April 12, 2010 Tuesday

PARADIGM BYTES
Newsletter for Paradigm 97
April 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

Why does helping people understand nursing matter?
When people think nursing is unskilled loser work, or that, as in a recent Dr. Oz episode nurses exist to serve physicians, then nurses have a tough time getting the resources they need to provide good nursing care. Nurses are spread too thinly because many have been replaced by lesser-educated workers who can't assess or intervene as nurses can. Decision-makers believe that non-nurses can perform nursing work because they do not understand the nature or value of nursing. That leads to poor care--and sadly, even death.

The Truth About Nursing fights this deadly lack of understanding. Decision-makers get these wrong ideas from many sources, but especially by watching, reading and listening to the omnipresent media. The media constantly tells us that physicians are the only ones whose work matters. Physicians deserve credit for their good work, but not for the work of nurses. And when physicians get credit for nurses' work, they get the funding for it too. That's why nursing residencies only get $1 for every $375 that physicians residencies get. That's why the NIH gives nursing researchers only half of one percent of its budget. Nurses make up the largest body of health professionals in the U.S., working on the cutting edge of health care inventing innovative ways to deliver health care, and half of one percent is all they deserve?

As a report by the Institute of Medicine recently stressed, in order for the health care crisis to end, nurses must be a part of the decision-making process. That means more resources and respect.

Consider how hospitals are managed. Hospitals exist mainly to provide nursing care. If patients did not need nursing care, they would go to an outpatient center. Yet nurses rarely hold positions of leadership in hospitals; few nurses serve on hospital boards. Why should any nursing institution be run by anything less than a majority of nurses? Yet that's the status quo in the vast majority of health institutions across the world.

Nurses must become stronger.

They must become leaders of hospitals, non-profit organizations, and decision-making bodies within the government.

But that's not going to happen unless we work together to change the way people think about nursing. That means changing how the media depicts nurses. Particularly because of the quickly expanding elderly populations in many nations, the future of health care depends on nursing.

If people don't know what nursing is or why it matters, the profession won't get the funding it needs, and the global nursing shortage will continue to spiral out of control. More patients will suffer and die.

This is what we try to prevent every day. Please read about some of our 2010 achievements at our website and join us in our efforts. Thank you! Sandy Summers, RN, MSN, MPH

Co-author: Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk
Founder and Executive Director The Truth About Nursing ssummers@truthaboutnursing.org

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NEWS FROM THE MEMBERS

(This article is from our newest member: Maureen "Shawn" Kennedy)
IOM Report: The Evidence Shows the Future of Health Care Rests on the Backs of Nurses

October 8, 2010 By Shawn Kennedy, AJN interim editor-in-chief

This past Tuesday, I attended the release of the highly anticipated (at least by nursing) report by the Institute of Medicine (IOM) on the future of nursing. Spearheaded and supported by the Robert Wood Johnson Foundation (RWJF), the report provides a review of nursing’s role in health care and details what changes need to occur for the future—not just of nursing, but for the future health of the health care system.

While the findings support what nursing has been claiming all along—that nurses have a critical role in health care and the health care system needs nurses to practice to the full extent of their capability—what is especially important about this report is that it is backed by the IOM’s multidisciplinary panel and an “objective evaluation of evidence according to the robust evaluation processes of the National Academy of Sciences,” said John Rowe, a committee member and professor at Mailman School of Public Health at Columbia University. More….

Ms Kennedy writes, "I'm interested in knowing what staff nurses feel about the report. Do they feel it will support changes in hospital/institutional practices so that can practice more professionally? Anyone participating /considering participating on a local Regional Action Committee? " Shawn.

Maureen "Shawn" Kennedy, MA, RN Editor-in-Chief, American Journal of Nursing Wolters Kluwer Health

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Congratulations are in order for Hayat Barron !!!! He wrote: "Just wanted to share my good news with my virtual family: I finally took my CCRN exam yesterday and PASSED it. I couldn't believe it. I was sick as a dog for the last 3 days and I was closing my eyes during the test to rest so when I got the results I was surprised.....The test was loooong and hard. I thought for sure I had flunked it :) Oh, and to celebrate, I visited the urgent care center on the way back home and got a liter of NS IV because the doc thought I was dehydrated LOL"
Hayat Barron, BSN, ICU-RN, CCRN

