May 2010

PARADIGM BYTES
Newsletter for Paradigm 97
May 16, 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.

***~~~***~~~***~~~***
SNIPPETS
(This is from Kurt Ullman-- thanks)
Eating and Drinking During Labour: Let Women Decide

Women should be allowed to eat and drink what they want during labour, say Cochrane Researchers. The researchers carried out a systematic review of studies examining the traditional practice of restricting food and fluid intake during labour and found no evidence for any risk or benefit for women at low risk of complications.

Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated “nil by mouth” policies or restricted what women in labour were allowed to eat and drink, regardless of women’s preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by “Mendelson’s syndrome”, where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour.

The Cochrane Systematic Review, which included five studies and a total of 3130 women, looked at the evidence for restricting food and drink in women who were considered unlikely to need anaesthesia. They found no evidence of any risk or benefit associated with eating or drinking, whether in studies comparing eating and drinking at will or just water with complete restriction, or in studies comparing specific foods, fluids, or carbohydrate drinks with water.

“Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications,” said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. “Women should be able to make their own decisions about whether they want to eat or drink during labour, or not.”

The researchers did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anaesthesia. Therefore, further research is need before specific recommendations can be made for this group.

However, Singata concludes that there may be better ways to approach studies of eating and drinking during labour. “While it is important to try to prevent Mendelson’s syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it,” she said.

Work on this review was supported by a grant from the National Institute for Health Research (NIHR), UK.

Full citation: Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2.

~~**~~**~~**~~**~~**~~
MEDICAL NEWS

Top Story in Medscape Nurses is Stokowski's Article, "Will We Have a National Nurse?" Nurses around the country are weighing in and overwhelmingly agree that the time has come for the United States to have a National Nurse. Of the dozens of emails the NNNO received, only three were of a negative nature (one nurse thought this was a left/liberal idea; one nurse felt we should be putting the fire that was already in the hospital out before we moved to prevention; and another nurse thought this would cost too much, not realizing that HR 4601 asks that a position already funded through taxpayer dollars be known as the National Nurse).
The National Nursing Network Organization (NNNO) agenda is to have a National Nurse to promote prevention. The NNNO is not a union and is not affiliated with the CNA/NNOC of AFL-CIO. The NNNO is a 501(c)4 non-profit legislative advocacy organization. Read the bill: HR 4601: The National Nurse Act of 2010 http://www.nationalnurse.org

~~**~~**~~**~~**~~**~~
INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days

The Calcium Side Your Bones Crave Keep your skeleton strong and fracture-free by serving that calcium supplement with a salad on the side.

Salad? Yep, salad. A 4-year study found that older adults with the highest intakes of carotenoids -- think tomatoes, carrots, and leafy greens for major sources -- retained more bone mineral density than folks eating fewer fruits and veggies.... http://www.realage.com/tips/the-calcium-side-your-bones-crave

***********************

People get hungrier when they're starved for sleep (Reuters 4/9) - People who are trying to stay trim may want to make sure they get plenty of sleep. In a study, researchers found that normal-weight young men ate a Big Mac's-worth of extra calories when they'd gotten four hours of sleep the night before compared to when they slept for eight hours.
Given the findings, and the fact that people have been sleeping less and getting fatter over the past few decades, "sleep restriction could be one of the environmental factors that contribute to the obesity epidemic," they write in the American Journal of Clinical Nutrition.... http://www.reuters.com/article/idUSTRE63854120100409

*************************

April 10 (HealthDay News) -- Severe peripheral vascular disease may be much more common in younger American adults and women than previously suspected, according to a new study.

The disease causes a narrowing in blood vessels that carry blood to the arms, legs, kidney and stomach and leads to symptoms that include pain and cramping in the legs during exercise.

