PARADIGM BYTES October 12, 2011

PARADIGM BYTES
Newsletter for Paradigm 97
October 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

This is from Sandy Summers..........Thank you
10 common body language traps for women in the workplace

A female executive was having problems dealing with her male colleagues. "They like me, but they never take me seriously," she complained. "It's as if they think I'm flirting with them. Which I definitely am not!"

After watching her interact with various men on the senior management team, I saw the problem. She was trying to discuss work-related issues while using a "social gaze."

Here's what I mean . . .

If you create an imaginary triangle on someone’s face, with their eyes as the base and mid-forehead as the apex, you will have mapped out the "look of business." When you keep your gaze in that area, you nonverbally signal a no-nonsense, business-like approach. But when you invert the triangle and move your focus to the area between the eyes and mouth, you turn your gaze into one more appropriate for social encounters. And a social gaze can be misinterpreted as flirtatious—even in a corporate setting.

It’s a small thing, really. But as this woman found out, one small nonverbal signal can change the dynamics of an entire business interaction.

There are two sets of nonverbal signals that are especially important to all professionals. When first introduced to a leader, followers immediately and unconsciously assess him or her for warmth (empathy, likeability, caring) and authority (power, credibility, status). “Warm” leaders connect with staff in a way that makes them want to do a really good job because of that personal connection, affection and respect. But employees also look for leaders who project stability and authority, who make them feel secure, and whom they believe can follow through and achieve results.

Obviously the most appealing leaders are seen to have both qualities, and the least effective leaders are those regarded as uncaring and insecure. Perhaps not so obviously, many of the nonverbal signals for warmth and authority are divided along gender lines. Although I know several leaders of both sexes who do not fit the stereotypes, I’ve also observed that gender differences in body language most often do align with these two groupings. Women are the champions in the warmth and empathy arena, but lose out with power and authority cues—mostly because they fall prey to ten common body language traps. Read Traps 1-10 here, they wouldn't all fit in one posting: http://tinyurl.com/3tm55rv

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FROM THE MEMBERS

HeadsUp on Critical ThinkingTMcomes occasionally to your inbox whenever there are new issues or resources related to critical thinking and clinical reasoning.

This HeadsUp deals with the question, What's the difference between Critical Thinking (CT) and Clinical Reasoning (CR)? I'm getting lots of questions like this and I must say that I'm not surprised, given some of the statements I've read. For example, in a recent PowerPoint presentation, a Harvard Professor stated that "While CT is analytical, CR is based on pattern recognition."

Statements like the above make NO sense. What evidence supports this? With all the complexity we have today, we need expert analytical CR, which INCLUDES pattern recognition! To me, statements like this from leaders confuse nurses and show little knowledge of the CT and CR literature.

If you want clarity about the relationship between CT and CR, I'm happy to tell you that my new online CE article, Improving Critical Thinking and Clinical Reasoning addresses both CT and CR and is now available, FREE, at http://ce.nurse.com/ce168-60/improving-your-ability-to-think-critically/ (taking the test costs $10, unless you have a subscription or if your organization belongs to Gannett's CE Direct--see https://lms.nurse.com/).

The fifth edition of Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach, 5th Edition ---due out in December from Elsevier ---clarifies this issue in depth. For now, I hope this article helps you make sense of the relationship between CT and CR.

Duke, researchers sued over cancer clinical trials

DURHAM – Two cancer patients and the estates of six others have sued Duke University and the Duke University Health System, accusing them of negligence and other wrongs stemming from disgraced researcher Anil Potti’s work.

Filed Thursday in state court, the suit, in addition to going after Duke, targets two spinoff companies, Potti and four other researchers or administrators.