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( I received this a while back, but want to include it in this newsletter) Debbie writes" I am Debbie Dasney RN (oneacre454@msn.com) , I am so tired with the nursing market, new RNs in the NYC area are being hired with LPN pay because of their lack of experience. I decided to join with two other RNs and we are being accredited by ANCC to be providers of nurse competency job training skills for specialty. We will have stimulated labs. My target market is 1199. NYSNA, and new grad's.
It will be a one week course and the cost range will be reasonable. When a nurse wants to change specialty, she/he are told that he/she has to have experience. so where do they acquire these competencies? We are hoping to fill that need with our courses."
She writes"The following are some examples of the simulation labs, future of nurse education, and nurse competency)

http://www.laerdal.com/us/nav/36/Medical-Education

http://www.laerdal.com/us/nav/36/Medical-Education

http://www.laerdal.com/us/nav/36/Medical-Education

http://www.laerdal.com/us/nav/36/Medical-Education
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MEDICAL NEWS

Not Playing Dead April 2, 2011 -- Today the News-Press of Fort Myers ran a short item about a march and rally of nurses at the Florida Capitol two days earlier that was led by a St. Bernard. Actually, the Tallahassee march was organized by nurses affiliated with the National Nurses Organizing Committee (NNOC), a national nurses' union. The dog, Paxton, came with NNOC member Gail Ghigna Hallas, RN, PhD, who explains in the piece that the nurses were there to seek legislation requiring minimum nurse staffing ratios. ... http://www.truthaboutnursing.org/news/2011/apr/02_florida.html
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Designer drug abuse out of control: U.N. drugs board - The problem of so-called "designer drugs" is running out of control in many regions of the world, the U.N. global drugs watchdog said Wednesday.
The International Narcotics Control Board (INCB) said detailed instructions for how to make designer drugs, which are slightly altered to bypass existing control systems, are often shared via the Internet. The report said the problem was "escalating out of control" and "major efforts" were needed to counter it.

"Given the health risks posed by the abuse of designer drugs, we urge governments to adopt national control measures to prevent the manufacture, trafficking in and abuse of these substances," Hamid Ghodse, the INCB's president, said at a briefing in London as the board's annual report was published. ... http://www.reuters.com/article/2011/03/02/us-narcotics-designer-drugs-idUSTRE72126J20110302?feedType=nl&feedName=ushealth1100

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FDA approves new treatment for a type of late-stage skin cancer The U.S. Food and Drug Administration today approved Yervoy (ipilimumab) to treat patients with late-stage (metastatic) melanoma, the most dangerous type of skin cancer.

Melanoma is the leading cause of death from skin disease. An estimated 68,130 new cases of melanoma were diagnosed in the United States during 2010 and about 8,700 people died from the disease, according to the National Cancer Institute.

“Late-stage melanoma is devastating, with very few treatment options for patients, none of which previously prolonged a patient’s life,” said Richard Pazdur, M.D., director of the Office of Oncology Drug Products in the FDA’s Center for Drug Evaluation and Research. "Yervoy is the first therapy approved by the FDA to clearly demonstrate that patients with metastatic melanoma live longer by taking this treatment." ...
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm1193237.htm
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Texas approves bill requiring sonogram before abortion Reuters Women seeking an abortion would have to first get an ultrasound under a measure approved on Thursday by the Texas House of Representatives.
The proposal, the first significant bill considered by the House this year, was designated by Republican Governor Rick Perry as an emergency priority. A similar measure has already been approved by the state Senate.

Women would have to get an ultrasound between 24 and 72 hours before an abortion, the bill says. They would view the sonogram, hear an explanation of the image and listen to the heartbeat, if it is audible. ... http://www.reuters.com/article/2011/03/04/us-texas-abortion-idUSTRE7230VK20110304?feedType=nl&feedName=ushealth1100 (What is your reaction?)

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INTERESTING READING

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


Developing competencies for end-of-life care in care homes The English Department of Health's End of Life Care Strategy suggests that suboptimal end-of-life care in care homes results from inadequate training of staff at all levels. This article reports on one hospice's pilot project that addressed the question, 'Does a competency development package provide a way in which the hospice can support improved end-of-life care in care homes in a sustainable way through education?' The project followed the Medical Research Council framework for the development and evaluation of complex interventions. ... http://www.internurse.com/cgi-bin/go.pl/library/article.cgi?uid=82845;article=IJPN_17_3_143
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RANDOM FACT: Carbon ( The name "carbon" comes from Latin carbo, coal), is the fourth most abundant chemical element in the universe by mass after hydrogen, helium, and oxygen.
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No Good Deed: A Story of Medicine, Murder Accusations, and the Debate over How We Die (2010). Most nurses provide palliative care, whether we work in acute care or end-of-life care, because we manage the symptoms of critically ill people who may die. But moral distress, anger, and misinformation can abound when we forget that others do not necessarily share our sense of ethics and morality. There are those who see our goal not as quality of life, but quantity of life. Reading this book really opened my eyes and increased my understanding of those who oppose quality-focused end-of-life care. I recommend the book not only because of the subject matter, but because of psychiatrist Lewis Cohen's recognition of nurses as equals who practice at the forefront of end-of-life care. ... (This book has received four star ratings)http://www.truthaboutnursing.org/media/books/no_good_deed.html
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When Alzheimer's turns violent (CNN.com)-- One minute, Sam Cohen, 80, points to photos of his kids and talks about how his son wanted to become an actor. The next minute, he unravels.
Cohen, a former New Jersey taxi driver and ironworker, is convinced his family will steal his money. He talks about escaping to Israel. He ignores his grown children's pleas to take his medication -- he tells them they've been brainwashed. And he threatens his wife, Haya.

