Friday, February 15, 2013

February PARADIGM BYTES

PARADIGM BYTES Newsletter for Paradigm 97 February 15, 2013 PARADIGM DEFINED: 1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated. Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it. MISSION STATEMENT We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience. ***~~~***~~~***~~~*** SNIPPETS Tuberculosis: WHO-Endorsed Test Offers Rapid Detection A diagnostic test for tuberculosis (TB) can accurately and quickly detect both TB and drug-resistant strains, according to a new study. The authors of a new systematic review assessing the diagnostic accuracy of the Xpert® MTB/RIF test published in The Cochrane Library say their study can provide timely advice for clinicians and policymakers in countries where TB is a major public health problem. Millions of people develop TB every year. Around 13% of cases occur in people living with HIV and more than a quarter of these people die as a result. Drug resistance is a major public health problem that further complicates efforts to control TB. Multidrug-resistant TB is defined as resistance to rifampicin and isoniazid, which are two of the most effective and widely used anti-TB drugs. Xpert® (Cepheid Inc, California) is a diagnostic test endorsed by the World Health Organization (WHO) that simultaneously detects TB and resistance to rifampicin, as an indicator of multidrug resistance. The test takes around two hours, with minimal hands-on technical time required. Like sputum smear microscopy, which relies on detecting TB with a microscope in a laboratory, Xpert requires a sample of sputum. However, while thousands of bacteria must be present in each millilitre of sample for TB to be detected under the microscope, Xpert can detect TB bacteria at much lower concentrations. In addition, the conventional microscopy approach does not detect drug resistance. Instead, TB has to be grown in the lab. This presents problems, especially for multidrug-resistant TB, due both to the length of time required for the cultures to grow and the specialized laboratories and highly skilled staff needed. The researchers, from the Cochrane Infectious Diseases Group, McGill University and the Foundation for Innovative New Diagnostics (FIND), analysed data from 18 studies involving a total of 7,816 people, with most studies being carried out in low- and middle-income countries. The results show that when Xpert is used to screen 1,000 people, 150 of whom have TB, it picks up 132 of the 150 cases (88%) and falsely diagnoses 17 (2%) with TB. This is in a scenario where it is being used as a replacement for smear microscopy. In a scenario where Xpert is being used as a replacement for culture-based drug susceptibility testing, it is also able to detect the equivalent of 141 out of 150 cases (94%) of rifampicin resistance. When Xpert is used as a follow-on test, after conventional smear microscopy has already produced a negative result, it picks up 101 out of 150 cases (67%). By definition, smear-negative TB is not picked up by smear microscopy because microscopy cannot detect small numbers of bacteria. Xpert picked up 67% of this group that would have been missed by microscopy. “This study represents the most comprehensive review on the diagnostic accuracy of Xpert to date and may help countries make decisions about scaling up its use for management of TB and drug-resistant TB,” said lead researcher, Karen Steingart, of the Cochrane Infectious Diseases Group. Karin Weyer, Coordinator, Laboratories, Diagnostics and Drug Resistance at the World Health Organization (WHO) said, “This Cochrane Review provides high quality evidence that reinforces WHO’s endorsement of this test. Recent price reductions have greatly facilitated roll-out of this technology, including a new three-year initiative called the TB Xpert Project, funded by UNITAID and executed by WHO and the Stop TB Partnership. 1.4 million test cartridges and over 200 GeneXpert instruments for the rapid detection of TB and rifampicin resistance will be distributed in 21 countries with a high burden of TB.” Lucica Ditiu, Executive Secretary of the Stop TB Partnership, said, “We welcome the Cochrane Review of Xpert, an innovation that represents a major milestone in our quest to achieve the goal of zero deaths from TB – which is curable but still takes the life of three people every minute. The Stop TB Partnership is making every effort to help countries understand how best to use this new technology. Our TB REACH initiative is deploying Xpert to numerous c ountries through projects that seek to increase the number of TB cases detected and treated, and these projects will deliver data that can provide an evidence base for determining how Xpert should be used for the greatest impact.” Full citation: Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD009593. DOI: 10.1002/14651858.CD009593.pub2 URL Upon publication: http://doi.wiley.com/10.1002/14651858.CD009593.pub2 (The full review will be available open access upon publication) ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Study: lumpectomy survival rates good for early breast cancer Reuters A new U.S. study examining survival rates for women with early stage breast cancer found that surgery such as lumpectomy that preserves the rest of the breast may offer survival odds as good as, or even better than, mastectomies. Despite clinical trials showing lumpectomy, or removal of the cancer only, to be as effective as mastectomies in treating early breast cancers, the number of women choosing breast removal has been on the rise, wrote lead researcher E. Shelley Hwang in the journal Cancer. "It was kind of an exciting and hopeful message that women don't have to go off to get a mastectomy to do better," said Hwang, from the Duke Cancer Institute in Durham, North Carolina. "I think a lot of women were making that decision (for mastectomy) because they thought the lumpectomy was not enough. In that context, we wanted to know if lumpectomy works just as well as mastectomy in the modern era." ... http://www.reuters.com/article/2013/02/01/us-breastcancer-idUSBRE91003320130201?feedType=RSS&feedName=healthNews ***************** Inked and Regretful: Removing Tattoos That tattoo on your arm of a former flame—the one that seemed like a great idea years ago—is kind of embarrassing today. And your spouse is not too crazy about it either. You may not know that FDA considers the inks used in tattoos to be cosmetics, and the agency takes action to protect consumers when safety issues arise related to the inks. At the other end of the tattoo process, FDA also regulates laser devices used to remove tattoos. FDA has cleared for marketing several types of lasers as light-based, prescription devices for tattoo lightening or removal. A Massachusetts company recently received FDA clearance to market its laser workstation for the removal of tattoos and benign skin lesions. ... http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm336842.htm ************************ RANDOM FACT: February 3 was the 100th anniversary of the ratification of the Sixteenth Amendment, that is the income tax. Americans for Tax Reform commemorated the occasion by publishing a few fun facts about the income tax. Another Random Fact: The initial top tax bracket was only 7 percent, and it didn't kick in until income reached a whopping $11.6 million in 2013 dollars. Only 358,000 people had to fill out 1040 forms at first, because the standard family deduction was an adjusted $93,000. ****************** This year the focus is on preventing scald injuries: 75%: Percentage of all burns to young children that are scalds 120: The temperature setting for a water heater thermostat in the home should not exceed 120 degrees to avoid scald injuries. 