated for infertility, researchers writing in American Journal of Obstetrics & Gynecology found sperm in greater numbers, with faster swimming speeds and fewer abnormalities in semen made during the winter, with a steady decline in quality from spring onward. "The winter and spring semen patterns are compatible with increased fecundability and may be a plausible explanation of the peak number of deliveries during the fall," wrote lead researcher Eliahu Levitas from Ben-Gurion University of the Negev in Beer-Sheva. If there is a seasonal pattern, they said, that knowledge may "be of paramount importance, especially in couples with male-related infertility struggling with unsuccessful and prolonged fertility treatments." For the new study, Levitas and his colleagues collected and analyzed 6.455 semen samples from men at their fertility clinic between January 2006 and July 2009. Of those, 4,960 were found to have normal sperm production, and 1,495 had abnormal production, such as low sperm counts. ... http://links.reuters.com/r/WZINC/0N8P8/304TQV/9ZZ6PD/K9I590/YT/h?a=http://links.reuters.com/r/WZINC/0N8P8/304TQV/9ZZ6PD/VTU9NI/YT/h ~~**~~**~~**~~**~~**~~ HUMOR SECTION While working as a pediatric nurse, I had the difficult assignment of giving immunization shots to children. One day I entered the examining room to give a four-year-old Leah her shot. "No! No! No!" she screamed. "Leah," her mother said, "the nurse is trying to help you. Please be polite." At that, the girl yelled even louder, "No, thank you! No, thank you!" ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. Pay Only $34.99 for a full year of CONTACT HOURS Uncovering Common Bacterial Skin Infections: The four most common bacterial skin infections are impetigo, erysipelas, cellulitis, and folliculitis. Review the etiology, clinical presentation, diagnosis, prevention, treatment, and implications for primary care practice necessary The Nurse Practitioner: The American Journal of Primary Health Care (2.3 contact hours/0.5 contact hour) http://email.lww.com/t?r=1483&c=3470514&l=59027&ctl=4637908:B54AB34282EDAD0065A06A219B3283E9D396447CC72D81E1& ***************** What You Need to Know about Pharmacogenomics Recent studies have shown that a patient's response to drug therapy, including adverse drug reactions, can be strongly influenced by the patient's genetic makeup. Pharmacogenomics, or tailoring medications to a patient's genomic information, is a significant and growing area of research with the potential to improve patient outcomes. Nursing2013 (2.3 contact hours) http://email.lww.com/t?r=1483&c=3470514&l=59027&ctl=463790C:B54AB34282EDAD0065A06A219B3283E9D396447CC72D81E1& *************** www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx ~~**~~**~~**~~**~~**~~ 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/ Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ The 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 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Lactated Ringers and 5 Percent Dextrose Injection, USP, 1000 ML, Flexible Containers: Recall - Due to Non-Sterility Hospira, Inc. is initiating a voluntary nationwide user-level recall of one lot of Lactated Ringers and 5% Dextrose Injection, USP, 1000 mL, Flexible Container, NDC 0409-7929-09. This action is due to one confirmed customer report where a spore-like structured particulate, consistent with mold, was noted in the solution. Hospira has not received reports of any adverse events associated with this issue for this lot, and has not identified any quality issues with retention samples for this lot. If contaminated solution is used on a patient, this may cause thrombosis, phlebitis, bacteremia, sepsis, septic shock and/or endocarditis, or result in a fatal infection in a broad array of patients. Anyone with an existing inventory should stop use and distribution, quarantine the product immediately, and call Stericycle at 1-888-965-5798 between the hours of 8am to 5pm EST, Monday through Friday, to arrange for the return of the product. Replacement product from other lots is available. For medical inquiries, please contact Hospira Medical Communications at 1-800-615-0187. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm337089.htm **************** Stryker Instruments Neptune 1 Silver and Neptune 2 Ultra Waste Management System (Neptune 1 Silver and Neptune 2 Ultra): Safety Communication - Reports of Serious Tissue Damage and Patient Death Stryker issued updated recall notifications dated Feb. 20, 2013 for the Neptune 1 Silver and the Neptune 2 Ultra reminding customers of the steps they need to take to continue using these devices. Health care facilities that must use these devices need to ensure the following steps are completed, as stated in their Certificate of Medical Necessity: Ensure ALL USERS of the Neptune 1 Silver and Neptune 2 Ultra are properly trained before the use of the device and aware of the risks associated with the device. Implement the Neptune Pre-use Checklist within your facility. This checklist must be completed BEFORE EVERY PROCEDURE for which a Neptune 1 Silver and/or Neptune 2 Ultra device is used. Identify a training facilitator or device champion for each facility/hospital who will ensure the Neptune Pre-use Checklist is implemented consistently with your facility’s standard protocol, and in a way that makes sense for your facility to document the checklist was completed. Prior to using the device, health care providers should follow the recommendations listed in the updated safety communication to mitigate the risks of using these devices. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm322811.htm ********************** Omontys (peginesatide) Injection by Affymax and Takeda: Recall of All Lots - Serious Hypersensitivity Reactions Affymax, Inc. and Takeda Pharmaceutical Company Limited along with the U.S. Food and Drug Administration (FDA) are informing the public of a voluntary recall of all lots of OMONTYS® (peginesatide) Injection to the user level as a result of new postmarketing reports regarding serious hypersensitivity reactions, including anaphylaxis, which can be life-threatening or fatal. To date, fatal reactions have been reported in approximately 0.02% of patients following the first dose of intravenous administration. The reported serious hypersensitivity reactions have occurred within 30 minutes after such administration of Omontys. There have been no reports of such reactions following subsequent dosing, or in patients who have completed their dialysis session. Since launch, more than 25,000 patients have received Omontys in the postmarketing setting. The rate of overall hypersensitivity reactions reported is approximately 0.2% with approximately a third of these being serious in nature including anaphylaxis requiring prompt medical intervention and in some cases hospitalization. **************************** Spacelabs Anesthesia Workstations and Service Kits: Class 1 Recall - Defect in CAS I/II Absorbers There is a defect in CAS I/II Absorbers in the Spacelabs Anesthesia Workstations and Service Kits that may cause a condition leading to an increase in the carbon dioxide concentration within the inhaled gas being delivered to the patient. This product may cause serious adverse health consequences, including death. These products were manufactured and distributed from Oct. 31, 2012 to Jan. 15, 2013. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm345368.htm ******************** Vascular Solutions Inc., Guardian II and Guardian II NC Hemostasis Valves: Class I Recall - Risk of Air Being Introduced Into Device FDA notified healthcare professionals of a Class I recall of the Vascular Solutions Inc., Guardian II and Guardian II NC Hemostasis Valves, Model Numbers 8210, 8211, 8215, and 8216. The firm is recalling the product due to a risk that air may be introduced into the device which may lead to an air embolism. This product may cause serious adverse health consequences, including death. A list of the recalled lot numbers is available from Vascular Solutions and has been provided to each facility that purchased the affected products. The recalled products were manufactured and distributed from February 2012 to February 2013. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm345520.htm ***************** The FDA Safety Information and Adverse Event Reporting Program BIVIGAM Immune Globulin Intravenous (Human), 10 Percent Liquid, 100 mL Sterile Vial: Recall - Visible Particles Observed During a routine annual reserve inspection, visible particles were observed in lot number 120016 (Expiration Date: March 31, 2014) of BIVIGAM Immune Globulin Intravenous (Human), 10% Liquid. Biotest is voluntarily recalling this lot from the market. Inspections of other lots of product have not shown the presence of visible particles. BIVIGAM is indicated for the treatment of patients with primary humoral immunodeficiency (PI). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm346771.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: bapd@bellsouth.net Barbara (April 1, 2013) rebeccalynnsands@gmail.com (Rebecca) April 16, 2013 mjalean@gmail.com (Marcella) April 16, 2013 Ciejones@Valdosta.edu (Cieshia) April 16, 2013 bgwilson1959@hotmail.com (Brenda) April 16, 2013 Laura.browning81@yahoo.com (Laura) April 16, 2013 KJustice3@yahoo.com (Kelly) April 16, 2013 ~~**~~**~~**~~**~~**~~ 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/address, okay? 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. ~~**~~**~~**~~**~~**~~ Correct Answer: d. Advantages of dry suction system include higher levels of suction pressure, easier set-up, quieter operation (no bubbling sound), and more constant pressure because no water is lost to evaporation. THOUGHT FOR THE DAY "Learning is a treasure that will follow its owner everywhere.” - Chinese Proverb Hope to hear from you..... Frankie RNFrankie@AOL.com

