Paradigm Bytes for Paradigm97

PARADIGM BYTES
Newsletter for Paradigm 97
February 12, 2011

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

DEATH BY DISRESPECT October 2010 -- The cover story in this month's Reader's Digest offers a fairly strong look at hospital errors, relying mainly on short personal essays by five health professionals. Three are physicians, and the feature has other physician-centric elements, including the title on the magazine's cover, "Doctors Confess Their Fatal Mistakes." But the final essay is by nurse Sunnie Bell, who gives a powerful account of how a patient died because a physician ignored Bell's warnings. Bell then urges several specific improvements in nurses' working conditions. Her essay vividly illustrates how disrespect for nursing can kill, and it at least suggests the role nurses should play as patient advocates. Another piece, a sad story by a pharmacist who was criminally prosecuted for a deadly error, also shows that physicians are not the only health professionals whose work matters. One of the physician pieces is by Johns Hopkins's Peter Pronovost, a health care errors expert who has become well known for his efforts to promote the use of checklists and other safety measures. Pronovost makes a point, as he often does, to include nursing empowerment as a key element of reform. And a sidebar with short descriptions of some new patient safety ideas includes one about Boston's Brigham and Women's Hospital, where "WalkRounds" are done by "senior executives," a category that reportedly includes the chief nursing officer! Some publications would have mentioned only the CEO and the chief of medicine. Unfortunately, an essay by University of California San Francisco physician Robert Wachter indicates a distressing lack of awareness of the role nurses play in monitoring patient conditions and in hospital care generally, as the author attributes a failure to detect an impending pulmonary embolism 30 years ago solely to himself (as a second year medical student) and the hierarchy of physicians on duty. On the whole, though, Joe Kita's cover story includes nursing to an extent that is unusual for such an influential publication. We commend him and Reader's Digest.
The 12-page feature's general introductory material is somewhat more inclusive of nurses than the magazine cover. The table of contents describes the article, "White Coat Confessions," this way: "Doctors, nurses, and pharmacists hold your life in their hands. Here, their shocking stories of what can go wrong--and what must change to keep us safe." Of course, it's far from widely understood that nurses are among those who hold patients' lives in their hands, so this is helpful. The feature begins with a short introduction by Kita, who briefly explains the prevalence of hospital errors. As an example, Kita uses a diagnostic error by one of the physician essayists, University of Nevada ED physician Bryan Bledsoe. And Kita relies on Pronovost for expert input on the need to talk about the errors problem despite practitioners' fear of doing so. This part of the feature gives the general impression that physician errors are what matter, and that we need better systems to prevent them. However, Kita does at least note that the traditional reluctance to admit errors is changing because "doctors, nurses, and pharmacists" all stepped forward for this piece to say "I'm sorry," and more importantly to address the flawed systems that make the errors possible. http://www.truthaboutnursing.org/news/2010/oct/rd.html

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ABSTRACT Background: Sickness absence leads to understaffing and interferes with nursing efficiency and quality. It has been reported in literature that managerial leadership is associated with self-reported sickness absence in the working population.
Purposes: This study investigated the relationship between managerial leadership and sickness absence in health care by associating nurse managers' leadership styles with registered sickness absence among their nursing staff.

Methodology: The cross-sectional study included 699 nurses working in six wards (staff range = 91-140 employees) of a Dutch somatic hospital employing a total of 1,153 persons. The nurse managers heading the wards were asked to complete the Leadership Effectiveness and Adaptability Description questionnaire for situational leadership. The Leadership Effectiveness and Adaptability Description scores were linked to employer-registered nursing staff sickness absence.

Findings: High relationship-high task behavior (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.65-0.85) and high relationship-low task behavior (OR = 0.37, 95% CI = 0.14 -0.98) were inversely related to the number of short (one to seven consecutive days) episodes of sickness absence among the staff. Low relationship-high task styles (OR = 2.44, 95% CI = 1.14-5.22) as well as low relationship-low task styles (OR = 2.44, 95% CI = 1.26-4.71) were positively associated with the number of short episodes of sickness absence. However, the leadership styles only explained 10% of the variance in short episodes of sickness absence.

