February PARADIGM BYTES

PARADIGM BYTES Newsletter for Paradigm 97 February 15, 2013 PARADIGM DEFINED: 1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated. Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it. MISSION STATEMENT We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience. ***~~~***~~~***~~~*** SNIPPETS Tuberculosis: WHO-Endorsed Test Offers Rapid Detection A diagnostic test for tuberculosis (TB) can accurately and quickly detect both TB and drug-resistant strains, according to a new study. The authors of a new systematic review assessing the diagnostic accuracy of the Xpert® MTB/RIF test published in The Cochrane Library say their study can provide timely advice for clinicians and policymakers in countries where TB is a major public health problem. Millions of people develop TB every year. Around 13% of cases occur in people living with HIV and more than a quarter of these people die as a result. Drug resistance is a major public health problem that further complicates efforts to control TB. Multidrug-resistant TB is defined as resistance to rifampicin and isoniazid, which are two of the most effective and widely used anti-TB drugs. Xpert® (Cepheid Inc, California) is a diagnostic test endorsed by the World Health Organization (WHO) that simultaneously detects TB and resistance to rifampicin, as an indicator of multidrug resistance. The test takes around two hours, with minimal hands-on technical time required. Like sputum smear microscopy, which relies on detecting TB with a microscope in a laboratory, Xpert requires a sample of sputum. However, while thousands of bacteria must be present in each millilitre of sample for TB to be detected under the microscope, Xpert can detect TB bacteria at much lower concentrations. In addition, the conventional microscopy approach does not detect drug resistance. Instead, TB has to be grown in the lab. This presents problems, especially for multidrug-resistant TB, due both to the length of time required for the cultures to grow and the specialized laboratories and highly skilled staff needed. The researchers, from the Cochrane Infectious Diseases Group, McGill University and the Foundation for Innovative New Diagnostics (FIND), analysed data from 18 studies involving a total of 7,816 people, with most studies being carried out in low- and middle-income countries. The results show that when Xpert is used to screen 1,000 people, 150 of whom have TB, it picks up 132 of the 150 cases (88%) and falsely diagnoses 17 (2%) with TB. This is in a scenario where it is being used as a replacement for smear microscopy. In a scenario where Xpert is being used as a replacement for culture-based drug susceptibility testing, it is also able to detect the equivalent of 141 out of 150 cases (94%) of rifampicin resistance. When Xpert is used as a follow-on test, after conventional smear microscopy has already produced a negative result, it picks up 101 out of 150 cases (67%). By definition, smear-negative TB is not picked up by smear microscopy because microscopy cannot detect small numbers of bacteria. Xpert picked up 67% of this group that would have been missed by microscopy. “This study represents the most comprehensive review on the diagnostic accuracy of Xpert to date and may help countries make decisions about scaling up its use for management of TB and drug-resistant TB,” said lead researcher, Karen Steingart, of the Cochrane Infectious Diseases Group. Karin Weyer, Coordinator, Laboratories, Diagnostics and Drug Resistance at the World Health Organization (WHO) said, “This Cochrane Review provides high quality evidence that reinforces WHO’s endorsement of this test. Recent price reductions have greatly facilitated roll-out of this technology, including a new three-year initiative called the TB Xpert Project, funded by UNITAID and executed by WHO and the Stop TB Partnership. 1.4 million test cartridges and over 200 GeneXpert instruments for the rapid detection of TB and rifampicin resistance will be distributed in 21 countries with a high burden of TB.” Lucica Ditiu, Executive Secretary of the Stop TB Partnership, said, “We welcome the Cochrane Review of Xpert, an innovation that represents a major milestone in our quest to achieve the goal of zero deaths from TB – which is curable but still takes the life of three people every minute. The Stop TB Partnership is making every effort to help countries understand how best to use this new technology. Our TB REACH initiative is deploying Xpert to numerous c ountries through projects that seek to increase the number of TB cases detected and treated, and these projects will deliver data that can provide an evidence base for determining how Xpert should be used for the greatest impact.” Full citation: Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Dendukuri N. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD009593. DOI: 10.1002/14651858.CD009593.pub2 URL Upon publication: http://doi.wiley.com/10.1002/14651858.CD009593.pub2 (The full review will be available open access upon publication) ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Study: lumpectomy survival rates good for early breast cancer Reuters A new U.S. study examining survival rates for women with early stage breast cancer found that surgery such as lumpectomy that preserves the rest of the breast may offer survival odds as good as, or even better than, mastectomies. Despite clinical trials showing lumpectomy, or removal of the cancer only, to be as effective as mastectomies in treating early breast cancers, the number of women choosing breast removal has been on the rise, wrote lead researcher E. Shelley Hwang in the journal Cancer. "It was kind of an exciting and hopeful message that women don't have to go off to get a mastectomy to do better," said Hwang, from the Duke Cancer Institute in Durham, North Carolina. "I think a lot of women were making that decision (for mastectomy) because they thought the lumpectomy was not enough. In that context, we wanted to know if lumpectomy works just as well as mastectomy in the modern era." ... http://www.reuters.com/article/2013/02/01/us-breastcancer-idUSBRE91003320130201?feedType=RSS&feedName=healthNews ***************** Inked and Regretful: Removing Tattoos That tattoo on your arm of a former flame—the one that seemed like a great idea years ago—is kind of embarrassing today. And your spouse is not too crazy about it either. You may not know that FDA considers the inks used in tattoos to be cosmetics, and the agency takes action to protect consumers when safety issues arise related to the inks. At the other end of the tattoo process, FDA also regulates laser devices used to remove tattoos. FDA has cleared for marketing several types of lasers as light-based, prescription devices for tattoo lightening or removal. A Massachusetts company recently received FDA clearance to market its laser workstation for the removal of tattoos and benign skin lesions. ... http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm336842.htm ************************ RANDOM FACT: February 3 was the 100th anniversary of the ratification of the Sixteenth Amendment, that is the income tax. Americans for Tax Reform commemorated the occasion by publishing a few fun facts about the income tax. Another Random Fact: The initial top tax bracket was only 7 percent, and it didn't kick in until income reached a whopping $11.6 million in 2013 dollars. Only 358,000 people had to fill out 1040 forms at first, because the standard family deduction was an adjusted $93,000. ****************** This year the focus is on preventing scald injuries: 75%: Percentage of all burns to young children that are scalds 120: The temperature setting for a water heater thermostat in the home should not exceed 120 degrees to avoid scald injuries. 110: The temperature setting for a water heater thermostat in nursing homes and child care facilities should not exceed 110 degrees to avoid scald injuries. To check hot water temperature, run hot water up to 2 minutes at the tap and measure with a cooking thermometer. Even if initial test temperature is below 120 degrees, safety may not be constant: Retest several times. About half of burn injuries treated in EDs are scald injuries. 50%: Reprinted with permission from: Production/Electronic Channels Coordinator *************** Understanding core measures for heart-failure treatment HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ... (Heart Failure) is the primary cause of more than 55,000 deaths each year in the United States. The most common signs and symptoms of HF are shortness of breath on exertion; orthopnea; weight gain with edema in the feet, legs, or lower back; fatigue; and weakness. Major causes of HF are coronary artery disease, high blood pressure, and diabetes. According to the Centers for Disease Control and Prevention (CDC), HF is diagnosed in 670,000 new persons annually. Currently, about 5.8 million persons in the United States are living with HF. In women, HF incidence has dropped by about 30% due to earlier diagnosis and treatment. In men, the number of new cases remains unchanged. The annual economic toll of HF is about $34.5 billion. As with most diseases, the earlier HF is diagnosed and treated, the greater the chance for improving the patient’s quality of life and increasing life expectancy. Over the past 50 years, scientists and healthcare providers have made great strides in treatment and patient outcomes by examining best practices for patients with HF. ... http://www.americannursetoday.com/Article.aspx?id=9952&fid=9912&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_February_2013_House&utm_medium=email ******************* Teaching patients about FDA recommendations for proper medication disposal Accidental exposure to medication in the home is a major cause of unintentional