March PARADIGM BYTES Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 March 10, 2013 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 Denounce Court Ruling on Federal Labor Board Bid to Return to Era of Open Season on U.S. Workers The nation’s largest organization of nurses today condemned a conservative federal appeals court ruling overturning President Obama’s recess appointments to the National Labor Relations Board, a step taken by the President only after the refusal of Senate Republicans to restore a quorum on the board to enable it to function. “It is appalling that the court would reward the giant corporations and Wall Street, and the politicians they control in Washington, who have worked for years to overturn even modest protections for working people in the U.S.,” said RoseAnn DeMoro, executive director of the 185,000-member National Nurses United. “What that means in healthcare is a clear assault on the ability of nurses to act collectively to improve safety standards and public protections for patients,” said DeMoro. “If nurses are unable to speak out for patients and act together to safeguard conditions, all patients are threatened in an era in which most hospital employers place their bottom line above patient safety.” “When the board is not controlled by corporate-oriented appointees, as it has been most of the past four decades, the game plan of the anti-union crowd is to bar it from operating, either by refusing to confirm appointees, defunding or other destabilization tactics,” DeMoro noted. ... National Nurses United. 01/25/13 http://www.nationalnursesunited.org/press/entry/nurses-denounce-court-ruling-on-federal-labor-board/ ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Bee Venom Kills HIV: Nanoparticles Carrying Toxin Shown To Destroy Human Immunodeficiency Virus A new study has shown that bee venom can kill the human immunodeficiency virus (HIV). Researchers at Washington University School of Medicine in St. Louis have demonstrated that a toxin called melittin found in bee venom can destroy HIV by poking holes in the envelope surrounding the virus, according to a news release sent out by Washington University. Visit Washington University's website to read more about the study. Nanoparticles smaller than HIV were infused with the bee venom toxin, explains U.S. News & World Report. A "protective bumper" was added to the nanoparticle's surface, allowing it to bounce off normal cells and leave them intact. Normal cells are larger than HIV, so the nanoparticles target HIV, which is so small it fits between the bumpers. “Melittin on the nanoparticles fuses with the viral envelope,” said research instructor Joshua L. Hood, MD, PhD, via the news release. “The melittin forms little pore-like attack complexes and ruptures the envelope, stripping it off the virus.” Adding, “We are attacking an inherent physical property of HIV. Theoretically, there isn’t any way for the virus to adapt to that. The virus has to have a protective coat, a double-layered membrane that covers the virus.” *************************** The American Nurses Association (ANA) is seeking YOUR input on the need for the Review of Code of Ethics for Nurses with Interpretive Statements This is for both members and non-members, http://nursingworld.org/MainMenuCategories/EthicsStandards/Codeof EthicsforNurses/Code-of-Ethics-Review.html Code of Ethics for Nurses with Interpretative Statements (the Code) to be reviewed and YOUR suggestions for revision. ANA’s Center for Ethics and Human Rights has undertaken this very important review. Ethics is integral to nursing practice, and the Code - one of ANA’s foundational documents - is essential for nursing practice. YOUR input is critical to the success of this review! The deadline for comments is March 15, 2013. The survey will take approximately 30 minutes to complete. It is best to complete the survey in one sitting, so please make sure you have ample time to complete the survey. All of the provisions and interpretive statements are embedded in the survey but the Preface and Afterword are not, so be sure you look at them before you begin the survey so you can address them. Learn more about the 2nd National Nursing Ethics Conference. The conference theme is Cultivating Ethical Awareness:Moments of Truth. The overall conference objective is to motivate and empower each participant with skills, courage and knowledge to speak confidently and be creative and steadfast while tackling ethical challenges. Contact us: ethics@ana.org. ****************** FROM A MEMBER Remember the article about the disposition of drugs? If you don't check out Feb's newsletter. This note is from MarGerlach (Marlene) who writes: OOps, wasn't a typo...BUT, I think it was misleading and the advice still potentially dangerous.. It said that some drugs can go in the trash, (okay) but some can be flushed. It said those that are potentially life threatening, etc...etc....whatever..... were on a list that could be flushed, supposedly keeping them out of people's hands when putting them in the household garbage, but it has always been my understanding that NOTHING should be flushed due to ground water contamination, etc,..etc...etc....I think all unused drugs should go into toxic waste, and especially the most dangerous ones. Am I way off base with this? Write in with your opinion, please.....this is an important issue. ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days This is an interesting article/survey from Rozalfaro (Roz)....try it: You can take a quiz on international eating etiquette. http://www.fekids.com/img/kln/flash/DontGrossOutTheWorld.swf ************************* U.S. recovers $4.2 billion from healthcare fraud probes: report (Reuters) - The Obama administration said on Monday that its efforts to combat fraud in the Medicare and Medicaid healthcare programs were paying off as the government recovered a record $4.2 billion in fiscal 2012 from individuals and companies trying to cheat the system. For every dollar spent investigating healthcare fraud over the past three years, the government recovered $7.90, according to a report released on Monday by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. This was the highest three-year average return on investment in the 16-year history of the federal Health Care Fraud and Abuse Program, the report said. ******** WORD ORIGINS: Greed *** "Greed" is one of the few words to enter English from the Gothic language, which was spoken in scattered pockets of eastern and northern Europe until the ninth century. Its original form, gredas, meant "hunger," a sense that later came to be applied to a kind of insatiable hunger of the soul. ************** What would you have done? (Thank you Barbara (BAcello) for sending this ) This independent living facility does not permit staff to do CPR. The dispatch tape broke my heart. With all the negative press, the BNE will probably investigate. The whole situation is unconscionable & I am ashamed to call this nurse a peer.................Barbara A 911 dispatcher pleaded with a nurse at a Bakersfield, Calif., senior living facility to save the life of an elderly woman by giving her CPR, but the nurse said policy did not allow her to, according to a newly released audiotape of the call. “Is there anybody there who is willing to help this lady and not let her die?” the dispatcher asked in a recording of the 911 call released by the Bakersfield Fire Department. “Not at this time,” the nurse said. http://abcnews.go.com/blogs/headlines/2013/03/elderly-woman-dies-after-nurse-refuses-to-give-her-cpr/ ************************** March 3-9 is Patient Safety Awareness Week, an awareness campaign led by the National Patient Safety Foundation. This year’s theme is “Patient Safety 7/365: 7 days of recognition, 365 days of commitment to safe care.” Here are some patient safety facts from the World Health Organization (WHO): 1 in 10: As many as one in 10 patients in developed countries is harmed while receiving hospital care. 1.4 million: At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals.50%: 20: The risk of healthcare-associated infection in some developing countries is as much as 20 times higher than in developed countries. 50: Problems associated with surgical safety in developed countries account for half of the avoidable adverse events that result in death or disability. 1 in 1,000,000: The chance of a traveler being harmed while in an aircraft. 