Researchers analyzed data on 994 men and women, age 55 and younger, treated in the Wake Forest University School of Medicine Vascular Center between 1998 and 2009. They found that most of them had premature atherosclerosis (hardening of the arteries). Severe premature arterial disease of the legs (64 percent) was the most common finding.... http://healthday.com/Article.asp?AID=637753

****************

RANDOM FACT: What is called a "French kiss" in the English speaking world is known as an "English kiss" in France.
***********************

Spanish for You: Bridging the Language Gap in Healthcare With more than 32 million Hispanics in the United States, half of whom speak only Spanish, healthcare professionals today are faced with a number of challenges on the job. The biggest obstacle many U.S. healthcare providers face is the obvious language barrier that exists with patients who don’t speak English. It’s a problem of particular relevance, as the US has the third-largest Hispanic population anywhere in the world! Hispanics make up 15% (2007 U.S. Census Bureau) of our population and that number is projected to grow exponentially. One of every eight American is of Hispanic descent and the number is projected to steadily increase to 98 million. ... http://w3.rn.com/News/news_features_details.aspx?Id=33600

*************
Progress Toward Ovarian Cancer Early Detection: Strategies, Guidelines, and Clinical Trials Drescher CW et al. – Women at high risk for ovarian cancer based on gene mutations or a significant family history are candidates for ovarian cancer screening using CA–125 and TVS and/or risk reduction surgery. Routine population–based screening is not currently recommended. Early results from randomized trials demonstrate that screening detects many ovarian cancers prior to clinical diagnosis. The impact of screening on ovarian cancer mortality requires additional study. ... http://www.femalepatient.com/html/arc/sig/Gyn/articles/035_04_022.asp
********************
(Reuters 4/21) - Shutting off a single gene can help stop the cascade of damage that can paralyze people with spinal cord injuries, U.S. researchers reported on Wednesday. They propose using a common, generic diabetes drug in combination with a gene-silencing technique to stop spine injuries from getting any worse, and believe the approach may also work in people with stroke and traumatic brain injuries. Their experiment, published in the journal Science Translational Medicine, shows it is possible to stop the bleeding that can cause the damage from an injured spinal cord to spread and worsen.... http://www.reuters.com/article/idUSTRE63K4VB20100421?feedType=nl&feedName=ushealth1100
************

April 14, 2010 -- Today, Voice of America ran "Nurse, I Need a Reality Check: Hollywood shapes many perceptions of medical professionals but that's a problem for real-life nurses," a helpful, in-depth piece about Hollywood's portrayal of nursing by Faiza Elmasry. The piece featured extensive quotes from Truth executive director Sandy Summers and nurses at Johns Hopkins Hospital. see the article and hear the radio report... http://www1.voanews.com/english/news/american-life/Nurse-I-Need-a-Reality-Check-90822599.html

**********************

FDA turns attention to radiation therapy devices The U.S. Food and Drug Administration said on Thursday it has received nearly 1,200 complaints in the last decade about devices that deliver radiation treatments to cancer patients and has called on manufacturers to help improve safety.
The FDA sent letters to 93 makers of radiation treatment devices, urging them to attend a workshop to address concerns about patient exposure to excess radiation from medical treatments and procedures.

Companies sent letters include Varian Medical Systems, Siemens, Philips, GE Healthcare, Hitachi Ltd and several private firms.

Radiation exposure became a major concern in October after the FDA said it was investigating 206 cases of patients being exposed to toxic doses of radiation during CT scans of the brain at Cedars-Sinai Medical Center in Los Angeles.... http://www.reuters.com/article/idUSTRE6374IP20100408?feedType=nl&feedName=ushealth1100

************************

RANDOM FACT: Forest fires move faster uphill than downhill.
*************************

Factors associated with safe patient handling behaviors among critical care nurses Lee S–J et al. – More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort–reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior. Safe work behaviors are best understood as socio–cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury. http://www3.interscience.wiley.com/journal/123362984/abstract

*******************
A once-a-day pill helped completely rebuild bone in rodents with severe osteoporosis, a finding that could lead to a new class of drugs to treat the brittle-bone disease in humans, U.S. researchers said. The team tested a compound that blocks the production of serotonin produced in the gut in mice and rats with a severe form of the disease and found they completely recovered their bone density.
"If you break the bone, it looks like a normal bone," said Dr. Gerard Karsenty of Columbia University Medical Center in New York, whose study appears in the journal Nature Medicine.