110: The temperature setting for a water heater thermostat in nursing homes and child care facilities should not exceed 110 degrees to avoid scald injuries. To check hot water temperature, run hot water up to 2 minutes at the tap and measure with a cooking thermometer. Even if initial test temperature is below 120 degrees, safety may not be constant: Retest several times. About half of burn injuries treated in EDs are scald injuries. 50%: Reprinted with permission from: Production/Electronic Channels Coordinator *************** Understanding core measures for heart-failure treatment HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ... (Heart Failure) is the primary cause of more than 55,000 deaths each year in the United States. The most common signs and symptoms of HF are shortness of breath on exertion; orthopnea; weight gain with edema in the feet, legs, or lower back; fatigue; and weakness. Major causes of HF are coronary artery disease, high blood pressure, and diabetes. According to the Centers for Disease Control and Prevention (CDC), HF is diagnosed in 670,000 new persons annually. Currently, about 5.8 million persons in the United States are living with HF. In women, HF incidence has dropped by about 30% due to earlier diagnosis and treatment. In men, the number of new cases remains unchanged. The annual economic toll of HF is about $34.5 billion. As with most diseases, the earlier HF is diagnosed and treated, the greater the chance for improving the patient’s quality of life and increasing life expectancy. Over the past 50 years, scientists and healthcare providers have made great strides in treatment and patient outcomes by examining best practices for patients with HF. ... http://www.americannursetoday.com/Article.aspx?id=9952&fid=9912&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_February_2013_House&utm_medium=email ******************* Teaching patients about FDA recommendations for proper medication disposal Accidental exposure to medication in the home is a major cause of unintentional poisoning in children. Recent data show even child-resistant containers can’t completely prevent a child from taking medication meant for someone else. Reported cases of accidental exposure further emphasize the need for nurses to counsel patients on how to store medication safely out of reach of children and pets, as well as on proper disposal of unused or expired drugs. Nearly all medications can be thrown away in the household trash after they’ve been mixed with an unpalatable substance, such as coffee grounds, and sealed in a container. However, a few select drugs—primarily controlled substances—should be flushed down the sink or toilet to permanently remove the risk of accidental exposure from the home. The Food and Drug Administration (FDA) recently made available recommendations for proper medication disposal and a list of drugs that should be flushed due to their potential to cause serious or life-threatening adverse reactions (such as difficulty breathing, heart problems, and even death) if someone other than the person for whom the drug was prescribed is exposed to it accidentally. ... http://www.americannursetoday.com/Article.aspx?id=9956&fid=9912 ********************** Drugs in the environment: Nurses’ roles and responsibilities News that pharmaceuticals have been found in our rivers and streams, fish, wildlife, and even our drinking water has captured our interest and concern. This isn’t a new phenomenon. Active pharmaceutical ingredients (APIs) have been in the water since humans first started using and excreting drugs. But we’re just beginning to recognize the magnitude of the problem. Drug prescriptions in this country have increased 61% over the past decade and now total about 3.4 billion annually, with retail sales of $250 billion. Nurses, who administer, dispose of, and in some cases prescribe drugs, can play a key role in developing policies and practices that help minimize the amount of pharmaceuticals that end up in the environment. The U.S. Geological Survey has detected codeine, sulfa drugs, hormones (such as estradiol), and many other medications in a wide swath of surface waters around the country. Tissue samples of the nation’s fish reveal that these drugs are being absorbed in fish, resulting in body burdens of pharmaceuticals that may travel up the food chain. About half the country derives its drinking water from surface water sources, yet no one knows how many APIs are in circulation, nor what percentage is derived from human excretion, animal excretion from veterinary use (particularly in agriculture), disposal activities, or manufacturing activities. Drinking water standards don’t require testing for APIs. ... http://www.americannursetoday.com/Article.aspx?id=9954&fid=9912&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_February_2013_House&utm_medium=email ********************* Study: Donor feces more effective than vancomycin in treatment of recurrent C. difficile (if this happens on your shift, how will you handle any explanation to patient/family?) Background Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. Full Text of Background... Methods We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks. ... http://www.nejm.org/doi/full/10.1056/NEJMoa1205037?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_Week_of_January_21st_2013&utm_medium=email&#t=abstract ; ******************* December 12, 2012, was the century's last sequential date (unless we go to a 13 month calendar really soon). But is there more to this unique arrangement of numbers than just oddity? RANDOM FACTS: A much-cited survey conducted by US-based David's Bridal estimated that around 7,500 brides would be getting married in America today � a 1,446 percent increase from 12/12/11. The New York Times wrote that many couples considered it lucky to get married on repetitive dates, with 07-07-07, 10-10-10 and 11-11-11 each breaking Las Vegas records *** Bonus Fact: According to Chinese numerology, the number one is a yang number which is ruled by the sun and represents independence and individualism. Two is a yin number which is ruled by the moon and represents symmetry and balance. When placed together, the number 12 brings harmony to the yin and yang, balancing the feminine energy of the moon with the masculine energy of the sun. ******************** QUIZ TIME: Which of the following is an advantage of a dry-suction chest drainage system? a. Lower levels of suction pressure b. Variable bubbling, which indicates proper functioning c. A steady bubbling sound, which indicates proper functioning d. Higher levels of suction pressure ** Answer at end of this Newsletter ** Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 *********************** Many aspects of “We Can Improve the Safety of PICC Lines” (Viewpoint, November 2012) don't reflect national standards of practice. The safety of peripherally inserted central catheter (PICC) insertion at the bedside has been well established, yet the author questions this practice without the benefit of fluoroscopy. Fluoroscopy is not necessary for PICC insertion. While there are challenges with proper tip location based on external measurement, a postinsertion chest X-ray is mandatory.1 Technology advancement now allows for the identification of PICC tip location during the insertion procedure by using electrocardiogram changes, a much more accurate method.2 The primary or original tip location can change during the catheter dwell time, producing a secondary malposition.1 Saying that PICCs have an “inherent characteristic of instability” is not accurate. The author is confusing two different types of secondary catheter malposition. First, there is tip migration, which can occur with any type of central vascular access device (CVAD) and is caused by changes in intrathoracic pressure, such as coughing, sneezing, congestive heart failure, and mechanical ventilation. There is no change to the external catheter length. It's the nurse's responsibility to know the clinical signs and symptoms of tip migration and to take appropriate action if it's suspected. There are no nursing interventions that could easily prevent this type of tip movement.1 Another type of secondary malposition is known as catheter dislodgment or displacement. In this case, the catheter is either pulled out of or pushed into the insertion site. This involves a change in the external catheter length, which subsequently produces a change in the catheter's tip location.1 The most common cause of this problem is lack of catheter stabilization. The Infusion Nurses Society and the Centers for Disease Control and Prevention (CDC) recommend CVAD stabilization with an engineered, sutureless catheter stabilization device.1, 3 A transparent membrane dressing alone or “sticky occlusive clear dressing,” as stated by the author, is not a stabilization device. While a dressing has an important role in catheter care, relying on a dressing alone for stabilization puts patients at risk for catheter dislodgment. This is not the fault of the catheter design but rather the absence of proper catheter stabilization techniques, a lack of appropriately engineered products for this purpose, and a lack of knowledge and skill by the nursing staff to adequately use these stabilization devices. During each CVAD dressing change, measurement of the external catheter length with comparison to the original length is required.1 A label on the catheter or dressing would assist nurses in locating this critical information. A simple piece of tape with this information can be added to the edge of the dressing. Infusion nursing practice is measured against the documents produced by the Infusion Nurses Society and the CDC, and nurses must be familiar with these. Lynn Hadaway, MEd, RN, BC, CRNI Milner, GA References: 1. Infusion Nurses Society. Infusion nursing standards of practice J Infus Nurs. 2011;34(1 Suppl):S1–S109 Cited Here... 2. Smith B, et al. Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters J Electrocardiol. 2010;43(3):274–8 Cited Here... 3. O'Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. Atlanta: Centers for Disease Control and Prevention; 2011. ****************** Clinicians at NorthShore University HealthSystem's three hospitals near Chicago have found a method of reducing bloodstream infections by half. Using a tiny alcohol-impregnated cap on central line hubs prevented four CLABSI deaths and prevented 21 patients from infections, they calculated during the study year, a result sustained with proven cost-effectiveness during the 18 months following their experiment. The cap method differs from the traditional 15-second "scrub the hub" ... http://www.healthleadersmedia.com/content/QUA-288009/Drop-in-CentralLine-Infection-Rates-Linked-to-Disinfection-Caps ***************** Patient Navigation: Revenue Opportunities for Hospitals According to a report from the Center for Health Affairs, patient navigation could save billions of dollars at hospitals. http://www.fiercehealthcare.com/story/patient-navigation-revenue-opportunities-hospitals/2013-01-03?utm_medium=nl&utm_source=internal ************ California: Registered nurses able to dispense birth control under new law Nurses can dispense hormonal birth control in California, but new law draws controversy http://www.huffingtonpost.com/2013/01/05/nurses-hormonal-birth-control_n_2414605.html ************** Identity Theft's Taxing New Trend: Scammers Are After Your Tax Refund Along with the rapid rise in identity theft has come the explosion of a specialized and sophisticated form of theft: tax identity theft. During the 2011 tax processing year, roughly 940,000 tax returns were filed fraudulently. This year the number will likely reach 1 million. Even the IRS' own taxpayer advocate, Nina Olson, says the IRS is woefully incapable of handling the boom. A recently released report from the National Taxpayer Advocate to Congress says that the IRS "has failed to provide effective and timely assistance to victims of identity theft" even as the number of crimes continues to soar. Olson says in the report that tax-related identity theft has risen some 650 percent since 2008 ... http://www.dailyfinance.com/2013/01/25/identity-theft-tax-refund-scammers/?ncid=webmail26 ************************* In a telling demonstration of their lack of faith in the future of the U.S. dollar, lawmakers in Virginia are considering minting their own state coinage. But could the dollar really fail? National currencies have failed before, and it has happened more frequently and more recently than you probably think. RANDOM FACT: The most famous example in the 20th century is Germany's Weimer Republic of 1922-1923. When Germany was unable to pay the war reparations imposed after WW I the government began printing unbacked currency. Too much money was circulated, and the money was soon considered worthless. In 1922, the largest denomination of the Papiermark was 50,000. A year later it was 100 Trillion. This means that by December 1923, the exchange rate with the US Dollar was 4.2 Trillion to 1. It is estimated that by November 1923, the yearly inflation rate was 325,000,000 percent. ************* Men more likely to die of cancer: study (Reuters) - Not only are men more likely than women to be diagnosed with cancer, men who get it have a higher chance of dying from the disease, according to a U.S. study. In an analysis of cases of all but sex-specific cancers such as prostate and ovarian cancer, for example, men were more likely than women to die in each of the past ten years, said researchers, whose findings appeared in The Journal of Urology. That translates to an extra 24,130 men dying of cancer in 2012 because of their gender. "This gap needs to be closed," said Shahrokh Shariat from Weill Cornell Medical College in New York, who worked on the study. "It's not about showing that men