In 90 pages, the patients and their lawyer, Thomas Henson Jr., accuse Duke and the health system of ignoring numerous warning signs that Potti’s research wasn’t valid and later trying to cover up its deficiencies. ... gronberg@heraldsun.com; 419-6648

http://www.heraldsun.com/view/full_story/15465032/article-Duke--researchers-sued-over-cancer-clinical-trials?instance=homethirdleft
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American Regent Pulls Another Drug
American Regent has recalled a number of lots of its injectable vasopressin because it may lose potency during the product's shelf life.
The recall affects a total of 17 lots of Vasopressin Injection, USP -- five lots of 20 units/mL (200 units/10 mL), 10 mL multiple dose vials; 11 lots of 20 units/mL, 1 mL multiple dose vials; and one lot of 10 units/0.5 mL multiple dose vials.
The drug is indicated for use in abdominal roentgenography to dispel interfering gas shadows, to treat diabetes insipidus, and for treatment or prevention of postoperative abdominal distention. ...
http://www.medpagetoday.com/PublicHealthPolicy/FDAGeneral/27919
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FDA Warns LASIK Providers: Stop Making False Claims; Agency giving practitioners 90 days to curtail inflated promises, missing safety info in ads
THURSDAY, Sept. 29 (HealthDay News) -- The U.S. Food and Drug Administration is once again cracking down on eye care professionals who make false safety claims and promises about the popular LASIK eye surgery.
The agency's Letter to Eye Care Professionals, issued this week, follows an earlier warning from May of 2009. In its latest salvo against deceptive, potentially harmful advertising, the FDA is now giving eye doctors 90 days to get in line and update any advertising or promotional materials that make false claims. After this time, the agency will take regulatory action, said FDA spokeswoman Erica Jefferson. ... http://consumer.healthday.com/Article.asp?AID=657349

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INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days
(I found this to be fascinating)... an amazing procedure:

Doctors gave a 5 year old boy devil-like horns When George Ashman was born in 2006 with a large unsightly red scar on his forehead, his mother feared he'd become a target for bullies.
"When he was born, immediately my mind raced forward 10 years. George would be the picked-on kid with no friends, no girlfriend," mom Karen Ashman of Somerset, United Kingdom, told the Daily Mail.
The haemangioma birthmark was made up of bright, soft lumps of abnormal blood vessels, making it tricky to remove.
After the family sought help from the Great Ormond Street Hospital in London, doctors implanted devil-like horns to stretch out the skin on his forehead so the blemish could then be removed, The Daily Mirror reports.
IB Times explains that "small inflatable sacks were inserted under his hairline at either side of his forehead," which filled up with natural bodily fluid. Over four months, the pair of horns stretched the skin, allowing for his birthmark to be removed. ...
http://www.huffingtonpost.com/2011/09/24/george-ashman-devil-horns_n_979381.html?1316907894&ncid=webmail2
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Harvard's "Healthy Eating Plate" adds to diet guidelines
A few months back, the USDA announced it had scrapped the famous food pyramid and replaced it with a plate as a way of conceptualizing the government’s advice on diet.
As will happen with this kind of thing, myplate.gov won praise but also some criticism.
To address some perceived flaws, experts from the Harvard School of Public Health and Harvard Health Publications have unveiled their own iteration of the new icon, which they’re calling the Healthy Eating Plate. ...
http://blogs.wsj.com/health/2011/09/14/from-harvard-a-different-take-on-a-healthy-plate/

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Hospital Uniforms Teeming with Germs, Study Finds
More than 60% of physicians' coats and nurses' uniforms sampled in a major Israeli hospital tested positive for disease-causing bacteria, including methicillin-resistant Staphylococcus aureus, researchers said.

For 63% of the 60 physicians and 75 nurses at Hebrew University's Shaare Zedek Medical Center in Jerusalem in the study, at least one spot sampled on their outer clothing carried pathogenic bacteria, according to Yonit Wiener-Well, MD, and colleagues there.

