Paradigm Bytes Newsletter for June 2013

PARADIGM BYTES Newsletter for Paradigm 97 June 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 Do You Wash Your hands? (We nurses know how to wash the hands....especially between the fingers for the correct period of time. But we have all seen people leave the restroom doing just as the following research shows. How can we teach the correct method...to children, it would be easy. However, how about teaching adults?) In fascinating news, new research shows that most people don't wash their hands properly after using the bathroom. The study from Michigan State University found that a staggering 95 percent of people don't wash their hands long enough to kill illness-causing bacteria. Yep, that makes you just about as dirty as the person who walks out of the bathroom without stopping at the sink first. For the study, the research team trained 12 research assistants to unobtrusively watch people's behavior in public restrooms in a college town. The assistants recorded whether and how people washed their hands—if they left the bathroom without washing their hands at all, if they just wetted their hands without using soap, or if they washed their hands with soap. They also recorded how long people's hands were placed under running water during the washing process. In total, 3,749 people were observed. The findings, published in the April 2013 issue of Journal of Environmental Health, showed that only two out of three people use soap and that one out of 10 people skip the sink altogether. While women significantly wash their hands better than men, many still don't do right. "These findings were surprising to us because past research suggested that proper hand washing is occurring at a much higher rate," said Carl Borchgrevink, one of the study's authors and a Michigan State associate professor of hospitality business, in a statement. To prevent the spread of disease, the U.S. Centers for Disease Control and Prevention recommends washing hands under running water and with soap for at least 20 seconds. (Don't want to count in your head? Silently sing the "Happy Birthday" song twice.) Then, leaving the water running, dry your hands with a paper towel and use the towel to turn the faucet off and open the door, before tossing it into the trash. Tell us: Do you always remember to wash your hands properly? (We, as nurses, were taught the proper procedure of washing hands. Do you teach this procedure to your patients? If so, how? It is easy to teach children...but adults?) ****************************** (I just had to add this....didn't know just where to put it........chose this spot. Let me know if you like the Random Fact, please). With the ubiquitousness of the Internet it is easy to forget that once upon a time the recording and passing on of knowledge was a monumentally important, even sacred task and books were frequently more valuable than gold. Now, many books aren't even worth the paper they are printed on, but those rare examples of historic publications in antiquity that are still in good condition can fetch kingly prices. Some of the most expensive books ever sold at auction are... RANDOM FACTS: Traite Des Arbres Fruitiers The "Treatise on Fruit Trees" is a five volume set written in 1750. It contains illustrations and descriptions of sixteen different varieties of fruit trees. With a 2006 purchase price of $4.5 million, it has the distinction of being the most expensive book about fruit trees ever sold. The Gutenberg Bible There are 48 Gutenberg Bibles left of the original 180 believed to have been produced. They were printed in 1456 and were the first books produced with moveable type. A copy sold in 1987 for $4.9 million at Christie's New York. First Folio This book, a collection of William Shakespeare's plays, was published after his death in 1623. Seven hundred and fifty copies were published, but only 228 survived. Microsoft co-founder Paul Allen purchased a copy for around $6.1 million in 2001. The Canterbury Tales There are only 12 known first edition copies left since its publishing in 1477, and only one is in a private collection. The book was originally purchased in 1776 and not sold again until 1998 with a purchase price of $7.5 million by Christie's of London. Birds Of America This three and a half foot tall book depicts 400 life size North American bird species known to the Audubon Society in the 19th century. Only 200 complete first editions were produced, and 120 exist today. In 2010, one was sold for $11.5 million, but a 2012 copy sold for only $7.9 million. The Gospels Of Henry The Lion Commissioned by Henry the Lion for the alter of the Virgin Mary at Brunswick Cathedral, the German government purchased this 266 page book in 1983 for $11.7 million. The Codex Leicester Da Vinci wasn't only an artist, but also a scientist. This 72 page notebook is a handwritten journal chronicling his thoughts on everything from fossils to what makes the moon glow. Microsoft founder Bill Gates purchased the book for $30.8 million and had it scanned to use as a screensaver for Windows 95. ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS Thank you, Laura for the following links: Nursing-related News Docs, Nurses Disagree Over Expanded Nurse Roles Postings from the KHN and Human Capital blogs. Article from HealthDay. Free, full-text article and abstract from The New England Journal of Medicine. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fcapsules.kaiserhealthnews.org%2Findex.php%2F2013%2F05%2Fdoctors-nurse-practitioners-disagree-about-expanded-roles-for-nurses%2F&i=61&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com The U.S. Nursing Workforce: Trends in Supply and Education Analysis from the HHS Health Resources and Services Administration. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fbhpr.hrsa.gov%2Fhealthworkforce%2Freports%2Fnursingworkforce%2Findex.html&i=66&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com The American Academy of Nursing Applauds Senate Confirmation of Marilyn Tavenner, MHA, BSN, RN, as New CMS Administrator News release. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.aannet.org%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D500%3Aacademy-applauds-senate-confirmation-of-tavenner-as-new-cms-administrator%26catid%3D23%3Apressreleases%26Itemid%3D133&i=67&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com California Weighs Expanded Role For Nurse Practitioners Article from Kaiser Health News. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.kaiserhealthnews.org%2FStories%2F2013%2FMay%2F09%2FCalifornia-expanded-role-nurse-practitioners.aspx&i=68&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com The Registered Nurse Safe Staffing Act of 2013 Is Introduced in Congress News item from the American Nurses Association web site. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.aannet.org%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D500%3Aacademy-applauds-senate-confirmation-of-tavenner-as-new-cms-administrator%26catid%3D23%3Apressreleases%26Itemid%3D133&i=67&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com ~~**~~**~~**~~**~~**~~ MEDICAL NEWS The so-called Monsanto Protection Act signed into law earlier this year caused such an outrage that people around the world are planning to protest the biotech company later this month. Now a United States Senator is expected to try and repeal that law after mounting pressure. The notorious ‘Monsanto Protection Act’ rider stuffed into the non-related Senate spending bill may soon be repealed thanks to the massive amounts of activism and outrage that have now amounted into a legislative charge towards action. Action that has turned into legislation progress through Senator Jeff Merkley of Oregon, who has announced an amendment that would remove Section 735 (the Monsanto Protection Act as its known) from the Consolidated and Further Continuing Appropriations Act of 2013 Senate spending bill. The rider, which almost managed to slip incognito and pass by the alarm system of the alternative media, grants GMO juggernaut Monsanto full immunity from federal courts in the event that one of its genetically modified creations is found to be causing damage to health or the environment. Essentially, it grants Monsanto power over the United States federal government. Thankfully, I was able to get on the subject through news tips and covered the Monsanto Protection Act all the way up until the bill containing it was signed into law by Obama. Ultimately, as the Monsanto Protection Act became more a hot issue, we had an increasing amount of publicity — but the Senate vote came just too quickly for the attention to put a halt on the rider. But even after its passing, sources like Russia Today, NaturalNews, Infowars, and myself here at NaturalSociety were sounding the alarm big time. Enough so that it even led to an apology from the top Senator who actually ended up approving the bill containing the rider. Senator Barbara Mikulski of Maryland actually went and released a statement apologizing for allowing the Monsanto Protection Act through and vowing to fight against GMOs and Monsanto. Ultimately, multiple Senators had entered damage control after the jig was up. That is besides Senator Roy Blunt from Missouri, who actually worked with Monsanto (as in he let them write it while he received funding) on the Monsanto Protection Act rider. A rider he says is perfectly reasonable. After all, why not give Monsanto full immunity from the legal system the rest of us are subject to? Even Obama was getting blasted on his Facebook page following the approval of the Monsanto Protection Act, with the majority of comments coming into his page criticizing his signature on the bill that contained the rider. Thanks to this activism, it looks like the Monsanto Protection Act may soon be repealed after this new bill hits Washington. This time, we will have plenty of time to let the Senators know that they are voting against the public if they choose to side with Monsanto. And with such a specific agenda for this bill, I see it doing well in the Senate. Source: http://naturalsociety.com/monsanto-protection-act-soon-repealed-activism/ *********************** Los Angeles launches probe of alleged 'patient dumping' by Nevada (Reuters) - Nevada health officials acknowledged on Thursday that a state-run hospital improperly bused 10 newly discharged psychiatric patients out of the state with deficient plans for their care, while Los Angeles launched a criminal probe into the alleged "patient dumping." Rawson-Neal Psychiatric Hospital has been under fire since last month, after a Sacramento Bee investigative series reported that hospital staff gave as many as 1,500 patients one-way Greyhound bus tickets from Las Vegas to California and 46 other states over the past five years. "If the conduct is true as alleged, it's no less than human trafficking," Los Angeles City Attorney Carmen Trutanich told Reuters, adding he was working with San Francisco City Attorney Dennis Herrera, who last month opened an investigation into the practice. http://www.reuters.com/ ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Gut bugs are implicated in heart attacks and stroke NEW YORK (Reuters) - Thousands of heart attack victims every year have none of the notorious risk factors before their crisis - not high cholesterol, not unhealthy triglycerides. Now the search for the mystery culprits has turned up some surprising suspects: the trillions of bacteria and other microbes living in the human gut. In a study released on Wednesday, scientists discovered that some of the bugs turn lecithin - a nutrient in egg yolks, liver, beef, pork and wheat germ - into an artery-clogging compound called TMAO. They also found that blood levels of TMAO predict heart attack, stroke or death, and do so "independent of other risk factors," said Dr Stanley Hazen, chairman of cellular and molecular medicine at the Cleveland Clinic's Lerner Research Institute, who led the study. That suggests a TMAO test could enter the arsenal of blood tests that signal possible cardiovascular problems ahead. "TMAO might identify people who are at risk (for heart attacks and strokes) despite having no other risk factors," Hazen said. The discovery also suggests a new approach to preventing these cardiovascular events: altering gut bacteria so they churn out less TMAO.... http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNDI1LjE4MTUzMzYxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDQyNS4xODE1MzM2MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTAxNjM1JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&113&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_136236.html *************** Fluid and electrolyte imbalances can quickly turn into life-threatening situations and it is critical to be able to recognize subtle signs and symptoms and intervene appropriately. Test your knowledge of fluids and electrolytes by answering the following questions: What are the major organs involved in electrolyte and fluid homeostasis? What medications can cause hypernatremia? What are the recommended treatments for dilutional hyponatremia? What is the relationship between calcium level and phosphorous level? Which medication, commonly given in CCUs, is contraindicated in patients with hypokalemia? Check your answers and learn more by exploring the articles in More Resources. Also, we now have a new collection, Focus On: Fluids & Electrolytes, which includes a variety of articles, CE, and special features all about fluid and electrolytes! http://email.lww.com/t?r=1483&c=3480712&l=59027&ctl=4661F84:B54AB34282EDAD00F9F852C93A3ECCCEBB9E742C260FE2D0&; ******************** In 1970, Americans spent about $6 billion on fast food. In 2006, the spending rose to nearly $142 billion. It is not surprising that every month, approximately nine out of 10 American children visit a McDonald's restaurant. What are some other not so surprising facts about America's fast food industry. RANDOM FACTS: McDonald's is the largest purchaser of beef, pork, and potatoes and the second largest purchaser of chicken in the world. Its annual orders for french fries constitute 7.5 percent of America's entire potato crop. *** Bonus Fact: Due to anti-German sentiment during WWI, an alternative name for a hamburger (which was derived from the Hamburg steak sandwiches eaten on immigrant ships between Hamburg, Germany, and America in the 1800s) was "salisbury steak." It was named after Dr. Salisbury who prescribed ground beef for patients suffering from anemia, asthma, and other illnesses. ****************** Earlier, The Joint Commission