are only doing worse and, 'poor men.' It's about closing gender differences and improving health care." ... http://www.reuters.com/article/2012/12/07/us-cancer-men-idUSBRE8B604R20121207?feedType=RSS&feedName=healthNews **************** Provisions contained in American Taxpayer Relief Act (ATRA , known colloquially as the fiscal cliff deal, will further reduce Medicare payments for skilled nursing facility (SNF) care, according to a press release from The Alliance for Quality Nursing Home Care (AQNHC). An analysis from Avalere Health shows that by extrapolating from the Congressional Budget Office estimate of $1.8 billion in savings over 10 years (FY 2013 to FY 2022), it estimates that the provision in the fiscal cliff deal will cut payments to SNFs by approximately $600 million over that period. http://tinyurl.com/anehmq3 (Thanks BAcello..Barbara) ************ Metal-on-Metal Hip Implants: Safety Communication - Updated Safety Recommendations FDA notified healthcare professionals that it is providing updated safety information and recommendations to patients and health care providers, based on the FDA’s current assessment of metal-on-metal hip implants, including the benefits and risks, the evaluation of the published literature, and the results of the June 2012 Orthopaedic and Rehabilitation Devices Advisory Panel meeting. BACKGROUND: In metal-on-metal hip implants, the metal ball and the metal cup slide against each other during walking or running. Metal can be released from other parts of the implant where two implant components connect. Metal release will cause some tiny metal particles to wear off of the device around the implant, which may cause damage to bone and/or soft tissue surrounding the implant and joint. Soft tissue damage may lead to pain, implant loosening, device failure and the need for revision surgery Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause symptoms or illnesses elsewhere in the body. Presently, the FDA does not have enough scientific data to specify the concentration of metal ions in a patient’s body or blood necessary to produce adverse systemic effects. In addition, the reaction seems to be specific to individual patients, with different patients having different reactions to the metal wear particles. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm336069.htm ************************ January was National Blood Donor Month; here are some facts about the need for blood and the power of donation: 1: One pint of blood can save up to three lives. 2: Every two seconds someone in the U.S. needs blood. 44,000: More than 44,000 blood donations are needed every day. 3: The average red blood cell transfusion is about three pints. 38%: The percentage of U.S. population eligible to give blood is less than 38%. 9.5 million: Number of blood donors in the U.S. in a year. 10 to 12: The actual blood donation usually takes less than 10 to 12 minutes. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************** WORD ORIGINS: been there, done that *** A phrase indicating that something is wearying or just plain old hat, "been there, done that" comes to American English by way of Australian slang. It first turned up in 1982 in an American newspaper article that said of a recent divorcee who did not plan to marry again, "Using an Australian expression, she says,' Been there, done that'" ~~**~~**~~**~~**~~**~~ HUMOR SECTION A story from the pages of the Manchester Evening Times Last Wednesday a passenger in a taxi heading for Salford Station leaned over to ask the driver a question and gently tapped him on the shoulder to get his attention. The driver screamed, lost control of the cab, nearly hit a bus, drove up over the curb, and stopped just inches from a large plate window. For a few moments everything was silent in the cab. Then, the shaking driver said "Are you OK? I'm so sorry, but you scared the daylights out of me." The badly shaken passenger apologized to the driver and said, "I didn't realize that a mere tap on the shoulder would startle someone so badly." The driver replied, "No, no, I'm the one who is sorry, it's entirely my fault. Today is my very first day driving a cab.......I've been driving a hearse for 25 years." ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as Dr Robert Hess. ___________ Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ The Nursing Site http://thenursingsite.com . http://www.snopes.com http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Qualitest Hydrocodone Bitartrate and Acetaminophen Tablets 10 mg/500 mg: Recall - Potential for Oversized Tablets Qualitest, a subsidiary of Endo Health Solutions, issued a voluntary nationwide recall for 101 lots of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10 mg/500 mg. Bottles from the affected lots may contain tablets that have a higher dosage of acetaminophen, and as a result, it is possible that consumers could take more than the intended acetaminophen dose. Unintentional administration of tablets with increased acetaminophen content could result in liver toxicity, especially in patients on other acetaminophen containing medications, patients with liver dysfunction, or people who consume more than 3 alcoholic beverages a day. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm331224.htm ******************* Vycor Viewsite Brain Access System (VBAS): Class 1 Recall - Unidentified Fiber Found on Device Vycor Medical recalled its VBAS because an unidentified black fiber was found on the device. This product may cause serious adverse health consequences, including death. Vycor Medical recalled its VBAS because an unidentified black fiber was found on the device. This product may cause serious adverse health consequences, including death. BACKGROUND: The Vycor Medical Viewsite Brain Access System serves as a self-retaining retractor system for brain tissue and provides access to allow the surgeon to see the surgical site during brain and spinal procedures. RECOMMENDATION: Vycor Medical called their customers requesting that they place products of Model # TC171105, Lot # VM83450 into quarantine until further notice. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm337475.htm ~~**~~**~~**~~**~~**~~ ADVERTISEMENTS from the members This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: Audreycarmellasmith@yahoo.com (Audrey) January 31, 2013 ~~**~~**~~**~~**~~**~~ NOTICE: I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number. So please send me your new name/address, okay? RNFrankie@AOL.com OLD ADDRESS: chousm@AOL.com (Connie) NEW ADDRESS: chousm@bendbroadband.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY The farther a society drifts from truth, the more it will hate those who speak it. George Orwell Would love to hear from you......suggestions always welcome. RNFrankie@AOL.com QUIZ Correct answer: d. Advantages of dry suction system include higher levels of suction pressure, easier set-up, quieter operation (no bubbling sound), and more constant pressure because no water is lost to evaporation. Learn more by reading the continuing education program "Chest-tube care: The more you know, the easier it gets."
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Saturday, January 12, 2013