"He is starting to make Charlie Sheen look rational," said his son, Michael Cohen, about his dad's Alzheimer's disease.

Earlier this month, he went from paranoid to physically violent. An attack on Haya put Cohen in a hospital psych ward. Sometimes, verbal rants, as in Cohen's case, escalate, leaving families in a bind. What can you do when your loved one with Alzheimer's becomes physically aggressive? ... http://www.cnn.com/2011/HEALTH/03/30/alzheimers.violence.caregiving/index.html

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RANDOM FACTS: McDonald's fast food restaurant opened an official school, Hamburger University, in Oak Brook, IL, in 1961. McDonald's purchases the more beef than any other entity in the world.
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Nursing homes to be judged by 21 new quality measures on federal website The National Quality Forum on Wednesday came out in support of 21 measures to be used to care for both long-term nursing home residents and short-stay patients. These measures will be included in the Centers for Medicare & Medicaid Services' Nursing Home Compare website. http://tinyurl.com/4w895m4
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HINTS:
When washing leather or canvas sneakers in the washing machine, slip them inside clean white socks to keep the laces from tangling and reduce noise you might get from shoes banging the machine. Wash in cold water and then let air-dry.


When storing lettuce in a plastic bag, put in a slice of bread. It absorbs moisture and prevents the lettuce from becoming rotten.
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Here are two quick weight loss tricks that are so simple, they're almost too good to be true: Just read and walk. Research shows that middle-aged adults who read food labels and also stick with a regular exercise program -- like walking -- are much more likely to succeed at weight loss than folks who practice just one of these little habits. ... http://www.realage.com/tips/reading-food-labels-key-to-weight-loss-success?eid=1098933003&memberid=4687812

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(Thank you, Barbara (BAcello) OIG releases report on nursing homes’ employment of people with criminal convictions By: MacKenzie Kimball March 2nd, 2011
The Office of Inspector General (OIG) recently released a report, titled Nursing Facilities’ Employment of Individuals With Criminal Convictions, that revealed some shocking statistics about nursing home staff nationwide. The report revealed that, based on analysis of criminal history records maintained by the Federal Bureau of Investigation (FBI), 92% of nursing facilities employed at least one individual with at least one criminal conviction. It also states that, overall, 5% of nursing facility employees had at least one criminal conviction.

According to the CMS interpretive guidelines, nursing facilities “must be thorough in their investigations of the past histories of individuals they are considering hiring.” However, there is no Federal law that requires nursing homes to conduct FBI or statewide criminal background checks. Based on the findings in this report, the OIG recommends that CMS develop background check procedures for nursing facility employees. http://oig.hhs.gov/oei/reports/oei-07-09-00110.asp
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Mission Possible: Nurse Scientists Improve Healthcare/ National Nursing News
The National Institute of Nursing Research (NINR) may not be a common topic of conversation on most hospital units, but behind the scenes the NINR has become a change-engine that is quietly — but profoundly — shaping the delivery of healthcare.

Case in point: The NINR funded research studies that developed and tested the effectiveness of a method of improving health outcomes among at-risk, chronically ill elderly patients. The method, known as the Transitional Care Model, involves a program of home visits and telephone support for patients after discharge. Nurse scientist Mary Naylor, RN, PhD, FAAN, a professor at the University of Pennsylvania School of Nursing, published her studies in 1994, 1999, and 2004 and testified before Congress in April 2009 that a TCM benefit could translate to improved outcomes for millions of older Americans and achieve substantial healthcare savings for the Medicare program. The Patient Protection and Affordable Care Act now includes provisions for coverage of pilot programs and demonstration projects that will further explore services such as transitional care. ... http://news.nurse.com/article/20110228/NATIONAL01/102280030/-1/frontpage
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RANDOM FACT #1: The fastest jet in the world is the SR-71 Blackbird, which flies more than three times the speed of sound at 2,500 mph.
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RANDOM FACT #2: The first functional jet was built by the Germans and flew combat missions during the last two years of World War II; its name was the Messerschmitt Me 262.
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Johnson & Johnson, which has been plagued by repeated recalls of its consumer medicines and medical devices over the past year, on Wednesday said it recalled 107 batches of surgical sutures in December due to potential sterility problems. The recall came to light on Wednesday after the United Kingdom Medicines and Healthcare products Regulatory Agency (MHRA) described the action on the agency's website.
The diversified healthcare company said the voluntary recall took place mostly in Europe and involved a total of 585,000 individual strands of sutures. The action stemmed from potentially faulty packaging seals on the individually wrapped sutures that raised a contamination risk, J&J said. ... http://www.reuters.com/article/2011/03/02/us-johnsonandjohnson-sutures-idUSTRE7217VQ20110302?feedType=nl&feedName=ushealth1100

