Friday, August 9, 2013

Paradigm97......August issue


PARADIGM BYTES

Newsletter for Paradigm 97
August 10, 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.
 
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SNIPPETS
Come with me if you want to live...
June 3, 2013 -- Today, during a speech about mental health awareness, U.S. Vice President Joe Biden spent about a minute paying tribute to nurses. That short part of his speech implicated issues including nursing skills, nursing autonomy, the nurse as angel, the profession's gender mix, and even the naughty nurse. Biden mentioned psychiatric nurses, and then, apparently departing from his prepared text, said that "if there's any angels in heaven, by the way, they're all nurses," referring to his personal experience with neurosurgery. Of course, nurses are not angels, but real professionals who save lives with education and skill--and unlike angels, they need the resources to do so. Then, in the remark that's gotten the most attention, Biden said:  "Doctors allow you to live, nurses make you want to live." Well, sort of. If he meant nurses focus on psychosocial care, motivating you to keep trying and showing you how, that's good, although he might have simply meant nurses are nice people who cheer you up. Unfortunately, the remark implies that physicians save lives and nurses don't save lives, which is false. And as titters from the audience alerted Biden, the statement can also be interpreted, though not fairly, as a clichéd reference to hot female nurses making sick men want to live for reasons that we can't specify here or our news alert will bounce back. Biden quickly noted that he was referring to "male nurses and female nurses." Finally, Biden said that during the two months he spent in the ICU, his neurosurgeon would enter his room and say (here Biden adopted a deep, somewhat pompous voice): "We gotta do this, this, this, and the other," and "my nurses would all go, 'yes, sir,' and then they'd do exactly what I needed." We appreciate Biden's suggestion that the nurses had the knowledge and skill to do "exactly what [he] needed." It's sad but plausible that the nurses felt they had to do it covertly, as Biden implies, presumably because they lacked the social power to simply discuss care with the surgeon as a professional colleague. We thank Vice President Biden for presenting some helpful information about nursing.
http://www.truthaboutnursing.org/news/2013/jun/03_biden.html         

The most common way people give up their power
is by thinking they don't have any.
          
    Alice Walker
                                                                                                            
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MEDICAL  NEWS


 Nurses & Healthcare Workers in 14 Nations Form   GLOBAL NURSES UNITED

With aim to Step Up Fight against Austerity, Privatization, Attacks on Public Health
And Work for Safe Nurse Staffing Ratios and Improved Patient Care for All
SAN FRANCISCO – Leaders of the premiere nurses and health care workers unions in 14 nations in the Americas, Africa, Asia, and Europe have announced plans to form a new international organization to step up the fight against the harmful effects of austerity measures, privatization, and cuts in health care services that they say are putting people and communities at risk across the planet.
Calling the new formation Global Nurses United, leaders of the initial endorsing countries said they would also work collectively to guarantee the highest standards of universal healthcare as a human right for all, to secure safe patient care, especially with safe nurse-to-patient ratios, and safe health care workplaces.
Endorsers of the San Francisco declaration included top nurse and health care worker unions from Argentina, Australia, Brazil, Canada, Costa Rica, the Dominican Republic, Guatemala, Honduras, Ireland, Israel, the Philippines, South Africa, South Korea, and the United States.
Pledging to work together with all health care workers and other organizations committed to economic and social justice, the leaders of Global Nurses United said they are also unified in opposition to the adverse effects of income inequality, poverty, mal distribution of wealth and resources, attacks on public workers, and the ravages of climate change.
As participants noted, there are international union formations of other sectors ranging from teachers to steel workers.  Now nurses have one as well, said enthusiastic GNU participants.

http://nationalnursesunited.org/page/m/6c0b009d/ac723bd/71f9f14f/16a3e7f7/3726559121/VEsC/
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 Statement: Safe staffing key to quality healthcare

An appropriate number of nurses and other staff should be available at all times across the continuum of care, with a mix of education, skills and experience to ensure patient care needs are met and working conditions stay hazard-free, according to a policy statement on safe staffing levels released July 15 by the International Centre for Human Resources in Nursing in Geneva, Switzerland.

"It is well known that nurse staffing affects the patient’s length of stay in hospital, morbidity and mortality and their reintegration into the community," Judith Shamian, president of the International Council of Nurses, said in a news release. "In addition, safe staffing levels are associated with improved retention, recruitment and workforce sustainability as well as better cost efficiency for the healthcare system — in short this is essential to the functioning of all health services."


The policy statement, which was prepared with the ICN International Workforce Forum, sets out key principles that underpin safe staffing levels. These principles include:

• Ensuring the safe delivery of care should be the main consideration in healthcare staffing decisions.

• Safe staffing means care is delivered without harm to either patients or staff.