PARADIGM BYTES
Newsletter for Paradigm 97
January 12, 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.
 
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 (The following is an explanation of Truth About Nursing's objectives.  If possible, please donate $5 or more to support them in their endeavors.  Contact Sandy for instructions about donations.)

As a report by the Institute of Medicine recently stressed, in order for the health care crisis to end, nurses must be a part of the decision-making process. That means more resources and respect. Hospitals exist mainly to provide nursing care, but nurses rarely hold positions of leadership; few nurses serve on hospital boards. Why should any nursing institution be run by anything less than a majority of nurses? Yet that's the status quo in the vast majority of health institutions across the world.

Why does helping people understand nursing matter?
When people think nursing is unskilled loser work, or that nurses exist to serve physicians, then nurses have a tough time getting the resources they need to provide good nursing care. Nurses are spread too thinly because many have been replaced by lesser-educated workers who can't assess or intervene as nurses can. Decision-makers believe that non-nurses can perform nursing work because they do not understand the nature or value of nursing. That leads to poor care--and sadly, even death.
The Truth About Nursing fights this deadly lack of understanding. Decision-makers get these wrong ideas from many sources, but especially by watching, reading and listening to the omnipresent media. The media constantly tells us that physicians are the only health professionals whose work matters. Physicians deserve credit for their good work, but not for the work of nurses. And when physicians get credit for nurses' work, they get the funding for it too. That's why nursing residencies only get $1 for every $375 that physicians residencies get. That's why the NIH gives nursing researchers only half of one percent of its budget , even though nurses work on the cutting edge of health care and make up the largest body of health professionals. truthaboutnursing.org

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                  Postoperative recovery in elderly patients: 
Implications for respiratory care    by Helen M. Sorenson, MA, RRT, CPFT, FAARC
The increasing population of older adults will result in an increased amount of surgical procedures being performed on
geriatric patients. The number of elderly (> 65 years) patients who undergo noncardiothoracic surgery is projected to increase from 7 million to 14 million over the next 30 years.  Surgery can potentially be debilitating for older adults. While survival may be the ultimate goal, improving quality of life and functional capacity may be far more important to the elderly. Ms. Sorenson outlines in her article how many of the postoperative pulmonary complications can be prevented with advances in medicine, technology, and risk stratification.
Unplanned extubation (UE) can be a devastating event for critically ill patients, with potentially life threatening complications including
airway trauma, bronchospasm, severe hypoxemia, and cardiac arrest. UE can lead to an increased number of ventilator days,
resulting in excessive resource use for patients, and increased risk of litigation for healthcare professionals. Dr. Foster describes methods
to protect against UE including education, quality improvement processes, sedation protocols, physical restraints, and tube securing
methods. ...   http://www.accelacommunications.com/microsite/hospital_acquired_uti/Perspectives28.pdf                                     
 

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  MEDICAL NEWS

 More Than 30 Nursing Organizations Call for Action in Wake of Newtown Tragedy

More than 30 leading organizations representing registered nurses signed on to a call to action sent today to President Obama, congressional leaders, and leaders of both the National Governors Association and The United States Conference of Mayors that urges swift action to address factors that together will help prevent more senseless acts of violence in the wake of the tragedy in Newtown, Conn.   http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/Call-to-Action-from-the-Nations-Nurses-in-the-Wake-of-Newtown.pdf  ; 
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FDA approves first subcutaneous cardiac defibrillator
On Sept. 28, the U.S. Food and Drug Administration (FDA) approved the first subcutaneously inserted cardiac defibrillator: Subcutaneous Implantable Defibrillator (S-ICD) System.  
An implantable defibrillator is a small battery-powered device that constantly monitors a person’s heart rhythm and can deliver a therapeutic dose of electricity to restore the rhythm when it senses the heart is beating dangerously fast (tachycardia) or chaotically (sudden cardiac arrest). 
Other implantable defibrillators on the market require a physician to insert one or more electrical conductor wires, called “leads,” into a vein in the upper chest and guide them into the patient’s heart. X-ray fluoroscopy, a real-time imaging method, helps the physician to visualize the heart and blood vessels to guide the leads to the correct position.
The Subcutaneous Implantable Defibrillator (S-ICD) System uses a lead that is implanted just under the skin along the bottom of the rib cage and breast bone. Because the lead is placed under the skin rather than through a vein into the heart, a physician can implant the device without accessing a patient’s blood vessels or heart and without the need for fluoroscopy.
“The S-ICD System provides an alternative for treating patients with life-threatening heart arrhythmias for whom the routine ICD placement procedure is not ideal,” said Christy Foreman, director of the Office of Device Evaluation at FDA’s Center for Devices and Radiological Health. “Some patients with anatomy that makes it challenging to place one of the implantable defibrillators currently on the market may especially benefit from this device.” ... 

      http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm321755.htm?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_October_15th_2012&utm_medium=email
                                                                                    
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FROM A MEMBER
The following was sent in by Rozalfaro.    
After many comments from colleagues, I'm starting a campaign to have "Be on Your Patients' S.I.D.E" (summarized below; applies to all settings) posted on every unit and at every school of nursing. You can download an eye-catching handout free from http://www.alfaroteachsmart.com/handouts.html (Choose Handout #16, S.I.D.E Care Principles). Please download, copy, and share!
 
  Be On Your Patients' S.I.D.E.*
 
Use S.I.D.E to remember overarching care principles:
  
      S-   Safety and comfort. Make safety and comfort top priority.
       I-    Infection prevention. Be alert to infection risks; wash your hands;
              teach patients to do the same
      D-   Dignity. Help patients maintain self-respect; ensure privacy.
      E-   Engage and educate. Involve patients and families in making decisions;
     teach them what they need to know to be independent.
 