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Updated USDA Dietary Guidelines Released
http://www.medscape.org/viewarticle/736605?src=cmemp
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TODAY'S THRIFTY TIP: Eat raw. Eat as many raw foods as you can. 84 percent of the vitamins are destroyed by cooking. 100 percent of the enzymes are killed when you heat food over 118 F. Minerals are coagulated and difficult to assimilate. In cooked food, because of coagulation, the protein is 50 percent less assimilated, as research showed at the Max Planck Institute for National Research in Germany. This means that a person needs to eat twice as much protein if it is cooked as opposed to raw.
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Half of the men in the general population may be infected with human papillomavirus or HPV, the human wart virus that causes cervical and other cancers, strengthening the case for vaccinating boys against HPV, U.S. researchers said on Monday.
U.S. vaccine advisers have been weighing whether boys and young men should be vaccinated against the human papillomavirus, as they already recommend for girls and young women, but some worry the vaccine is too costly to justify its use. ... http://www.reuters.com/article/2011/03/01/us-cancer-vaccine-idUSTRE7200CJ20110301?feedType=nl&feedName=ushealth1100 ***********************

DEFINITIONS OF Degradable and Biodegradable:

*Degradable A material that breaks down through chemical reactions rather than through the activity of microorganisms (fracture into smaller and smaller pieces). This is largely what the great Pacific garbage patch is made up of.

* Biodegradable A material that breaks down with the assistance of microorganisms, eventually returning to its original organic components.
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RANDOM FACT: Approximately 43.6 million Americans were living in poverty in 2009.

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ACIP Tweaks Pertussis Advice for Healthcare Workers The Advisory Committee on Immunization Practices (ACIP), which provides guidance to the CDC, has modified its recommendations for vaccinating healthcare workers against pertussis to remove obstacles to adherence.
In its 2005 guidelines, ACIP recommended that healthcare personnel with direct patient contact receive one dose of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) as soon as feasible and that other healthcare workers receive the vaccine when they are scheduled for their next dose of the tetanus and diphtheria toxoids vaccine (Td).

The guidance included a recommended interval as short as two years after the last Td dose. ... http://www.medpagetoday.com/PrimaryCare/Vaccines/25041

********************* (Thank you, Barbara... BAcello) Lifting the Fog Curetoday.com A current focus is to understand who is at risk for chemobrain so that patients can better gauge their risk for cognitive impairment. ... http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1642 ***********************

Unfortunate RANDOM FACTS: A mistake made by doctors in 2006 cost a 47 year-old Los Angeles man his healthy right testicle. They were supposed to remove the left one!
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12 newborns will be given to the wrong parents daily.
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There are two main types of brain cancer. Primary brain cancer starts in the brain. Metastatic brain cancer starts somewhere else in the body and moves to the brain. Brain tumors can be benign, with no cancer cells, or malignant, with cancer cells that grow quickly. Brain tumors can cause many symptoms. Some of the most common are
Headaches, usually worse in the morning
Nausea and vomiting
Changes in your ability to talk, hear or see
Problems with balance or walking
Problems with thinking or memory
Muscle jerking or twitching
Numbness or tingling in arms or legs
No one knows the exact causes of brain tumors. Doctors can seldom explain why one person develops a brain tumor and another does not. NIH: National Cancer Institute http://www.nlm.nih.gov/medlineplus/braincancer.html

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RANDOM FACT: In 2008 2,260 tons of gold was produced globally and around 26 tons of diamonds.
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12 lead EKG Interpretation Part #1
http://nursingpub.com/12-lead-ekg-explained-part-1
12 Lead EKG Interpretation Part #2 http://nursingpub.com/12-lead-ekg-interpretation-part-2
12 Lead EKG Interpretation Part #3
http://nursingpub.com/12-lead-ekg-interpretation-part-3
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WEDNESDAY, March 23 (HealthDay News) -- The risk of lung cancer for people who smoke menthol cigarettes is no greater than that of those who prefer regular cigarettes, researchers report.