• Safe staffing takes into account not only numbers of staff and mix of competencies, but also other variables such as a manageable workload, a responsive and supportive workplace culture, adequate supervision, appropriate training and a range of high-quality facilities and equipment.

For the full policy statement, visit http://bit.ly/12HwSgb.   
Launched by the International Council of Nurses and the Florence Nightingale International Foundation in 2006, ICHRN is dedicated to strengthening the nursing workforce globally through the development, ongoing monitoring and dissemination of comprehensive information, standards and tools on nursing human resources policy, management, research and practice.

http://news.nurse.com/article/20130725/NATIONAL06/107290022
 
 
 
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INTERESTING READING
 
Please remember that the REUTERS articles are usually good for only 30 days
 

Surgeons may have a new way to smoke out cancer. 
 
An experimental surgical knife can help surgeons make sure they've removed all the cancerous tissue, doctors reported Wednesday. Surgeons typically use knives that heat tissue as they cut, producing a sharp-smelling smoke. The new knife analyzes the smoke and can instantly signal whether the tissue is cancerous or healthy.
Now surgeons have to send the tissue to a lab and wait for the results.
Dr. Zoltan Takats of Imperial College London suspected the smoke produced during cancer surgery might contain some important cancer clues. So he designed a ‘‘smart’’ knife hooked up to a refrigerator-sized mass spectrometry device on wheels that analyzes the smoke from cauterizing tissue.
The smoke picked up by the smart knife is compared to a library of smoke ‘‘signatures’’ from cancerous and non-cancerous tissues. Information appears on a monitor: green means the tissue is healthy, red means cancerous and yellow means unidentifiable.
To make sure they've removed the tumor, surgeons now send samples to a laboratory while the patient remains on the operating table. It can take about 30 minutes to get an answer in the best hospitals, but even then doctors cannot be entirely sure, so they often remove a bit more tissue than they think is strictly necessary....         

http://www.boston.com/lifestyle/health/2013/07/17/new-surgical-knife-can-instantly-detect-cancer/WeC7vmWiQay8OUMdU2OW1L/story.html

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  The 10 warning signs of Alzheimer's  By 2050, the number of people living with Alzheimer's is expected to triple. But diagnosing someone online isn't a good idea, experts say.   

If you suspect a family member or friend is developing Alzheimer's, take a look at these 10 warning signs of Alzheimer's Disease, put together by the Alzheimer's Association:
1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, at work, or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing the ability to retrace steps 
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood and personality
Rather than diagnose Alzheimer's disease at home, head to your doctor's office. You can also find more information at www.alz.org, or by calling the Alzheimer's Association's 24-hour hotline at (800) 272-3900.

http://www.cnn.com/2013/07/18/health/alzheimers-warning-signs/index.html?hpt=he_c1
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 Release of Eliquis blood clot preventer story

(Reuters) The blood clot preventer Eliquis, sold by Pfizer Inc and Bristol-Myers Squibb Co, proved as effective as widely used warfarin in treating a dangerous condition known as venous thromboembolism and caused far less bleeding, according to data from a large clinical trial.
The Pfizer and Bristol-Myers pill met the main goal of the study by showing it worked just as well as conventional treatment with warfarin, a generic blood thinner, in reducing recurrence of the condition and related deaths.
Eliquis also led to a nearly 70 percent reduction in the risk of major bleeding and more than a 50 percent reduction in a category known as clinically relevant non-major bleeding. Bleeding is typically the most troubling side effect of extended use of blood thinning drugs.
Dr. Giancarlo Agnelli, the study's lead investigator, called the bleeding results "a remarkable real advantage" for Eliquis.
"This is to me the most striking finding of this study in terms of potential changes to clinical practice," Agnelli, who presented the data on Monday at the International Society on Thrombosis and Hemostasis (ISTH) meeting in Amsterdam, said in a telephone interview. The results were also published in the New England Journal of Medicine. ...

http://links.reuters.com/r/Z59UA/D0M8F/7AD8R7/RN36V0/B442YX/YT/h?a=http://links.reuters.com/r/Z59UA/D0M8F/7AD8R7/RN36V0/4VVGZT/YT/h
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FDA approves the first non-hormonal treatment for hot flashes associated with menopause

The U.S. Food and Drug Administration today approved Brisdelle (paroxetine)to treat moderate to severe hot flashes (vasomotor symptoms) associated with menopause. Brisdelle, which contains the selective serotonin reuptake inhibitor paroxetine mesylate, is currently the only non-hormonal treatment for hot flashes approved by the FDA.
 
There are a variety of FDA-approved treatments for hot flashes, but all contain either estrogen alone or estrogen plus a progestin.
 