For more information S.I.D.E. or coaching on teaching critical thinking (on-site, on the phone, or electonic coaching) simply reply to this email.   Rosalinda (Roz) Alfaro-LeFevre teachsmartalfaro@aol.com

 
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INTERESTING READING
 
Please remember that the REUTERS articles usually good for only 30 days
Incidence and Severity of Phlebitis in Patients Receiving Peripherally Infused Amiodarone  
Abstract

Background:  Nurses noted that the rate of phlebitis was high when intravenous amiodarone was infused via a peripheral site. Hospital policy recommends a central vascular catheter, but this method is often not feasible because the drug is administered in emergent situations for short periods....   http://ccn.aacnjournals.org/content/32/4/27.abstract?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_August_20th_2012&utm_medium=email
                                                                                   
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The Evidence is In: RN-to-Patient Ratios Save Lives
A major new study led by one of the nation's most eminent nurse researchers provides compelling new evidence that California's landmark RN-to-patient staffing law reduces patient mortality, assures nurses more time to spend with patients, and substantially promotes retention of experienced RNs. "This research documents what California RNs have long known - safe staffing saves lives. We see the effects every day at the bedside in improved patient care, an enhanced quality of life for patients, and nurses able to more safely practice the profession to which we have dedicated our lives," said Malinda Markowitz, RN, co-president of the California Nurses Association, a National Nurses United founding affiliate.
 
"This research documents what California RNs have long known - safe staffing saves lives. We see the effects every day at the bedside in improved patient care, an enhanced quality of life for patients, and nurses able to more safely practice the profession to which we have dedicated our lives," said Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses United.
CNA/NNU, Sponsor of Law, Cites Major Gains for Patient Safety, RN Shortage
CNA/NNU, the nation's largest organization of direct care RNs with 155,000 members, sponsored the California law and has fought off repeated hospital industry attempts to erode it, including a well-chronicled fight with Gov. Arnold Schwarzenegger who sought to roll back the law in late 2004. ...   http://www.nationalnursesunited.org/press/entry/the-evidence-is-in-california-rn-to-patient-ratios-save-lives/

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Nurses Earn Highest Ranking Ever, Remain Most Ethical of Professions in Poll
ANA Urges Policymakers to Listen to Nurses on Health Care Policy, Funding SILVER SPRING, MD —

The public continues to rate registered nurses (RNs) as the most trusted profession according to this year’s Gallup survey that ranks professions based on their honesty and ethical standards.
“This poll consistently shows that people connect with nurses and trust them to do the right thing,” said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. “Policymakers should do the same as they debate crucial budget decisions that will affect health care quality and access for millions of Americans.”  ...
http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/Nurses-Remain-Most-Ethical-of-Professions-in-Poll.pdf

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 Code of Ethics for Nurses The ICN Code of Ethics for Nurses, most recently revised in 2012, is a guide for action based on social values and needs.The Code has served as the standard for nurses worldwide since it was first adopted in 1953. The Code is regularly reviewed and revised in response to the realities of nursing and health care in a changing society. The Code makes it clear that inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect. The ICN Code of Ethics guides nurses in everyday choices and it supports their refusal to participate in activities that conflict with caring and healing. [Links to download in numerous languages. 12 pages..]  Thank you, Barbara (BAcello) for this article.

http://www.icn.ch/about-icn/code-of-ethics-for-nurses/

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RANDOM FACT:  Town laws in the U.S. Midwest in the 1880s were passed prohibiting the sale of ice cream sodas on Sunday. In Illinois, ingenious soda fountain owners got around the law by omitting the carbonated water and serving just the scoop of ice cream and the syrup. They called this a "Sunday Soda." Later the name was shortened to "sunday" and eventually just "sundae."

***
Study: Extended shifts associated with nurse burnout and patient dissatisfaction
"The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction," in November’s Health Affairs, found that nurses working shifts of 10 hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction, and as the proportion of hospital nurses working shifts of more than 13 hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses’ well-being, may result in expensive job turnover, and can negatively affect patient care. Policies regulating work hours for nurses, similar to those set for resident physicians, may be warranted.

 http://content.healthaffairs.org/content/31/11/2501.abstract?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_November_12th_2012&utm_medium=email
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Study: Supplemental nurses compared to permanent nurses 
Supplemental nurses and permanent nurses share similar education levels, but supplemental nurses are slightly less experienced, more racially and ethnically diverse, and more likely to be male, according to a study in November’s Health Affairs. 
In the past three decades, the shortage of nurses willing to work in hospitals has been a persistent challenge in the United States. Hiring supplemental registered nurses—nurses on short-term contracts obtained through an external staffing agency—has been common to fill gaps in nurse staffing. But there has been insufficient evidence about supplemental nurse workforce trends to inform workforce policy. To address this concern, we compared qualifications and characteristics of supplemental nurses with those of permanent nurses during 1984–2008. The two groups shared similar education levels in terms of possessing a baccalaureate or higher degree. Supplemental nurses were somewhat less experienced than permanent nurses, averaging fifteen years of experience in 2008 compared to eighteen years for permanent nurses. ...  http://content.healthaffairs.org/content/31/11/2510.abstract?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_November_12th_2012&utm_medium=email

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 Shifting the safety balance for overnight workers 
An international team of sleep researchers has developed the world’s first screening tool to help reduce workplace accidents and illnesses, including cardiovascular disease and cancer, caused by shift work.

Published in the journal Sleep, the new tool will enable health professionals and industry to better understand individual vulnerability to the health and safety impacts of shift work.

This screening questionnaire for a condition known as shift work disorder (SWD) has been developed by researchers from Monash University, and US partners, Harvard Medical School, Brigham and Women's Hospital, and the Henry Ford Hospital.

