April PARADIGM BYTES Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 April 20,2013 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 Study: Nurse understaffing associated with infections in neonatal ICUs A study in JAMA Pediatrics found that nurse understaffing was associated with an increased risk for nosocomial infections in very low birth weight infants in neonatal ICUs Importance There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights. Objective To study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes. Design Retrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 2009 were collected for 4 shifts in 4 calendar quarters (3 in 2009 and 1 in 2010). Setting Sixty-seven US NICUs from the Vermont Oxford Network, a national voluntary network of hospital NICUs. Participants All inborn very low-birth-weight (VLBW) infants, with a NICU stay of at least 3 days, discharged from the NICUs in 2008 (n = 5771) and 2009 (n = 5630). All staff-registered nurses with infant assignments. Exposures We measured nurse understaffing relative to acuity-based guidelines using 2008 survey data (4046 nurses and 10 394 infant assignments) and data for 4 complete shifts (3645 nurses and 8804 infant assignments) in 2009-2010. Main Outcomes and Measures An infection in blood or cerebrospinal fluid culture occurring more than 3 days after birth among VLBW inborn infants. The hypothesis was formulated prior to data collection. Results Hospitals understaffed 32% of their NICU infants and 92% of high-acuity infants relative to guidelines. To meet minimum staffing guidelines on average would require an additional 0.11 of a nurse per infant overall and 0.39 of a nurse per high-acuity infant. Very low-birth-weight infant infection rates were 16.5% in 2008 and 13.9% in 2009. A 1 standard deviation–higher understaffing level (SD, 0.11 in 2008 and 0.08 in 2009) was associated with adjusted odds ratios of 1.39 (95% CI, 1.19-1.62; P < .001) in 2008 and 1.39 (95% CI, 1.18-1.63; P < .001) in 2009. Conclusions and Relevance Substantial NICU nurse understaffing relative to national guidelines is widespread. Understaffing is associated with an increased risk for VLBW nosocomial infection. Hospital administrators and NICU managers should assess their staffing decisions to devote needed nursing care to critically ill infants. http://healthcommedia.benchmarkmails26.com/c/l?u=2237D5B&e=2997CD&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o **************** "How to help nurses practice at the top of their game" August 5, 2012 -- Recent press items report that new research has revealed critical aspects of nurse understaffing in the United States and the United Kingdom. On July 31, the Philadelphia Inquirer ran a generally good piece by Don Sapatkin (with Meeri Kim) about a study by researchers at the University of Pennsylvania that used 2006 data from 161 Pennsylvania hospitals to analyze the link between worse staffing and higher rates of infection. The study focused on the burnout associated with poor staffing, which researchers found played a critical role in higher infection rates, taking lives and costing money. The Inquirer article quotes two of the nurses responsible for the study, as well as nurses from the American Nurses Association and elsewhere as outside experts. Although its account of the study findings is not totally clear, the report does give a sense of why having enough skilled, engaged nurses plays such an important role in patient outcomes, particular because of good input from a Pittsburgh union leader. And on July 31, the Telegraph (U.K.) published a good article by Laura Donnelly about a new study of staffing at 46 National Health Service (NHS) hospitals by nursing researchers at Kings College London. That study found that nurses had an average of eight patients during the day and 11 at night (in some places 15 patients at night). Not surprisingly, most of the nurses did not have enough time to do their work. The Telegraph piece is more about the government's responsibility for the poor staffing amid an ongoing public inquiry into the 2009 Stafford Hospital scandal, and the piece does not quote the researchers, though it does include key findings and quote two nursing leaders. The article stresses that understaffing is closely linked to the growing use of less-qualified support staff. The piece could have done more to explain what nurses do to save lives (like detecting infections) that other staff cannot; instead, we hear mostly about custodial care and "compassion." But both the Telegraph and the Inquirer convey the importance of nurse staffing and show that nurses can be academic and health policy leaders. http://www.truthaboutnursing.org/news/2012/aug/staffing.html ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS These are responses to the March issue in which was the following: What would you have done? (Thank you Barbara (BAcello) for sending this ) This independent living facility does not permit staff to do CPR. The dispatch tape broke my heart. With all the negative press, the BNE will probably investigate. The whole situation is unconscionable & I am ashamed to call this nurse a peer.................Barbara A 911 dispatcher pleaded with a nurse at a Bakersfield, Calif., senior living facility to save the life of an elderly woman by giving her CPR, but the nurse said policy did not allow her to, according to a newly released audiotape of the call. “Is there anybody there who is willing to help this lady and not let her die?” the dispatcher asked in a recording of the 911 call released by the Bakersfield Fire Department. “Not at this time,” the nurse said. http://abcnews.go.com/blogs/headlines/2013/03/elderly-woman-dies-after-nurse-refuses-to-give-her-cpr/ ; MarGerlach (Marlene) writes: What would you have done?" Wow! I would have done CPR and so would any nurses I know and the facility be damned! And, Jenxl (Linda) writes: "There's more to the no CPR than was first reported or reported in Paradigm97.... The woman who died did not want any life saving measures which was part of why she went to that establishment. Family was perfectly happy with what happened." ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Do Women Need Bras? French Study Says Brassieres Are A 'False Necessity' Women who go braless may actually have the right idea, new research suggests. According to the results of a 15-year study in France published Wednesday, bras provide no benefits to women and may actually be harmful to breasts over time. "Medically, physiologically, anatomically, the breast does not benefit from being deprived of gravity," Jean-Denis Rouillon, a professor at the University of Franche-Comté in Besançon, told France Info. Conducting the study at the university's hospital, Rouillon measured and examined the breasts of more than 300 women, aged 18 and 35, taking note of how the additional support provided by bras affects the body over time. (It should be noted the study does not mention breast size.) Overall, he found that women who did not use bras benefited in the long term, developing more muscle tissue to provide natural support. As France's The Local notes, Rouillon also noticed that nipples gained a higher lift, in relation to the shoulders, on women who went braless. When bras are worn, the restrictive material prevents such tissue from growing, which may actually accelerate sagging, the study concluded. Capucine Vercellotti, a 28-year-old woman who participated in the research, found that she breathes easier without the constraints of a bra. "At first, I was a little reluctant to the idea of running without a bra, but I got started and after five minutes, I had no trouble at all," Vercellotti said, according to the Agence France-Presse. http://www.franceinfo.fr/societe/les-seins-se-portent-mieux-sans-soutien-gorge-947307-2013-04-10 ***************** Analysis: Emerging deadly virus demands swift sleuth work (Reuters) - The emergence of a deadly virus previously unseen in humans that has already killed half those known to be infected requires speedy scientific detective work to figure out its potential. Experts in virology and infectious diseases say that while they already have unprecedented detail about the genetics and capabilities of the novel coronavirus, or NCoV, what worries them more is what they don't know. The virus, which belongs to the same family as viruses that cause the common cold and the one that caused Severe Acute Respiratory Syndrome (SARS), emerged in the Middle East last year and has so far killed seven of the 13 people it is known to have infected worldwide. Of those, six have been in Saudi Arabia, two in Jordan, and others in Britain and Germany linked to travel in the Middle East or to family clusters. "What we know really concerns me, but what we don't know really scares me," said Michael Osterholm, director of the U.S.-based Center for Infectious Disease Research and Policy and a professor at the University of Minnesota. Less than a week after identifying NCoV in September last year in a Qatari patient at a London hospital, scientists at Britain's Health Protection Agency had sequenced part of its genome and mapped out a so-called "phylogenetic tree" - a kind of family tree - of its links. ... http://links.reuters.com/r/F367J/9BVV6/C49VUX/OJJXSR/B473WS/YT/h?a=http://links.reuters.com/r/F367J/9BVV6/C49VUX/OJJXSR/XBL43J/YT/h ****************** As amazing and complex as the human body is, we are blind and deaf to most of the world around us. Consider... RANDOM FACT: Humans can see less than 1 percent of the electromagnetic spectrum and hear less than 1 percent of the acoustic spectrum. *** Bonus Fact: The existence of the rainbow depends on the conical photoreceptors in your eyes. To animals without cones the rainbow does not exist. So you don't just look at a rainbow, you "create it". ******************** Screening might avert many lung cancer deaths: study (Reuters Health) - A calculation based on results from a large lung cancer screening trial projects that 12,000 deaths a year among the highest-risk smokers and ex-smokers in the U.S. could be avoided with a national screening program. The National Lung Screening Trial, published in 2010, found 20 percent fewer deaths from lung cancer in a group of people at highest risk for the disease when they were screened annually with CT scans, a form of high-resolution X-ray that can spot suspicious lung nodules. Based on the 8.6 million Americans who would fall into that high-risk category because of a decades-long history of smoking, researchers at the American Cancer Society say in a new study that 12,000 fewer people a year would die of lung cancer if national screening were put in place. ... http://links.reuters.com/r/X7E3V/8HVKX/QNGEAP/HDDZK4/MJQ0CD/YT/h?a=http://links.reuters.com/r/X7E3V/8HVKX/QNGEAP/HDDZK4/MJQOX4/YT/h ************************** FDA approves Biogen's oral MS drug, Tecfidera (Reuters) - U.S. regulators on Wednesday approved a new multiple sclerosis drug made by Biogen Idec Inc that is widely expected to become the No. 1 oral treatment for the disease, with annual sales topping $3 billion. The drug, Tecfidera, activates a chemical pathway in the body known as Nrf2 that helps protect nerve cells from damage and inflammation. Following Wednesday's approval by the Food and Drug Administration, Biogen said it will launch the drug within the coming days. Multiple sclerosis is a chronic condition that attacks the central nervous system and can lead to numbness, weakness, paralysis and blindness. It affects more than 2.1 million people worldwide, according to the National Multiple Sclerosis Society. ... http://links.reuters.com/r/CRB2Q/FV9HU/7AD8R7/JIIXCS/GYKFU1/YT/h?a=http://links.reuters.com/r/CRB2Q/FV9HU/7AD8R7/JIIXCS/3CO4CJ/YT/h ******************* The Cost of Collaboration Incorporating shared governance requires cooperation among all levels of staff as well as a comprehensive cost-benefit analysis The benefits of shared governance are recognized throughout the nursing community, but implementing the culture can be challenging when faced with the potential costs. "Nursing and non-nursing leaders are often concerned that shared governance is too costly, but that point of view is very short sighted given the increase in care quality and long-term savings this culture can bring," said Patricia Givens, DHA, EdM, RN, NEA-BC, associate chief nursing officer, Children's Hospital Colorado, Aurora. "Staff engagement at every level is necessary to ensure the highest level of care." While higher staff involvement can incur costs for facilities, when implemented with care and prior planning, shared governance is beneficial to patients, staff, leadership and the healthcare community as a whole. ... http://nursing.advanceweb.com/Archives/Article-Archives/The-Cost-of-Collaboration.aspx ******************** Statistics: 1.7 million: Number of people who sustain a traumatic brain injury (TBI) in the United States each year 475,000: Number of those people who are children 3.1 million: Number of individuals who live with life-long disability as a result of TBI 35%: Percentage of TBIs caused by falls; the highest percentage, 17% are caused by car crashes 30.5%: TBI is a contributing factor to 30.5% of all injury-related deaths in the United States.. Source: Brain Injury Association Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************** Early-onset baldness may predict prostrate cancer in black men. Going bald before age 60 and frontal baldness were significantly associated with high-stage and high-grade prostate cancer among black men, U.S. researchers found. They wrote in the journal Cancer Epidemiology, Biomarkers & Prevention that any form of baldness was linked to a greater likelihood of developing prostate cancer. MedPage Today (free registration) ************** Scientists find new gene markers for cancer risk NEW YORK (AP) -- A huge international effort involving more than 100 institutions and genetic tests on 200,000 people has uncovered dozens of signposts in DNA that can help reveal further a person's risk for breast, ovarian or prostate cancer, scientists reported Wednesday. It's the latest mega-collaboration to learn more about the intricate mechanisms that lead to cancer. And while the headway seems significant in many ways, the potential payoff for ordinary people is mostly this: Someday there may be genetic tests that help identify women with the most to gain from mammograms, and men who could benefit most from PSA tests and prostate biopsies. ... http://hosted.ap.org/dynamic/stories/U/US_MED_CANCER_GENES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2013-03-27-17-21-44 ******************** 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 Newsletter...... Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ***************** FDA approves once-monthly Abilify for schizophrenia (Reuters) - Regulators on Thursday approved a once-monthly injectable form of Abilify, the blockbuster treatment for schizophrenia, which will be sold by Japanese drugmaker Otsuka and Danish drug group Lundbeck. In July 2012, the Food and Drug Administration declined to approve the medicine, Abilify Maintena, citing deficiencies from an inspection of a third-party supplier of sterile water. Otsuka and Lundbeck resubmitted their marketing application soon afterward, after working with an alternative supplier. About 1 percent of adults in the United States are believed to have schizophrenia, a disorder of thought processes that can involve hallucinations, delusions and poor emotional responsiveness. ... FDA approves once-monthly Abilify for schizophrenia *************************** (Reuters) - A baby girl in Mississippi who was born with HIV has been cured after very early treatment with standard HIV drugs, U.S. researchers reported on Sunday, in a potentially ground-breaking case that could offer insights on how to eradicate HIV infection in its youngest victims. The child's story is the first account of an infant achieving a so-called functional cure, a rare event in which a person achieves remission without the need for drugs and standard blood tests show no signs that the virus is making copies of itself. More testing needs to be done to see if the treatment would have the same effect on other children, but the results could change the way high-risk babies are treated