Practice Implications: Leadership styles are associated with registered sickness absence. The nursing staff of relationship-oriented nurse managers has fewer short episodes of sickness absence than the staff of task-oriented managers. Training nurse managers in relational leadership styles may reduce understaffing and improve nursing efficiency and quality. (unfortunately, this is only the abstract; the full article has to be purchased)

http://journals.lww.com/hcmrjournal/Abstract/2011/01000/ Leadership_styles_of_nurse_managers_and_registered.9.aspx

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

Being a good nurse and doing the right thing: A replication study Nurs Ethics February 1, 2011 vol. 18 no. 1 54-63 This qualitative research study, a replication of a study published in 2002, investigated the qualities of a good nurse and the role ethics plays in decision making. After reviewing the limitations of the published work, the current study implemented modifications related to the research questions, sample selection, data collection, and use of software for data analysis. The original study identified seven categories that related to being a good nurse and doing the right thing. In the present study, the use of relational analysis led to the recognition of four categories: (1) personal traits and attributes; (2) technical skills and management of care; (3) work environment and co-workers; and (4) caring and caring behaviors. To understand what it means to be a good nurse and do the right thing is a complex task; however, this research adds to the small amount of empirical data that exists to describe those characteristics. Full text is free....in PDF form. available on the site:
http://nej.sagepub.com/content/18/1/54.abstract
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Monitoring by Nurses Aids Chronic Illness care-- Patients with chronic illnesses and coexisting depression had significantly better control of both conditions when medically supervised nurses provided guideline-based care, data from a randomized trial showed.

Outcomes related to diabetes, hypertension, and dyslipidemia all improved significantly more with the nursing-based care versus usual care (P<0.001), and depression scores declined significantly (P<0.001).

Patients received care that was more consistent with guidelines (P=0.006 to P<0.001), and they had better quality of life and were more satisfied with their care compared with patients in the usual-care arm (P<0.001), as reported in the Dec. 30 issue of the New England Journal of Medicine.

"The intervention was associated with improved outcomes among the joint primary disease-control measures in depressed patients with poorly controlled diabetes, coronary heart disease, or both," Wayne J. Katon, MD, of the University of Washington in Seattle, and co-authors wrote. ... http://www.medpagetoday.com/Psychiatry/Depression/24132

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RANDOM FACT: A 2005 National Household Survey on Drug Use and Health indicates that 46 percent of U.S. residents 12 years of age and older have tried marijuana one or more times.
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( Why don't hospital CEO's etc. take note of these studies and consider the financial impact if any suits would be filed by the patients?)

Nurses' Long Shifts "may" (my quotation marks) Put Hospital Patients at Risk: Study WEDNESDAY, Jan. 19 (HealthDay News) -- Patients in hospitals where nurses work long hours are much more likely to die of pneumonia and heart attack, researchers have found.

In most U.S. hospitals, nurses work 12-hour shifts exclusively, a trend that began during the 1980s due to nationwide nursing shortages, the authors of the new study explained.

"Although many nurses like these schedules because of the compressed nature of the work week, the long schedule, as well as shift work in general, leads to sleep deprivation," study author Alison Trinkoff, a professor at the University of Maryland School of Nursing, said in a university news release. ... http://consumer.healthday.com/Article.asp?AID=648964

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RANDOM FACT: A study done by a mathematician showed that getting in the shorter grocery store line is usually faster than the longer express line, even if the people in the shorter line have a lot more items.

Each extra person in line adds 48 seconds to the line length without even considering the items in the cart. Meanwhile, an extra item only costs you an extra 2.8 seconds. Therefore, you'd rather add 17 more items to the line than one extra person! (I tried this, and it really worked !)
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7 tips to improve your professional etiquette By Kathleen D. Pagana, PhD, RN
Etiquette is more than just please and thank-you. Knowing how to present yourself in a professional manner helps you stand out and increases your chance for career success. ... http://www.nursingcenter.com//upload/static/403753/NMIEeNews_Bonus_Dec09.htm
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Can adjustable glasses help kids in poor countries? Reuters For many children in poor nations, a simple pair of glasses can be out of reach. But a new study suggests relatively cheap specs that people can adjust themselves hold some promise.
The study, reported in the journal Ophthalmology, looked at the usefulness of "self-refracting" glasses for adolescents with vision problems, mostly nearsightedness.

The glasses are designed so that the wearer can adjust them to the right strength without the need for eye professionals, who are scarce in developing parts of the world. In parts of sub-Saharan Africa, for example, there is just one optometrist for every 1 million people. ... (hopefully, this innovation is for USA poor children, also.) http://www.reuters.com/article/2011/01/27/us-adjustable-glasses-idUSTRE70Q6G920110127?feedType=nl&feedName=ushealth1100

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HANDY HINT: If you've been yanking on a cork in a wine bottle and it just simply won't budge, here's a quick tip: Take a hot, wet towel and wrap it around the neck of the bottle. The heat will cause the glass to expand a little so the cork will pop right out.
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Artificial pancreas shows promise in pregnancy Reuters Scientists have shown how an "artificial pancreas" can help pregnant women with type 1 diabetes and say their finding could significantly reduce cases of stillbirth and death among diabetic expectant mothers.