At least 15 per cent of workers in Australia, the US, and the United Kingdom, and around 23 per cent of workers in Japan are estimated to work outside normal hours, causing significant disruption to their natural sleep-wake schedules. SWD, characterised by extreme sleepiness and/or insomnia, is thought to affect around 10 per cent of shift workers.  ...

http://www.monash.edu.au/news/releases/show/shifting-the-safety-balance-for-overnight-workers?utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_December_2012_House&utm_medium=email
                                                                             ********************
Quiz  Time:
Which type of temporary pacing usually is used for a patient having major cardiac surgery?
a. Epicardial pacing
b. Transvenous pacing
c. Noninvasive transcutaneous pacing
d. Biventricular pacing
                                                 Answer at end of Newsletter...
                                                                 ****************

RANDOM FACT:  The Massachusetts Law School of 1647 required that towns with 50 or more families establish schools or pay a fine of 5 British pounds. Several schools were opened as a result of this law. Although the schools were not the first supported by the public, the law forcing their creation was an important milestone in public education.
                                                                                                                                                                                       *************

Sepsis remains a serious problem worldwide. Consider these facts:
6,000,000:
Sepsis kills more than 6 million newborn and small children in the developing world.
377:
The number of cases of sepsis per 100,000 people in the U.S. and Europe, higher than stroke, cancer, heart disease, and HIV.
91:
In 2011, the U.S. spent $91 million for state-funded research on sepsis, the lower than that for stroke, cancer, heart disease, and HIV.
2:
Hospitalizations for sepsis have more than doubled over the last 10 years.
14.6 In 2008:
$14.6 billion was spent on hospitalization for sepsis in the U.S.

Reprinted  with permission from:  Production/Electronic Channels Coordinator
HealthCom Media  259 Veterans Lane Doylestown, PA 18901
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Johns Hopkins Malpractice Study: Surgical ‘Never Events’ Occur At Least 4,000 Times per Year   Researchers advocate public reporting of mistakes
 
After a cautious and rigorous analysis of national malpractice claims, Johns Hopkins patient safety researchers estimate that a surgeon in the United States leaves a foreign object such as a sponge or a towel inside a patient’s body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week and operates on the wrong body site 20 times a week.
The researchers, reporting online in the journal Surgery, say they estimate that 80,000 of these so-called "never events" occurred in American hospitals between 1990 and 2010 - and believe their estimates are likely on the low side.
The findings - the first of their kind, it is believed - quantify the national rate of "never events," occurrences for which there is universal professional agreement that they should never happen during surgery. Documenting the magnitude of the problem, the researchers say, is an important step in developing better systems to ensure never events live up to their name. ...

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RANDOM FACTS:  There was only one president that was a preacher -- James Garfield.
                                                                              ***

Bonus Fact:  President Lincoln owned only one home during his lifetime -- in Springfield, Ill.

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(Reuters) - Health authorities in northeast Thailand plan to screen people for fluke worms to detect early signs of bile duct cancer, a deadly disease linked to eating uncooked freshwater fish.
Rivers in northeast Thailand, Vietnam, Laos, Cambodia, the Koreas and China are infested with the tiny parasitic worms which find their way into the human body when seafood is eaten raw.
According to the World Health Organization, 67 million people are at risk of this worm and 9 million are infected in Cambodia, Laos and the northeastern parts of Thailand and Vietnam.
Most of the infected people are men and they can develop bile duct cancer by the time they are 40 or 50.   ...  (so...while you eat your sushi, remember this article....)

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Nursing education by the numbers
Data from the American Association of Colleges of Nursing show growth in nursing education at all levels and for all roles.
20,301:
The increase in the number of students enrolled in BSN programs from 2010 to 2011
41.6%:
Percent increase in graduates of Clinical Nurse Leaders programs over 1 year
15.8%:
Percent increase in enrollment in degree-completion programs over 1 year
77:
The number of baccalaureate to doctoral programs in the US
184:
The number of doctor of nursing practice programs in 2011, up from 20 in 2006
Source: http://www.aacn.nche.edu
Reprinted  with permission from:  Production/Electronic Channels Coordinator
HealthCom Media  259 Veterans Lane Doylestown, PA 18901
 
                                                                             ****************

 (Thank you, Barbara (BAcello)  

Promoting Safety: Alternative Approaches to the Use of Restraints |  Registered Nurses' Association of Ontario

2012 BOOK 152 Pages free download   RNAO has many excellent publications. All meet US standards. 

http://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints>

                                                     *************
    IRS rules breast pumps, supplies, etc. are now deductible http://tinyurl.com/6gchgun
(Thank you, Barbara  (BAcello)  
                                                                     *******************
  HINT: Aerosol spray starch isn't just for ironing. It also helps repel dirt and marks from white canvas tennis shoes! Just lightly mist the fabric of your sneakers and let it dry completely before the first wear.
                                                                          *****************
Study finds mammograms lead to unneeded treatment
Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.
Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.
It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.
But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.   http://health.yahoo.net/news/s/ap/study-finds-mammograms-lead-to-unneeded-treatment

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FDA marks 50 years of Kefauver-Harris amendment
This year the U.S. Food and Drug Administration (FDA) is marking the anniversary of the Kefauver-Harris amendment, passed 50 years ago. The legislation gave FDA weight to require drug manufacturers prove their products were safe and effective before receiving approval to market them in the U.S. Before the amendment, drugs could be sold 60 days after companies filed with the FDA, if the agency did not object, and drug manufacturers routinely sent new medications to doctors asking them to " try them out " on their patients. The amendment has its roots in then-FDA medical officer Frances O. Kelsey’s refusal to approve Kevadon (more commonly known as thalidomide) for morning sickness during pregnancy. Thalidomide was later shown to cause serious birth defects. Senator Estes Kefauver of Tennessee and Representative Oren Harris led the effort to pass the amendment. ...

  http://www.fda.gov/Drugs/NewsEvents/ucm320924.htm?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_October_8th_2012&utm_medium=email
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MP Acute Care Guidelines for Timely Administration of Scheduled Medications

The Institute for Safe Medication Practices (ISMP) developed these Acute Care Guidelines for Timely Administration of Scheduled
Medications after conducting an extensive survey in late-2010 involving almost 18,000 nurses regarding the requirement in the Centers for Medicare & Medicaid Services (CMS) Conditions of Participation Interpretive Guidelines to administer medications within 30 minutes before or after the scheduled time. The nurses who responded to the survey made it clear that changes to drug delivery methods and gradual increases in the complexity of care, number of prescribed medications per patient, and number of patients assigned to each nurse have made the long-standing CMS “30-minute rule” error prone.   