issued a Sentinel Event Alert entitled Medical device alarm safety in hospitals to address the issues presented due to providers becoming desensitized or immune to the beeping of medical devices. We'd like to share several resources available on Lippincott's NursingCenter.com to bring attention to this important issue. http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F63:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& Creating cultures of safety: Risk management challenges and strategies Nursing Management, December 2010 http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F64:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& Increasing the Use of 'Smart' Pump Drug Libraries by Nurses: A Continuous Quality Improvement Project AJN, American Journal of Nursing, January 2012 http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F65:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& ECG Challenges: Monitor Alarms and Alarm Fatigue AACN Advanced Critical Care, December 2011 Alarms are a necessary part of monitoring and caring for patients. Awareness of the technological and human factors associated with alarm fatigue is a first step in recognizing and remedying this issue. http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F66:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& Thank you, Lisa M. Bonsall, MSN, RN, CRNP Clinical Editor, Lippincott's NursingCenter.com ****************** FDA finds fungus, bacteria in recalled pain shots The Food and Drug Administration has found bacteria and fungus in vials of pain shots made by a Tennessee pharmacy whose products have been linked to infections. FDA said it found the contaminants in two sealed vials of steroids made by Main Street Family Pharmacy, which has recalled all its products nationwide after 24 people in Arkansas, Florida, Illinois and North Carolina developed abscesses at the sites where they got the injections. “FDA, in partnership with the Centers for Disease Control and Prevention, is working to identify the exact species of fungus and bacteria observed in the vials. FDA has received reports of adverse events, including skin and soft tissue abscesses,” FDA said in a statement.... http://vitals.nbcnews.com/_news/2013/06/07/18829371-fda-finds-fungus-bacteria-in-recalled-pain-shots?lite ************************ Super Glue*** A kind of extra-sticky adhesive, or cyanoacrylate, "Super Glue" was invented during World War II by a scientist named Harry Coover, who was experimenting with sealants for aircraft turrets. In the 1950s, he went to work for Eastman Kodak, a chemical and film manufacturer, and put a product on the market with the uncatchy name Eastman 910. The company licensed the product to another manufacturer, which renamed it "Super Glue" and made a fortune. ***************** Quiz Time For elderly patients recovering from surgery, you should anticipate which of the following? a. They will require higher opioid dosages than younger patients to experience the same analgesic effect. b. They will require lower opioid dosages than younger patients to experience the same analgesic effect. c. They will require longer opioid dosing intervals and will respond more slowly to opioids. d. They are likely to have differences in genetic makeup that affect opioid response. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 *************** Preventing catheter-related bloodstream infections related to I.V. connectors A year-long national effort to minimize catheter-related bloodstream infections (CR-BSIs) has produced only modest results. The Centers for Disease Control and Prevention (CDC) compared data from January through June 2009 to data from 2006 through 2008, and found these infections had decreased only 18%. The statistics are troubling, especially given the current intense focus on preventing hospital-acquired infections. Why do CR-BSIs still kill patients every year? Some experts believe I.V. connector design is a contributing factor. The Food and Drug Administration (FDA) requires all manufacturers of positive-displacement (PD) I.V. connectors to conduct postmarketing surveillance studies to assess whether they could be linked to a higher CR-BSI rate than other types and to assess factors that may contribute to the possible increased risk. FDA has taken this step because it has received information on possible safety problems linked to PD needleless connectors, including three reports of deaths. But despite mounting evidence against these connectors, they’re still used widely. William Jarvis, MD, an internationally recognized infection control expert, notes that studies also link negative-displacement (ND) connectors with increased CR-BSIs. As primary caregivers, nurses are responsible for the care and maintenance of central venous catheters. This article describes the various I.V. connector designs available and explains why some designs are more effective than others in preventing infections. Because I.V. connectors are attached to catheter hubs, they serve as gatekeepers of the intraluminal fluid pathway (the inside of the catheter). Their design plays a critical role in supporting—or thwarting—your care and maintenance efforts. If their design makes them hard to disinfect with thorough swabbing and flushing, infections are more likely. If their design promotes thorough swabbing and flushing, they can help minimize infections.... http://www.americannursetoday.com/Article.aspx?id=9354&fid=9326&utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_September_3rd_2012&utm_medium=email#comments ****************** Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted THURSDAY, May 2 (HealthDay News) -- Women who have a breast biopsy that turns out to be benign are typically told to undergo another imaging test, such as a mammogram, in six to 12 months. Now, a new study suggests that the longer interval might be better. Researchers who followed women who had benign breast biopsies say having that test less than a year later finds few cancers and is a drain on health care dollars. ''Doing a follow-up imaging study six months after a benign needle breast biopsy has a low likelihood of finding breast cancer at the biopsy site," said study author Dr. Andrea Barrio, an attending breast surgeon at Bryn Mawr Hospital, in Pennsylvania. Most of these women, she said, can wait longer than six months before repeating the mammogram, ultrasound or MRI. Dr. Demitra Manjoros, a breast fellow at Bryn Mawr, is due to present the research Thursday at the American Society of Breast Surgeons' annual meeting, in Chicago. ... http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNTAzLjE4NDE1MDAxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDUwMy4xODQxNTAwMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTEwNDM0JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&126&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_136464.html ********************* NICU treatments linked to intellectual disabilities (Reuters Health) - Neonatal intensive care unit (NICU) interventions for babies born very small and early have drastically reduced infant deaths in the United States, but in doing so they've contributed to more intellectual disabilities, according to a new study. Past research has shown such disabilities have been reduced in recent years through vaccines