Using the findings, he said the team is working to develop this type of treatment for human patients with osteoporosis, in which bones become fragile and porous, increasing the risk of fracture.

"There is an urgent need to identify new, safe therapies that can increase bone formation on a long-term basis," Karsenty said.... http://www.reuters.com/article/idUSTRE6170QN20100208?feedType=nl&feedName=ushealth1100

***************************

Fruit, veggies, exercise -- they all make the heart-healthy list. And now, according to a new study, so does this breakfast staple: cereal.

But we're not talking about Cocoa Puffs. We're talking about whole-grain cereals -- like steel-cut oats, shredded wheat, or muesli. Men in a study who noshed at least once a week on whole-grain cereals were significantly less likely to experience heart failure.... http://www.realage.com/tips/a-breakfast-staple-that-blocks-heart-failure

*****************************

WASHINGTON (Reuters) - People who drink two or more sweetened soft drinks a week have a much higher risk of pancreatic cancer, an unusual but deadly cancer, researchers reported on Monday.
People who drank mostly fruit juice instead of sodas did not have the same risk, the study of 60,000 people in Singapore found. Sugar may be to blame but people who drink sweetened sodas regularly often have other poor health habits, said Mark Pereira of the University of Minnesota, who led the study.

"The high levels of sugar in soft drinks may be increasing the level of insulin in the body, which we think contributes to pancreatic cancer cell growth," Pereira said in a statement. Insulin, which helps the body metabolize sugar, is made in the pancreas.

Writing in the journal Cancer Epidemiology, Biomarkers & Prevention, Pereira and colleagues said they followed 60,524 men and women in the Singapore Chinese Health Study for 14 years.... http://www.reuters.com/article/idUSTRE6170NY20100208?feedType=nl&feedName=ushealth1100

***********

The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used world wide. A plant-based diet protects against chronic oxidative stress-related diseases. Dietary plants contain variable chemical families and amounts of antioxidants. It has been hypothesized that plant antioxidants may contribute to the beneficial health effects of dietary plants. Our objective was to develop a comprehensive food database consisting of the total antioxidant content of typical foods as well as other dietary items such as traditional medicine plants, herbs and spices and dietary supplements. This database is intended for use in a wide range of nutritional research, from in vitro and cell and animal studies, to clinical trials and nutritional epidemiological studies.... http://www.nutritionj.com/content/9/1/3
***********************
What’s In The Health Care Reform For Nurse Practitioners And Their Patients?
A preliminary analysis of the final Health Care Reform legislation includes: a nondiscrimination provision that includes nurse practitioners, recognition of nurse practitioners as primary care providers and leaders in public and home care medical home pilots and demonstrations, funding for nurse managed clinics; funding for graduate nurse education and post graduate experience demonstrations, inclusion in primary care Medicare payment increases, and inclusion in ACOs (Accountable care organizations). The bill language is replete with provider neutral language that will facilitate the utilization of nurse practitioners in many venues.... http://www.aanp.org/AANPCMS2/LegislationPractice/What%92s%2BIn%2BThe%2BHCR%2BFor%2BNurse%2BPractitioners%2BAnd%2BTheir%2BPatients.htm


*************************

NEW YORK (Reuters April 26) - U.S. Department of Health and Human Services Secretary Kathleen Sebelius has called on health insurer WellPoint to stop dropping coverage for patients recently diagnosed with breast cancer, calling the practice "deplorable."
http://www.reuters.com/article/idUSTRE63M2YM20100423?loomia_ow=t0:s0:a49:g43:r2:c0.093023:b33334166:z0
**************************

Care model strives for efficiency As a nurse practitioner at the CareMore Health Plan center in Modesto, Calif., Heather Del Villar is trying to keep Medicare patients with chronic diseases from going back to hospitals by remotely monitoring their health and providing immediate treatment. "We prevent their conditions from getting worse. It makes sense from the patient's standpoint, the medical standpoint and the business standpoint," Del Villar said. The Modesto Bee (Calif.) http://www.modbee.com/2010/04/26/1142432/care-model-strives-for-efficiency.html
**************