British researchers used a so-called "closed-loop insulin delivery system" or artificial pancreas, in 10 pregnant women with Type 1 diabetes and found it provided the right amount of insulin at the right time, maintained near normal blood sugar, and prevented dangerous drops in blood sugar levels at night. ... http://www.reuters.com/article/2011/01/31/us-pancreas-diabetes-idUSTRE70U00N20110131?feedType=nl&feedName=ushealth1100

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CDC Offers Guidance for HIV Prophylaxis--in HIV/AIDS, So-called pre-exposure prophylaxis (PrEP) for HIV appears safe and at least partly effective, but clinicians and patients need to take care to avoid possible problems, the CDC said in an interim guidance.

A recent study showed that taking a daily antiretroviral pill containing two drugs could significantly reduce the risk of acquiring HIV, the agency noted in the Jan. 28 issue of Morbidity and Mortality Weekly Report.
But the agency cautioned that the finding applies only to people in the same circumstances as those in the trial -- men who have sex with men and who are at high risk of acquiring the virus -- and only if other aspects of the study are also translated. ... http://www.medpagetoday.com/HIVAIDS/HIVAIDS/24561

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The Importance of Nurses in Medication AdherenceMedications taken as prescribed can make a significant difference in people’s health, yet, time and again, nurses hear from patients that they have stopped taking a medication. The reasons often given are that: they felt better, so didn’t feel they needed the medicine anymore; they felt worse and blamed it on the drug; or they could not see the value in spending good money on something that seemingly offers little effect, even if it was controlling their blood pressure.

Adherence to medication regimens remains a challenge to improving outcomes. A recent article in The New England Journal of Medicine reported that as many as half of all patients do not take their medications as prescribed. The New England Healthcare Institute, a nonprofit health policy organization, estimates non-adherence costs the health care system up to $290 billion a year in avoidable medical spending. Many hospitalizations ... http://w3.rn.com/News/news_features_details.aspx?Id=36024

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RANDOM FACT According to the U.S. Department of Agriculture, dandelions are more nutritious than broccoli or spinach, contain more cancer-fighting beta-carotene than carrots, and are a rich source of calcium, iron, magnesium, potassium, thiamine, riboflavin, lecithin, and dietary fiber!
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The Association Between Shift Work and Unhealthy Weight: A Cross-Sectional Analysis From the Nurses and Midwives e-Cohort Study Journal of Occupational & Environmental Medicine:
February 2011 - Volume 53 - Issue 2 - p 153–158 doi: 10.1097/JOM.0b013e318205e1e8
Original Article
Objective: To examine the association between shift work and unhealthy weight among female nurses and midwives.

Methods: A cross-sectional study. Measurement outcomes included shift work, unhealthy weight (underweight: body mass index [BMI] < 18.5; overweight: BMI 25.0 to 29.9; obesity: BMI > 30.0), diet quality, physical-activity level, alcohol consumption, and smoking status.

Results: Among the 2494 participants (1259 day and 1235 shift workers), only 1% of the participants were underweight, 31.8% were overweight, and 26.9% were obese. After adjusting the selected confounders, shift workers were 1.15 times more likely to be overweight/obese than day workers (P = 0.013, 95% confidence interval, 1.03 to 1.28; P = 0.02, 95% confidence interval, 1.02 to 1.30, respectively).

Conclusions: Shift work is associated with higher risk of being overweight/obese. Longitudinal studies are being undertaken to better understand the causal relationship between shift work and unhealthy weight. (The full article may be purchased) http://journals.lww.com/joem/Abstract/2011/02000/The_ Association_Between_Shift_Work_and_Unhealthy.8.aspx

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Studies show swift impact of rotavirus vaccines Countries that vaccinate babies against rotavirus, which can cause severe diarrhea and kill in days, have significantly reduced the number of children admitted to hospitals with the disease, a report showed on Thursday.
Data from the United States, Australia, Mexico and El Salvador, where rotavirus vaccines have recently become part of routine childhood immunizations, show steep and swift falls in the number of children under five becoming ill with the virus.