and possibly lead to a cure for children with HIV, the virus that causes AIDS. "This is a proof of concept that HIV can be potentially curable in infants," said Dr. Deborah Persaud, a virologist at Johns Hopkins University in Baltimore, who presented the findings at the Conference on Retroviruses and Opportunistic Infections in Atlanta. ... http://links.reuters.com/r/2XRTM/OXSOQ/U10J5T/UUU9H4/K9ICGQ/YT/h?a=http://links.reuters.com/r/2XRTM/OXSOQ/U10J5T/UUU9H4/Q3RM09/YT/h *********************** RANDOM FACTS : On November 19, 1863, at the dedication of a military cemetery at Gettysburg, Pennsylvania, during the American Civil War, President Abraham Lincoln delivers one of the most memorable speeches in American history. In just 272 words, Lincoln brilliantly and movingly reminded a war-weary public why the Union had to fight, and win the Civil War. ********************** Heart repair breakthroughs replace surgeon's knife SAN FRANCISCO (AP) - Have a heart problem? If it's fixable, there's a good chance it can be done without surgery, using tiny tools and devices that are pushed through tubes into blood vessels. Heart care is in the midst of a transformation. Many problems that once required sawing through the breastbone and opening up the chest for open heart surgery now can be treated with a nip, twist or patch through a tube. These minimal procedures used to be done just to unclog arteries and correct less common heart rhythm problems. Now some patients are getting such repairs for valves, irregular heartbeats, holes in the heart and other defects - without major surgery. Doctors even are testing ways to treat high blood pressure with some of these new approaches. All rely on catheters - hollow tubes that let doctors burn away and reshape heart tissue or correct defects through small holes into blood vessels. ... http://apnews.myway.com/article/20130324/DA57ILM80.html **************** Warfarin Communication Toolkit for Nurses This toolkit introduces a new set of training materials—presentations, exercises—as well as resources to help you adapt what you learn to your practice setting. The materials are based on the principles of effective standardized communication that includes these components: Situation, Background, Assessment, and Recommendation (SBAR). The materials will teach about how to use SBAR to improve communication about warfarin. The skills taught have applications for other clinical areas as well; SBAR has been used to address a variety of communication challenges in diverse settings. http://www.chainonline.org/practice-tools/warfarin-communication-toolkit-for-nurses/ ************* Word Origins: Atlanta*** Georgia's chief city came into being thanks to the railroad, which began to work its way through the area in 1836. A planned line from Chattanooga, Tennessee, to the northwest was to shunt at a place noted on the map simply as "Terminus." A few years later, a railroad official suggested naming the growing town around this point "Atlantica-Pacifica." The name stuck until 1847, when a resident suggested the shortened form "Atlanta," made official that year. ************* Improving Patient Safety in Nursing Homes: Resource List (Thank you, BAcello [Barbara] ) This document contains references to Web sites that provide practical resources nursing homes can use to implement changes to improve patient safety culture and patient safety. http://www.ahrq.gov/professionals/quality-patient-safety/surveys/nursing-home/2010/ ******************** FALLS TOOLKIT: Toolkit offers new ideas for preventing hospital falls (Thank you, BAcello [Barbara] ) http://www.ahrq.gov/legacy/research/ltc/fallpxtoolkit/ This 202-page public domain toolkit is written for hospitals but AHRQ is categorizing it under LTC. It contains a lot of good info, including these care plan approaches: 13 ways to prevent patient falls To reduce the risk of falls among all patients, health professionals in hospitals should: 1. Familiarize the patient with the environment. 2. Have the patient demonstrate call light use. 3. Maintain call light within reach. 4. Keep personal possessions within safe reach of the patient. 5. Have sturdy handrails in patient bathrooms, rooms and hallways. 6. Place the hospital bed in a low position when a patient is resting in bed; raise it to a comfortable height when the patient is getting out of bed. 7. Keep hospital bed brakes locked. 8. Keep wheelchair wheels in the locked position when it is stationary. 9. Keep nonslip, comfortable, well-fitting footwear on the patient. 10. Use night lights or supplemental lighting. 11. Keep floor surfaces clean and dry. Clean up all spills promptly. 12. Keep patient care areas uncluttered. 