RANDOM TIDBIT: REM sleep may help developing brains mature. Premature babies have 75 per cent REM sleep, 10 per cent more than full-term babies. Similarly, a newborn kitten puppy rat or hampster experiences only REM sleep, while a newborn guinea pig (which is much more developed at birth) has almost no REM sleep at all.
****************
Child abuse drops sharply in U.S. Study: Incidents declined by 26% from 1993 to 2006 NEW YORK - A massive new federal study documents an unprecedented and dramatic decrease in incidents of serious child abuse, especially sexual abuse. Experts hailed the findings as proof that crackdowns and public awareness campaigns had made headway.
An estimated 553,000 children suffered physical, sexual or emotional abuse in 2005-06, down 26 percent from the estimated 743,200 abuse victims in 1993, the study found... http://www.msnbc.msn.com/id/35205114/ns/health-kids_and_parenting/ (personally, I believe that child abuse is now hidden better)

********************

Now here is something we all need to know......hmmm

RANDOM FACT: After eating, a housefly regurgitates its food and then eats it again.
*****************
NEW YORK (Reuters 4/28) - Sticking to a strict diet of mom's milk during the first 4 months of life may reduce a child's risk of developing asthma by their eighth birthday, according to a new study.

"Breast milk is the optimal food for infants during the first months of life," lead researcher Dr. Inger Kull of the Karolinska Institute in Stockholm, Sweden, told Reuters Health in an email. "But whether or not breastfeeding reduces the risk of asthma has been debated."

Through her milk, a mother transfers "good" bacteria, antibodies and proteins that can help thwart infection. But the evidence for how breastfeeding might influence the later development of asthma remains confusing, with various studies suggesting protective, neutral and even detrimental effects.... http://www.reuters.com/article/idUSTRE63R4TL20100428?feedType=nl&feedName=ushealth1100

***********

FDA probes risks of HIV, prostate, other (Reuters 5.3) The Food and Drug Administration said on Monday it was probing reports of liver toxicity with patients who used Kaletra to prevent HIV infection after exposure to the AIDS virus.

The agency also said it was investigating cases of male breast cancer in patients treated with Avodart as well as Merck & Co's prostate drug Proscar and baldness treatment Propecia.

The FDA releases a quarterly list of safety probes to inform the public about early investigations of potential side effects that have been reported. The list released on Monday covered issues identified between October and December 2009.

Being on the list does not mean the FDA has concluded the drug causes the specific risk, the agency said. http://www.reuters.com/article/idUSTRE6424DA20100503

***************************

BMI is not an accurate measure of obesity Obesity may be far more of a problem than experts realize because body mass index is an insensitive measure of excess body fat, researchers said. A study of more than 1,200 patients found 66% of those deemed obese based on dual-energy X-ray absorptiometry scans had BMI values in the non-obese range. ... http://abcnews.go.com/Health/Wellness/bmi-underestimates-prevalence-obesity/story?id=10521712
***************
43 OTC drugs for infants, children are recalled Johnson & Johnson's McNeil Consumer Health care unit voluntarily recalled batches of 43 nonprescription drugs for children and babies, including liquid formulations of Tylenol and Benadryl, because of manufacturing problems at the company's facility in Fort Washington, Pa., that were cited by the FDA. ... http://www.washingtonpost.com/wp-dyn/content/article/2010/05/01/AR2010050103051.html
***************
Issue Date: October 2006 Vol. 1 No. 1 Author: Ira Gene Reynolds, BSN, RN, PCCN-CMC Calculating I.V. drip rates with confidence While you're working your shift on the progressive care unit, the physician phones in an order to start a patient's I.V. dopamine infusion at 5 mcg/kg/minute. As you hang up the phone, your mind starts to race: How fast should I set the infusion pump to deliver 5 mcg/kg/minute? Will I be able to remember the complex drip rate equation I learned in nursing school? Will I have to mix the solution or will it come premixed? Will I have to titrate the drug myself, or will I get a regular physician's order? If I need to titrate it myself, can I do this on my unit?
Many nurses are expected to deliver and titrate I.V. drugs regularly. Such factors as unit protocols, titration policies, and the specific drug ordered determine exactly how you'll deliver and titrate an I.V. drug.