The studies published in a supplement to The Pediatric Infectious Disease Journal, also show large reductions in rotavirus disease among older, unvaccinated children, suggesting that vaccination of babies may also limit the overall amount of virus transmission, giving what is known as "herd immunity." ... http://www.reuters.com/article/2011/01/20/us-rotavirus-vaccines-idUSTRE70J5MB20110120?feedType=nl&feedName=ushealth1100

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TRIVIA: The oceans cover 71% (and rising) of the Earth's surface and contain 97% of the Earth's water. Less than 1% is fresh water, and 2-3% is contained in glaciers and ice caps (and decreasing).
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The pressure at the deepest point in the ocean is more than 22 thousand pounds, or the equivalent of one person trying to support 50 jumbo jets.
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The highest tides in the world are at the Bay of Fundy, which separates New Brunswick from Nova Scotia. At some times of the year the difference between high and low tide is taller than a three-story building.
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The lowest known point on Earth, called the Challenger Deep, is 36,201 feet deep, in the Marianas Trench in the western Pacific. To get an idea of how deep that is, if you could take Mt. Everest and place it at the bottom of the trench there would still be over a mile of ocean above it.
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The Pacific Ocean, the world's largest water body, occupies a third of the Earth's surface. The Pacific contains about 25,000 islands (more than the total number in the rest of the world's oceans combined), almost all of which are found south of the equator.
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A mouthful of seawater may contain millions of bacterial cells, hundreds of thousands of phytoplankton and tens of thousands of zooplankton.
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Quality of Life and Urinary incontinence in Women Urinary incontinence greatly diminishes quality of life. It is important to diagnose the three main types of urinary incontinence correctly – stress, urge or mixed incontinence – and to evaluate the impact of incontinence on quality of life. After a detailed history, a bladder diary and questionnaires are the most useful tools with which to determine what aspects of quality of life are most impaired – daily, work-related, recreational or sexual activities. In general, urgency and urge incontinence have a worse effect on quality of life than stress urinary incontinence. Measures of quality of life have become essential in developing management plans and in follow-up. Maturitas Volume 68, Issue 2, Pages 137-142 (February 2011) Full text available http://www.maturitas.org/article/PIIS0378512210004172/abstract?rss=yes
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Effectiveness of Patient Simulation Manikins in Teaching Clinical Reasoning Skills to Undergraduate Nursing Students Human patient simulation manikins (HPSMs) are being used extensively in the education of health professionals, but their effectiveness in the teaching of clinical reasoning skills to undergraduate nursing students is not clear. The aim of this systematic review is to identify the best available evidence for their effectiveness in this regard. ...
http://www.mdlinx.com/read-article.cfm/3362966
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Get with the Guidelines: A Nurse's Quick-start Guide to Best Practices in Patient Safety : January 14, 2010 - Nurses are familiar with evidence-based care and the importance of following specific procedures that are based on “best practices” in health care delivery. But how can you keep up with all of the latest research, weed out the extraneous information and make sure you are following the most effective practices for you and your patients?

To help you get started, NurseZone has put together a list of current care guidelines from some of the most influential health care organizations and governing bodies, highlighting those that are most important to nurses.

Use this as your “guide to the guidelines” that are most likely to impact your daily nursing activities: #'s 1 through 7 ... http://www.nursezone.com/nursing-news-events/more-news.aspx?articleid=36008

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RANDOM FACT: The Andromeda galaxy is on a collision course with our galaxy, speeding at 720,000 mph. The catastrophic clash will likely occur in 3 billion years.
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Study debunks need for aggressive breast cancer surgery... Many breast cancer patients can skip aggressive lymph node surgery without increasing their chances of a recurrence or death if their disease shows limited spread, according to a study that has prompted changes in practice.

Under current guidelines, the often-debilitating surgery is done if the cancer has spread outside the breast to any lymph nodes.

In the study, rates of survival and of patients' remaining cancer-free were just as good whether the women with limited spread -- in one or two nearby nodes -- had lots more underarm nodes removed or skipped that major surgery.

At least 24,000 of the 180,000 U.S. women diagnosed every year with breast cancer have limited spread to lymph nodes. Under the standard approach, they would have a chunk of underarm tissue removed to check for further cancer spread, said Dr. Thomas Julian, a breast cancer specialist with West Penn Allegheny Healthcare System in Pittsburgh. He was not involved in the study. ...

That operation often leaves women with lasting arm swelling, stiffness and pain.