These bacteria were isolated from half of the total of 235 samples taken from participants' coats, uniforms, and scrub suits, the researchers reported in the September issue of the American Journal of Infection Control.
Most of the participants indicated that they changed their uniforms daily and that their clothing's hygiene was fair or better.
Wiener-Well and colleagues cautioned that the frequency of bacterial transmission from healthcare workers' clothing to patients is unknown. ... http://www.medpagetoday.com/HospitalBasedMedicine/InfectionControl/28359?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=379846
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Few Breast Cancer Patients Can Skip Adding Chemo Older patients with small, hormone-sensitive early breast cancer had normal life expectancy without adjuvant systemic therapy, data from a large cohort study showed.
Overall, omission of systemic therapy was associated with a 32% greater mortality risk in women with node-negative, receptor-positive breast cancer followed for 15 years.
The one exception was patients 60 or older with low-grade tumors ≤10 mm. That small subgroup, not specifically quantified by investigators, had a mortality risk similar to women without breast cancer, as reported online in the Journal of the National Cancer Institute.
"Patients with mortality rates exceeding the background mortality may potentially benefit from systemic adjuvant treatment," Peer Christiansen, MD, DMSc, of Aarhus University Hospital in Denmark, and coauthors wrote in conclusion. ...

http://www.medpagetoday.com/HematologyOncology/BreastCancer/28356?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=379846
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Orange Juice File this one under "things we always sort of knew, but wish we didn't." All that "100% orange juice, not from concentrate" stuff you've been drinking? Technically, it's "not from concentrate," but it's not really 100% orange juice either, a report at Civil Eats details.
The process is rather depressing. Gizmodo explains part of the process:

Once the juice is squeezed and stored in gigantic vats, they start removing oxygen. Why? Because removing oxygen from the juice allows the liquid to keep for up to a year without spoiling. But! Removing that oxygen also removes the natural flavors of oranges. Yeah, it's all backwards. So in order to have OJ actually taste like oranges, drink companies hire flavor and fragrance companies, the same ones that make perfumes for Dior, to create these "flavor packs" to make juice taste like, well, juice again.

Any taste difference in say Minute Maid versus Tropicana is therefore due to the specific flavor pack the company uses. Since these flavor packs are made from orange byproducts, they don't have to be considered an ingredient, and therefore are not required to appear on food labels. This is despite the fact they are chemically altered.
Perhaps its time to take the juicer out of that dusty corner in the garage.
http://www.huffingtonpost.com/2011/07/29/100-percent-orange-juice-artificial_n_913395.html
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Is it Rheumatoid arthritis?
Over one million Americans have rheumatoid arthritis (RA), an autoimmune condition that leads to inflammation, stiffness, pain, and swelling of joints, especially in the hands and feet. If left untreated, RA can cause joint damage or even disability, which is why experts say early diagnosis and treatment of this condition are essential for the best outcome. But because the symptoms of RA can mimic those of other inflammatory joint conditions, how do doctors make an accurate RA diagnosis?
Experts can often determine whether you have rheumatoid arthritis or a different type of joint problem by identifying the pattern of joints that are affected. One aspect of this pattern is symmetry. That means that if you drew a line down the center of your body, in some conditions your joint pain would be symmetric, or affect both sides equally in the same place. For example, if your left elbow hurt, your right elbow would hurt, too. If the joint involvement is asymmetric, however, your left elbow would hurt, but your right elbow would not.... http://www.everydayhealth.com/arthritis/rheumatoid-arthritis/understanding/index.aspx?xid=aol_eh-arthritis_36-_20110808&aolcat=AJA&ncid=webmail5
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(I don't know about you, but I hadn't given even two minutes of thought over possibility of contamination of privacy curtains. This looks like an excellent research for nursing).

Hospital privacy curtains laden with germs
To avoid spreading those bugs, health care providers should make sure to wash their hands after routine contact with the curtains and before interacting with patients, Dr. Michael Ohl, from the University of Iowa, Iowa City, said at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.
"There is growing recognition that the hospital environment plays an important role in the transmission of infections in the health care setting and it's clear that these (privacy curtains) are potentially important sites of contamination because they are frequently touched by patients and providers," Dr. Ohl told Reuters Health.
Health care providers often touch these curtains after they have washed their hands and then proceed to touch the patient. Further, these curtains often hang for a long time and are difficult to disinfect. ...

http://www.reuters.com/article/2011/09/22/us-hospital-curtains-idUSTRE78L64G20110922?feedType=nl&feedName=ushealth1100
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Bath Salts: Treatment Uses for Nurses

When Jane Evans, RN, heard a patient was running down the highway to escape the "electricity" pursuing him, she knew this wasn't an isolated incident but part of a frightening new trend. This spring, Schuylkill Medical Center in Pottsville, Pa., started seeing two or three patients like this per day — people who exhibited psychotic, even violent behavior, yet tested negative on drug screens.