Hot flashes associated with menopause occur in up to 75 percent of women and can persist for up to five years, or even longer in some women. Hot flashes are not life-threatening, but the symptoms can be very bothersome, causing discomfort, embarrassment and disruption of sleep.
 
“There are a significant number of women who suffer from hot flashes associated with menopause and who cannot or do not want to use hormonal treatments,” said Hylton V. Joffe, M.D., M.M.Sc., director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research. “Today’s approval provides women with the first FDA-approved, non-hormonal therapeutic option to help ease the hot flashes that are so common in menopause.”
 
The safety and effectiveness of Brisdelle were established in two randomized, double-blind, placebo-controlled studies in a total of 1,175 postmenopausal women with moderate to severe hot flashes (a minimum of seven to eight per day or 50-60 per week). The treatment period lasted 12 weeks in one study and 24 weeks in the other study. The results showed that Brisdelle reduced hot flashes compared to placebo. The mechanism by which Brisdelle reduces hot flashes is unknown.
 
The most common side effects in patients treated with Brisdelle were headache, fatigue, and nausea/vomiting.  (hmmmmm).

http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNzAxLjIwNTkyMTgxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDcwMS4yMDU5MjE4MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTc3Mzk3JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&102&&&http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm359030


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  FDA: Menthol cigarettes bigger public health risk than regular cigs

RICHMOND, Va. - A Food and Drug Administration review concludes that menthol cigarettes likely pose a greater public health risk than regular cigarettes but does not make a recommendation on whether to limit or ban the minty smokes — one of the few growth sectors of the shrinking cigarette business.
The federal agency released the independent review on Tuesday and is seeking input from the health community, the tobacco industry and others on possible restrictions on the mint-flavored cigarettes.
The FDA evaluation concluded that there is little evidence to suggest that menthol cigarettes are more or less toxic or contribute to more disease risk to smokers than regular cigarettes. However, there is adequate data to suggest that menthol use is likely associated with increased smoking initiation by younger people and that menthol smokers have a harder time quitting, the review said. ...
 
 http://www.nbcnews.com/health/fda-menthol-cigarettes-bigger-public-health-risk-regular-cigs-6C10713833
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 Cold caps tested to prevent hair loss during chemo

WASHINGTON (AP) -- Hair loss is one of chemotherapy's most despised side effects, not because of vanity but because it fuels stigma-revealing to the world an illness that many would rather keep private.
Now U.S. researchers are about to put an experimental hair-preserving treatment to a rigorous test: To see if strapping on a cap so cold it numbs the scalp during chemotherapy really works well enough to be used widely in this country, as it is in Europe and Canada.
The first time Miriam Lipton had breast cancer, her thick locks fell out two weeks after starting chemotherapy. But when the disease struck again, she used a cold cap during treatment and kept much of her hair, making her fight for survival seem a bit easier.  ...

http://hosted.ap.org/dynamic/stories/U/US_MED_HEALTHBEAT_CHEMO_CAPS?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2013-07-22-14-22-18
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  QUIZ TIME:                

Which statement about hemoglobin
A1c (HbA1c) is correct?
a. An HbA1c level of 3% signifies a blood glucose (BG) level that indicates diabetes mellitus.
b. An elevated HbA1c level indicates the patient’s BG was normal the past month.
c. The HbA1c test indicates the average BG level over the preceding 2 to 3 months.
d. The HbA1c test indicates the average BG level over the preceding 6 to 12 months.


  (Answer at end of Newsletter)

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    Frozen TV dinners weren’t served often when I was growing up in the 60’s. However, on rare, extra-busy nights, I remember eating my meal out of that small, compartmentalized aluminum tray. They were always heated in the oven (since microwaves were not yet staples in every home). Watery mashed potatoes, tough corn, and greasy fried chicken—in no way was it the finest of cuisines, but the novelty made it enjoyable. Eating in front of the TV was always off limits at my house. “We eat as a family,” my mom would preach.

The Perks of Frozen Dinners
  • Quick & easy. Being a practical mom, I know that there are nights when heating a frozen dinner can be the key to getting everyone in the family fed quickly and efficiently, with very little clean-up. Your family can eat in 15 minutes or so and spend some time catching up on the events of the day.
  • Built-in portion control! In the age of biggie-this and over-stuffed that, the frozen dinner is a portion-controlled delight! Few people will actually heat another dinner, and there's no temptation of going back for seconds.
  • Vegetable servings. Green beans, corn, carrots and more, there is at least one (sometimes two!) veggie servings on that tray.
  • Perfect for the single scene. Very few people like to cook for themselves. Whether you're 18 or 80, living in a college dorm or senior citizen apartment, frozen dinners offer great variety for those eating meals alone.
  • Easy prep for all. For anyone who has difficulty in the kitchen due to joint pain, a physical constraint, balance problems, or post-op healing time, frozen dinners can be the trick for easy-yet-nutritious meals.
  • When the cook's away, dinner still stays. When your family's "head cook" needs to take care of business or is gone for a few days, frozen dinners come to the rescue.
  • Economical. Frozen dinners are less expensive than dining out.
http://www.sparkpeople.com/email_click.asp?sn=9483026400&un=12844256&sm=11998674&em=RNFRANKIE@AOL.COM&li=0&rd=http://www.sparkpeople.com/resource/nutrition_articles.asp?id=585
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 Study Yields Genetic Clue to Rare Lung Disease