1 in 300: The chance of a patient being harmed during health care. Source: World Health Organization ************** One Man's Diagnosis Leads to Major Type 1 Diabetes Discovery Tuesday March 5, 2013, an ordinary patient visit recently led Swiss researchers to an extraordinary discovery: a single genetic mutation that causes type 1 diabetes, as reported today in the journal Cell Metabolism. The scientists are now exploring ways to translate their findings into clinical research, including a possible trial with drugs that activate the gene pathway, in the hopes of identifying new type 1 diabetes treatments. “This is the first time that a single gene was found that directly leads to type 1 diabetes,” says Marc Donath, MD, the study’s senior author and an endocrinologist at University Hospital Basel in Switzerland. “This gene was quite well-known from animal studies and was not expected to lead to this kind of disease.” Breakthrough that could benefit millions ************************ The Power of Pre-op and Surgical Checklists By Debra Wood, RN, contributor January 25, 2013 - Surgical teams learned several years ago that adhering to proven standards can improve safety and quality of care and employed checklists before starting a procedure to ensure nothing is missed. Now, research shows using checklists during crises situations can enhance clinicians’ response to the emergency, and teams in Washington State are investigating the use of pre-operative checklists in the clinic or surgeon’s office to improve outcomes. “Nurses have been doing checklists for a long time, and I agree there is value,” said Tanya Lecompte, MSN, ACNS-BS, CPAN, a clinical nurse specialist in perianesthesia at Mercy Medical Center in Baltimore. “But I am concerned we sometimes over-use them. However, I was very impressed with the critical elements checklist.” Boston researchers found while conducting a randomized clinical trial that when doctors, nurses and other hospital operating room staff, on 17 teams, follow a written safety checklist when responding to a simulation patient’s cardiac arrest, severe allergic reaction, bleeding followed by an irregular heartbeat or other crises during surgery, they were nearly 75 percent less likely to miss a critical clinical step than teams relying on memory alone. ... The Power of Pre-op and Surgical Checklists ************************* WORD ORIGINS: Chick-fil-A *** In 1946, an Atlanta-area restaurant called the Dwarf Grill began to serve chicken breast sandwiches, which, surprisingly, seems not to have been done elsewhere or earlier. Proprietor Truett Cathy thus holds claim to being the inventor of the treat, which he called "Chick-fil-A," a play on the work "fillet." Cathy established the first restaurant to bear the name in an Atlanta Mall. Today, there are more than 1,500 outlets across the country. ******************* FDA approves new use for Roche's Avastin in colon cancer treatment (Reuters) - The U.S. Food and Drug Administration on Wednesday approved the use of Roche's Avastin for patients whose colorectal cancer has worsened despite previous treatment with the drug. The new use will allow patients first treated with Avastin plus chemotherapy to be treated again with the biotechnology drug in combination with a different chemotherapy regimen. A pivotal clinical trial showed that such a treatment strategy improved survival. "The majority of people diagnosed with metastatic colorectal cancer receive Avastin plus chemotherapy as their initial treatment," Hal Barron, chief medical officer at Roche's Genentech unit, said in a statement. "These people now have the option to continue with Avastin plus a new chemotherapy after their cancer worsens, which may help them live longer than changing to the new chemotherapy alone." ************** Junk food is typically defined as foods with little nutritional value that are high in calories, fat, sugar, salt, or caffeine, and it is a staple in the American diet. Healthy or not, we love our junk food! RANDOM FACT: Doughnuts most likely originated in Germany and were brought to New York by Dutch settlers who called them olykoeks (oily cakes). The hole in the center was developed by the Pennsylvania Dutch perhaps because the shape provided easier dunking in coffee or made it easier to fry the donuts more thoroughly. Dunkin Donuts sells 6.4 million donuts per day (2.3 billion per year). *** Bonus Fact: In 1979, in what has become known as the 'Twinkie Defense,' Daniel White said he killed San Francisco mayor George Moscone and Harvey Milk because he ate too much junk food, such as Twinkies, candy bars, and cupcakes, which caused a chemical imbalance in his brain. He was still convicted and, in 1981, Congress outlawed the 'Twinkie Defense.' ************* Brain 'Pacemaker' May Help Ease Tough-to-Treat Anorexia WEDNESDAY, March 6 (HealthDay News) -- For people suffering from severe, tough-to-treat anorexia, having a biological "pacemaker" implanted in their brain may help ease the disorder, a small new study suggests. The researchers noted that anorexia is the psychiatric disorder with the highest mortality rate and, although therapies exist, not everyone benefits in the long term. The disorder is among the most common psychiatric ills diagnosed among teenage women. Up to 20 percent of patients do not respond to available treatments, which usually focus on behavioral change. The new study examined the effectiveness of an approach called deep brain stimulation (DBS), sometimes called a brain pacemaker. ... Brain 'Pacemaker' May Help Ease Tough-to-Treat Anorexia ********************* Anorexics Can't Judge Own Body Size: Study THURSDAY, Aug. 23 (HealthDay News) -- People with the eating disorder anorexia have difficulty judging their own body size but are able to size up others accurately, a small new study finds. The study included 25 people with anorexia and 25 people without the disorder who were shown a door-like opening and asked to judge whether they or other people in the room could pass through it. In earlier experiments, people with anorexia felt they could not pass through the door even if it was easily wide enough. In this study, people with anorexia were more accurate at judging whether other people could fit through the door than whether they could. The researchers also found a link between the anorexia patients' ability to fit through the door and their body size prior to becoming anorexic. This suggests that people with anorexia may still think of themselves as having their previous size, said study author Dewi Guardia, of the University Hospital of Lille in France. The study was published Aug. 22 in the journal PLoS One. Anorexics Can't Judge Own Body Size: Study ********************* FACTS: 1. Cucumbers contain most of the vitamins you need every day, just one cucumber contains Vitamin B1, Vitamin B2, Vitamin B3, Vitamin B5, Vitamin B6, Folic Acid, Vitamin C, Calcium, Iron, Magnesium, Phosphorus, Potassium and Zinc. 2. Feeling tired in the afternoon, put down the caffeinated soda and pick up a cucumber. Cucumbers are a good source of B Vitamins and Carbohydrates that can provide that quick pick-me-up that can last for hours. 3. Tired of your bathroom mirror fogging up after a shower? Try rubbing a cucumber slice along the mirror, it will eliminate the fog and provide a soothing, spa-like fragrance. 4. Are grubs and slugs ruining your planting beds? Place a few slices in a small pie tin and your garden will be free of pests all season long. The chemicals in the cucumber react with the aluminum to give off a scent undetectable to humans but drive garden pests crazy and make them flee the area. ****************** As nurses, we’re proud of the expert care we provide patients. But we also know that just doing our job isn’t enough to advance our careers. Mastering good communication skills is essential for all nurses at all career stages—especially with today’s flatter organizational structures and more participatory management styles. Knowing how to communicate in a professional manner can give you the edge you need for career advancement. Opportunity rarely knocks any more. Instead it may present as a phone call, voice mail, e-mail, or text message. Be sure to use proper etiquette with all communication forms. Speaking with managers When dealing with your manager, use a solution-focused approach. Don’t be a complainer. Some communication experts point out that people complain about things they can do something about—not things they have no power over. For example, they don’t complain about their foot size because there’s nothing they can do about it. Yet people often complain about their jobs because they’re unwilling to take the risk of making a change. ... How to keep your communications professional *********************** Tips to Improve your caregiving skills......... (Thanks, Roz Rozalfaro@AOL.com) http://www.nursezone.com/Nursing-News-Events/more-news/Tips-to-Improve-Your-Caregiving-Skills_41044.aspx ************ ********************** RANDOM FACTS: Approximately 800 tornadoes are reported in the United States each year, causing eighty fatalities and 1,500 injuries. A tornado can happen in any season and at any hour, from mountains to urban areas. *** Bonus Fact: Lightning is a leading cause of weather-related injury and even death in the United States. Lightning strikes the Earth more than 5,000 times every minute. Your odds of being struck by lightning in America are 1 in 700,000 in any given year. About 10 percent of lightning-strike victims are killed. ********************** Study: lumpectomy survival rates good for early breast cancer Reuters) - A new U.S. study examining survival rates for women with early stage breast cancer found that surgery such as