Today, with an emphasis on patient safety, the pharmacy staff customarily mixes the majority of drug solutions and also may calculate infusion pump rates. Many pharmaceutical companies have gotten in on the act, too, providing a drip rate matrix.

Although many I.V. infusion pumps calculate drip rates automatically, these rates must be double-checked to ensure patient safety. So chances are you'll need to calculate I.V. drip rates and titration scales yourself.

If you feel uneasy when performing these critical tasks, you're not alone. To boost your confidence, this article presents simplified equations to help you breeze through selected I.V. drip rate calculations.

NOTE TO READER: For the sake of accuracy, the rest of this article is available in PDF format only: http://www.americannursetoday.com/assets/0/434/436/440/6182/6184/6190/6208/0d39b2a0e79043daa 93d29d73cf4681a.pdf

http://www.americannursetoday.com/Article.aspx?id=6208&fid=6182
***************************
Your heart disease risk could probably be lower with a little more of this nutrient on board: vitamin D. Older adults who had the highest blood levels of vitamin D enjoyed a 33 percent lower risk of developing heart disease in a recent study. And supplements are a fine source. You can also look to sunshine and fortified dairy products to get your fill of D.

Beyond Bone Health Vitamin D has long been touted for its benefits to bone health. But more and more research is showing a bigger role in health. In a study, adults who had the highest levels of D had the lowest level of "cardiometabolic disorders" -- the family of conditions that includes heart disease, diabetes, and metabolic syndrome. ... http://www.realage.com/tips/take-this-supplement-for-heart-health

************************

Get more nutrition with every bite when you choose chickpeas that are dark in color. Black, red, purple -- chickpeas come in more colors than basic beige. And a recent study indicates that dark-hued chickpeas may have as much as 13 times more polyphenols in each serving.

Your True Colors With 6 grams of protein, 5 grams of fiber, and a scant 140 calories per half-cup serving, chickpeas are a dieter's dream. And not only will you get more polyphenols in the darker varieties, but those extra polyphenols pack 31 times more antioxidant power compared to the lighter colored legumes, research shows. In fact, the antioxidant powers of dark chickpeas power right past those of dried fruit, most nuts, and many other legumes.... http://www.realage.com/tips/choose-this-color-chickpea

*****************

RANDOM FACT: Almonds are part of the peach family.
***************
Study Shows RN Ratios Save Lives A new study provides evidence that California’s RN-to-patient staffing law reduces patient mortality, assures nurses spend more time with patients and promotes retention of experienced RNs. The study, published by Health Services Research, was conducted by University of Pennsylvania researchers led by Linda Aiken, RN, PhD, director of the Center for Health Outcomes and Policy Research at the school of nursing.

Surveying more than 22,000 RNs in California and two comparable states, Pennsylvania and New Jersey, the researchers found New Jersey hospitals would have 14% fewer patient deaths and Pennsylvania 11% fewer deaths if they matched California’s 1:5 ratios in surgical units.

Fewer California RNs miss changes in patient conditions because of their workload than New Jersey or Pennsylvania RNs, the researchers said.... (My daughter, a Florida nurse on a step-down cardiac unit, has a minimum of 7 patients !) http://news.nurse.com/article/20100423/NATIONAL02/105030017/-1/frontpage

(I think this article is "preaching to the choir"........the hospital administrations need to digest these facts).
***********************

Trepp R et al. –Knowledge of diabetes is mediocre among medical and nursing house staff. For physicians, the knowledge level depends on the speciality (internal medicine better than surgery and gynaecology) and correlates with the comfort level in dealing with diabetes, but is not higher in attending physicians than in residents. Nurses have a high comfort level, which, however, does not correlate with knowledge, which is similar in medicine, surgery and student nurses, but low in gynaecology.... Free full text pdf http://www.smw.ch/docs/PdfContent/smw-12974.pdf
**********************