poisoning in children. Recent data show even child-resistant containers can’t completely prevent a child from taking medication meant for someone else. Reported cases of accidental exposure further emphasize the need for nurses to counsel patients on how to store medication safely out of reach of children and pets, as well as on proper disposal of unused or expired drugs. Nearly all medications can be thrown away in the household trash after they’ve been mixed with an unpalatable substance, such as coffee grounds, and sealed in a container. However, a few select drugs—primarily controlled substances—should be flushed down the sink or toilet to permanently remove the risk of accidental exposure from the home. The Food and Drug Administration (FDA) recently made available recommendations for proper medication disposal and a list of drugs that should be flushed due to their potential to cause serious or life-threatening adverse reactions (such as difficulty breathing, heart problems, and even death) if someone other than the person for whom the drug was prescribed is exposed to it accidentally. ... http://www.americannursetoday.com/Article.aspx?id=9956&fid=9912 ********************** Drugs in the environment: Nurses’ roles and responsibilities News that pharmaceuticals have been found in our rivers and streams, fish, wildlife, and even our drinking water has captured our interest and concern. This isn’t a new phenomenon. Active pharmaceutical ingredients (APIs) have been in the water since humans first started using and excreting drugs. But we’re just beginning to recognize the magnitude of the problem. Drug prescriptions in this country have increased 61% over the past decade and now total about 3.4 billion annually, with retail sales of $250 billion. Nurses, who administer, dispose of, and in some cases prescribe drugs, can play a key role in developing policies and practices that help minimize the amount of pharmaceuticals that end up in the environment. The U.S. Geological Survey has detected codeine, sulfa drugs, hormones (such as estradiol), and many other medications in a wide swath of surface waters around the country. Tissue samples of the nation’s fish reveal that these drugs are being absorbed in fish, resulting in body burdens of pharmaceuticals that may travel up the food chain. About half the country derives its drinking water from surface water sources, yet no one knows how many APIs are in circulation, nor what percentage is derived from human excretion, animal excretion from veterinary use (particularly in agriculture), disposal activities, or manufacturing activities. Drinking water standards don’t require testing for APIs. ... http://www.americannursetoday.com/Article.aspx?id=9954&fid=9912&utm_source=BenchmarkEmail&utm_campaign=AMNT_Electronic_February_2013_House&utm_medium=email ********************* Study: Donor feces more effective than vancomycin in treatment of recurrent C. difficile (if this happens on your shift, how will you handle any explanation to patient/family?) Background Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. We studied the effect of duodenal infusion of donor feces in patients with recurrent C. difficile infection. Full Text of Background... Methods We randomly assigned patients to receive one of three therapies: an initial vancomycin regimen (500 mg orally four times per day for 4 days), followed by bowel lavage and subsequent infusion of a solution of donor feces through a nasoduodenal tube; a standard vancomycin regimen (500 mg orally four times per day for 14 days); or a standard vancomycin regimen with bowel lavage. The primary end point was the resolution of diarrhea associated with C. difficile infection without relapse after 10 weeks. ... http://www.nejm.org/doi/full/10.1056/NEJMoa1205037?utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_Week_of_January_21st_2013&utm_medium=email&#t=abstract ; ******************* December 12, 2012, was the century's last sequential date (unless we go to a 13 month calendar really soon). But is there more to this unique arrangement of numbers than just oddity? RANDOM FACTS: A much-cited survey conducted by US-based David's Bridal estimated that around 7,500 brides would be getting married in America today � a 1,446 percent increase from 12/12/11. The New York Times wrote that many couples considered it lucky to get married on repetitive dates, with 07-07-07, 10-10-10 and 11-11-11 each breaking Las Vegas records *** Bonus Fact: According to Chinese numerology, the number one is a yang number which is ruled by the sun and represents independence and individualism. Two is a yin number which is ruled by the moon and represents symmetry and balance. When placed together, the number 12 brings harmony to the yin and yang, balancing the feminine energy of the moon with the masculine energy of the sun. ******************** QUIZ TIME: Which of the following is an advantage