http://www.aolhealth.com/2011/02/09/study-debunks-need-for-aggressive-breast-cancer-surgery/?icid=main%7Chtmlws-main-n%7Cdl1%7Csec1_lnk3%7C200246
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Sandy Summers is a highly respected webmaster --- we nurses should support her site financially because she IS our voice to the media. Every little bit helps maintain her site. Please help. January 25, 2011 -- Much of the press coverage of the tragic January 8 shooting of U.S. Rep. Gabrielle Giffords and others in Tucson, Arizona, has focused on the responses of the local health care system. Unfortunately, as is generally the case in reporting about such mass casualty events, only physicians have been consulted about the victims' status, and the coverage has given the impression that physicians provided all the hospital care that mattered. A typical example is a 3,500-word report by Denise Grady and Jennifer Medina that ran on the front page of The New York Times on January 15. The long piece describes the experiences of a paramedic and the husband of one victim, but otherwise it is devoted to the actions, opinions, and feelings of five University of Arizona Medical Center (UMC) physicians, sending the message that physicians alone were responsible for the skilled hospital care the victims got, even though expert nurses kept them alive from the moment they arrived. No nurse is identified or quoted. This is not just a matter of fairness and accuracy. When millions of people are told, in riveting terms, that physicians alone save lives, it confirms that only physicians are worthy of real respect and resources to do their work. We did see one minor counter-example: a 565-word piece that ran today in the Arizona Daily Star and was aptly titled, "UMC nurses who staffed ICU called 'unsung heroes.'" more at: http://www.truthaboutnursing.org/news/2011/jan/25_tucson.html
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2010 Awards Rank Best and Worst Media Portrayals of Nursing (Please take a time out...and read these) -- The Truth About Nursing Awards rank the best and worst media portrayals of nursing that we've seen in 2010:
Ten Best Portrayals
Honorable Mention
Ten Worst Portrayals
I'm Saving the World, So It's OK If I Trample Nurses on the Way! Awards
news_alerts@truthaboutnursing.org

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Diabetes Soaring Among American Adults: Report The Agency for Healthcare Research and Quality reported that the number of Americans treated for diabetes increased from about 9 million to 19 million from 1996 to 2007, with rates increasing for all age groups studied. The agency's analysis also showed an increase of diabetes treatment costs -- from $18.5 billion to about $41 billion during the same period. http://consumer.healthday.com/Article.asp?AID=648552
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Autism-vaccine researcher a "fraud": medical journal WASHINGTON (Reuters) - Dr. Andrew Wakefield, the-now disgraced British doctor who published studies linking vaccines with autism, committed an "elaborate fraud" by faking data, the British Medical Journal said on Wednesday. ... http://www.reuters.com/article/2011/01/06/us-autism-vaccines-idUSTRE7050J420110106?feedType=nl&feedName=ushealth1100
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IDSA Targets MRSA With New Guidelines The Infectious Diseases Society of America rolled out its first-ever guidelines for treating methicillin-resistant Staphylococcus aureus – including recommendations to battle the growing threat posed by MRSA-related skin and soft-tissue infections.

The comprehensive guidelines also outline evidence-based approaches on topics ranging from personal hygiene and wound care to antibiotic therapies for invasive MRSA, as well as options after vancomycin treatment failure.

The guidelines’ primary objective is "to provide recommendations on the management of some of the most common clinical syndromes encountered by adult and pediatric clinicians who care for patients with MRSA infections," according to the executive summary, published online Jan. 5 (Clin. Infect. Dis. 2010 [doi:10.1093/cid/ciq146]) Guidelines download:
http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full.pdf

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RANDOM FACT: Nonsmokers who are exposed to second hand smoke at home or in the work place face a 30 percent increase in their chances of developing heart disease or lung cancer.
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End-of-Life Caregiving Trajectories--Clin Nurs Res The purpose of this study is to illustrate variations in caregiving trajectories as described by informal family caregivers providing end-of-life care. Instrumental case study methodology is used to contrast the nature, course, and duration of the phases of caregiving across three distinct end-of-life trajectories: expected death trajectory , mixed death trajectory, and unexpected death trajectory. The sample includes informal family caregivers (n = 46) providing unpaid end-of-life care to others suffering varied conditions (e.g., cancer, organ failure, amyotrophic lateral sclerosis). The unifying theme of end-of-life caregiving is “seeking normal” as family caregivers worked toward achieving a steady state, or sense of normal during their caregiving experiences. Distinct variations in the caregiving experience correspond to the death trajectory. Understanding caregiving trajectories that are manifest in typical cases encountered in clinical practice will guide nurses to better support informal caregivers as they traverse complex trajectories of end-of-life care. AbstractFree Full Text (PDF) Free to you
http://cnr.sagepub.com/content/20/1/7.abstract Published online before print September 27, 2010, doi: 10.1177/1054773810384852 Clin Nurs Res February 2011 vol. 20 no. 1 7-24
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Make onions even healthier with this storage Trick... Onions are fairly bursting with antioxidants and other nutritious goodies. But you can get even more out of them if you tuck them away for a spell.
Storing red onions for several months may boost their levels of cancer-fighting, heart-disease-diminishing quercetin by up to 30 percent, according to a new study.