lumpectomy that preserves the rest of the breast may offer survival odds as good as, or even better than, mastectomies. Despite clinical trials showing lumpectomy, or removal of the cancer only, to be as effective as mastectomies in treating early breast cancers, the number of women choosing breast removal has been on the rise, wrote lead researcher E. Shelley Hwang in the journal Cancer. "It was kind of an exciting and hopeful message that women don't have to go off to get a mastectomy to do better," said Hwang, from the Duke Cancer Institute in Durham, North Carolina. "I think a lot of women were making that decision (for mastectomy) because they thought the lumpectomy was not enough. In that context, we wanted to know if lumpectomy works just as well as mastectomy in the modern era." ... http://www.reuters.com/article/2013/02/01/us-breastcancer-idUSBRE91003320130201?feedType=RSS&feedName=healthNews ******************* Diet Sodas: Changing Your Brain And Your Waistline Diet sodas may not be helping you lose weight—in fact, these and other artificially sweetened foods may sabotage your diet by confusing and rewiring your brain’s reward centers. This study from the journal Physiology & Behavior is yet another example of how lifestyle choices can alter your brain—negatively or positively. Scanning diet soda drinkers' brains The University of San Diego study followed 24 young adults: half the group drank at least one serving of diet soda every day, while the other half avoided the artificially sweetened drinks. These adults were then hooked up to brain scanning equipment while scientists fed them water alternately flavored by natural and artificial sweeteners—then the researchers sat back and watched what unfolded in the brain. The results, according to University of California San Diego researchers Green and Murphy, were pronounced: “[Diet soda drinkers] who consumed a greater number of diet sodas had reduced caudate head activation. These findings may provide some insight into the link between diet soda consumption and obesity.” https://www.lumosity.com/blog/diet-soda/?utm_source=SilverpopMailing&utm_medium=email&utm_campaign=RMKTG_DietSoda_2012.10.16_A&utm_content=&ll_src=RMKTG_DietSoda_2012.10.16_A&ll_ch=EMAIL&ll_u=18261521&spMailingID=9661449&spUserID=MjA0OTQ3NzA2NTYS1&spJobID=206096646&spReportId=MjA2MDk2NjQ2S0 ********************** RANDOM FACTS : On November 19, 1863, at the dedication of a military cemetery at Gettysburg, Pennsylvania, during the American Civil War, President Abraham Lincoln delivers one of the most memorable speeches in American history. In just 272 words, he brilliantly and movingly reminded a war-weary public why the Union had to fight, and win, the Civil War. Bonus Fact: Also on this date; for the first time in eight years, the leaders of the Soviet Union and the United States hold a summit conference. Meeting in Geneva, President Ronald Reagan and Soviet leader Mikhail Gorbachev produced no earth-shattering agreements. However, the meeting boded well for the future, as the two men engaged in long, personal talks and seemed to develop a sincere and close relationship. *************** WORD ORIGINS: Atlanta*** Georgia's chief city came into being thanks to the railroad, which began to work its way through the area in 1836. A planned line from Chattanooga, Tennessee, to the northwest was to shunt at a place noted on the map simply as "Terminus." A few years later, a railroad official suggested naming the growing town around this point "Atlantica-Pacifica." The name stuck until 1847, when a resident suggested the shortened form "Atlanta," made official that year. ************* Hospital-acquired pressure ulcers: results from the national Medicare Patient Safety Monitoring System study. Lyder CH; Wang Y; Metersky M; Curry M; Kliman R; Verzier NR; Hunt DR School of Nursing, University of California at Los Angeles, Los Angeles, California 90095, USA. clyder@sonnet.ucla.edu OBJECTIVES: To determine the national and state incidence levels of newly hospital-acquired pressure ulcers (PUs) in Medicare beneficiaries and to describe the clinical and demographic characteristics and outcomes of these individuals. DESIGN: Retrospective secondary analysis of the national Medicare Patient Safety Monitoring System (MPSMS) database. SETTING: Medicare-eligible hospitals across the United States and select territories. PARTICIPANTS: Fifty-one thousand eight hundred forty-two randomly selected hospitalized fee-for-service Medicare beneficiaries discharged from the hospital between January 1, 2006, and December 31, 2007. ... J Am Geriatr Soc. 2012: 60(9): 1603 -8 (ISSN: 1532-5415) http://reference.medscape.com/medline/abstract/22985136?src=nlbest ***************** Medscape Medical News GI Bleeds: Withholding Transfusions Boosts Survival Withholding transfusions until hemoglobin levels are lower than 7%, rather than 9%, improves overall survival by 45% in patients with acute upper gastrointestinal (GI) bleeding, according to a study published in the January 3 issue of the New England Journal of Medicine. "[This study] provides long-awaited evidence to guide practice and justify current recommendations for the management of upper gastrointestinal bleeding," asserts Loren Laine, MD, from the Yale University School of Medicine in New Haven and the VA Connecticut Healthcare System in West Haven, in an accompanying editorial. Although prior meta-analyses have largely excluded the potential for benefit with a liberal transfusion strategy, only 1% or less of included patients had acute GI bleeds, Dr. Laine writes.... http://www.medscape.com/viewarticle/777187 *********************** Catheter hub decontamination requires a thorough scrub and compliance varies. This study evaluates the effectiveness of a disinfection cap with 70% alcohol in preventing contamination/infection. ( the full article is also available at this link) Methods A 3-phased, multifacility, quasi-experimental study of adult patients with central lines divided into P1 (baseline), when the standard scrub was used; P2, when the cap was used on all central lines; and P3, when standard disinfection was reinstituted. House-wide central-line associated bloodstream infection (CLABSI) rates are reported with catheter-associated urinary tract infections (CAUTI) as a control measure. Adults with peripherally inserted central catheters inserted during hospitalization having 5+ consecutive line-days gave consent and were enrolled, and 1.5 mL of blood was withdrawn from each lumen not in use and quantitatively cultured. Results Contamination was 12.7% (32/252) during P1; 5.5% (20/364) in P2 (P = .002), and 12.0% (22/183; P = 0.88 vs P1 and P = .01 vs P2) in P3 (P = .001 vs P2). The median colony-forming units per milliliter was 4 for P1, 1 for P2 (P = .009), and 2 for P3 (P = .05 vs P2). CLABSI rates declined from 1.43 per 1,000 line-days (16/11,154) to 0.69 (13/18,972) in P2 (P = .04) and increased to 1.31 (7/5,354) in P3. CAUTI rates remained stable between P1 and P2 (1.42 and 1.41, respectively, P = .90) but declined in P3 (1.04, P = .03 vs P1 and P2). Conclusion Disinfecting caps reduce line contamination, organism density, and CLABSIs. http://www.ajicjournal.org/article/S0196-6553%2812%2901023-1/abstract?utm_campaign=Weekly_eNewsletter_Week_of_January_7th_2013&utm_medium=email&utm_source=BenchmarkEmail ************ A Patient Teaching Moment: Grapefruit may turn more drugs deadly, scientists find More than 85 drugs that interact with whole grapefruit, grapefruit concentrate or fresh grapefruit juice have been identified, though not all have serious consequences. Those that do, however, can cause problems that include acute kidney failure, respiratory failure, gastric bleeding -- and worse. A complete list of drugs that interact with grapefruit: http://www.cmaj.ca/content/suppl/2012/11/26/cmaj.120951.DC1/grape-bailey-1-at.pdf ***************************** Ivermectin hair lotion found effective against lice (Reuters Health) - A single 10-minute hair application of a drug used in oral form since the 1980s to control river blindness and other parasitic diseases eliminated head lice in nearly three of four children in a new study. The lotion contains ivermectin and is sold under the brand name Sklice by Sanofi Pasteur, which paid for the study. The U.S. Food and Drug Administration used the results to approve topical ivermectin lotion in February. "The advantage of it is, it's a one-application, one-shot treatment," lead author Dr. David Pariser of Eastern Virginia Medical School, in Norfolk, told Reuters Health. ... http://www.reuters.com/article/2012/10/31/us-ivermectin-hair-idUSBRE89U1Q920121031?feedType=RSS&feedName=healthNews ******************* Quiz Time For a patient with dilated cardiomyopathy, which type of pacing should you anticipate? a. Epicardial pacing b. Transvenous pacing c. Noninvasive transcutaneous pacing d. Biventricular pacing. (answer at end of Newsletter) Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ******************** New Hold-n-Place Adhesive Patch The Dale Hold-n-Place Foley Catheter Holder is an adhesive patch which has a clear, skin-friendly base and a locking tab that features a dual holding system of adhesive and Velcro to secure indwelling catheters. Designed for short-term use, the adhesive patch can remain in place for up to three