The findings echo those of a U.S. Food and Drug Administration advisory panel that made headlines Friday when it said a ban on mentholated cigarettes might benefit the public health. While the panel concluded that menthols' minty flavor seems to help people take up smoking more readily, it added that there was no evidence menthols were any more dangerous than regular cigarettes in terms of risks for lung cancer or other respiratory ailments.... http://www.nlm.nih.gov/medlineplus/news/fullstory_110176.html (Although, in my experience, menthol cigarettes are addictive over and above the nicotine)

************************* Thanks to the ACA, insurers cannot drop or deny coverage because of pre-existing conditions, children up to the age of 26 are now allowed to stay on their parent’s insurance plans, and Seniors are protected from the Medicare “Donut Hole” that threatened so many of our most vulnerable citizens. These are just some of the initial life-changing benefits that are cause for celebration today.

•Take a look at our quick Summary of Benefits and Protections -- Do your Patients know what the ACA is already doing for them? http://www.nursingworld.org/HCR-Brief.aspx

•Visit http://www.healthcareandyou.org/-- ANA partnered with organizations that represent consumers, physicians, hospitals and pharmacists to create this website, which provides easy-to-understand information about the health care law. Find out what’s happening in your state and what Health Care Reform means for you!

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Greater brain risks from real-world ecstasy use (Reuters) - For a glimpse into real-world drug use, Australian researchers went to parties where people were using a drug known as ecstasy - and discovered that users' brains were at far more risk from the drug than anyone had suspected.
The researchers also found that ecstasy pills often contain a variety of other drugs.

"What's concerning is that most studies looking at toxicity in people or animals look at a single drug," said Dr. Thomas Newton, a professor at Baylor College of Medicine, who was not involved in this study. "We have no idea what happens when you start mixing like this."

For this study, 56 people who had taken ecstasy at least five times in the past agreed to invite the researchers to house parties where they took ecstasy once again. ... http://www.reuters.com/article/2011/03/29/us-ecstasy-study-idUSTRE72S67920110329?feedType=nl&feedName=ushealth1100

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HINT: If you end up with unpleasant cooking odors in your kitchen, place a lemon (can be sliced, or if whole, pierce the skin a few times) covered with water in a baking dish in your oven. on a medium heat for 20 minutes. It will make your kitchen smell nice and the oven will be easy to wipe out. You can use this idea in the microwave as well.

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Emergency response: civil liability of volunteer health professionals The devastation inflicted on the Gulf region by Hurricanes Katrina and Rita in 2005 and Hurricanes Gustav and Ike in 2008, in addition to recent disasters in the Midwest due to tornadoes and flooding, triggered mass relief efforts by local, state, and federal government agencies, as well as private organizations and individuals. As unpaid volunteers have carried out much of the relief effort, some have questioned whether such volunteers-particularly medical personnel, so-called "volunteer health professionals" (VHPs)-will be protected from potential civil liability in carrying out their duties. This report provides a general overview of the various federal and state liability protections available to VHPs responding to disasters. http://www.fas.org/sgp/crs/misc/R40176.pdf
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Before dialing, check out DialAHuman.com or GetHuman.com, which list customer service numbers and give instructions on how to bypass automated prompts to reach a LIVE representative. With another free service, LucyPhone.com, you can avoid being placed on hold. You enter the company's name of phone number and your number and hit "start". Lucy-phone connects you to the company's line, where you pick an option for getting a live rep. You hang up and get a callback when a person is actually on the line.

I checked out DialAHuman.com ( http://dialahuman.com/ ) ---- looks to be very good. I did not try the Lucy suggestion. I hate the automated recordings......they take forever .
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(The following is an old article, but is still on line) Modest weight loss may curb urine leakage - Reuters 7/26 Overweight women with bladder-control problems can often improve those symptoms if they lose even a modest amount of weight, a new study suggests.
Excess weight, particularly in the abdomen, is one risk factor for urinary incontinence, and studies have found that shedding those extra pounds can help prevent the problem or reduce symptoms. However, it has not been known exactly how much weight women need to lose in order to see a significant improvement in symptoms. ... http://www.reuters.com/article/idUSTRE66P5KJ20100726

*********************** RANDOM FACT: Although Americans eat about the same amount of calories (3,400 a day) as they did in 1910, the average weight has increased due to lack of exercise.