Popular Diet Plans Can Unclog Arteries Low-fat, low-carbohydrate and Mediterranean diets ( http://www.healthday.com/Article.asp?AID=636488) all can help to reverse thickening of the artery walls that can lead to heart attack and stroke, Israeli researchers said. They found that even if weight loss is only moderate, sticking to the diets long-term can reverse atherosclerosis. HealthDay News http://www.healthday.com/Article.asp?AID=636488
***********************
Your body might be able to break down fat better if you do this one simple thing: stand more. A small study suggests that when people sit around too much, enzymes that help break down fat are practically turned off. Bad news not just for your waist but also for your heart and artery health. The solution? Fidget, pace, get up, get down. Do whatever you have to do to move those legs of yours. Often.... http://www.realage.com/tips/lose-fat-just-by-standing

**************

Fundamental Patterns of Knowing in Nursing: the Challenge of Evidence-Based Practice Porter et al. – This article reconsiders the fundamental patterns of knowing in nursing in light of the challenge of narrow empirics in the form of evidence–based practice. Objections to the dominance of evidence–based practice are reviewed, and the reasons for it are examined. This ineffability can be countered only by introducing a wider form of empirics than countenanced by evidence–based practice into all patterns of knowing, to demonstrate their salience and to make their use in practice transparent. ... http://journals.lww.com/advancesinnursingscience/Abstract/2010/01000/ Fundamental_Patterns_of_Knowing_in_Nursing__The.3.aspx
*************
RANDOM FACT: Antarctica has as much ice as the Atlantic Ocean has water.
****************

Inkjet'like device 'prints' cells right over burns WINSTON-SALEM, North Carolina (Reuters 4/8) - Inspired by a standard office inkjet printer, U.S. researchers have rigged up a device that can spray skin cells directly onto burn victims, quickly protecting and healing their wounds as an alternative to skin grafts....
http://www.reuters.com/article/idUSTRE63657520100408?feedType=nl&feedName=ushealth1100
*****************
RANDOM FACT: Your body is creating and killing 15 million red blood cells per second!
********************
New Drug Shows Promise for Curing Hepatitis C Antiviral telaprevir works when previous treatments failed, trial results show WEDNESDAY, April 7 (HealthDay News) -- Adding the antiviral drug telaprevir to a second-round treatment for hepatitis cures about half the people who were not helped in the first round, new research shows.

"This is the first large study in patients who had not responded to standard treatment," said Dr. John G. McHutchison, associate director of the Duke Clinical Research Institute and lead author of a report in the April 8 issue of the New England Journal of Medicine.... http://www.healthday.com/Article.asp?AID=637811

*******************

TODAY'S THRIFTY TIP: After heating and cooling, water heating is typically the largest energy user in the home because it is necessary for so many domestic activities. So it pays to keep your water heater working as efficiently as possible like lowering the water temperature thermostat by ten degrees and wrapping the water tank in an insulating blanket. But there is a simple and very important part of maintenance that many people ignore or don't even know about.

In the course of normal use, minerals and natural sediment in your water condense and settle to the bottom of your water heater. This sediment can seriously impede the efficiency of your water heater and can eventually cause it to malfunction, not to mention the fact that the sediment will eventually start to get into your tap water.

Learning how to clean hot water heater sediment is easy: First turn off the power so you don't risk electrical shock or burn out your element. Then turn off the cold water valve to the tank. Attach a garden hose to the tank drain valve and then drain a few gallons of the hot water in the tank through the hose. Then close the drain valve and open the cold water valve and you're ready to use the tank again.
*************************
RANDOM FACT: The average human head has about 100,000 hairs
**********************

“Over my 20 years in neonatal nursing, I’ve seen an evolution of change to a more baby-driven approach, rather than a nurse-driven or parent-driven one,” said Kim Guglielmo, RN, (at left in photo) a clinical nurse at UNC Health Care’s Newborn Critical Care Center in Chapel Hill, NC.