Once calm, these patients admitted to abusing the same product: bath salts. Not a relaxing spa accessory, "bath salt" is a synthetic cathinone called methylenedioxypyrovalerone, packaged under a benign name but specifically made to be abused. Upon ingesting the powdery white substance, users experience euphoria as well as hallucinations, delusions and paranoia.

Bath salt use has exploded nationwide: calls to poison control centers regarding bath salts surged from 303 last year to 4,137 as of July 2011, according to the American Association of Poison Control Centers. Bath salts are sold legally in some states, and manufacturers skirt the law by labeling packets "not for human consumption," according to Wendy Stephan, health education coordinator, Florida Poison Information Center, Miami. The drug also is cheap. Head shops and websites sell it for $25-$40 under names such as White Rush and Meow Meow.

Given the increase of abuse, nurses across the country who haven't yet treated patients who have ingested bath salts are likely to do so in the near future. ... http://news.nurse.com/article/20110919/NATIONAL01/109190044

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The U.S. government advocates eating more fruits and vegetables but does not subsidize their growers anywhere near the level used to support meat and other crop producers who grow food for animals that become meat. Land that qualifies for direct commodity-crop subsidies does not need to be planted, and putting in fruits and vegetables can disqualify it, even as estimates show that if Americans follow the new dietary guidelines, the country will need another 13 million acres of fruit and vegetable crops to meet demand. ... The Washington Post http://www.washingtonpost.com/national/health-science/us-touts-fruit-and-vegetables-while-subsidizing-animals-that-become-meat/2011/08/22/gIQATFG5IL_story.html

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It's been dubbed the "21st century equivalent of the Black Death." In the U.K., it's the most common reason employees take long-term sick leave. It costs American companies $300 billion a year. In Japan, it's a fatal epidemic.

It's stress.
Stress has beaten out stroke, heart attack, cancer and back problems as the main reason British workers take four or more weeks away from the job, according to a new report by the Chartered Institute of Personnel and Development. The Japan Ministry of Labor began publishing official statistics on "Karoshi" (death from overwork) in 1987, but the first case was documented in 1969, when a worker dropped dead of a stroke. He was 29.
The symptoms of stress are similar to those of someone in withdrawal from an addictive drug: finding it difficult to focus; losing your sense of humor; irritability; and shortened temper. Stress can also lead to under- and overeating, as well as smoking and drinking to excess. And in its most extreme forms it can result in stomach and bowel problems, heart disease and stroke. ...
http://jobs.aol.com/articles/2011/10/06/top-cause-of-workplace-sickness-dubbed-black-death-of-21st-cent/?ncid=webmail2
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Scientists find gene that controls chronic pain
Reuters) - British scientists have identified a gene responsible for regulating chronic pain, called HCN2, and say their discovery should help drug researchers in their search for more effective, targeted pain-killing medicines.
Scientists from Cambridge University said that if drugs could be designed to block the protein produced by the gene, they could treat a type of pain known as neuropathic pain, which is linked to nerve damage and often very difficult to control with currently available drugs. ...