Know Your Onions Thick-skinned storage onions are the perfect pantry addition. Not only do they make a great addition to savory soups, spinach salads, and crusty-bread sandwiches, but they store well, too. So snap up whatever you can find this summer, and keep the extras until fall. Choose a cool, dry, dark location, and store them in a mesh bag, a nylon stocking, or a container that allows the onions to breathe. Quercetin and isorhamnetin in sweet and red cultivars of onion (Allium cepa L.) at harvest, after field curing, heat treatment, and storage. Olsson, M. E. et al., Journal of Agricultural and Food Chemistry 2010 Feb 24;58(4):2323-2330. http://www.realage.com/tips/make-onions-even-healthier-with-this-storage-trick?eid=7208&memberid=4687812

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The effect of intimate partner violence and other forms of violence against women on health Abstract
Background There are many studies concerning the health consequences of intimate partner violence (IPV). However, little research has been done on the health consequences of other forms of violence against women (VAW) such as the violence perpetrated by male relatives, friends or strangers. The aims of this paper were: (i) to analyze the prevalence of different forms of VAW perpetrated by males at home, workplace and other social environments in Spain and (ii) to analyze whether IPV and other forms of VAW have a different or similar negative impact on women's health.

Methods A sample of 13 094 women interviewed in the Spanish National Health Survey 2006 was included. Outcomes were physical and mental health indicators. Predictor variables were IPV and other VAW forms. Logistic regression models were fitted.

Results The likelihood of coronary heart disease [OR: 5.28 (1.45–19.25)], chronic neck [OR: 2.01 (1.35–2.97)] and back pain [OR: 2.34 (1.53–3.57)] was higher among women who reported IPV than among those who did not. Similar associations were found in the case of women affected by other forms of VAW. Mental health problems, with the exception of psychotropic drug use, were more frequent and more strongly associated with IPV than with other forms of VAW.

Conclusion There are health inequities between battered and non-battered women, which may be related to exposure to not only IPV but also other forms of VAW.
http://jpubhealth.oxfordjournals.org/content/early/2010/12/31/pubmed.fdq101.abstract
J Public Health (2010) doi: 10.1093/pubmed/fdq101 First published online: December 31, 2010
Full Text (HTML)Free
Full Text (PDF)Free
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Once is not enough with Endo AAA Repair--in Surgery/Thoracic Surgery Reinterventions and readmissions occur more frequently after endovascular abdominal aortic aneurysm (AAA) repair than after open repair -- partly explaining why the early survival benefit seen with the endovascular approach disappears over time, researchers found.

A study of more than 45,000 Medicare patients who underwent elective AAA repairs over a three year period found that major and minor reinterventions were more common with endovascular repair (0.4 versus 0.2 per 100 person-years, P<0.001), according to Marc Schermerhorn, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

Ruptures were uncommon, but also occurred at a higher rate following endovascular repair (0.5 verus 0.1 per 100 person-years, P<0.001), the researchers reported in the January issue of the Journal of Vascular Surgery. ... http://www.medpagetoday.com/Surgery/ThoracicSurgery/24151
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Put away your ABCs, and start learning your CAB — compressions, airway, and breathing. That’s the message from the American Heart Association for both adult and pediatric cardiopulmonary resuscitation in the “2010 American Heart Association Guidelines for CPR and ECC.” The AHA now says both laypeople and healthcare professionals should start CPR by compressing the chest at least 100 times a minute. “Look, listen and feel” is out of the basic life support algorithm for laypeople.


http://news.nurse.com/article/20101206/NATIONAL01/112060070/-1/frontpage
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Many women face cancer risk ' due to waistlines' BBC News Nearly half of women in England are at increased risk of some cancers because of their large waistlines, says a cancer charity.
The World Cancer Research Fund warning is based on data from the Health Survey for England suggesting 44% have a waist size exceeding 31.5 inches (80cm).

Research has found that these women are [also] particularly at risk from bowel and breast cancer.

A third of men had a larger than recommended waistline. The Health Survey for England, which monitors trends in the country's health and is commissioned by the Department of Health, was published earlier this month. ... http://www.bbc.co.uk/news/health-12068966

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HCG weight-loss products are fraudulent, FDA says A popular type of weight-loss products, heavily promoted on the Internet, is fraudulent and illegal, Food and Drug Administration officials say. HCG weight-loss products that promise dramatic results and claim to be homeopathic are sold as drops, pellets and sprays on the Web, in drugstores and at General Nutrition Centers. They are supposed to be used in combination with a very low-calorie diet of 500 calories a day.
Many of the labels indicate the products contain HCG, or human chorionic gonadotropin, a hormone made by the placenta during pregnancy. The hormone itself is approved as a prescription treatment for infertility and other conditions.