Many nurses reported feeling great pressure to take shortcuts to comply with the rule, which have led to errors, some harmful. While delays in administering certain time-sensitive medications can also result in harm, a one-size-fits-all, inflexible requirement to administer all scheduled medications within 30 minutes of the scheduled time is a precarious mandate given that relatively few medications truly require exact timing of doses. ...

https://www.ismp.org/Tools/guidelines/acutecare/tasm.pdf?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_December_10th_2012&utm_medium=email                                                                                     
                                                                           **************                                                                                                 
Beer is the second most popular beverage in the world, right behind tea. It's not surprising since beer, in one form or another, has been around since at least 3100 BC where evidence of brewing was found in western Iran. And there are even more fun facts about the golden nectar.

  RANDOM FACTS:  The first consumer protection law ever written was enacted over beer by Duke Wilhelm IV of Bavaria in 1516. It was a purity law limiting the ingredients of beer to barley, hops and water.

***                                                                              
Bonus Fact:  American beer is made partially by rice, unlike the beers of other countries. This was invented to give American beer a lighter taste and tap into the market of women buyers.
                                                                              

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HUMOR SECTION

A few years ago the battery in my beat-up VW Beetle had died because I left the lights on overnight. I was in a hurry to get to work on time so I ran into the house to get my wife to give me a hand to start the car. I told her to get into our second car, a prehistoric oversized gas guzzler, and use it to push my car fast enough to start it. I pointed out to her that because the VW had an automatic transmission, it needed to be pushed at least 20mph for it to start.

She said fine, hopped into her car and drove off.

I sat there fuming wondering what she could be doing.

A minute passed by and when I saw her in the rear-view mirror coming at me at about 30 mph, I realized that I should have been a bit clearer with my directions...
   
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Go to www.sharedgovernance.org for access to a  free continuing education module about shared governance,
written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.    
Please follow him on Twitter as Dr Robert Hess.
 
 Pay Only $34.99 for a full year of CONTACT HOURS  

www.nurse.com for CNE offerings.
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
 
This is an excellent nursing site, check it out:  http://nursingpub.com/
 
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 
 
 
 
 
    Rozalfaro's Website    http://www.alfaroteachsmart.com/articles.htm

Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/
 
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*
MEDICAL RECALLS
*
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The U.S. Food and Drug Administration (FDA) is notifying health care professionals that the 32 mg, single intravenous (IV) dose of the anti-nausea drug Zofran (ondansetron hydrochloride) will no longer be marketed because of the potential for serious cardiac risks.  This dose has been removed from the Zofran drug label.  FDA is now working with the manufacturers of all 32 mg dose ondansetron injectable products (brand and generic) to voluntarily recall them from the market.  These drugs are sold pre-mixed in solutions of either dextrose or sodium chloride in plastic containers (See Table 1).
A previous Drug Safety Communication (DSC), issued on June 29, 2012, communicated that the 32 mg, single IV dose should be avoided due to the risk of a specific type of irregular heart rhythm called QT interval prolongation, which can lead to Torsades de Pointes, an abnormal, potentially fatal heart rhythm.
The 32 mg, single IV dose had been used to prevent chemotherapy-induced nausea and vomiting.  As stated in the previous DSC, FDA continues to recommend the intravenous regimen of 0.15 mg/kg administered every 4 hours for three doses to prevent chemotherapy-induced nausea and vomiting.  If the calculated weight-based dose were to exceed 16 mg, the potential for prolonged QT interval would be greater; therefore, no single intravenous dose should exceed 16 mg.  In addition, oral dosing of ondansetron remains effective for the prevention of chemotherapy-induced nausea and vomiting. At this time, there is not enough information available for FDA to recommend an alternative single IV dose regimen. 
FDA anticipates these products (see Table 1, below) to be removed from the market through early 2013.  FDA does not anticipate that removal of the 32 mg intravenous dose of ondansetron currently sold as pre-mixed injections will contribute to a drug shortage of IV ondansetron, as the 32 mg dose makes up a very small percentage of the current market. According to sales distribution data, ondansetron IV 32 mg premixed bags accounted for less than 1% of ondansetron IV sales (vials, bags, etc.) from the manufacturers to retail and non-retail channels of distribution in the 12-month period ending in June 2012.1  ...
                     

                                                                                   ************************FDA Drug Safety Communication: Important change to heparin container labels to clearly state the total drug strength

  The U.S. Food and Drug Administration (FDA) is notifying health care professionals, caregivers, and patients about a change to the container and carton labels for heparin products.  This label change will require manufacturers of Heparin Lock Flush Solution, USP and Heparin Sodium Injection, USP to clearly state the strength of the entire container of the medication followed by how much of the medication is in 1 milliliter (mL). These modifications will eliminate the need for health care professionals to calculate the total amount of heparin medication in a product containing more than 1 mL, thereby reducing the risk of miscalculations that may result in medication errors. ...  
                        http://www.fda.gov/Drugs/DrugSafety/ucm330695.htm?utm_source=BenchmarkEmail&                    ; utm_campaign=Weekly_eNewsletter_December_10th_2012&utm_medium=email                                                                     

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

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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
 
WELCOME TO:
Nankristin@yahoo.com  (Nan)   December 6, 2012
 

lvjones@dhr.state.ga.us (Lisa)  December 15, 2012

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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address. ...  So, please send me your new name/address, okay?   RNFrankie@AOL.com     
 
 
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
 

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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)

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

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THOUGHT FOR THE DAY

“When one door of happiness closes, another opens;
but often we look so long at the closed door that we do
not see the one which has been opened for us.”

 - Helen Keller

Correct answer:  a. Epicardial pacing is used only with cardiac surgery patients. Common postoperative complications of cardiac valve surgery and coronary artery bypass surgery include episodic sinus bradycardia, second- and third-degree heart block, and asystole.     http://www.americannursetoday.com/Article.aspx?id=9780&fid=9722&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_December_2012_House&utm_medium=email

Would really like to hear from you..... Frankie
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