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It’s yet another recall from the makers of Tylenol. McNeil Consumer Healthcare withdrew one lot, or about 34,000 bottles, of Tylenol 8 Hour extended-release caplets because of an odor. The Johnson & Johnson unit also expanded a January wholesale recall to include 10 lots, or about 718,000 packages or bottles, of Benadryl, Sudafed and Tylenol products. They were manufactured before the closure of McNeil's plant in Fort Washington, Pa. ... http://prescriptions.blogs.nytimes.com/2011/03/29/another-tylenol-recall/?partner=rss&emc=rss

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(This is still available-- please check it out) 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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U.S. Cancer Rates Continue to fall THURSDAY, March 31 (HealthDay News) -- The rate of new cancers in the United States has dropped by almost 1 percent a year and the rate of death from cancer has fallen 1.6 percent a year, a new report shows.
These declines, seen between 2003 and 2007, continue a trend that began in the 1990s, the researchers added. Importantly, this is the first time a drop in the rate of deaths from lung cancer among women has been seen, coming a decade after lung cancer death rates started declining in men, they noted. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_110487.html

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Changes in Gay Men's Participation in Gay Community Life: Implications for HIV Surveillance and Research (full text is available)
SUMMARY: Successful antiretroviral treatments, achievements in gay acceptance and human rights, and internet use have prompted changes in gay socialising which create potential challenges for engaging with gay men for HIV surveillance and research. We used data from the Australian behavioural surveillance and explored (i) the relationship between community engagement and HIV related practices, and (ii) time trends in gay men’s engagement with the gay community. Analyses were conducted using log-binomial regression and chi-square test for trend. The proportion of men who socialized mainly with gay men declined and the Internet use to connect with sex partners increased over time. Gay social engagement was associated with HIV positive serostatus, unprotected anal intercourse with regular partners and a high frequency of HIV/STI testing. Our findings indicate a shift in how gay men socialise and find partners. We discuss the challenges for ongoing engagement with gay men for behavioural surveillance and HIV research. http://www.springerlink.com/content/mv1t48ur72828611/
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One of my most favorite children's stories was "Green Eggs and Ham" so here is some trivia about Dr. Seuss:

Dr. Seuss was the pen name chosen by Theodor Geisel. Before his first children's book was published, he drew cartoons for Vanity Fair, Saturday Evening Post, Judge and PM.
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Dr. Seuss derived the idea of writing about "The Cat in the Hat" from a word list given to him by a publisher. When "The Cat and the Hat" was first published, it sold 12,000 copies per week.
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Dr. Seuss' penchant for rhyming was inherited from his mother, who used chants to memorize pie recipes as a child in her father's bakery.
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Dr. Seuss never had children but developed a close relationship with his nephew, who was the inspiration for "Green Eggs and Ham."
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Geisel's first use of the nom de plume "Seuss" occurred during his Darmouth College years when he could no longer openly publish in the school's humor magazine as a punishment for a rules violation. Seuss was his mother's maiden name and his own middle name. He changed the pronunciation of "Seuss" from "soice" to "soose" due to its sound similarity with Mother Goose.
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Geisel's birthplace, Springfield, Mass., honors him with a national memorial consisting of sculptures of his imaginative characters including the Cat in the Hat, the Lorax, Horton the Elephant, Thidwick the Big-Hearted Moose, and Yertle the Turtle's 10-turtle stack.

(Published by Carol Bengle Gilbert on Associated Content from Yahoo!)
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Polypharmacy and Nutritional Status in Older Adults: A Cross-Sectional Study

Background: Older adults have more chronic medical conditions, and the level of polypharmacy increases with advancing age. Malnutrition and drug nutrient interactions are of concern in this population.

Objectives: The aims of this cross-sectional study were to examine nutritional status, the use of medications, and drug-nutrient interactions in older adults.

Methods: Interviewer-administered surveys were conducted in 1100 community-dwelling older (age >65 years) adults. Information regarding demographics, nutritional status, medical history and medication usage was obtained. Self-reported data were verified by third parties when feasible. Informed consent and Human Subjects Committee approval were obtained. A pilot conducted prior to the onset of the study revealed high rates of inter-rater reliability. Data were recorded and entered into Excel spreadsheets for coding and cleaning and transferred to SPSS v. 17.0 for analyses.

Results: The respondents' mean age was 75.5 years. The top six most frequently used classes of medications were gastrointestinal agents, antihypertensives, diuretics, analgesics, β-adrenoceptor antagonists and antihyperlipidaemics. The prevalence of polypharmacy among the participants was 43.4%, with 51.1% of those participants using five or more medications. Most notable was the statistically significant inverse correlation between increasing number of medications and intake of fibre. Intake of cholesterol, glucose and sodium were positively associated with increasing medication use. A trend was also observed for increased phosphorus intake and increased number of medications used. Intake of fat-soluble vitamins, B vitamins, carotenoids and minerals was lower in those with increasing number of medications. Decrements in physical health were associated with decreasing intake of many fat-soluble and water-soluble vitamins, major minerals, trace minerals and electrolytes. Excessive macronutriture, specifically relating to the intake of saturated fats, refined carbohydrates and cholesterol, along with decreased intake of fibre and bioavailable protein sources, was also associated with poor physical health.