http://www.reuters.com/article/2011/09/08/us-pain-gene-idUSTRE7875PN20110908?feedType=nl&feedName=ushealth1100
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So before you leave the house, read our list of what NOT to keep in your wallet, so you can pare down to just the essentials—and protect your finances and identity. 1,000 wallets and purses are stolen every two minutes in America. (44% of LearnVest readers have had their wallets lost or stolen once, while 8% have had theirs stolen twice or more). While it’s smart to be concerned with online security (check out our article on creating the perfect password here), 76% of identity thefts result from the theft of something physical, like a wallet. Additionally, it costs an average of $8,000 to recover from identity theft. ... http://www.learnvest.com/money-tuneup/credit-and-loans/what-not-to-keep-in-your-wallet/?utm_source=email&utm_medium=lvdaily&utm_campaign=click-here#top-block
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HINT: Remove the fish first... Don't throw out the water from the fish tank--pour it on your garden. It's a great fertilizer and green to boot !
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(Reuters) - A listeria outbreak linked to cantaloupes from Colorado has infected 72 people in the United States and killed 13, U.S. health officials said.
The foodborne outbreak is the deadliest in the United States in more than a decade, exceeding the 2008-2009 salmonella outbreak from tainted peanuts that killed nine and infected more than 700 people in the United States, according to the U.S. Centers for Disease Control and Prevention.
So far, 18 states have reported infections from one of the four strains of listeria involved in the outbreak, the CDC said.
Of the 13 deaths, four were in New Mexico, two were in Colorado, two were in Texas, and there was one each in Kansas, Maryland, Missouri, Nebraska and Oklahoma.
All of the illnesses started on or after July 31.
The CDC has traced the source of the outbreak to cantaloupes grown at Jensen Farms in Granada, Colorado. ... (apparently, this outbreak is expected to get worse)

http://www.reuters.com/article/2011/09/28/us-usa-listeria-deaths-idUSTRE78R03L20110928?feedType=nl&feedName=ushealth1100
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Linezolid versus Glycopeptide Antibiotics for the Treatment of Suspected Methicillin-Resistant Staphylococcus Aureus Nosocomial Pneumonia: A Meta-Analysis of Randomized Controlled Trials
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Societal guidelines suggest linezolid may be the preferred treatment of MRSA nosocomial pneumonia. We investigated the efficacy of linezolid compared with glycopeptide antibiotics (vancomycin or teicoplanin) for nosocomial pneumonia. ...

http://chestjournal.chestpubs.org/content/early/2010/09/21/chest.10-1556.short?rss=1
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Apixaban Prevents Strokes, Boosts Survival in Afib Patients

PARIS -- Compared with warfarin treatment, atrial fibrillation patients treated with the investigational factor Xa inhibitor apixaban had fewer strokes or embolic events, fewer major bleeding events, and were less likely to die during an average of almost two years of treatment, researchers said. Those results emerged from the 18,201-patient ARISTOTLE study, which was published online today by the New England Journal of Medicine.

"The primary outcome of stroke or systemic embolism occurred in 212 patients in the apixaban group (1.2% per year) as compared with 265 patients in the warfarin group (1.60% per year)," Christopher B. Granger, MD, of the Duke Clinical Research Institute at Duke University Medical Center in Durham, N.C., and colleagues wrote.


Explain that apixaban, an oral factor Xa inhibitor, was compared to dose adjusted warfarin in subjects with atrial fibrillation.

Note that in the primary outcome of hemorrhagic or ischemic stroke or systemic embolization, apixaban was superior to warfarin.

Note that apixaban had a lower rate of major bleeding and a lower rate of death from any cause than warfarin.