days. http://dalemed.com/ContactUs/RequestAdditionalInformation.aspx **************** Help kiss metabolic syndrome goodbye just by touching your lips to a glass of this: grape juice. Seems that resveratrol -- a compound found in red grapes, red wine, and grape juice -- starts a helpful chain reaction that could keep metabolic syndrome in check. And that's a very good thing, because metabolic syndrome significantly increases the likelihood of heart disease. Resveratrol Benefits Here's how it works: In an animal cell study, researchers watched it all go down. Seems that resveratrol triggers a process that results in a hormone called adiponectin -- and this hormone is something special. Resveratrol benefits include protecting the lining of blood vessels from inflammation, enhancing the function of insulin, increasing glucose tolerance, and putting an end to the development of both metabolic syndrome and heart disease. Pretty hot stuff. Especially for people who are struggling with their weight, since arterial inflammation and insulin and glucose problems can be a real problem for obese people. Not only that, but obese people tend to have lower adiponectin levels to begin with. (Related: Does obesity run in your family? http://www.realage.com/information-on-diabetes/reduce-metabolic-syndrome-with-resveratrol?eid=1010643037&memberid=31741808 ******************* Looking for a pill-free way to ease back pain? A survey recently revealed the top six. And none of the alternative therapy methods for back pain treatment requires surgery. They are chiropractic care, massage, acupuncture, herbal therapy, relaxation training, and stretching-based Eastern exercises (think yoga and tai chi). Ache-Alleviating Alternatives In a large national survey, 60% of people who had used one of these alternative therapy methods in the previous year said that it brought them a "great deal" of relief from their low back pain. And, in fact, more was better. People who used a combination of one or more of these therapies tended to experience even greater back pain relief compared with people who used just one. (Related: Discover what dangerous health condition may be ameliorated by massage.) ... http://www.realage.com/chronic-pain-management/reduce-back-pain-complementary-therapies?eid=1010643037&memberid=31741808 ~~**~~**~~**~~**~~**~~ HUMOR SECTION The reception area of the doctor's office was fllled to capacity, but the doctor was working at a snail's pace. After waiting for two hours, an old man slowly stood up and headed for the door. When everyone stopped talking to look at him, he announced, "I guess I will just go home to die a natural death." ***** A naked man was admitted to the ER suffering a large bump on his head and a severely scratched scrotum. He was diagnosed with a concussion. The nurses wondered why he wasn't dressed...why he had all the scratches on his scrotum, but since he was still unconscious, those answers would have to be on hold. Finally, the second day he was aware enough to hold a conversation and the questions were finally asked. He said that he was a day sleeper. He had been awakened by a dripping faucet and couldn't go back to sleep without checking it out. As he was under the sink looking for the drip, his cat came up and started batting at his swaying scrotum. This it really hurt and he was startled into leaping up, resulting in bumping his head so hard, that he became unconscious. The next he knew, he was in the hospital. ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx ~~**~~**~~**~~**~~**~~ 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/ Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ The 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 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Ad-Tech Macro Micro Subdural Electrodes FDA and Ad-Tech notified healthcare professionals of a Class 1 recall due to concern the microelectrodes are defective and may cause injury to the brain. These devices are intended for temporary (less than 30 days) use on patients with epilepsy for the recording, monitoring and stimulation of electrical signals on the surface level of the brain. There is the potential for abrasion of brain tissue and for broken pieces to remain in the brain tissue when the physician removes the electrode. This may lead to hemorrhaging or a seizure, as well as death. BACKGROUND: There has been one reported serious injury that may have been related to the use of the device. On Dec. 18, 2012, the firm sent its customers an "Urgent Medical Device Recall" letter. The letter described the reason for recall, the risk to health, actions to be taken by the customers, product and distribution information, and type of action taken by the firm. The recalled products were manufactured from June 2006 to March 2012, and distributed from June 8, 2006 to March 14, 2012. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm342834.htm ********************* Samsca (tolvaptan): Drug Warning - Potential Risk of Liver Injury Otsuka and FDA notified healthcare professionals of significant liver injury associated with the use of Samsca. In a double-blind, 3-year, placebo-controlled trial in about 1400 patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) and its open-label extension trial, 3 patients treated with the drug developed significant increases in serum alanine aminotransferase (ALT) with concomitant, clinically significant increases in serum total bilirubin. In the trials the maximum daily dose of Samsca administered (90 mg in the morning and 30 mg in the afternoon) was higher than the maximum 60 mg daily dose approved for the treatment of hyponatremia. Most of the liver enzyme abnormalities were observed during the first 18 months of therapy. Following discontinuation of treatment, all 3 patients improved. An external panel of liver experts assessed these 3 cases as being either probably or highly likely to be caused by tolvaptan. These findings indicate that Samsca (tolvaptan) has the potential to cause irreversible and potentially fatal liver injury. These data are not adequate to exclude the possibility that patients receiving Samsca for its indicated use of clinically significant hypervolemic and euvolemic hyponatremia are at a potential increased risk for irreversible and potentially fatal liver injury. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm336669.htm ********************* FDA approves new silicone gel-filled breast implant Agency requires post-approval safety studies to assess rare events The U.S. Food and Drug Administration today approved the Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Gel Filled Breast Implant to increase breast size (augmentation) in women at least 22 years old and to rebuild breast tissue (reconstruction) in women of any age. Natrelle 410 implants are manufactured by Allergan, Inc. The silicone gel in the Natrelle 410 implant contains more cross-linking compared to the silicone gel used in Allergan’s previously approved Natrelle implant. This increased cross-linking results in a silicone gel that’s firmer. Cross-linking refers to the bonds that link one silicone chain to another. The clinical significance of this type of silicone gel is not known. ... http://www.fda.gov/ForConsumers/byAudience/ForWomen/default.htm ********************** Omontys (peginesatide) Injection by Affymax and Takeda: Recall of All Lots - Serious Hypersensitivity Reactions Affymax, Inc. and Takeda Pharmaceutical Company Limited along with the U.S. Food and Drug Administration (FDA) are informing the public of a voluntary recall of all lots of OMONTYS® (peginesatide) Injection to the user level as a result of new postmarketing reports regarding serious hypersensitivity reactions, including anaphylaxis, Omontys (peginesatide) Injection is indicated for the treatment of anemia due to chronic kidney disease in adult patients on dialysis and is packaged in 10 mg and 20 mg Multi-dose vials: 10mg Multi-dose Vials - NDC 64764-610-10 Lots C18685, C18881, C19258 20mg Multi-dose vials - NDC 64764-620-20 Lots C18686, C18696 All lots of Omontys are affected by this recall and distributed nationwide, including Puerto Rico and Guam, to dialysis centers via specialty distributors. Dialysis organizations are instructed to discontinue use. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm340895.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: tsherryeddie@msn.com (Sherry) February 16, 2013 bwillis@archbold.org (Beth) February 27, 2013 ~~**~~**~~**~~**~~**~~ ADDRESS CHANGE: FROM: Chousm@AOL.com TO: chousm@bendbroadband.com Thank you for letting me know. ~~**~~**~~**~~**~~**~~ 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 "Nursing should not be a sacrifice, but one of the highest delights of life." ~ Florence Nightingale Answer to Quiz Time: Correct answer: d. Biventricular pacing (also called cardiac resynchronization therapy) is indicated for patients with heart failure, dilated cardiomyopathy, prolonged ventricular conduction, or a reduced ejection fraction. Hope to hear from you..... Frankie RNFrankie@AOL.com

February PARADIGM BYTES