Conclusions: The number of medications used by older adults in this convenience sample was associated with poorer nutritional status. Decrements in physical health have a statistically significant effect on nutrient intake. Further research into these issues is required. http://adisonline.com/aging/Abstract/2011/28040/Polypharmacy_and_Nutritional_Status_in_Older.7.aspx

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HUMOR SECTION


Eric is sitting at the bar staring morosely into his beer. Tom walks in, sits down and asks him what the problem is. "Well," said Eric, "I ran afoul of one of those awkward questions women ask. Now I'm in deep trouble at home."

"What kind of question?" asked Tom.

"My wife asked me if I would still love her when she gets old, fat and wrinkly."

"That's easy," said Tom. "You just say 'Of course I will'".

"Yeah," said Eric, "That's what I wanted to do, except I said 'Of course I DO...'"

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

Nurses in Recovery
This site is for all healthcare professionals who are either in recovery or have a desire to be in recovery from drug addiction, alcoholism, gambling, codependency - any obsessive compulsive addictive process. The site includes links to resources, stories from healthcare professionals in recovery, a message board, and link to a nurse-only, long-term recovery survey. To learn more, go to www.brucienne.com/nir


12 lead EKG Interpretation Part #1
http://nursingpub.com/12-lead-ekg-explained-part-1
12 Lead EKG Interpretation Part #2 http://nursingpub.com/12-lead-ekg-interpretation-part-2
12 Lead EKG Interpretation Part #3
http://nursingpub.com/12-lead-ekg-interpretation-part-3

Updated USDA Dietary Guidelines Released
http://www.medscape.org/viewarticle/736605?src=cmemp


(Thank you, Cindy FNPMSN@AOL.com) Check out: http://www.healthgrades.com/business/img/HealthGradesAmericas50BestHospitalsReport2011.pdf

An excellent nursing site...........http://nursingpub.com/

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?

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


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

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/

http://www.nlm.nih.gov/medlineplus/intestinalcancer.html Intestinal cancer

http://www.nlm.nih.gov/medlineplus/pancreaticcancer.html Pancreatic cancer

http://www.nlm.nih.gov/medlineplus/adrenalglandcancer.html Adrenal gland

http://www.nlm.nih.gov/medlineplus/pituitarytumors.html Pituitary gland

http://www.nlm.nih.gov/medlineplus/livercancer.html Liver cancer

http://www.nlm.nih.gov/medlineplus/colorectalcancer.html Colorectal Cancer

http://www.nlm.nih.gov/medlineplus/gallbladdercancer.html Gallbladder cancer

http://www.nlm.nih.gov/medlineplus/stomachcancer.html Stomach cancer

http://www.nlm.nih.gov/medlineplus/thyroidcancer.html Thyroid Cancer

http://www.nlm.nih.gov/medlineplus/mesothelioma.html Mesothelioma

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MEDICAL RECALLS
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Topamax (topiramate): Label Change - Risk For Development of Cleft Lip and/or Cleft Palate in Newborns FDA notified healthcare professionals and patients of an increased risk of development of cleft lip and/or cleft palate (oral clefts) in infants born to women treated with Topamax (topiramate) during pregnancy. Because of new human data that show an increased risk for oral clefts, topiramate is being placed in Pregnancy Category D. Pregnancy Category D means there is positive evidence of human fetal risk based on human data but the potential benefits from use of the drug in pregnant women may be acceptable in certain situations despite its risks. (Topiramate is an anticonvulsant medication approved for use alone or with other medications to treat patients with epilepsy who have certain types of seizures. Topiramate is also approved for use to prevent migraine headaches. The new data was from the North American Antiepileptic Drug (NAAED) Pregnancy Registry). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm245777.htm
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Pradaxa (dabigatran etexilate mesylate) Capsules: Special Storage and Handling Requirements FDA is alerting the public to important storage and handling requirements for Pradaxa (dabigatran etexilate mesylate) an anticoagulant known as a direct thrombin inhibitor. Due to the potential for product breakdown from moisture and loss of potency, Pradaxa capsules should only be dispensed and stored in the original bottle or blister package. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm249005.htm
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Davol XenMatrix Surgical Graft: Class I Recall - Elevated Endotoxin Levels FDA notified healthcare professionals that several lots of XenMatrix Surgical Graft (used in hernia and abdominal wall repair) have been found to have elevated endotoxin levels. Endotoxins (pyrogens) are substances found in certain bacteria that, at elevated levels, can cause serious illness which can be fatal. This product was manufactured from June 1, 2010 through October 31, 2010 and distributed from July 1, 1010 through October 31, 2010. See the Recall Notice for a listing of specific lots affected by this recall. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm245720.htm
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Three new FDA alerts have been posted recently:

· FDA Notification: H & P Industries Recall: Povidine Iodine Prep Pads - Potential Microbial Contamination view FDA annoucement [Posted 03/18/2011] or download KCER notification 3/21/2011. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm247743.htm

FDA Notification: American Regent Recall: Injectable Products - Visible Particulates in Products view FDA annoucement [Posted 03/18/2011] or download KCER notification 3/21/2011. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm242365.htm

B. Braun Recalls: Outlook 400ES Safety Infusion System, Model Number 621-400ES view FDA announcement [Posted 02/01/2011] or download KCER notification 3/1/2011. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm241637.htm
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Cook Inc., Single, Double, Triple, and Five-Lumen Central Venous Catheter Trays AND Single and Double Lumen PICC (Peripheral Inserted Central Venous Catheter) Trays: Class 1 Recall- Leaks in Plunger Luer Detected. FDA notified healthcare professionals of leaks in the plunger luer detected during a routine syringe leak test. The potential exists for leakage and possible loss of sterility. This may lead to serious adverse health consequences and/or death. These products were manufactured from December 4, 2008 through May 1, 2009 and distributed from January 1, 2009 through September 30, 2010. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm245634.htm
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Unapproved Cough, Cold, Allergy Products: FDA Prompts Removal From Market FDA announced that it intends to remove certain unapproved prescription cough, cold, and allergy drug products from the U.S. market. Unapproved prescription cough, cold, and allergy drug products have not been evaluated by the FDA for safety, effectiveness, and quality. People may be at greater risk when using these products than when using FDA-approved prescription drugs or drugs that are appropriately marketed over-the-counter (OTC).

Many health care providers are unaware of the unapproved status of drugs and have continued to unknowingly prescribe them because the drugs’ labels do not disclose that they lack FDA approval. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm245279.htm

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Proton Pump Inhibitor drugs (PPIs): Drug Safety Communication - Low Magnesium Levels can be associated with long-term use. (Prescription PPIs include Nexium (esomeprazole magnesium), Dexilant (dexlansoprazole), Prilosec (omeprazole), Zegerid (omeprazole and sodium bicarbonate), Prevacid (lansoprazole), Protonix (pantoprazole sodium), AcipHex (rabeprazole sodium), and Vimovo (a prescription combination drug product that contains a PPI (esomeprazole magnesium and naproxen). Over-the-counter (OTC) PPIs include Prilosec OTC (omeprazole), Zegerid OTC (omeprazole and sodium bicarbonate), and Prevacid 24HR (lansoprazole).

FDA notified healthcare professionals and the public that prescription proton pump inhibitor (PPI) drugs may cause low serum magnesium levels (hypomagnesemia) if taken for prolonged periods of time (in most cases, longer than one year). Low serum magnesium levels can result in serious adverse events including muscle spasm (tetany), irregular heartbeat (arrhythmias), and convulsions (seizures); however, patients do not always have these symptoms. Treatment of hypomagnesemia generally requires magnesium supplements. In approximately one-quarter of the cases reviewed, magnesium supplementation alone did not improve low serum magnesium levels and the PPI had to be discontinued. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm245275.htm

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NURSING HINTS CORNER

Peripheral pulses: Hear the difference You may have difficulty detecting arterial peripheral pulses with a Doppler ultrasound stethoscope. Try placing the probe at a 45-degree angle instead of at a 90-degree angle. The pulses will sound louder---sometimes twice as loud---because blood is flowing more directly toward the probe. That can make a big difference if the patient has peripheral vascular disease. Debbie Metzler, RN, CCRN, MSN

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.118, Springhouse Corporation/www.springnetcom.

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


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

WELCOME TO:

JMABURK@AOL.com (Jackie) 2/26/11

bbg_8907@yahoo.com (Leilani) nursing student in 2nd of 4 years March 14, 2011

shawn.kennedy@wolterskluwer.com (Shawn) March 15,2011
AKA: Maureen "Shawn" Kennedy, MA, RN Editor-in-Chief, American Journal of Nursing



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

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

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

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

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THOUGHT FOR THE DAY


“If one cannot enjoy reading a book over and over
again, there is no use in reading it at all.”

Oscar Wilde.
(1854-1900), Irish poet, novelist, dramatist and critic.


Hope to see you online or better yet, WRITE ME. I would love to get suggestions, constructive criticisms, articles.......please......

RNFrankie@AOL.com