Additionally, the hazard ratio in the apixaban group was 0.79 (95% CI 0.66 to 0.95; P<0.001 for noninferiority and P=0.01 for superiority.
The benefit was largely driven by the difference in hemorrhagic stroke -- 0.24% per year for apixaban (40 strokes) versus 0.47% (78 strokes) for warfarin (HR 0.51, 95% CI 0.35-0.75, P<0.001). The rate of ischemic stroke was similar in both arms of the trial, 0.9% per year with apixaban and 1.05% per year with warfarin (P=0.42). ... http://www.medpagetoday.com/clinical-context/Strokes/28230
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America's 10 Poorest States: 24/7 Wall St.
The U.S. Census Bureau released two pieces of widely followed data Tuesday — one on poverty and the other on median income for 2010. The most interesting findings in this release were the state-by-state figures, especially when compared to national averages. A closer look at the statistics shows that a relatively small number of states suffer such widespread levels of low income and poverty that they skew the national numbers downward.
The national poverty rate last year was 15.1%. That is up from 11.3% in 2000 and is the highest it has been since 1993. Over 46 million people lived below the poverty line in 2010. The cut-off for that line is households of four people who made under $22,314. The other troubling news was that median income per household nationwide was an inflation-adjusted $49,445. This is about the same as in 1989 and down 2.3% from 2009. Economists fear that Americans are not consumers. It is easy to tell why when their real income has been frozen in place for more than two decades. ...
http://www.huffingtonpost.com/2011/09/15/americas-poorest-states-_n_964058.html?ncid=webmail1
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Inappropriate use of blood cell booster widespread
Costly drugs that boost red blood cells are being routinely misused in cancer patients, raising concerns about side effects and wasted resources, researchers say.
A quarter of the time, they found patients got the so-called erythropoiesis-stimulating agents (ESAs) for no more than a week, which is too short to do much good.
"These are very expensive drugs and there are a fair number of side effects," said Dr. Jason Wright of Columbia University Medical Center in New York, whose findings were published in the Journal of Clinical Oncology. ... http://www.reuters.com/article/2011/08/05/us-inappropriate-use-blood-cell-booster-idUSTRE7746VH20110805?feedType=nl&feedName=ushealth1100
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ESGO: Ultrasound Allows Early Ovarian Cancer Diagnosis
MILAN -- Ovarian cancer screening with transvaginal ultrasound has shifted the balance of detection to early-stage disease and improved survival, according to a study reported here.
Early-stage tumors have accounted for about 70% of cancers diagnosed through the Kentucky-based program. Patients with screen-detected ovarian cancer had an estimated five-year survival of 88%, as compared with 40% to 50% for unscreened patients in two different cancer registries.
Diagnostic accuracy has improved with the integration of an imaging-based morphology index for assessing tumor growth potential, Edward J. Pavlik, MD, reported at the European Society of Gynecological Oncology meeting. ...
http://www.medpagetoday.com/MeetingCoverage/ESGO/28522?utm_source=WC&utm_medium=email&utm_campaign=Meeting_Roundup_ESGO
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Tick-borne parasite infecting blood supply: CDC
CHICAGO (Reuters) - A tick-borne infection known as Babesiosis, which can cause severe disease and even death, is becoming a growing threat to the U.S. blood supply, government researchers said on Monday.
There are currently no diagnostic tests approved by the U.S. Food and Drug Administration that can detect the infection before people donate blood.
A 31-year study by the Centers for Disease Control and Prevention now suggests the parasitic infection may be increasing.
Babesia infections are marked by anemia, fever, chills and fatigue, but they can also cause organ failure and death. ...

http://news.yahoo.com/tick-borne-parasite-infecting-blood-supply-cdc-220254618.html
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More B Vitamins May Cut Risk of Elderly Depression
Higher intakes of two B vitamins -- but not folate -- may help ward off depression among older people, particularly if they take supplements, according to a large population study.
The prospective study, which followed more than 3,000 people ages 65 and older, found that higher intakes of vitamins B-12 and B-6 were both associated with a slightly reduced risk of depression (P=0.01 and P=0.05, respectively) for up to 12 years of follow-up, reported Kimberly A. Skarupski, MD, of Rush University in Chicago, and colleagues.
"In the assessment and treatment of depressive symptoms in older adults, clinicians and other healthcare professionals should be mindful of the patient's nutritional status in general, and whether there are vitamin insufficiencies in these nutrients before treatment," they wrote in the August issue of the American Journal of Clinical Nutrition. ... http://www.medpagetoday.com/PrimaryCare/DietNutrition/21376
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#96 Call overseas for free... Freephone2phone.com gives you 10 minutes of free talk to landlines in 55 countries and cellphones in some. You listen to short ads, then connect.
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Brain Takes Multiple Hits from Low B12 Levels Low levels of vitamin B12 may contribute to cognitive problems for older adults in more than one way, according to a cross-sectional study.

Markers of B12 insufficiency all predicted lower global cognitive scores over nearly five years of follow-up, Christine C. Tangney, PhD, of Rush University Medical Center in Chicago, and colleagues found.