There is no evidence the oral over-the-counter products are effective for weight loss, says Elizabeth Miller, FDA's leader for the Internet and health fraud team. While they may not be dangerous, they're at least "economic fraud," she says.

Because the products do not seem to be "a serious direct health hazard or a serious indirect health hazard," they have been a lower priority for FDA action than other products. Still, Miller says, "they could be subject to enforcement at any time. ... http://www.usatoday.com/yourlife/fitness/weight-loss-challenge/2011-01-24-hcgdiet24_ST_N.htm

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Factors affecting Wound Healing... In an ideal world, the complex and sophisticated natural wound-healing processes that are initiated in response to skin trauma would take effect instantly and resolve every wound, every time. Unfortunately, anyone involved in wound care knows that this is simply not the case. There are a number of reasons why certain wounds prove more reluctant to heal than others, from the age of the patient to the location of the wound. In this article, we will look briefly at some of the factors that can inhibit wound healing.


The particular characteristics of an individual wound are one of the key factors which determine its speed of healing. The size of wound is clearly an important consideration, but so too is its shape. Linear wounds close more quickly than rectangular wounds, which are generally quicker to heal than circular wounds. Healing is also inhibited in wounds that are desiccated, infected or which contain necrotic tissue or foreign bodies. ... http://woundeducators.net/profiles/blogs/factors-affecting-wound

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Fruit Facts:

RANDOM FACT: Lemons are thought to have originated in the wild both in China and India and have been in existence for at least 4,000 years. They were taken to the Middle East between 400 and 600 BC and then to the Mediterranean where food historians say they have been in cultivation from as early as the first century AD.
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The kiwi fruit has its origins in China's Yangtze River valley. The fruit has been around for over 700 years and was a favourite in the courts of the great Khans.
In the early 1900s, New Zealand missionaries took the seeds from kiwi fruit home where the plant was named for the indigenous bird. Plants were later sent to the United States, Italy, South Africa and Chile.

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The watermelon is of the same botanical family as cucumbers, pumpkins and squash. They were first harvested in Egypt about 5,000 years ago and are now grown in almost 100
countries. Every part of a watermelon is edible, even the seeds, and the rinds which are often pickled.

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The papaya, or paw paw, is believed to have originated in southern Mexico or Central America and now grows in all tropical and subtropical countries as the plants need warmth throughout the year. Papayas are the only natural source of papain, an effective natural digestive aid, which breaks
down protein and cleanses the digestive track.

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RANDOM FACT: Once squeezed, the vitamin C in an orange quickly begins to dissipate. After eight hours at room temperature or 24 hours in the refrigerator, the orange will experience a 20 percent vitamin C loss. ~~**~~**~~**~~**~~**~~ ~~**~~**~~**~~

HUMOR SECTION

After doctors set my broken arm and put a cast on it, I paid the bill and went on my way. Shortly thereafter, I received a bill from the hospital, this time for the $1.57 they claimed I still owed.

Apparently to prove that this was a hospital with heart, they included a payment book. It had me paying 3 cents a month for four years.

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Five-year-old Becky answered the door when the census taker came by. She told the census taker that her daddy was a doctor and wasn't home, because he was performing an appendectomy.

"My," said the census taker, "that sure is a big word for such a little girl. Do you know what it means?"

"Sure! Fifteen hundred bucks, and that doesn't even include the anesthesiologist!"

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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/ !


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

Back issues of the ISMP 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


Just pass your cursor over the area of the map to learn about that area's weather. http://www.wrh.noaa.gov/zoa/mwmap3.php?


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

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

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

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

The Nursing Site http://thenursingsite.com .

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

http://www.snopes.com

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

Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions

http://www.metric-conversions.org/

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*
MEDICAL RECALLS
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Fresenius Medical Care North America, CombiSet True Flow Series Hemodialysis Blood Tubing Set with Priming Set and Transducer Protectors for Use with the Blood Volume Monitor: Class I Recall - Potential for Kinking of Arterial Line
The hemodialysis blood tubing sets (The CombiSet Hemodialysis Blood Tubing Set) may develop kinking of the arterial line. Kinking can cause the destruction of red blood cells which may result in serious injury and/or death. This recall affects ONLY Part Number 03-2695-9 and Part Number 03-2795-7. These products were manufactured between June 11, 2010 and October 17, 2010. Part Number 03-2695-9 was distributed between August 2010 and November 2010. Part Number 03-2795-7 was distributed between August 2009 and November 2010. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm240588.htm