and newborn screening, for example. But disability rates may also be rising due to procedures that save the lives of children who go on to have limitations in social and practical skills, according to researchers led by Dr. Jeffrey Brosco. "We actually through medical interventions, in some sense, cause a fair amount of intellectual disability as well (as preventing it)," said Brosco, from the University of Miami Miller School of Medicine. Of course, that doesn't mean doctors should stop performing life-saving procedures in the NICU and elsewhere, Brosco told Reuters Health. But the findings are part of a larger trend suggesting researchers and policymakers not focus all of their attention on new medical interventions as the best way to prevent disabilities, but start looking toward public health efforts, he added. "There's a great debate regarding the value of medical versus public health and social interventions in improving child health," said Dr. Jeffrey Baker, a medical historian who studies medical technology, ethics and child health and the Duke University School of Medicine in Durham. "What this study does is to show that medical intervention has been a two-edged sword," he said. http://links.reuters.com/r/8Q1OD/G2T0C/II35GQ/ZBG8RN/4VC4RT/YT/h?a=http://links.reuters.com/r/8Q1OD/G2T0C/II35GQ/ZBG8RN/EKXSHH/YT/h ~~**~~**~~**~~**~~**~~ HUMOR SECTION The brilliant lawyer F. E. Smith once defended a bus driver against claims that his negligence had caused injury to a young man's arm: "Will you please show us how high you can lift your arm now?" Smith asked the plaintiff. The young man obediently raised his arm to shoulder level, his face contorted with apparent pain. "Thank you," said Smith. "And now, please, will you show us how high you could lift it before the accident?" The man's arm shot above his head. ~~**~~**~~**~~**~~**~~ 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 This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. 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/ RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 http://www.washingtonwatch.com/bills/show/110_HR_2123.html Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263 The Nursing Site http://thenursingsite.com . http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.snopes.com (to verify the veracity of a rumor) http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 National Do Not Call Registry If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** (Considering the seriousness of both these Class I recalls, there will be only these two in this Newsletter) Symbios GOPump and GOBlock Kits Recall Class: Class I Date Recall Initiated: June 6, 2013 Product(s): Symbios GOPump in the GoPump Rapid Recovery System Kits Symbios GOBlock Kits Lot numbers: All lots of GOPumps in the GoPump Rapid Recovery System kits and GOBlock kits manufactured with flow control components before July 2012. Please see the chart below listing all the lot numbers. Manufacturing and Distribution Dates: The affected products were manufactured before July 2012 and distributed from April 27, 2011 to April 30, 2013. Use: The Symbios GOPump Rapid Recovery System is a disposable local pain management system that consists of a small balloon that is inflated with a local anesthetic medication. The medication is delivered slowly through tubes from the balloon to the surgical site. Recalling Firm: Symbios Medical Products, LLC 7301 Georgetown Road, Suite 150 Indianapolis, Indiana 46268 Distributor: B. Braun Medical Inc. 901 Marcon Blvd. Allentown, Pennsylvania 18109 Reason for Recall: The affected products may have excessively high flow rates. As a result, medications could be delivered too quickly from the balloon to the surgical site and cause patient toxicity due to the rapid influx of medication. This can lead to serious illness, including seizure, abnormal heart rhythms and death. Elderly patients and patients with low body mass are at high risk of these complications. ***************** Class I Recall and Safety Investigation of Counterfeit Polypropylene Surgical Mesh: Updated June 10, 2010 This is an update of FDA's Initial Communication on counterfeit polypropylene surgical mesh, which was issued on March 11, 2010. It contains additional information about the recall of this product and updates FDA's recommendations and activities. Audiences: Healthcare Professionals, Patients, Hospitals and Surgical Centers, Operating Rooms, Operating Room Nurses, Purchasing Departments, Risk Managers Medical Specialty: Surgery Product: Various sizes of counterfeit flat sheets of polypropylene surgical mesh have been marketed in the United States labeled with the C. R. Bard/Davol brand name. These meshes, specifically identified below, are NOT Bard-manufactured products. Surgical meshes of this kind are used to reinforce soft tissue where weakness exists, such as in the repair of hernias and chest wall defects. Summary of Problem and Scope: FDA's and Bard's investigations found the counterfeit product is labeled with the following product codes, sizes and lots of Bard Flat Mesh (commonly known as Marlex mesh). Investigations found most of the counterfeit product is labeled with genuine Bard lot numbers. To date, four product sizes have been identified: Product Codes and Sizes Lot Numbers 0112650 – Bard Flat Mesh 2" x 4" Lot 48HVS036 Lot 43APD007 0112660 – Bard Flat Mesh 10" x 14" Lot HUSD0629 Lot HURL0336 0112680 – Bard Flat Mesh 3" x 6" Lot 43HPD027 Lot 43HPD032 Lot 43HPD034 Lot HUSG0540 Lot 43HDP027 Lot HUSE0532 Lot 43LPD507 Lot HUSF0763 Lot 43IOD011 Lot 43IPD038 0112720 – Bard Flat Mesh 6" x 6" Lot 43FQD327 These counterfeit products were distributed from October 21, 2008 to October 27, 2009. Although counterfeiting of surgical mesh has occurred in the past, we are not aware of any other counterfeit mesh products being distributed at this time. Voluntary Recall: RAM Medical, Inc., a medical product distributor located in Wayne, New Jersey, initiated a voluntary recall of one lot of the counterfeit surgical mesh on March 5, 2010. RAM Medical expanded the recall on March 15, 2010 to include all of the above lots. RAM Medical sold the counterfeit products to the distributors below, who then distributed them to hospitals or possibly other distributors: Amerimed Corporation Henry Schein Inc. Marathon Medical Corporation Medline Industries MMS - A Medical Supply Company Q-Med Corporation Recommendations/Actions: Healthcare professionals and facilities Do NOT use any surgical mesh from the lots listed above. Contact RAM Medical at 973-633-0400 for further instructions about returning it. Contact Bard at 1-800-556-6275 if you received one of the recalled lots from a distributor not listed above, as Bard might be able to confirm if the product is authentic. Carefully examine all manufacturers' polypropylene surgical mesh products, packaging and labeling for anything unusual that might indicate they are counterfeit. If you notice anything unusual or suspicious with any brand of surgical mesh product, including its packaging or labeling, contact the manufacturer. If you suspect that a counterfeit product was implanted in a patient, continue to monitor the patient for adverse events as you would any patient with an authentic polypropylene surgical mesh implant. Report any adverse events to FDA as instructed in the “Reporting Problems to FDA” section below. If you believe you have received counterfeit or suspect product, contact FDA's Office of Criminal Investigations by calling 800-551-3989 or by visiting the Office of Criminal Investigations website. FDA Activities: On June 2, 2010, FDA classified the distributor's voluntary recall as a Class I recall. Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of the product will cause serious adverse health consequences or death. An FDA recall notice was posted on the Medical Devices website. Here is what FDA has found in its laboratory analysis of the counterfeit mesh samples to date: The counterfeit samples are not sterile although labeled as sterile,which may mean increased risk for infection if implanted in a patient. They have a weave pattern and structure that is different from the authentic mesh. For example, the counterfeit mesh weave openings are larger than the authentic mesh. The counterfeit mesh does not have properly finished selvage edges as compared to the authentic mesh, which may allow the counterfeit mesh to unravel. The counterfeit mesh edges appear to be cut using heat, as the edge is fused or melted together. The packaging of the counterfeit samples is different from that of the authentic mesh. The expiration dates shown on the labeling of some of the counterfeit product samples do not match. The counterfeit mesh may not meet the authentic product's specifications, including strength and clinical performance. FDA is continuing to test samples of the counterfeit mesh and will update this communication if additional information becomes available. FDA is also investigating to determine who is responsible for the counterfeiting and how the counterfeiting and distribution occurred. ~~**~~**~~**~~**~~**~~ 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: ccpierce62@live.com (Cecilia) May 22, 2013 Johnsie.Newman@gmail.com (Johnsie) June 8, 2013 fsdbuckley@hotmail.com (Farrar) June 12, 2013 Peggylee1.ps@gmail.com (Peggy) June 13, 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. So, be certain to let me know when you change your address. If, for personal reasons, you want to opt out...let me know, also. RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government. --Thomas Jefferson Answer to Quiz Time: Correct answer: b. Increased age has a linear correlation to increased opioid sensitivity. Thus, elderly patients require lower opioid dosages than younger patients to experience the same analgesic effect. Take time out to write me...with suggestions/criticisms AN "atta girl" is always appreciated Frankie RNFrankie@AOL.com

May 16, 2013 Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 May 16, 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 (This is from Kurt Ullman, a member--- Thank you, Kurt) Nurses more prone to being bullied than other workers New book Toxic Nursing addresses workplace incivility INDIANAPOLIS — Twice as many nurses as other working Americans have experienced bullying in the workplace. According to a recent study in the Journal of Nursing Management, among 612 staff nurses, 67.5 percent had experienced bullying from their supervisors, while a whopping 77.6 percent had been bullied by their co-workers. Outside the health care industry, just 35 percent of Americans had reported workplace incivility, revealed a recent survey by the Workplace Bullying Institute. Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil, published by the Honor Society of Nursing, Sigma Theta Tau International (STTI), directly addresses the issue. Written by Cheryl Dellasega, PhD, RN, CRNP, author of Surviving Ophelia and When Nurses Hurt Nurses, and Rebecca L. Volpe, PhD, Toxic Nursing gives nurse managers and administrators the tools they need to defuse conflict and create a positive work environment. Nurse managers and nurse administrators at all levels are frequently confronted by the need to manage employee issues arising from interpersonal relationships, including conflict, cynicism, and unnecessary drama. As a follow-up to When Nurses Hurt Nurses, this book offers concrete strategies for dealing with common employee challenges that nurse supervisors face. “Toxic Nursing is a must-read for nurse managers, nurse preceptors, and new nurses,” said Anita J. Tarzian, PhD, RN, associate professor and program coordinator at the University of Maryland School of Nursing. “Dellasega and Volpe provide a comprehensive toolkit of approaches to address destructive workplace behaviors among nurses. The combination of vignettes based on cases gleaned from blog postings and thorough literature review is novel and effective. It will broaden the reader’s view of bullying, how it harms nurses and those they serve, and what to do about it.” Purchase the book at www.nursingknowledge.org. Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil By Cheryl Dellasega, PhD, RN, CRNP, and Rebecca L. Volpe, PhD Published by the Honor Society of Nursing, Sigma Theta Tau International ISBN-13: 9781-937554-42-2 Price: US $34.95 Trade paperback, 336 pages Trim size: 53/8 x 73/8 Available at www.nursingknowledge.org/STTIbooks About the authors Cheryl Dellasega, PhD, RN, CRNP, author of When Nurses Hurt Nurses (STTI, 2011), Mean Girls Grown Up (Wiley, 2005), Girl Wars (Simon & Schuster, 2003), and Surviving Ophelia (Perseus, 2001), is a professor of humanities in the College of Medicine and a professor of women’s studies at Pennsylvania State University. As the founder of Club and Camp Ophelia, she has helped girls confront and overcome relational aggression. She has worked clinically as a nurse practitioner and is an international expert on family relationships. Rebecca L. Volpe, PhD, is an assistant professor in the department of humanities in the College of Medicine at Pennsylvania State University. She is also coordinator of the Clinical Ethics Consultation Service for the Penn State Hershey Medical Center. Dr. Volpe earned her PhD from Saint Louis University’s Center for Health Care Ethics and went on to complete a Clinical Ethics Fellowship at California Pacific Medical Center. http://www.nursingknowledge.org/ ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Number of Endorsers Tops 110! for HR 485 (To establish the position of National Nurse for Public Health, to be filled by the same individual serving as the Chief Nurse Officer of the Public Health Service). Support continues to pour in from around the country for H.R. 485, The National Nurse Act of 2013. This past month, the American Federation of State, County, and Municipal Employees (AFSCME) joined over 110 organizations and prominent individuals who have signed on the support letter being delivered to members of Congress. Many chose to vote by email so that they could provide the NNNO with a quick decision regarding support, and several mentioned that the decision was unanimous. If your organization is interested in exploring how to add on to the list of endorsers please contact the National Nursing Network Organization's Board of Directors. ******************* (Please contribute your opinion...the article will give you your rep's name) The American Nurses Association applauds Congresswoman Lois Capps (D-CA) and Congressman David Joyce (R-OH) for introducing the Registered Nurse Safe Staffing Act of 2013 (H.R. 1821). As