13. Follow safe practices when helping patients in and out of bed. Source: “Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care,” Agency for Healthcare Research and Quality, January. ************** Nine-year-old Awonder Liang of Madison, Wisconsin just became the youngest chess master in the United States. He earned the title Saturday while competing in the Midwest Open Team Chess Festival. RANDOM FACT: The United States Chess Federation (USCF) awards the Title of National Master to anyone who achieves a USCF rating of 2200, and the title of Senior Master to anyone who achieves a USCF rating of 2400. The USCF also awards the Life Master title to anyone who holds a 2200 rating for a total of 300 or more games in his or her lifetime The title Grandmaster is awarded to strong chess players by the world chess organization FIDE. Apart from World Champion, Grandmaster is the highest title a chess player can attain. Once achieved, the title is held for life. ********* Bonus Fact: Blindfold chess is real and documented in world records. It is as it sounds: a player makes all of his or her moves without looking at a board. Usually there is a 'middle man' of sorts to give and receive moves for the game. Blindfold chess is an impressive skill that many stronger chess players possess. It certainly requires a keen ability to see the board clearly, which can get difficult after many moves. The record was set in 1960 in Budapest by Hungarian Janos Flesch, who played 52 opponents simultaneously while blindfolded � he won 31 of those games. *************** U.S. funds 25 states to test new Medicaid models (Reuters) - The Department of Health and Human Services said on Thursday that it would provide 25 of the 50 states with funding to test new ways to lower costs and improve care within the national Medicaid program for the poor. The first states to receive State Innovation Model awards are Arkansas, Maine, Massachusetts,Minnesota, Oregon and Vermont, which will implement plans to transform their healthcare delivery system under President Barack Obama's healthcare reform law, which sets aside $300 million for the overall venture. Medicaid, jointly funded by federal and state funds, accounts for about one-quarter of state budgets nationwide and has taken on new urgency as a funding item since the recession expanded the program's enrollment in many areas. "I understand the real sense of urgency that states feel to improve the health of their populations, while also reducing total health care costs, and it's critical that the many elements of health care in each state - including Medicaid, public health, and workforce training - work together," Health and Human Services Secretary Kathleen Sebelius said in a statement. ... http://links.reuters.com/r/P65EH/JZXIO/2O5LEC/0GGF7B/K9IL6U/YT/h?a=http://links.reuters.com/r/ P65EH/JZXIO/2O5LEC/0GGF7B/VTU2MS/YT/h ************* ALI patients on ventilation vulnerable to PTSD (As one nurse stated: "I don't understand the disbelief that ICU patients would suffer PTSD. Sleep deprivation, narcotics, 24 hours of constant noice, interruptions, temperature changes (to cold, to hot), memory lapses etc. can cause anyone to experience major anxiety and bad dreams. Children are the same. We called it ICU psychosis. You can see it happening right before your eyes. I'm hopeful that we can prevent some of the anxiety that occurs during intense hospital stays d/t a life a/o death situation. What good is living if you can't survive the traumatic memories and not know which was real and which were not. Go research!")(This is not my interjection, however I agree with her) One in three patients with acute lung injury who survived stays in an ICU and required use of a mechanical ventilator showed substantial post-traumatic stress disorder symptoms that lasted for up to two years, according to a study. Because ALI is considered an archetype for critical illness, the researchers suspect PTSD is common among other ICU survivors as well. "We usually think of PTSD as something you develop if you go to war, are sexually assaulted or suffer a similar emotional trauma, " Dale Needham, MD, PhD, the study’s senior author and a critical care specialist at the Johns Hopkins University School of Medicine, said in a news release. ... The study appeared Feb. 26 on the website of the journal Psychological Medicine. The study abstract is available at http://bit.ly/Wg5fwA. ******************* To college graduates saddled with student debt, reaching a day when they don't have to make a monthly payment may seem far off, especially since U.S. Senators are still paying off their loans. However, Brian McBride, an associate producer at CNN and a 2010 graduate out of Arizona State University, managed to pay off $26,500 in debt in just two years. He explained his plan on CNN Money's website. http://www.huffingtonpost.com/2013/01/09/brian-mcbride-paying-off-26500-in-debt_n_2441339.html?ncid=webmail6 ******************** Bleeding, No Extra Ischemic Protection With High-Dose Aspirin Heartwire An analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial has shown that patients with ST-segment-elevation MI (STEMI) undergoing primary PCI discharged on high-dose aspirin have higher rates of major bleeding than those discharged on low-dose aspirin. The high-dose aspirin also failed to provide any additional protection against ischemic events [1]. "In the clinical guidelines, the recommended dose of aspirin ranges anywhere from 82 mg to 325 mg because we don't really have any prospective, randomized study showing which dose is actually best for these patients, which is kind of interesting given that we are now putting so much of our attention on the bleeding complications," Dr Roxana Mehran (Mount Sinai School of Medicine, New York), one of the study authors, told heart wire . "I think it's important that agents not only protect you against ischemia but also don't expose you to the harm of bleeding complications." ... http://www.medscape.com/viewarticle/776458 **************** Ever do the sugar-or-sweetener cha-cha-cha at the coffee shop? You know, when you dance between the sugar shaker and the pink, blue, and yellow packets? If this were a cartoon strip, the thought bubble over your