The mediating factors appeared to be white matter lesions and cerebral infarcts in association with the nonspecific marker homocysteine and brain atrophy for the vitamin B12-specific marker methylmalonic acid (MMA). "Vitamin B12 status may affect the brain through multiple mechanisms," the group wrote in the Sept. 27 issue of Neurology.
The Institute of Medicine already recommends B12 supplements for seniors, co-author Martha Clare Morris, ScD, director of nutrition at Rush University Medical Center, noted in an interview with MedPage Today.
"Insufficient vitamin B12 is very common in older people," she explained. "The older we get we have a decreased ability to absorb vitamin B12 from our diet. ... Medications can also impair absorption."
http://www.medpagetoday.com/Neurology/GeneralNeurology/28740?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g379846d0r&userid=379846&email=rnfrankie@aol.com
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Eyelid Lipid Plaques Predict CV Disease The presence of the lipid-containing yellow plaques known as xanthelasmata on the eyelids is an independent predictor of cardiovascular disease, a large prospective study found.

During a mean follow-up of 22 years, adults participating in a long-term Danish heart study who had xanthelasmata at baseline had an adjusted hazard ratio for myocardial infarction of 1.48 (95% CI 1.23 to 1.79), according to Anne Tybjærg-Hansen, MD, of Rigshospitalet in Copenhagen, and colleagues.

Participants with these plaques also were at increased risk of ischemic heart disease (HR 1.39, 95% CI 1.20 to 1.60) and death (HR 1.14, 95% CI 1.04 to 1.26), the researchers reported online in BMJ. ... http://www.medpagetoday.com/Cardiology/Atherosclerosis/28541?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g379846d0r&userid=379846&email=rnfrankie@aol.com
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Study: Agency staff at higher risk of ED errors Agency staff members working in an ED are twice as likely as permanent employees to be involved in medication errors that harm patients, according to new Johns Hopkins research.

The researchers cautioned that while blaming the agency staff members themselves for the errors might be the simplest explanation, the problem is probably more diffuse and complex.

"A place that uses a lot of temporary staff may have more quality of care issues in general," said lead researcher Julius Cuong Pham, MD, PhD, an assistant professor for anesthesiology and critical care medicine and emergency medicine at the Johns Hopkins University School of Medicine. "It may not be the temporary staff that causes those errors, but a function of the whole system." ... http://news.nurse.com/apps/pbcs.dll/article?AID=2011109190002
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CPSC Urges Consumers to Check Their Homes for Numerous Simplicity Nursery Product Recalls.
Since 2007, the U.S. Consumer Product Safety Commission (CPSC) has recalled more than 11 million cribs whose detaching drop-side rails were associated with at least 32 infant suffocation and strangulation deaths since 2000. Additional deaths have occurred due to faulty or defective hardware. These new standards aim to prevent these tragedies and keep children safe in their cribs.Babies spend much of their time sleeping; therefore, the nursery should be the safest room in the house. ...
To check to see if the crib has been recalled: http://www.cpsc.gov/cgi-bin/cribs.aspx
http://www.cpsc.gov/info/cribs/index.html
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ELEPHANT RANDOM FACTS:

Elephants can drink 60 gallons of water per day and can feed for up to 16 hours a day.
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Elephants sleep mostly standing. They usually only sleep four to five hours per night.
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Female elephants have a gestation period of 22 months. They give birth to a single infant referred to as a calf.
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Elephants use their large ears like fans to cool themselves down. The ears of an adult African elephant range from 5 to 6 feet long and
4 feet wide. Elephants have excellent hearing and can hear sounds that humans cannot.
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Elephants have been known to recognize other elephants or even humans that they haven't seen in years. They are highly intelligent animals.
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Elephants live in matriarchal families called a herd. The leader of the herd is the oldest female. Young males remain with the herd until
approximately 15 years before going out on their own.
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Green-glowing cats are new tool in AIDS research (What next???)

(Reuters) - U.S. scientists have developed a strain of green-glowing cats with cells that resist infection from a virus that causes feline AIDS,
a finding that may help prevent the disease in cats and advance AIDS research in people.