you know, insufficient nurse staffing can be a life-or-death issue for patients. Federal legislation is needed to ensure that hospitals set upwardly adjustable minimum nurse to patient ratios. The Safe Staffing Bill would require hospitals that participate in Medicare to create staffing committees. Committees would be comprised of a majority of staff nurses and would be responsible for developing and publicly reporting nurse staffing plans for each unit. It would place limits on the practice of “floating” nurses by ensuring that RNs are not forced to work on units if they lack the education and experience in that specialty. The bill also calls for holding hospitals accountable for safe nurse staffing by requiring the development of procedures for receiving and investigating complaints, allowing imposition of civil monetary penalties for knowing violations, and providing whistle-blower protections for those who file a complaint about staffing Please urge your Representatives to support this important piece of legislation today. http://www.rnaction.org/site/R?i=sIoJYvrVn-CszZrPmbnc_w ******************** Residency Program for New Nurses Healthcare professionals across Iowa, led by the Iowa Action Coalition, are pushing for increased residency programs for new nurses. The programs will help new graduates make a successful transition from school to the work force and help keep new nurses from leaving the profession. The Iowa Action Coalition is working on developing a residency program that can be adopted by any hospital or healthcare facility. The program is funded by a grant from the Robert Wood Johnson Foundation. Iowa, along with 19 other states, will receive two-year grants of up to $150,000. Read more: http://thegazette.com/2013/04/17/iowa-hospitals-push-nurse-residency-programs) http://r20.rs6.net/tn.jsp?e=001GPVjCEn9qP_6ZmAvifSMHWsUDyNTe88pGRLgLT30D9NtB-0BL0CBssM5IDRAPBTAVRMmN7zmYFy0Pi8xyQYGsPLlb5ZUTtdWHq0RPa1XM91atorGVV7ILG3oibXthQHmrxirswdrg-YmMPOaGnVH-vf05JNJlPHKJN8WLdjutz1TTAsCa8_VkoHmZB3Pb2t6XeofDyG-tDQ= ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days 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 ********************* On April 29, the U.S. Food and Drug Administration (FDA) approved Kcentra (Prothrombin Complex Concentrate, Human) for the urgent reversal of vitamin K antagonist (VKA) anticoagulation in adults with acute major bleeding. Plasma is the only other product approved for this use in the United States; Kcentra doesn’t require blood group typing or thawing, so it can be administered more quickly than frozen plasma. http://healthcommedia.benchmarkmails26.com/c/l?u=2494C69&e=2C4B2E&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ********************** Most teens well down road to heart disease, study finds A stunning 80 percent of U.S. teenagers are eating diets that put them on a clear path to heart disease, researchers reported on Monday. They’re eating too much fat, salt and sugar and not eating enough fruits and vegetables, the American Heart Association study found. Just 1 percent ate what the Heart Association considers a perfectly healthy diet. Plus they don’t exercise enough, says Christina Shay of the the University of Oklahoma Health Sciences Center, who led the study. “The far less-than-optimal physical activity levels and dietary intake of current U.S. teenagers, is translating into obesity and overweight that, in turn, is likely influencing worsening rates of high blood pressure, high cholesterol and blood glucose at these young ages,” Shay said in a statement. ... http://vitals.nbcnews.com/_news/2013/04/01/17553021-most-teens-well-down-road-to-heart-disease-study-finds?lite ; **************** Infections Tied to Cognitive Decline A new study adds to the evidence that chronic infection, known to be associated with vascular disease, is also associated with poorer performance on tests of mental ability. Researchers studied 1,625 people in northern Manhattan with an average age of 69, testing them with two well-validated tests of mental acuity. They also tested their blood for “infectious burden” — their degree of exposure to five common viruses and bacteria: cytomegalovirus, herpes 1 and 2, Helicobacter pylori, and Chlamydia pneumoniae. The study appeared online in Neurology. ... http://well.blogs.nytimes.com/2013/03/29/infections-tied-to-cognitive-decline/ ****************** FDA warns of potentially fatal arrhythmias with azithromycin On March 12, 2013, the U.S. Food and Drug Administration (FDA) strengthened the warning for QT interval prolongation and torsades de pointes, a potentially fatal heart rhythm, associated with azithromycin (Zithromax or Zmax). http://healthcommedia.benchmarkmails26.com/c/l?u=21DC719&e=2944BF&c=F275&t=0&l=242D6A&email =khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ******************* (Since I am so very late with the Newsletter, I am not sure if any of the below still is available. Should be on time in June) National Nurses Week page each day from May 6th to May 12th for details on offers such as: Free CE credits, including a Joanna Briggs Institute Best Practice CE activity Free articles Free Take5 resource on laboratory values related to fluids and electrolytes http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52C6:B54AB34282EDAD004590D7C92BFD7A5A50CB97921045BA00&; It is not enough to base practice on one research study. A critical analysis of available research, putting the findings in the context of your organization, and adding the perspectives and judgment of clinicians and patients is imperative for true evidence-based practice. New articles have been added to help you in Understanding Evidence-Based Practice. http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52D4:B54AB34282EDAD004590D7C92BFD7A5A50CB97921045BA00&; ********************* Robotic Surgery Tied to Temporary Nerve Injuries (Reuters Health) - One in 15 people undergoing robot-assisted prostate, kidney or bladder surgery develops a nerve injury related to pressure from positioning on the operating table, a new study suggests. Patients on the table getting those types of robotic surgery need to be tilted steeply - with their head by the floor and their feet in the air - to give the surgeon better traction, researchers explained. "When somebody is in that position, there's a chance they could slide down - it's like a big ramp," said lead author Dr. Tracey Krupski, from the University of Virginia School of Medicine in Charlottesville. "When you slide, you then could be pulling, or having the drag on some of the nerves. It's like a constant pulling on the muscle." Earlier this month, the Food and Drug Administration announced it would be taking a closer look into safety reports regarding da Vinci surgical robots, made by Intuitive Surgical. The robots cost about $1.5 million each. http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNDAxLjE3MjQ4NzQxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDQwMS4xNzI0ODc0MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MDYzMTQ2JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&134&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_135431.html ******************** (If someone tries this.........please let me know. It sounds good, but ....) Chinese herbs may reduce hot flashes (Reuters Health) - Women taking a Chinese