Paradigm Bytes

PARADIGM BYTES
Newsletter for Paradigm 97
April 11, 2010

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

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

MISSION STATEMENT

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

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

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

Topic: Temp or no temp ?

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

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

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

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

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

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

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

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FROM THE MEMBERS


Received this from Bacello (Barbara) Thank you !

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

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

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

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

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


Of my present professional credentials, I took a comprehensive review course for one (ten weeks, twice a week, a real college-level class in a new field for me) and did free self-study for the others. No legitimate credentialling agency tells the any test-prep course the content of the exam, so the test-prep companies find out the way the rest of us do: they take it and try to remember for the next exam. No guarantee at all of specific content. I would encourage people to look into that.
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Oneacre454@msn.com wrote: We need an economic plea for RNs , the hospitals are hiring LPNs and placing them on Med/Surg floor and Having one RN cover them under their license, Lots of RNs are out of work. (the local hospital in this little town is laying off RNs.......hospital CEOs etc. all seem to have the mistaken belief that Nurses are Overhead ! )
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

8 more things a burglar won't tell you:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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WEBSITES/ LINKS

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

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

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

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

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

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

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

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

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

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

The Nursing Site http://thenursingsite.com .

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

http://www.snopes.com

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


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

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

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

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

Should Clinical Courses Get a Letter Grade?

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

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

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

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

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

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

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

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

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


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NURSING HINTS CORNER

No Mess Mouth Care

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

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.128, Springhouse Corporation/www.springnetcom.

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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com

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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)

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

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

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THOUGHT FOR THE DAY


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


--Samuel Adams


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