The trend of cue-based feeding in the NICU has nurses paying more attention than ever to signals young patients provide about their hunger. A recent study links hunger-based feeding with shorter lengths of stay. ... http://nursing.advanceweb.com/Regional-Articles/Features/Promoting-Early-Discharge-in-NICU.aspx?prg=15



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

HUMOR SECTION


An elderly man was on the operating table awaiting surgery. He had insisted that his son, a renowned surgeon, perform the operation. As he was about to receive anesthesia, he asked to speak to his son.

"Yes, Dad, what is it?"

" Don't be nervous. Do your best. And just remember, if something happens to me, your mother is going to come to live with you and your wife."


~~**~~**~~**~~**~~**~~
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/ !


~~**~~**~~**~~**~~**~~
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://nursenetworkers.com/ Check this site out....it's new and seems interesting

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

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

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

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

The Nursing Site http://thenursingsite.com .

http://www.snopes.com

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

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

National Do Not Call Registry

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

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
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/
** http://www.chegg.com/ Cheap textbook rentals. Best way to rent books for college

*******************************************************
********************************************
*
MEDICAL RECALLS
*
*******************************************
******************************************************

LIFEPAK 15 Monitor/Defibrillator by Physio-Control Inc. FDA notified healthcare professionals of a Class I recall of LIFEPAK 15 Monitor/Defibrillator manufactured and distributed between Marcy 26, 2009 and December 15, 2009. There is a potential for the device to unexpectedly:
Power Off then On by itself.
Power Off then NOT turn On.
Power Off by itself requiring the operator to turn it back On.
Stay powered On and not allow itself to be turned Off.
Healthcare professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm209467.htm

***********************

Coviden Initiates Voluntary Recall of Certain Shiley™ Tracheostomy Tubes FDA and Coviden notified healthcare professionals of a recall of certain lots of its cuffed ShileyTM tracheostomy tubes and Custom/Specialty tracheostomy tubes due to the product’s cuff not holding air as a result of leaks in the pilot balloon inflation assembly. With respect to the affected units, if a cuff does not hold air, ventilation will be adversely affected since the ability to generate positive pressure in the airway could be compromised by lack of cuff seal. This could result in a sudden decrease in the amount of oxygen in the blood or a sudden increase in the amount of carbon dioxide in the blood, especially if the patient requires assisted mechanical ventilation. In some instances, this could result in serious injury, including death.
The voluntary recall only affects lot numbers from a specific period of time. Only Shiley tracheostomy tubes from lot numbers listed in the firms' press release are affected by this action. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts

***************************

Cardiac Science Automated External Defibrillators - Powerheart, Cardiovive, NK, Responder models: Class I Recall [UPDATED 04/27/2010] This update alerts users that Nihon Kohden (NK) and GE Responder models are also affected although they were not identified in earlier communications about this recall. In addition, Cardiac Science issued a software upgrade for the devices’ self tests on 02/24/10 for the Powerheart automatic external defibrillators (Models 9390A and 9390E) and is planning on issuing a similar software upgrade for other affected devices. However, FDA’s review of the updated software indicates that it detects some but not all electrical component defects. Updated recommendations and complete list of affected models can be found in the 04/27/2010 Medical Device Update. http://www.fda.gov/Safety/MedWatch/SafetyInformation /SafetyAlertsforHumanMedicalProducts/ucm205165.htm

*********************

McNeil Consumer Healthcare Over-the-Counter Infants’ and Children’s Products: Recall including Tylenol, Motrin, Zyrtec, and Benadryl products McNeil Consumer Healthcare and FDA notified healthcare professionals of a voluntary recall of certain over-the-counter (OTC) Children’s and Infants’ liquid products manufactured in the United States, including Tylenol, Motrin, Zyrtec, and Benadryl products. Some of these products may not meet required quality standards. This recall is not being undertaken on the basis of adverse medical events. However, as a precautionary measure, parents and caregivers should not administer these products to their children. These products were distributed in the United States, Canada, Dominican Republic, Dubai (UAE), Fiji, Guam, Guatemala, Jamaica, Puerto Rico, Panama, Trinidad & Tobago, and Kuwait. See the company Press Release for a list of products affected by this recall. Consumers can contact the company at 1-888-222-6036 and also at www.mcneilproductrecall.com . http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm210442.htm