herbal formula experienced less than half the number of menopausal hot flashes they had before the treatment, according to a new study from Hong Kong. Among women taking an herbal mix called Er-xian decoction (EXD), the frequency of daily hot flashes dropped by 62 percent, compared to a 52-percent drop seen among women taking a placebo. "It's a modest effect, but not a zero effect," said Katherine Newton, a researcher who has studied herbal menopause therapies at the Group Health Research Institute in Seattle. Newton, who was not involved in the research, said she'd want to see more, long-term studies demonstrating that these herbs are safe before she would recommend them to women, but that the current study makes EXD look promising as an alternative menopause treatment. ... http://links.reuters.com/r/ASTCI/UQ6Q6/ZGZPD6/TPPRXR/OFJ8OY/YT/h?a=http://links.reuters.com/r/ASTCI/UQ6Q6/ZGZPD6/TPPRXR/LSQHBQ/YT/h ******************** RANDOM FACT: Why do dimes, quarters and half dollars have notches around their edges, while pennies and nickels do not? The US Mint began putting notches on the edges of coins containing gold and silver to discourage holders from shaving off small quantities of the precious metals. Dimes, quarters and half dollars are notched because they used to contain silver. Pennies and nickels aren't notched because the metals they contain are not valuable enough to shave. ************ Bonus Fact: Why are zero scores in tennis called 'love'? In France, where tennis first became popular, a big, round zero on scoreboard looked like an egg and was called 'l'oeuf,' which is French for 'egg.' When tennis was introduced in the U.S., Americans pronounced it 'love.' ************** (Found this poem, and just had to share it) Not how did he die, but how did he live Not what did he gain, but what did he give? These are the units to measure the worth Of a man as a man, regardless of birth. Not what was his church, nor what was his creed? But had he befriended those really in need? Was he ever ready, with word of good cheer, To bring back a smile, to banish a tear? Not what did the sketch in the newspaper say, But how many were sorry when he passed away? ----Author Unknown---- ******************* 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. 20: The risk of healthcare-associated infection in some developing countries is as much as 20 times higher than in developed countries. 1.4 million: At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals. 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 traveller being harmed while in an aircraft. 1 in 300: The chance of a patient being harmed during health care. Source: World Health Organization Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ********************* 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. ********************* Thank you , Laregis for this great link! She writes: "It's amazing what they are doing these days with these smart phones...." Click: iDoctor http://www.youtube.com/watch_popup?v=r13uYs7jglg ************* Quiz Time When taking clopidogrel, patients who are poor CYP2C19 metabolizers are at increased risk for: a. rhabdomyolysis. b. stroke. c. dyslipidemia. d. lung cancer. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 (Answer at end of Newsletter) ******************* Fluid and electrolyte imbalances can quickly turn into life-threatening situations and it is critical to be able to recognize subtle signs and symptoms and intervene appropriately. Test your knowledge of fluids and electrolytes by answering the following questions: What are the major organs involved in electrolyte and fluid homeostasis? What medications can cause hypernatremia? What are the recommended treatments for dilutional hyponatremia? What is the relationship between calcium level and phosphorous level? Which medication, commonly given in CCUs, is contraindicated in patients with hypokalemia? Check your answers and learn more by exploring the articles in More Resources. Also, we now have a new collection, Focus On: Fluids & Electrolytes, which includes a variety of articles, CE, and special features all about fluid and electrolytes! http://email.lww.com/t?r=1483&c=3480712&l=59027&ctl=4661F84:B54AB34282EDAD00F9F852C93A3ECCCEBB9E742C260FE2D0&; ******************** The vernal equinox happens every March 20 or 21. RANDOM FACT: "Vernal" is Latin for "spring" and "equinox" is Latin for "equal night." There are two equinoxes every year � vernal and autumnal. Those two days are the only times during the year when the sunrise is due east and the sunset is due west. *** Bonus Facts: Ancient Egyptians built the Great Sphinx to point directly East toward the sunrise on the vernal equinox. Stonehenge in England also marks the position of the rising sun on the vernal equinox. ********************* An Important Step Forward in Addressing the Rare Disease Health Crisis April 23, 2013 (Huffington Post) - We have a health crisis on our hands, and we're finally taking strides to make a difference. The way we are doing so: The Rare Disease Impact Report. http://enews.hcplive.com/c.html?ufl=4&rtr=on&s=lwo0yi,112aj,1qvv,bzse,22yh,6o8t,78ko ********************* White Paper Lists Several Recommendations To Speed Up Orphan Drug Approval April 24, 2013 (Rare Disease Report) - A search of orphan drugs designated by the FDA for the treatment of duchenne muscular dystrophy (DMD) yields 27 drugs. When you repeat the search for approved orphan drugs for the treatment of DMD, zero drugs appear. And that discrepancy was the stimulus for the patient organization Parent Project Muscular Dystrophy (PPMD) to issue a white paper ... http://enews.hcplive.com/c.html?ufl=4&rtr=on&s=lwo0yi,112aj,1qvv,7ns7,ork,6o8t,78ko ********************* No difference in survival rates between teaching and nonteaching hospitals for patients with acute MI A study published in Academic Medicine has found no survival benefit for patients with acute myocardial infarction (MI) who are admitted to teaching hospitals, rather than nonteaching hospitals. Read more. http://healthcommedia.benchmarkmails26.com/c/l?u=242EDCA&e=2BEA28&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ********************** Posted: Apr 29, 2013 - Joint Commission Announces Accreditation of DaVita Inpatient Dialysis Units - For the first time, The Joint Commission has awarded Ambulatory Health Care Accreditation to an inpatient kidney care provider DaVita Hospital Services. Denver based DaVita, with nearly 700 sites located in Joint Commission-accredited hospitals across the U.S., is a division of DaVita HealthCare Partners Inc. http://www.jointcommission.org/joint_commission_announces_accreditation_davita_inpatient_dialysis_units/ ************ (If anyone has encountered Naval Corpsmen, as I have, you know their knowledge and their capabilities are excellent) HHS launches nursing program for veterans HHS' Health Resources and Services Administration has introduced a program aimed at training military medics and other veterans with medical backgrounds for careers in nursing. The agency will provide as much as $350,000 each to as many as nine nursing schools annually. The program "helps veterans formalize their skills to get jobs, while strengthening Americans’ access to care," HHS Secretary Kathleen Sebelius said. Nurse.com