head would read, "What’s the more healthful choice? The no-calorie fakes? The full-calorie hard stuff? Help!" It's like choosing between raising taxes and increasing the national debt. Pick your poison. Okay, neither sugar nor sweeteners are poison if they're eaten in reasonable quantities, but that's our point. There's nothing reasonable about the amount of sugars and syrups in all kinds of foods, from bagels to frozen veggie mixes. The effect of these added sugars? Imagine eating 22 teaspoons of sugar for breakfast every day. That's average for Americans. Canadians average 14 teaspoons of sugar a day. What that does to your health reads like a dirty laundry list. Research shows it lowers HDL (good) cholesterol and raises bad triglycerides. It also gloms onto proteins that create destructive substances called AGEs (short for advanced glycation end products). These set you up for heart disease, stiff joints, wrinkles, Alzheimer's, diabetes, kidney problems, bone fractures, and vision loss. Phew. (Follow these 4 steps to stop sugar cravings. ) ... http://www.realage.com/food/sugar-vs-artificial-sweeteners-which-is-healthier-and-safer?eid=1010665687&memberid=4687812 *********************** (Reuters Health) - Electronic alerts and other technology-based aids may help prevent costly missed or delayed diagnoses, according to a new review of past evidence. "I think there's a general feeling that we're probably going to need multiple strategies," said Dr. David Newman-Toker, who studies diagnostic errors at the Johns Hopkins University School of Medicine in Baltimore but was not involved in the study. He gave as examples computer programs that generate a list of possible diagnoses based on patient symptoms or policy initiatives that reward doctors for making correct diagnoses. For years researchers have known about the dangers of medication prescribing errors and mistakes in the operating room. And last week, another team of scientists reported that diagnostic errors are common in primary care and may put patients at risk for serious complications (see Reuters Health story of Feb 26, 2013 here: reut.rs/YxG9WC). But, according to the researchers behind the new analysis, most studies have not tracked whether patient safety efforts aimed at preventing such mistakes directly improve patient health down the line, or considered their costs and possible harms. ... http://links.reuters.com/r/JLVW3/7H23O/DWS21K/TPP9XU/FDWOYE/YT/h?a=http://links.reuters.com/r/JLVW3/7H23O/DWS21K/TPP9XU/FDWODK/YT/h ************************ New treatment benefits hemorrhagic stroke patients A minimally invasive procedure to remove blood clots in brain tissue after hemorrhagic stroke appears safe and may reduce long-term disability, according to late-breaking research presented Feb. 7 at the American Stroke Association’s international conference in Honolulu. Of the hundreds of thousands of Americans who have intracerebral hemorrhages each year, most are severely debilitated, noted Daniel Hanley, MD, the study’s lead author and professor of neurology at Johns Hopkins School of Medicine in Baltimore. ICH is the most common type of bleeding stroke. There has not been a specific evidence-based targeted treatment recommended for ICH nor any long-term randomized data on surgical treatment, according to the researchers. In one-year results of the Phase II study, researchers found that patients treated with surgery and recombinant tPA had less disability, spent less time in the hospital and were less likely to be in a long-term care facility than were other ICH patients. ... http://news.nurse.com/article/20130218/NATIONAL01/302180008 **************** Tips to Improve Your Caregiving Skills The opportunity to provide personal and attentive patient care is what draws many people to the nursing profession, yet the job itself can sometimes get in the way. Amid the myriad of tasks and responsibilities of each shift, nurses need to remember that caring for patients is always at the core. And caregiving is a skill that can be continually improved. “I think the biggest mistake nurses make in their caregiving is becoming ‘task-oriented’ and losing connection with the patient,” began Kathleen Lattavo, MSN, RN, CNS-MS, CMSRN, RNBC, ACNSBC, president, Academy of Medical-Surgical Nurses. “We run in to hang an IV piggyback and might ask the patient how they’re doing, but it can be obvious we just want to complete our task and get on our way. We are constantly thinking about everything else we need to do, when we should concentrate on the present encounter, give it our undivided attention and then move on from there.” ... http://www.nursezone.com/Nursing-News-Events/more-news/Tips-to-Improve-Your-Caregiving-Skills_41044.aspx ******************* Word Origins: Aztec *** The ethnographic term Aztec comes from the Nahuatl word Aztecatl, meaning "people of Aztlan," a place that archaeologists believe lies in present-day Arizona or New Mexico. Thousands of years ago, those people, who called themselves Nahua, moved to the site of present-day Mexico City. The Nahua are the most populous indigenous people in Mexico today, but we reserve the term "Aztec" for their forebears, whose empire collapsed with the Spanish conquest of Mexico. Greed *** "Greed" is one of the few words to enter English from the Gothic language, which was spoken in scattered pockets of eastern and northern Europe until the ninth century. Its original form, gredas, meant "hunger," a sense