PARADIGM BYTES Newsletter for Paradigm 97 February 15, 2013 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 Tuberculosis: WHO-Endorsed Test Offers Rapid Detection A diagnostic test for tuberculosis (TB) can accurately and quickly detect both TB and drug-resistant strains, according to a new study. The authors of a new systematic review assessing the diagnostic accuracy of the Xpert® MTB/RIF test published in The Cochrane Library say their study can provide timely advice for clinicians and policymakers in countries where TB is a major public health problem. Millions of people develop TB every year. Around 13% of cases occur in people living with HIV and more than a quarter of these people die as a result. Drug resistance is a major public health problem that further complicates efforts to control TB. Multidrug-resistant TB is defined as resistance to rifampicin and isoniazid, which are two of the most effective and widely used anti-TB drugs. Xpert® (Cepheid Inc, California) is a diagnostic test endorsed by the World Health Organization (WHO) that simultaneously detects TB and resistance to rifampicin, as an indicator of multidrug resistance. The test takes around two hours, with minimal hands-on technical time required. Like sputum smear microscopy, which relies on detecting TB with a microscope in a laboratory, Xpert requires a sample of sputum. However, while thousands of bacteria must be present in each millilitre of sample for TB to be detected under the microscope, Xpert can detect TB bacteria at much lower concentrations. In addition, the conventional microscopy approach does not detect drug resistance. Instead, TB has to be grown in the lab. This presents problems, especially for multidrug-resistant TB, due both to the length of time required for the cultures to grow and the specialized laboratories and highly skilled staff needed. The researchers, from the Cochrane Infectious Diseases Group, McGill University and the Foundation for Innovative New Diagnostics (FIND), analysed data from 18 studies involving a total of 7,816 people, with most studies being carried out in low- and middle-income countries. The results show that when Xpert is used to screen 1,000 people, 150 of whom have TB, it picks up 132 of the 150 cases (88%) and falsely diagnoses 17 (2%) with TB. This is in a scenario where it is being used as a replacement for smear microscopy. In a scenario where Xpert is being used as a replacement for culture-based drug susceptibility testing, it is also able to detect the equivalent of 141 out of 150 cases (94%) of rifampicin resistance. When Xpert is used as a follow-on test, after conventional smear microscopy has already produced a negative result, it picks up 101 out of 150 cases (67%). By definition, smear-negative TB is not picked up by smear microscopy because microscopy cannot detect small numbers of bacteria. Xpert picked up 67% of this group that would have been missed by microscopy. “This study represents the most comprehensive review on the diagnostic accuracy of Xpert to date and may help countries make decisions about scaling up its use for management of TB and drug-resistant TB,” said lead researcher, Karen Steingart, of the Cochrane Infectious Diseases Group. Karin Weyer, Coordinator, Laboratories, Diagnostics and Drug Resistance at the World Health Organization (WHO) said, “This Cochrane Review provides high quality evidence that reinforces WHO’s endorsement of this test. Recent price reductions have greatly facilitated roll-out of this technology, including a new three-year initiative called the TB Xpert Project, funded by UNITAID and executed by WHO and the Stop TB Partnership. 1.4 million test cartridges and over 200 GeneXpert instruments for the rapid detection of TB and rifampicin resistance will be distributed in 21 countries with a high burden of TB.” Lucica Ditiu, Executive Secretary of the Stop TB Partnership, said, “We welcome the Cochrane Review of Xpert, an innovation that represents a major milestone in our quest to achieve the goal of zero deaths from TB – which is curable but still takes the life of three people every minute. The Stop TB Partnership is making every effort to help countries understand how best to use this new technology. Our TB REACH initiative is deploying Xpert to numerous c ountries through projects that seek to increase the number of TB cases detected and treated, and these projects will deliver data that can provide an evidence base for determining how Xpert should be used for the greatest impact.” Full citation: Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD009593. DOI: 10.1002/14651858.CD009593.pub2 URL Upon publication: http://doi.wiley.com/10.1002/14651858.CD009593.pub2 (The full review will be available open access upon publication) ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Study: lumpectomy survival rates good for early breast cancer Reuters A new U.S. study examining survival rates for women with early stage breast cancer found that surgery such as lumpectomy that preserves the rest of the breast may offer survival odds as good as, or even better than, mastectomies. Despite clinical trials showing lumpectomy, or removal of the cancer only, to be as effective as mastectomies in treating early breast cancers, the number of women choosing breast removal has been on the rise, wrote lead researcher E. Shelley Hwang in the journal Cancer. "It was kind of an exciting and hopeful message that women don't have to go off to get a mastectomy to do better," said Hwang, from the Duke Cancer Institute in Durham, North Carolina. "I think a lot of women were making that decision (for mastectomy) because they thought the lumpectomy was not enough. In that context, we wanted to know if lumpectomy works just as well as mastectomy in the modern era." ... http://www.reuters.com/article/2013/02/01/us-breastcancer-idUSBRE91003320130201?feedType=RSS&feedName=healthNews ***************** Inked and Regretful: Removing Tattoos That tattoo on your arm of a former flame—the one that seemed like a great idea years ago—is kind of embarrassing today. And your spouse is not too crazy about it either. You may not know that FDA considers the inks used in tattoos to be cosmetics, and the agency takes action to protect consumers when safety issues arise related to the inks. At the other end of the tattoo process, FDA also regulates laser devices used to remove tattoos. FDA has cleared for marketing several types of lasers as light-based, prescription devices for tattoo lightening or removal. A Massachusetts company recently received FDA clearance to market its laser workstation for the removal of tattoos and benign skin lesions. ... http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm336842.htm ************************ RANDOM FACT: February 3 was the 100th anniversary of the ratification of the Sixteenth Amendment, that is the income tax. Americans for Tax Reform commemorated the occasion by publishing a few fun facts about the income tax. Another Random Fact: The initial top tax bracket was only 7 percent, and it didn't kick in until income reached a whopping $11.6 million in 2013 dollars. Only 358,000 people had to fill out 1040 forms at first, because the standard family deduction was an adjusted $93,000. ****************** This year the focus is on preventing scald injuries: 75%: Percentage of all burns to young children that are scalds 120: The temperature setting for a water heater thermostat in the home should not exceed 120 degrees to avoid scald injuries. 110: The temperature setting for a water heater thermostat in nursing homes and child care facilities should not exceed 110 degrees to avoid scald injuries. To check hot water temperature, run hot water up to 2 minutes at the tap and measure with a cooking thermometer. Even if initial test temperature is below 120 degrees, safety may not be constant: Retest several times. About half of burn injuries treated in EDs are scald injuries. 50%: Reprinted with permission from: Production/Electronic Channels Coordinator *************** Understanding core measures for heart-failure treatment HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ... (Heart Failure) is the primary cause of more than 55,000 deaths each year in the United States. The most common signs and symptoms of HF are shortness of breath on exertion; orthopnea; weight gain with edema in the feet, legs, or lower back; fatigue; and weakness. Major causes of HF are coronary artery disease, high blood pressure, and diabetes. According to the Centers for Disease Control and Prevention (CDC), HF is diagnosed in 670,000 new persons annually. Currently, about 5.8 million persons in the United States are living with HF. In women, HF incidence has dropped by about 30% due to earlier diagnosis and treatment. In men, the number of new cases remains unchanged. The annual economic toll of HF is about $34.5 billion. As with most diseases, the earlier HF is diagnosed and treated, the greater the chance for improving the patient’s quality of life and increasing life expectancy. Over the past 50 years, scientists and healthcare providers have made great strides in treatment and patient outcomes by examining best practices for patients with HF. ... http://www.americannursetoday.com/Article.aspx?id=9952&fid=9912&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_February_2013_House&utm_medium=email ******************* Teaching patients about FDA recommendations for proper medication disposal Accidental exposure to medication in the home is a major cause of unintentional poisoning in children. Recent data show even child-resistant containers can’t completely prevent a child from