The study, published on Sunday in the journal Nature Methods, involved inserting monkey genes that block the virus into feline oocytes,
before they are fertilized.


The scientists also inserted jellyfish genes that make the modified cells glow an eerie green color -- making the altered genes easy to spot. ...

http://www.reuters.com/article/2011/09/11/us-cats-aids-idUSTRE78A2LY20110911?feedType=nl&feedName=ushealth1100 **********************
Get dental work for a fraction of the cost from dentist-supervised students at a dental school. Find a school at ada.org by clicking on “Dental Schools.” For low-cost, federally funded care, go to the National Institute of Dental and Craniofacial Research website. ***********************

Hint 1: Zest is the best! Zest is simply grated peel, and is the epitome of lemon essence--it can be used fresh, dried, or frozen. If you don't have an official zester, you can use the smallest size of a box grater. (If you know you will be using lemons for zest, it is easier to grate the zest from the lemon before juicing them.) To dry zest, spread it on a towel and leave out until dried, then store in a jar. To freeze, use a freezer-safe container. Use zest in salads, marinades, baked goods, grain dishes, etc.

Hint 2: A small amount of lemon juice dripped onto minor wounds can help stop bleeding and disinfect the injury (it will sting a bit). (not too sure about this one... ) Lemon juice applied to itches, poison ivy rashes and wasp stings is said to relieve discomfort.

#81 Penny-wise superfoods... What foods give you the most vitamins and minerals for the least money? In descending order, the best
vegetables are cabbage, collard greens, mustard greens, turnip greens, and carrots. Top fruits are watermelon, plums, oranges, apples, and
strawberries.
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For those who use First Cold Pressed Extra Virgin Olive Oil :
http://www.kitchendaily.com/2011/09/23/the-best-extra-virgin-olive-oil/#photo-1?ncid=webmai




(Sorry about this large blank spot---blame AOL)


~~**~~**~~**~~**~~**~~ HUMOR SECTION

My husband grew increasingly displeased as our teenage daughter and her boyfriend studied in her room late one evening. Finally losing patience shortly after midnight, he knocked sharply on her door. Her boyfriend immediately opened it and asked if something was wrong.

"I have to ask you to move your car," my husband told him.

"Oh, sure. Is it in someone's way?"

"No," he replied, "it's parked in the wrong driveway."


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

Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess.

Pay Only $34.99 for a full year of CONTACT HOURS

www.nurse.com for CNE offerings.

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

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

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.

This is an excellent nursing site, check it out: http://nursingpub.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

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

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


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/

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*
MEDICAL RECALLS
*
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FDA MedWatch - Medtronic Model 8637 SynchroMed II Implantable Infusion Pump: Class I Recall - Potential for Reduced Battery Performance
Medtronic and FDA notified healthcare professionals of a Class I recall of the SynchroMed II Infusion system. Medtronic’s analysis of the problem indicates it is related to the formation of a film within the pump battery. This problem can lead to the sudden loss of therapy and the return of underlying symptoms and/or therapy withdrawal symptoms.
The recall includes the SynchroMed II Implantable Infusion Pump models 8637-20 and 8637-40, distributed between May 2004 and July 8, 2011. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm271510.htm

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NURSING HINTS CORNER
Dry Labels for specimens When you are collecting a 24-hour urine specimen, place the collection "jar" in a basin that already had a plastic bag filled with ice. That way, the label on the jar will stay dry and the specimen will remain cool. Loosely knot the end of the bag so you can refill it as the ice melts.
Loretta A. Debus

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.147, 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:

engleharts@bellsouth.net (Kay) October 5, 2011

sandsfamily4@att.net (Becky) October 6, 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....(?) So please send me your new name/address, okay? RNFrankie@AOL.com


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


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

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

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THOUGHT FOR THE DAY

A Good description of a nurse

Do not assume that she who seeks to comfort you now, lives untroubled among the simple
and quiet words that sometimes do you good. Her life may also have much sadness and difficulty,
that remains far beyond yours. Were it otherwise, she would never have been able to find these words.

--Rainer Maria Rilke

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

RNFrankie@AOL.com