http://r.smartbrief.com/resp/eudTDrrXoMfJaTkgfDcXdUfCZVrR?format=standard ~~**~~**~~**~~**~~**~~ HUMOR SECTION All of us, at one time or other, have had difficult patients who could never be satisfied. This nurse had such a patient and the patient's doctor was sympathetic with the nurse. He ordered ... soapsuds enema..an enema that the nurse detested. Seeing her face, he asked what was the problem. Once he heard her explanation, he asked her when was her shift over. "1900 hrs", she answered. The doc then ordered the SS enema at HS (Hour of sleep). (what a perfect solution) ~~**~~**~~**~~**~~**~~ 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 Your role in redesigning health care http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52C8:B54AB34282EDAD004590D 7C92BFD7A5A50CB97921045BA00& Advancing the science of nursing and improving the quality of care: http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52C9:B54AB34282EDAD004590D 7C92BFD7A5A50CB97921045BA00& ~~**~~**~~**~~**~~**~~ 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 * ******************************************* ****************************************************** Anticoagulant Citrate Phosphate Dextrose Solution, USP (CPD) BLOOD-PACK Unit By Fenwal: Recall - Labeling Issue Identified Fenwal has initiated a voluntary Urgent Product Recall of one lot (FM13A15027) of product code 4R1584, Anticoagulant Citrate Phosphate Dextrose Solution, USP (CPD) BLOOD-PACK unit. Fenwal identified a labeling issue with this batch of Product Code 4R1584 in which the platelet container is incorrectly labeled as “AS-1 Red Blood Cell Adenine-Saline added”. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350275.htm ******************** Samsca (Tolvaptan): Drug Safety Communication - FDA Limits Duration and Usage Due To Possible Liver Injury Leading to Organ Transplant or Death. FDA has determined that the drug Samsca (tolvaptan) should not be used for longer than 30 days and should not be used in patients with underlying liver disease because it can cause liver injury, potentially leading to liver transplant or death. FDA has worked with the manufacturer to revise the Samsca drug label to include new limitations. BACKGROUND: Samsca is a selective vasopression V2-receptor antagonist indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia, including patients with heart failure and Syndrome of Inappropriate Antidiuretic Hormone (SIADH). An increased risk of liver injury was observed in recent large clinical trials evaluating Samsca for a new use in patients with autosomal dominant polycystic kidney disease (ADPKD). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350185.htm ******************** Piperacillin and Tazobactam for Injection, USP 40.5 grams: Recall - Precipitation or Crystallization in IV Bag or IV Line Upon Reconstitution Apotex Corp. notified healthcare professionals it is conducting, on behalf of the manufacturer Hospira, Inc., a voluntary nationwide recall of 15 lots of Piperacillin and Tazobactam for Injection, USP 40.5 grams, to the hospital/healthcare provider/user level. The impacted lots may show precipitation/ crystallization in IV bag or IV line after reconstitution. The product can also be identified by NDC number 60505-0773-00 and UPC 360505077304. The product was distributed nationwide in the United States to wholesalers, distributors, HMOs, home infusion and long term care service providers. See Press Release for a list of affected lot numbers Hospira stated that administration of precipitated Piperacillin/Tazobactam in an IV bag or IV line may result in local reactions such as phlebitis, renal impairment, end-organ embolism and ischemia, and/or vasculitis (because the precipitate was visible, its particles may be large enough to cause these adverse events). In addition, the precipitation of the drug may not allow delivering a needed therapeutic dose of piperacillin and tazobactam, thus resulting in inadequate treatment of the targeted infection. This could result in adverse health consequences that could range from transient and minor impairment or complaints to permanent impairment of a body function or permanent damage to a body structure. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350085.htm ******************** CareFusion Corporation, Alaris PC Unit (Model 8015) with Software Version 9.12 Recall Class: Class I Date Recall Initiated: March 6, 2013 Product: Alaris PC Unit (Model 8015) with Software Version 9.12 This product was distributed from Sept. 21, 2012 through March 5, 2013. Use: The Alaris PC unit (model 8015) is part of the Alaris electronic infusion pump. An electronic infusion pump delivers controlled amounts of medications or other fluids to patients through intravenous (IV), intra-arterial (IA), epidural, and other acceptable routes of administration. Recalling Firm: CareFusion Corporation 3750 Torrey View Court San Diego, California 92130-2622 Reason for Recall: CareFusion has received reports of a communication error on the Alaris PC unit (model 8015) with software version 9.12 when the Alaris EtCO2 module or Alaris SpO2 module is attached. Use of this product may cause serious adverse health consequences, including death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm349002.htm ************* Potiga (Ezogabine): Drug Safety Communication - Linked To Retinal Abnormalities And Blue Skin Discoloration FDA is warning the public that the anti-seizure medication Potiga (Ezogabine) can cause blue skin discoloration and eye abnormalities characterized by pigment changes in the retina. FDA does not currently know if these changes are reversible. FDA is working with the manufacturer to gather and evaluate all available information to better understand these events. FDA will update the public when more information is available. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm349847.htm ************* Eba Multivitamin Supplement By Saratoga Therapeutics LLC: Recall - Allergy Alert On Undeclared Milk Components Saratoga Therapeutics, LLC of North Wales, PA recalled 900 bottles of ebA Multivitamin Supplement because they may contain undeclared milk components – milk protein(s) and lactose. The label lists the product as being free of milk components. People with an allergy or severe sensitivity to milk run the risk of a serious or life-threatening allergic reaction and people who have lactose intolerance run the risk of gastrointestinal symptoms if they consume ebA Multivitamin Supplement. Affected lot numbers include #0912164 expiration date 12/12 and #1110354 expiration date 10/14. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm349706.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 ~~**~~**~~**~~**~~**~~ 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. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY "Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent. Be careful lest you let other people spend it for you.” - Carl Sandburg Answer to Quiz Time: Correct answer: b. Drug effectiveness for clopidogrel depends on activation of the drug to an active metabolite by a CYP45O enzyme called CYP2C19. Poor CYP2C19 metabolizers are at increased risk for major cardiovascular events such as heart attack, stroke, and cardiovascular death. Hey, why don't you write? ..... Frankie RNFrankie@AOL.com

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