of a dry-suction chest drainage system? a. Lower levels of suction pressure b. Variable bubbling, which indicates proper functioning c. A steady bubbling sound, which indicates proper functioning d. Higher levels of suction pressure ** Answer at end of this Newsletter ** Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 *********************** Many aspects of “We Can Improve the Safety of PICC Lines” (Viewpoint, November 2012) don't reflect national standards of practice. The safety of peripherally inserted central catheter (PICC) insertion at the bedside has been well established, yet the author questions this practice without the benefit of fluoroscopy. Fluoroscopy is not necessary for PICC insertion. While there are challenges with proper tip location based on external measurement, a postinsertion chest X-ray is mandatory.1 Technology advancement now allows for the identification of PICC tip location during the insertion procedure by using electrocardiogram changes, a much more accurate method.2 The primary or original tip location can change during the catheter dwell time, producing a secondary malposition.1 Saying that PICCs have an “inherent characteristic of instability” is not accurate. The author is confusing two different types of secondary catheter malposition. First, there is tip migration, which can occur with any type of central vascular access device (CVAD) and is caused by changes in intrathoracic pressure, such as coughing, sneezing, congestive heart failure, and mechanical ventilation. There is no change to the external catheter length. It's the nurse's responsibility to know the clinical signs and symptoms of tip migration and to take appropriate action if it's suspected. There are no nursing interventions that could easily prevent this type of tip movement.1 Another type of secondary malposition is known as catheter dislodgment or displacement. In this case, the catheter is either pulled out of or pushed into the insertion site. This involves a change in the external catheter length, which subsequently produces a change in the catheter's tip location.1 The most common cause of this problem is lack of catheter stabilization. The Infusion Nurses Society and the Centers for Disease Control and Prevention (CDC) recommend CVAD stabilization with an engineered, sutureless catheter stabilization device.1, 3 A transparent membrane dressing alone or “sticky occlusive clear dressing,” as stated by the author, is not a stabilization device. While a dressing has an important role in catheter care, relying on a dressing alone for stabilization puts patients at risk for catheter dislodgment. This is not the fault of the catheter design but rather the absence of proper catheter stabilization techniques, a lack of appropriately engineered products for this purpose, and a lack of knowledge and skill by the nursing staff to adequately use these stabilization devices. During each CVAD dressing change, measurement of the external catheter length with comparison to the original length is required.1 A label on the catheter or dressing would assist nurses in locating this critical information. A simple piece of tape with this information can be added to the edge of the dressing. Infusion nursing practice is measured against the documents produced by the Infusion Nurses Society and the CDC, and nurses must be familiar with these. Lynn Hadaway, MEd, RN, BC, CRNI Milner, GA References: 1. Infusion Nurses Society. Infusion nursing standards of practice J Infus Nurs. 2011;34(1 Suppl):S1–S109 Cited Here... 2. Smith B, et al. Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters J Electrocardiol. 2010;43(3):274–8 Cited Here... 3. O'Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. Atlanta: Centers for Disease Control and Prevention; 2011. ****************** Clinicians at NorthShore University HealthSystem's three hospitals near Chicago have found a method of reducing bloodstream infections by half. Using a tiny alcohol-impregnated cap on central line hubs prevented four CLABSI deaths and prevented 21 patients from infections, they calculated during the study year, a result sustained with proven cost-effectiveness during the 18 months following their experiment. The cap method differs from the traditional 15-second "scrub the hub" ... http://www.healthleadersmedia.com/content/QUA-288009/Drop-in-CentralLine-Infection-Rates-Linked-to-Disinfection-Caps ***************** Patient Navigation: Revenue Opportunities for Hospitals According to a report from the Center for Health Affairs, patient navigation could save billions of dollars at hospitals. http://www.fiercehealthcare.com/story/patient-navigation-revenue-opportunities-hospitals/2013-01-03?utm_medium=nl&utm_source=internal ************ California: Registered nurses able to dispense birth control under new law Nurses can dispense hormonal birth control in California, but new law draws controversy