********************

Camolyn eye drops, Fisiolin nasal drops: Voluntary recall due to non-sterility US Oftalmi and FDA notified healthcare professionals of the nationwide recall of all over-the-counter eye drops and nasal drops, initiated due to conditions at the manufacturing facility that cannot assure the sterility of the products. Products that are non-sterile have the potential to cause eye infections, which may be sight threatening. Products are packaged in 15mL plastic bottles and were distributed nationwide to food and drug distributors. The products affected by this recall with lot numbers, expiration dates and UPC codes are noted below. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlerts forHumanMedicalProducts/ucm207794.htm
****************
Stud Capsule For Men: Product contains Undeclared Drug Ingredient Kanec USA and FDA notified healthcare professionals of a nationwide recall of Stud Capsule For Men [Lot #060607-01/060108-01, Exp 6-2013], after being informed by FDA that laboratory analysis of a sample found the product to be adulterated with sildenafil, an FDA approved drug. The products are sold as a blister pack containing one capsule per unit of use 24-packs in a Box. Lot number and expiration date appears on the seal. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
**************
FDA notified healthcare professionals of the Class 1 recall of certain lots of the BD Q-Syte Luer Access Split Septum device and other finished products, including kits and trays, sold by other companies in which the Q-Syte Luer Access device is a component. This device is used with other infusion therapy products to administer therapies, such as chemotherapy, blood and fluids into the intravenous system. The affected BD products were distributed from August 1, 2008 through February 1, 2010.

These lots of the BD Q-Syte Luer Access Split Septum devices are defective, which may result in air bubbles leaking into the infusion system and into the patient’s bloodstream, resulting in an air embolism. In addition, these defective devices may result in leakage of therapy being infused and result in incomplete inadequate administration of therapy. There is also a potential for blood leakage through this defect. These problems may result in serious injuries or death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlerts forHumanMedicalProducts

***************

Boston Scientific Implantable Cardioverter Defibrillators: Recall FDA notified healthcare professionals that FDA has been notified by Boston Scientific that it has stopped shipment and started recalling all of its implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) that have not yet been implanted.

FDA is advising practitioners that they should not use these devices unless and until the agency reviews and approves the changes the company has made. FDA is not aware of new safety concerns and, therefore, does not recommend that any of the devices subject to the recall be explanted. Product families included in this advisory include Boston Scientific’s Cognis, Confient, Livian, Prizm, Renewal, Teligen and Vitality. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm205409.htm

***************************

Natural Wellness and FDA notified consumers that MasXtreme, a product sold as a dietary supplement contains aildenafil close in structure to sildenafil and is expected to possess a similar pharmacological and adverse event profile as well as the drug phentolamine which is an alpha-adrenergic blocker. This may pose a threat to consumers because aildenafil may interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. Common side effects of phentolamine include arrhythmia (abnormal heart rhythm) and tachycardia (rapid heart beat).

MasXtreme is sold in blister packs containing one (1) capsule. The product is distributed nationwide by Natural Wellness Inc. Consumers who have purchased MasXtreme capsules are urged to immediately discontinue their use. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm206791.htm

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

NURSING HINTS CORNER

(why don't you send in your hints? ...I would appreciate it)

Smooth Move: When I need to transfer an obese patient from one bed to another, I slide the patient and his mattress onto the new bed. Mattress handles make this easy to accomplish. This method reduces strain and discomfort for both the patient and the nurse. It also works well with patients who have difficulty moving. Fay Stout, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 41, Springhouse Corporation/www.springnetcom.

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


~~**~~**~~**~~**~~**~~
NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:

Our newest member: jessicafreeman4@yahoo.com (Jessica) April 28, 2010


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

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

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


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

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

~~**~~**~~**~~**~~**~~
THOUGHT FOR THE DAY


What a cruel thing is war: to separate & destroy families
and friends, and mar the purest joys and happiness God has
granted us in this world; to fill our hearts with hatred
instead of love for our neighbors, and to devastate the
fair face of this beautiful world.

Robert E. Lee, to his wife, 1864


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