that later came to be applied to a kind of insatiable hunger of the soul. ***************** Study: Effects of childhood bullying persist into adulthood: A new study published in JAMA Psychiatry sheds light on the effects of childhood bullying in adults by assessing victims of bullying, those who were victims and bullies, and bullies. Victims of bullying had higher rates of psychological disorders, including generalized anxiety, panic disorder, and agoraphobia in adulthood. Those who were both victims and bullies had an increased risk for adult depression, panic disorder, and, in males only, suicide. Bullies were at risk for antisocial personality disorder. The researchers assessed participants four to six times between the ages of 9 and 16 years and in young adulthood (19, 21, and 21-26 years). ... http://healthcommedia.benchmarkmails26.com/c/l?u=20CA33D&e=281425&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ******************* Even for sperm, there is a season (Reuters) - Autumn is the time of year most associated with bumper crops of new babies, and according to an Israeli study there may be a scientific reason for it: human sperm are generally at their healthiest in winter and early spring. Based on samples from more than 6,000 men treated for infertility, researchers writing in American Journal of Obstetrics & Gynecology found sperm in greater numbers, with faster swimming speeds and fewer abnormalities in semen made during the winter, with a steady decline in quality from spring onward. "The winter and spring semen patterns are compatible with increased fecundability and may be a plausible explanation of the peak number of deliveries during the fall," wrote lead researcher Eliahu Levitas from Ben-Gurion University of the Negev in Beer-Sheva. If there is a seasonal pattern, they said, that knowledge may "be of paramount importance, especially in couples with male-related infertility struggling with unsuccessful and prolonged fertility treatments." For the new study, Levitas and his colleagues collected and analyzed 6.455 semen samples from men at their fertility clinic between January 2006 and July 2009. Of those, 4,960 were found to have normal sperm production, and 1,495 had abnormal production, such as low sperm counts. ... http://links.reuters.com/r/WZINC/0N8P8/304TQV/9ZZ6PD/K9I590/YT/h?a=http://links.reuters.com/r/WZINC/0N8P8/304TQV/9ZZ6PD/VTU9NI/YT/h ~~**~~**~~**~~**~~**~~ HUMOR SECTION While working as a pediatric nurse, I had the difficult assignment of giving immunization shots to children. One day I entered the examining room to give a four-year-old Leah her shot. "No! No! No!" she screamed. "Leah," her mother said, "the nurse is trying to help you. Please be polite." At that, the girl yelled even louder, "No, thank you! No, thank you!" ~~**~~**~~**~~**~~**~~ 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 Uncovering Common Bacterial Skin Infections: The four most common bacterial skin infections are impetigo, erysipelas, cellulitis, and folliculitis. Review the etiology, clinical presentation, diagnosis, prevention, treatment, and implications for primary care practice necessary The Nurse Practitioner: The American Journal of Primary Health Care (2.3 contact hours/0.5 contact hour) http://email.lww.com/t?r=1483&c=3470514&l=59027&ctl=4637908:B54AB34282EDAD0065A06A219B3283E9D396447CC72D81E1& ***************** What You Need to Know about Pharmacogenomics Recent studies have shown that a patient's response to drug therapy, including adverse drug reactions, can be strongly influenced by the patient's genetic makeup. Pharmacogenomics, or tailoring medications to a patient's genomic information, is a significant and growing area of research with the potential to improve patient outcomes. Nursing2013 (2.3 contact hours) http://email.lww.com/t?r=1483&c=3470514&l=59027&ctl=463790C:B54AB34282EDAD0065A06A219B3283E9D396447CC72D81E1& *************** 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/ 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/ 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 * ******************************************* ****************************************************** Lactated Ringers and 5 Percent Dextrose Injection, USP, 1000 ML, Flexible Containers: Recall - Due to Non-Sterility Hospira, Inc. is initiating a voluntary nationwide user-level recall of one lot of Lactated Ringers and 5% Dextrose Injection, USP, 1000 mL, Flexible Container, NDC 0409-7929-09. This action is due to one confirmed customer report where a spore-like structured particulate, consistent with mold, was noted in the solution. Hospira has not received reports of any adverse events associated with this issue for this lot, and has not identified any quality issues with retention samples for this lot. If contaminated solution is used on a patient, this may cause thrombosis, phlebitis, bacteremia, sepsis, septic shock and/or endocarditis, or result in a fatal infection in a broad array of patients. Anyone with an existing inventory should stop use and distribution, quarantine the product immediately, and call Stericycle at 1-888-965-5798 between the hours of 8am to 5pm EST, Monday through Friday, to arrange for the return of the product. Replacement product from other lots is available. For medical inquiries, please contact Hospira Medical Communications at 1-800-615-0187. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm337089.htm **************** Stryker Instruments Neptune 1 Silver and Neptune 2 Ultra Waste Management System (Neptune 1 Silver and Neptune 2 Ultra): Safety Communication - Reports of Serious Tissue Damage and Patient Death Stryker issued updated recall notifications dated Feb. 20, 2013 for the Neptune 1 Silver and the Neptune 2 Ultra reminding customers of the steps they need to take to continue using these devices. Health care facilities that must use these devices need to ensure the following steps are completed, as stated in their Certificate of Medical Necessity: Ensure ALL USERS of the Neptune 1 Silver and Neptune 2 Ultra are properly trained before the use of the device and aware of the risks associated with the device. Implement the Neptune Pre-use Checklist within your facility. This checklist must be completed BEFORE EVERY PROCEDURE for which a Neptune 1 Silver and/or Neptune 2 Ultra device is used. Identify a training facilitator or device champion for each facility/hospital who will ensure the Neptune Pre-use Checklist is implemented consistently with your facility’s standard protocol, and in a way that makes sense for your facility to document the checklist was completed. Prior to using the device, health care providers should follow the recommendations listed in the updated safety communication to mitigate the risks of using these devices. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm322811.htm ********************** Omontys (peginesatide) Injection by Affymax and Takeda: Recall of All Lots - Serious Hypersensitivity Reactions Affymax, Inc. and Takeda Pharmaceutical Company Limited along with the U.S. Food and Drug Administration (FDA) are informing the public of a voluntary recall of all lots of OMONTYS® (peginesatide) Injection to the user level as a result of new postmarketing reports regarding serious hypersensitivity reactions, including anaphylaxis, which can be life-threatening or fatal. To date, fatal reactions have been reported in approximately 0.02% of patients following the first dose of intravenous administration. The reported serious hypersensitivity reactions have occurred within 30 minutes after such administration of Omontys. There have been no reports of such reactions following subsequent dosing, or in patients who have completed their dialysis session. Since launch, more than 25,000 patients have received Omontys in the postmarketing setting. The rate of overall hypersensitivity reactions reported is approximately 0.2% with approximately a third of these being serious in nature including anaphylaxis requiring prompt medical intervention and in some cases hospitalization. **************************** Spacelabs Anesthesia Workstations and Service Kits: Class 1 Recall - Defect in CAS I/II Absorbers There is a defect in CAS I/II Absorbers in the Spacelabs Anesthesia Workstations and Service Kits that may cause a condition leading to an increase in the carbon dioxide concentration within the inhaled gas being delivered to the patient. This product may cause serious adverse health consequences, including death. These products were manufactured and distributed from Oct. 31, 2012 to Jan. 15, 2013. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm345368.htm ******************** Vascular Solutions Inc., Guardian II and Guardian II NC Hemostasis Valves: Class I Recall - Risk of Air Being Introduced Into Device FDA notified healthcare professionals of a Class I recall of the Vascular Solutions Inc., Guardian II and Guardian II NC Hemostasis Valves, Model Numbers 8210, 8211, 8215, and 8216. The firm is recalling the product due to a risk that air may be introduced into the device which may lead to an air embolism. This product may cause serious adverse health consequences, including death. A list of the recalled lot numbers is available from Vascular Solutions and has been provided to each facility that purchased the affected products. The recalled products were manufactured and distributed from February 2012 to February 2013. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm345520.htm ***************** The FDA Safety Information and Adverse Event Reporting Program BIVIGAM Immune Globulin Intravenous (Human), 10 Percent Liquid, 100 mL Sterile Vial: Recall - Visible Particles Observed During a routine annual reserve inspection, visible particles were observed in lot number 120016 (Expiration Date: March 31, 2014) of BIVIGAM Immune Globulin Intravenous (Human), 10% Liquid. Biotest is voluntarily recalling this lot from the market. Inspections of other lots of product have not shown the presence of visible particles. BIVIGAM is indicated for the treatment of patients with primary humoral immunodeficiency (PI). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm346771.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: bapd@bellsouth.net Barbara (April 1, 2013) rebeccalynnsands@gmail.com (Rebecca) April 16, 2013 mjalean@gmail.com (Marcella) April 16, 2013 Ciejones@Valdosta.edu (Cieshia) April 16, 2013 bgwilson1959@hotmail.com (Brenda) April 16, 2013 Laura.browning81@yahoo.com (Laura) April 16, 2013 KJustice3@yahoo.com (Kelly) April 16, 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 ~~**~~**~~**~~**~~**~~ 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. ~~**~~**~~**~~**~~**~~ 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. THOUGHT FOR THE DAY "Learning is a treasure that will follow its owner everywhere.” - Chinese Proverb Hope to hear from you..... Frankie RNFrankie@AOL.com