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Triad Alcohol Prep Pads, Alcohol Swabs, and Alcohol Swabsticks: Recall Due to Potential Microbial Contamination Sold by Cardinal Health, PSS Select, VersaPro, Boca/Ultilet, Moore Medical, Walgreens, CVS, Conzellin Triad Group, a manufacturer of over-the-counter products and FDA notified healthcare professionals and patients of the recall involving all lots of alcohol prep pads, alcohol swabs, and alcohol swabsticks manufactured by Triad but sold as private labels at the consumer level. This recall has been initiated due to concerns about potential contamination of the products with Bacillus cereus. This recall involves those products marked as STERILE as well as non-sterile products. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm239319.htm
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Metronidazole Tablets, 250mg: Recall - Underweight Tablets Teva Pharmaceuticals and FDA notified healthcare professionals and the public of a recall of Metronidazole Tablets USP, 250mg, lot #312566, expiration date 05/2012. This product lot is being recalled due to the presence of underweight tablets. Underweight tablets may not contain the full amount of active ingredient within a single tablet, and a consumer may not receive the prescribed dose. This may cause the infection the drug was intended to treat to worsen or recur, which could be life-threatening when treating severe infections. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm239312.htm
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AngioScore Inc., AngioSculpt Percutaneous Transluminal Angioplasty (PTA) Scoring Balloon Catheter OTW 0.018" Platform - Class I Recall The device was recalled because of a design defect causing unintended fracture and peeling, and has resulted in peeling of the bond and/or detachment of the distal end of the scoring element. Use of affected devices may lead to retained device fragments or significant arterial injury which may lead to death, or need for additional surgical intervention. This recall affects 17,682 units distributed from 09/2007 to 11/2010, including the following model part (REF) numbers and includes all sizes and lot codes for each model listed: 2076-4020, 2076-5020, 2076-6020, 2092-6020, 2105-6020. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm239029.htm
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Albuterol Sulfate Inhalation Solution 0.083%, 3 mL Unit Dose Vials: Recall - Mislabeled Unit Dose Vials The Ritedose Corporation is conducting a voluntary recall of 0.083% Albuterol Sulfate Inhalation Solution, 3 mL in 25, 30, and 60 unit dose vials. This product is being recalled because the 2.5 mg/3 mL single use vials are embossed with the wrong concentration of 0.5 mg/ 3 mL and therefore, represents a potential significant health hazard. Only the unit dose vials are incorrectly embossed as containing 0.5 mg/3 mL. The correct concentration of 2.5 mg/3 mL is labeled on the primary foil overwrap pouches and shelf cartons. Administration of this defective product could result in a range of potential health effects that spans from temporary and medically reversible to life threatening and death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm238624.htm
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Cumberland Pharmaceuticals Inc. recalled 6 lots of Acetadote (acetylcysteine--used in the emergency department, Acetadote is administered intravenously within 8 to 10 hours after ingestion of a potentially hepatotoxic quantity of acetaminophen) Injection, 20% solution (200mg/mL) in 30 mL single dose glass vials as a precautionary measure based on observed particulate matter found in a very small number of vials. The source of the particulate matter was from the glass vial produced by a former supplier. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm238494.htm
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NOTICE: Avastin (bevacizumab): Process for Removal of Breast Cancer Indication Begun FDA notified healthcare professionals and patients that it is recommending removing the breast cancer indication for Avastin (bevacizumab) because the drug has not been shown to be safe and effective for that use. The drug itself is not being removed from the market and today’s action will not have any immediate impact on its use in treating breast cancer. Today’s action will not affect the approvals for colon, kidney, brain, and lung cancers. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm237280.htm

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NURSING HINTS CORNER

Pinwheel Power: Here is a way to get a child to breathe deeply so that you can auscultate his lungs. Give him a colorful pinwheel to play with. You can auscultate his lungs as he takes deep breaths to make the wheel spin. Christine M. McGrath, RN
(if you have nursing hints...please send them in!!)

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.81, 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 MEMBER
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:

mirajosh@AOL.com (John) February 11, 2011


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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

OLD ADDRESS: jahered@aol.com

NEW ADDRESS: jaherreid@q.com (JoAnn)

and

OLD ADDRESS: acp517@aol.com

NEW ADDRESS: APelosa@gmail (Agnes)

and

OLD ADDRESS: springns88@yahoo.com

NEW ADDRESS: springns88@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

" Do not wait; the time will never be 'just right.'
Start where you stand, and work with
whatever tools you may have at your command,
and better tools will be found as you go along."


~George Herbert (1593-1633)


Hope to see you online---or you can always write !
RNFrankie@AOL.com