taking medication meant for someone else. Reported cases of accidental exposure further emphasize the need for nurses to counsel patients on how to store medication safely out of reach of children and pets, as well as on proper disposal of unused or expired drugs. Nearly all medications can be thrown away in the household trash after they’ve been mixed with an unpalatable substance, such as coffee grounds, and sealed in a container. However, a few select drugs—primarily controlled substances—should be flushed down the sink or toilet to permanently remove the risk of accidental exposure from the home. The Food and Drug Administration (FDA) recently made available recommendations for proper medication disposal and a list of drugs that should be flushed due to their potential to cause serious or life-threatening adverse reactions (such as difficulty breathing, heart problems, and even death) if someone other than the person for whom the drug was prescribed is exposed to it accidentally. ... http://www.americannursetoday.com/Article.aspx?id=9956&fid=9912 ********************** Drugs in the environment: Nurses’ roles and responsibilities News that pharmaceuticals have been found in our rivers and streams, fish, wildlife, and even our drinking water has captured our interest and concern. This isn’t a new phenomenon. Active pharmaceutical ingredients (APIs) have been in the water since humans first started using and excreting drugs. But we’re just beginning to recognize the magnitude of the problem. Drug prescriptions in this country have increased 61% over the past decade and now total about 3.4 billion annually, with retail sales of $250 billion. Nurses, who administer, dispose of, and in some cases prescribe drugs, can play a key role in developing policies and practices that help minimize the amount of pharmaceuticals that end up in the environment. The U.S. Geological Survey has detected codeine, sulfa drugs, hormones (such as estradiol), and many other medications in a wide swath of surface waters around the country. Tissue samples of the nation’s fish reveal that these drugs are being absorbed in fish, resulting in body burdens of pharmaceuticals that may travel up the food chain. About half the country derives its drinking water from surface water sources, yet no one knows how many APIs are in circulation, nor what percentage is derived from human excretion, animal excretion from veterinary use (particularly in agriculture), disposal activities, or manufacturing activities. Drinking water standards don’t require testing for APIs. ... http://www.americannursetoday.com/Article.aspx?id=9954&fid=9912&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_February_2013_House&utm_medium=email ********************* Study: Donor feces more effective than vancomycin in treatment of recurrent C. difficile (if this happens on your shift, how will you handle any explanation to patient/family?) Background Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. Full Text of Background... Methods We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks. ... http://www.nejm.org/doi/full/10.1056/NEJMoa1205037?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_Week_of_January_21st_2013&utm_medium=email&#t=abstract ; ******************* December 12, 2012, was the century's last sequential date (unless we go to a 13 month calendar really soon). But is there more to this unique arrangement of numbers than just oddity? RANDOM FACTS: A much-cited survey conducted by US-based David's Bridal estimated that around 7,500 brides would be getting married in America today � a 1,446 percent increase from 12/12/11. The New York Times wrote that many couples considered it lucky to get married on repetitive dates, with 07-07-07, 10-10-10 and 11-11-11 each breaking Las Vegas records *** Bonus Fact: According to Chinese numerology, the number one is a yang number which is ruled by the sun and represents independence and individualism. Two is a yin number which is ruled by the moon and represents symmetry and balance. When placed together, the number 12 brings harmony to the yin and yang, balancing the feminine energy of the moon with the masculine energy of the sun. ******************** QUIZ TIME: Which of the following is an advantage of a dry-suction chest drainage system? a. Lower levels of suction pressure b. Variable bubbling, which indicates proper functioning c. A steady bubbling sound, which indicates proper functioning d. Higher levels of suction pressure ** Answer at end of this Newsletter ** Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 *********************** Many aspects of “We Can Improve the Safety of PICC Lines” (Viewpoint, November 2012) don't reflect national standards of practice. The safety of peripherally inserted central catheter (PICC) insertion at the bedside has been well established, yet the author questions this practice without the benefit of fluoroscopy. Fluoroscopy is not necessary for PICC insertion. While there are challenges with proper tip location based on external measurement, a postinsertion chest X-ray is mandatory.1 Technology advancement now allows for the identification of PICC tip location during the insertion procedure by using electrocardiogram changes, a much more accurate method.2 The primary or original tip location can change during the catheter dwell time, producing a secondary malposition.1 Saying that PICCs have an “inherent characteristic of instability” is not accurate. The author is confusing two different types of secondary catheter malposition. First, there is tip migration, which can occur with any type of central vascular access device (CVAD) and is caused by changes in intrathoracic pressure, such as coughing, sneezing, congestive heart failure, and mechanical ventilation. There is no change to the external catheter length. It's the nurse's responsibility to know the clinical signs and symptoms of tip migration and to take appropriate action if it's suspected. There are no nursing interventions that could easily prevent this type of tip movement.1 Another type of secondary malposition is known as catheter dislodgment or displacement. In this case, the catheter is either pulled out of or pushed into the insertion site. This involves a change in the external catheter length, which subsequently produces a change in the catheter's tip location.1 The most common cause of this problem is lack of catheter stabilization. The Infusion Nurses Society and the Centers for Disease Control and Prevention (CDC) recommend CVAD stabilization with an engineered, sutureless catheter stabilization device.1, 3 A transparent membrane dressing alone or “sticky occlusive clear dressing,” as stated by the author, is not a stabilization device. While a dressing has an important role in catheter care, relying on a dressing alone for stabilization puts patients at risk for catheter dislodgment. This is not the fault of the catheter design but rather the absence of proper catheter stabilization techniques, a lack of appropriately engineered products for this purpose, and a lack of knowledge and skill by the nursing staff to adequately use these stabilization devices. During each CVAD dressing change, measurement of the external catheter length with comparison to the original length is required.1 A label on the catheter or dressing would assist nurses in locating this critical information. A simple piece of tape with this information can be added to the edge of the dressing. Infusion nursing practice is measured against the documents produced by the Infusion Nurses Society and the CDC, and nurses must be familiar with these. Lynn Hadaway, MEd, RN, BC, CRNI Milner, GA References: 1. Infusion Nurses Society. Infusion nursing standards of practice J Infus Nurs. 2011;34(1 Suppl):S1–S109 Cited Here... 2. Smith B, et al. Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters J Electrocardiol. 2010;43(3):274–8 Cited Here... 3. O'Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. Atlanta: Centers for Disease Control and Prevention; 2011. ****************** Clinicians at NorthShore University HealthSystem's three hospitals near Chicago have found a method of reducing bloodstream infections by half. Using a tiny alcohol-impregnated cap on central line hubs prevented four CLABSI deaths and prevented 21 patients from infections, they calculated during the study year, a result sustained with proven cost-effectiveness during the 18 months following their experiment. The cap method differs from the traditional 15-second "scrub the hub" ... http://www.healthleadersmedia.com/content/QUA-288009/Drop-in-CentralLine-Infection-Rates-Linked-to-Disinfection-Caps ***************** Patient Navigation: Revenue Opportunities for Hospitals According to a report from the Center for Health Affairs, patient navigation could save billions of dollars at hospitals. http://www.fiercehealthcare.com/story/patient-navigation-revenue-opportunities-hospitals/2013-01-03?utm_medium=nl&utm_source=internal ************ California: Registered nurses able to dispense birth control under new law Nurses can dispense hormonal birth control in California, but new law draws controversy http://www.huffingtonpost.com/2013/01/05/nurses-hormonal-birth-control_n_2414605.html ************** Identity Theft's Taxing New Trend: Scammers Are After Your Tax Refund Along with the rapid rise in