http://www.huffingtonpost.com/2013/01/05/nurses-hormonal-birth-control_n_2414605.html ************** Identity Theft's Taxing New Trend: Scammers Are After Your Tax Refund Along with the rapid rise in identity theft has come the explosion of a specialized and sophisticated form of theft: tax identity theft. During the 2011 tax processing year, roughly 940,000 tax returns were filed fraudulently. This year the number will likely reach 1 million. Even the IRS' own taxpayer advocate, Nina Olson, says the IRS is woefully incapable of handling the boom. A recently released report from the National Taxpayer Advocate to Congress says that the IRS "has failed to provide effective and timely assistance to victims of identity theft" even as the number of crimes continues to soar. Olson says in the report that tax-related identity theft has risen some 650 percent since 2008 ... http://www.dailyfinance.com/2013/01/25/identity-theft-tax-refund-scammers/?ncid=webmail26 ************************* In a telling demonstration of their lack of faith in the future of the U.S. dollar, lawmakers in Virginia are considering minting their own state coinage. But could the dollar really fail? National currencies have failed before, and it has happened more frequently and more recently than you probably think. RANDOM FACT: The most famous example in the 20th century is Germany's Weimer Republic of 1922-1923. When Germany was unable to pay the war reparations imposed after WW I the government began printing unbacked currency. Too much money was circulated, and the money was soon considered worthless. In 1922, the largest denomination of the Papiermark was 50,000. A year later it was 100 Trillion. This means that by December 1923, the exchange rate with the US Dollar was 4.2 Trillion to 1. It is estimated that by November 1923, the yearly inflation rate was 325,000,000 percent. ************* Men more likely to die of cancer: study (Reuters) - Not only are men more likely than women to be diagnosed with cancer, men who get it have a higher chance of dying from the disease, according to a U.S. study. In an analysis of cases of all but sex-specific cancers such as prostate and ovarian cancer, for example, men were more likely than women to die in each of the past ten years, said researchers, whose findings appeared in The Journal of Urology. That translates to an extra 24,130 men dying of cancer in 2012 because of their gender. "This gap needs to be closed," said Shahrokh Shariat from Weill Cornell Medical College in New York, who worked on the study. "It's not about showing that men are only doing worse and, 'poor men.' It's about closing gender differences and improving health care." ... http://www.reuters.com/article/2012/12/07/us-cancer-men-idUSBRE8B604R20121207?feedType=RSS&feedName=healthNews **************** Provisions contained in American Taxpayer Relief Act (ATRA , known colloquially as the fiscal cliff deal, will further reduce Medicare payments for skilled nursing facility (SNF) care, according to a press release from The Alliance for Quality Nursing Home Care (AQNHC). An analysis from Avalere Health shows that by extrapolating from the Congressional Budget Office estimate of $1.8 billion in savings over 10 years (FY 2013 to FY 2022), it estimates that the provision in the fiscal cliff deal will cut payments to SNFs by approximately $600 million over that period. http://tinyurl.com/anehmq3 (Thanks BAcello..Barbara) ************ Metal-on-Metal Hip Implants: Safety Communication - Updated Safety Recommendations FDA notified healthcare professionals that it is providing updated safety information and recommendations to patients and health care providers, based on the FDA’s current assessment of metal-on-metal hip implants, including the benefits and risks, the evaluation of the published literature, and the results of the June 2012 Orthopaedic and Rehabilitation Devices Advisory Panel meeting. BACKGROUND: In metal-on-metal hip implants, the metal ball and the metal cup slide against each other during walking or running. Metal can be released from other parts of the implant where two implant components connect. Metal release will cause some tiny metal particles to wear off of the device around the implant, which may cause damage to bone and/or soft tissue surrounding the implant and joint. Soft tissue damage may lead to pain, implant loosening, device failure and the need for revision surgery Some of the metal ions released will enter the bloodstream and travel to other parts of the body, where they may cause symptoms or illnesses elsewhere in the body. Presently, the FDA does not have enough scientific data to specify the concentration of metal ions in a patient’s body or blood necessary to produce adverse systemic effects. In addition, the reaction seems to be specific to individual patients, with different patients having different reactions to the metal wear particles. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm336069.htm ************************ January was National Blood Donor Month; here are some facts about the need for blood and the power of donation: 1: One pint of blood can save up to three lives. 2: Every two seconds someone in the U.S. needs blood. 44,000: More than 44,000 blood donations are needed every day. 3: The average red blood cell transfusion is about three pints. 38%: The percentage of U.S. population eligible to give blood is less than 38%. 9.5 million: Number of blood donors in the U.S. in a year. 10 to 12: The actual blood donation usually takes less than 10 to 12 minutes. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************** WORD ORIGINS: been there, done that *** A phrase indicating that something is wearying or just plain old hat, "been there, done that" comes to American English by way of Australian slang. It first turned up in 1982 in an American newspaper article that said of a recent divorcee who did not plan to marry again, "Using an Australian expression, she says,' Been there, done that'" ~~**~~**~~**~~**~~**~~ HUMOR SECTION A story from the pages of the Manchester Evening Times Last Wednesday a passenger in a taxi heading for Salford Station leaned over to ask the driver a question and gently tapped him on the shoulder to get his attention. The driver screamed, lost control of the cab, nearly hit a bus, drove up over the curb, and stopped just inches from a large plate window. For a few moments everything was silent in the cab. Then, the shaking driver said "Are you OK? I'm so sorry, but you scared the daylights out of me." The badly shaken passenger apologized to the driver and said, "I didn't realize that a mere tap on the shoulder would startle someone so badly." The driver replied, "No, no, I'm the one who is sorry, it's entirely my fault. Today is my very first day driving a cab.......I've been driving a hearse for 25 years." ~~**~~**~~**~~**~~**~~ 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 Dr Robert Hess. ___________ 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 ~~**~~**~~**~~**~~**~~ 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/ Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ The Nursing Site http://thenursingsite.com . http://www.snopes.com http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Qualitest Hydrocodone Bitartrate and Acetaminophen Tablets 10 mg/500 mg: Recall - Potential for Oversized Tablets Qualitest, a subsidiary of Endo Health Solutions, issued a voluntary nationwide recall for 101 lots of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10 mg/500 mg. Bottles from the affected lots may contain tablets that have a higher dosage of acetaminophen, and as a result, it is possible that consumers could take more than the intended acetaminophen dose. Unintentional administration of tablets with increased acetaminophen content could result in liver toxicity, especially in patients on other acetaminophen containing medications, patients with liver dysfunction, or people who consume more than 3 alcoholic beverages a day. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm331224.htm ******************* Vycor Viewsite Brain Access System (VBAS): Class 1 Recall - Unidentified Fiber Found on Device Vycor Medical recalled its VBAS because an unidentified black fiber was found on the device. This product may cause serious adverse health consequences, including death. Vycor Medical recalled its VBAS because an unidentified black fiber was found on the device. This product may cause serious adverse health consequences, including death. BACKGROUND: The Vycor Medical Viewsite Brain Access System serves as a self-retaining retractor system for brain tissue and provides access to allow the surgeon to see the surgical site during brain and spinal procedures. RECOMMENDATION: Vycor Medical called their customers requesting that they place products of Model # TC171105, Lot # VM83450 into quarantine until further notice. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm337475.htm ~~**~~**~~**~~**~~**~~ ADVERTISEMENTS from the members This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: Audreycarmellasmith@yahoo.com (Audrey) January 31, 2013 ~~**~~**~~**~~**~~**~~ 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 OLD ADDRESS: chousm@AOL.com (Connie) NEW ADDRESS: chousm@bendbroadband.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY The farther a society drifts from truth, the more it will hate those who speak it. George Orwell Would love to hear from you......suggestions always welcome. RNFrankie@AOL.com QUIZ Correct answer: d. Advantages of dry suction system include higher levels of suction pressure, easier set-up, quieter operation (no bubbling sound), and more constant pressure because no water is lost to evaporation. Learn more by reading the continuing education program "Chest-tube care: The more you know, the easier it gets."