identity theft has come the explosion of a specialized and sophisticated form of theft: tax identity theft. During the 2011 tax processing year, roughly 940,000 tax returns were filed fraudulently. This year the number will likely reach 1 million. Even the IRS' own taxpayer advocate, Nina Olson, says the IRS is woefully incapable of handling the boom. A recently released report from the National Taxpayer Advocate to Congress says that the IRS "has failed to provide effective and timely assistance to victims of identity theft" even as the number of crimes continues to soar. Olson says in the report that tax-related identity theft has risen some 650 percent since 2008 ... http://www.dailyfinance.com/2013/01/25/identity-theft-tax-refund-scammers/?ncid=webmail26 ************************* In a telling demonstration of their lack of faith in the future of the U.S. dollar, lawmakers in Virginia are considering minting their own state coinage. But could the dollar really fail? National currencies have failed before, and it has happened more frequently and more recently than you probably think. RANDOM FACT: The most famous example in the 20th century is Germany's Weimer Republic of 1922-1923. When Germany was unable to pay the war reparations imposed after WW I the government began printing unbacked currency. Too much money was circulated, and the money was soon considered worthless. In 1922, the largest denomination of the Papiermark was 50,000. A year later it was 100 Trillion. This means that by December 1923, the exchange rate with the US Dollar was 4.2 Trillion to 1. It is estimated that by November 1923, the yearly inflation rate was 325,000,000 percent. ************* Men more likely to die of cancer: study (Reuters) - Not only are men more likely than women to be diagnosed with cancer, men who get it have a higher chance of dying from the disease, according to a U.S. study. In an analysis of cases of all but sex-specific cancers such as prostate and ovarian cancer, for example, men were more likely than women to die in each of the past ten years, said researchers, whose findings appeared in The Journal of Urology. That translates to an extra 24,130 men dying of cancer in 2012 because of their gender. "This gap needs to be closed," said Shahrokh Shariat from Weill Cornell Medical College in New York, who worked on the study. "It's not about showing that men are only doing worse and, 'poor men.' It's about closing gender differences and improving health care." ... http://www.reuters.com/article/2012/12/07/us-cancer-men-idUSBRE8B604R20121207?feedType=RSS&feedName=healthNews **************** Provisions contained in American Taxpayer Relief Act (ATRA , known colloquially as the fiscal cliff deal, will further reduce Medicare payments for skilled nursing facility (SNF) care, according to a press release from The Alliance for Quality Nursing Home Care (AQNHC). An analysis from Avalere Health shows that by extrapolating from the Congressional Budget Office estimate of $1.8 billion in savings over 10 years (FY 2013 to FY 2022), it estimates that the provision in the fiscal cliff deal will cut payments to SNFs by approximately $600 million over that period. http://tinyurl.com/anehmq3 (Thanks BAcello..Barbara) ************ Metal-on-Metal Hip Implants: Safety Communication - Updated Safety Recommendations FDA notified healthcare professionals that it is providing updated safety information and recommendations to patients and health care providers, based on the FDA’s current assessment of metal-on-metal hip implants, including the benefits and risks, the evaluation of the published literature, and the results of the June 2012 Orthopaedic and Rehabilitation Devices Advisory Panel meeting. BACKGROUND: In metal-on-metal hip implants, the metal ball and the metal cup slide against each other during walking or running. Metal can be released from other parts of the implant where two implant components connect. Metal release will cause some tiny metal particles to wear off of the device around the implant, which may cause damage to bone and/or soft tissue surrounding the implant and joint. Soft tissue damage may lead to pain, implant loosening, device failure and the need for revision surgery Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause symptoms or illnesses elsewhere in the body. Presently, the FDA does not have enough scientific data to specify the concentration of metal ions in a patient’s body or blood necessary to produce adverse systemic effects. In addition, the reaction seems to be specific to individual patients, with different patients having different reactions to the metal wear particles. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm336069.htm ************************ January was National Blood Donor Month; here are some facts about the need for blood and the power of donation: 1: One pint of blood can save up to three lives. 2: Every two seconds someone in the U.S. needs blood. 44,000: More than 44,000 blood donations are needed every day. 3: The average red blood cell transfusion is about three pints. 38%: The percentage of U.S. population eligible to give blood is less than 38%. 9.5 million: Number of blood donors in the U.S. in a year. 10 to 12: The actual blood donation usually takes less than 10 to 12 minutes. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************** WORD ORIGINS: been there, done that *** A phrase indicating that something is wearying or just plain old hat, "been there, done that" comes to American English by way of Australian slang. It first turned up in 1982 in an American newspaper article that said of a recent divorcee who did not plan to marry again, "Using an Australian expression, she says,' Been there, done that'" ~~**~~**~~**~~**~~**~~ HUMOR SECTION A story from the pages of the Manchester Evening Times Last Wednesday a passenger in a taxi heading for Salford Station leaned over to ask the driver a question and gently tapped him on the shoulder to get his attention. The driver screamed, lost control of the cab, nearly hit a bus, drove up over the curb, and stopped just inches from a large plate window. For a few moments everything was silent in the cab. Then, the shaking driver said "Are you OK? I'm so sorry, but you scared the daylights out of me." The badly shaken passenger apologized to the driver and said, "I didn't realize that a mere tap on the shoulder would startle someone so badly." The driver replied, "No, no, I'm the one who is sorry, it's entirely my fault. Today is my very first day driving a cab.......I've been driving a hearse for 25 years." ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. ___________ Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ 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 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Qualitest Hydrocodone Bitartrate and Acetaminophen Tablets 10 mg/500 mg: Recall - Potential for Oversized Tablets Qualitest, a subsidiary of Endo Health Solutions, issued a voluntary nationwide recall for 101 lots of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10 mg/500 mg. Bottles from the affected lots may contain tablets that have a higher dosage of acetaminophen, and as a result, it is possible that consumers could take more than the intended acetaminophen dose. Unintentional administration of tablets with increased acetaminophen content could result in liver toxicity, especially in patients on other acetaminophen containing medications, patients with liver dysfunction, or people who consume more than 3 alcoholic beverages a day. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm331224.htm ******************* Vycor Viewsite Brain Access System (VBAS): Class 1 Recall - Unidentified Fiber Found on Device Vycor Medical recalled its VBAS because an unidentified black fiber was found on the device. This product may cause serious adverse health consequences, including death. Vycor Medical recalled its VBAS because an unidentified black fiber was found on the device. This product may cause serious adverse health consequences, including death. BACKGROUND: The Vycor Medical Viewsite Brain Access System serves as a self-retaining retractor system for brain tissue and provides access to allow the surgeon to see the surgical site during brain and spinal procedures. RECOMMENDATION: Vycor Medical called their customers requesting that they place products of Model # TC171105, Lot # VM83450 into quarantine until further notice. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm337475.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: Audreycarmellasmith@yahoo.com (Audrey) January 31, 2013 ~~**~~**~~**~~**~~**~~ 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/address, okay? RNFrankie@AOL.com OLD ADDRESS: chousm@AOL.com (Connie) NEW ADDRESS: chousm@bendbroadband.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 The farther a society drifts from truth, the more it will hate those who speak it. George Orwell Would love to hear from you......suggestions always welcome. RNFrankie@AOL.com QUIZ Correct answer: d. Advantages of dry suction system include higher levels of suction pressure, easier set-up, quieter operation (no bubbling sound), and more constant pressure because no water is lost to evaporation. Learn more by reading the continuing education program "Chest-tube care: The more you know, the easier it gets."