Finding offers insight into pulmonary arterial hypertension, researchers say

FRIDAY, July 26 (HealthDay News) -- A new genetic cause of a rare and fatal lung disease has been identified by U.S. researchers.
The Columbia University Medical Center team found that mutations on the gene KCNK3 are linked to pulmonary arterial hypertension, which is high blood pressure in the lungs.
The mutations in the gene appear to affect potassium channels in the pulmonary artery, a mechanism not previously linked to pulmonary arterial hypertension, according to the study published online July 25 in the New England Journal of Medicine.
The researchers also found that the effects of the mutations in the KCNK3 gene could be reversed with a drug compound called a phospholipase inhibitor.
"The most exciting thing about our study is not that we've identified a new gene involved in pulmonary hypertension, but that we've found a drug that can 'rescue' some mutations," study co-senior author Dr. Wendy Chung, an associate professor of pediatrics and medicine, said in a Columbia news release.
"In genetics, it's common to identify a gene that is the source of a disease. However, it's relatively rare to find potential treatments for genetic diseases," she explained.
The findings were made in cell cultures.

http://consumer.healthday.com/circulatory-system-information-7/blood-pressure-news-70/researchers-find-another-genetic-clue-to-rare-lung-disease-678634.html
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Word Origins:  pelf ***  In the English of eight hundred years ago, borrowing from French, pelfre referred to ordinary household property of the kind that one might keep out in easy sight --- a hammer, say, or a beaker.  Sneaking off with such a piece of property was called by the same term, giving us our "pilfer."  In time, the object of pilferage became known as "pelf," an uncommon term that, when used today, usually means "stolen property."
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New Clues to Why Black Women Fare Worse Against Breast Cancer

TUESDAY, July 23 (HealthDay News) -- The survival differences between black women and white women diagnosed with breast cancer has long been recognized, but now a new study focuses on the reasons why black women don't fare as well.
"The vast differences in breast cancer survival between white and black patients relates to the risk factors blacks present with when diagnosed," said lead researcher Dr. Jeffrey H. Silber, the Nancy Abramson Wolfson Endowed Chair in Health Services Research at Children's Hospital of Philadelphia.
"That includes differences in tumor stage and size, and higher rates of chronic health conditions such as diabetes and heart failure," he said.
Although treatment differences, which often are blamed, do play a role, Silber said they did not explain a large portion of the survival disparity he saw in his research.
The study is published in the July 24/31 issue of the Journal of the American Medical Association.
For the study, Silber and his team compared nearly 7,400 black women, all aged 65 and older, who were diagnosed with breast cancer between 1991 and 2005. They followed them through 2009. All patients had Medicare insurance.
Silber compared the black women with breast cancer with three different groups of nearly 7,400 white women. One group was matched on demographics (age, year of diagnosis and geographic area). Another was matched on "presentation" (demographic variables plus tumor characteristics and coexisting health problems such as high blood pressure and heart failure). A third group was matched on treatment (the presentation variables plus information on surgery, radiation therapy and chemotherapy).
Silber found survival times were longer in whites, as other researchers have seen. "Whites live three years longer," he said.
When he looked at white women who had presentations similar to blacks, however, the story was different. "If the presentation is similar to blacks, they only live one year longer," he said.
Although nearly 69 percent of whites were alive at five years after diagnosis, less than 56 percent of black women were.
When Silber matched blacks and whites on presentation, the difference in five-year survival declined to 4.4 percent; when matched on treatment, it dropped to 3.6 percent.
These presentation factors explain most of the disparity, Silber said. "That includes differences in tumor stage and size, and higher rates of chronic health conditions such as diabetes and heart failure," he said.  ... 

http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNzI0LjIxNDMxNjgxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDcyNC4yMTQzMTY4MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MjAzOTg2JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&112&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_138971.html
                                                                                                        
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 Cancer, Chemo May Lower Alzheimer's Risk, Study Suggests

                                             Results, if confirmed, might point to new treatments.


MONDAY, July 15, 2013 (HealthDay News) — If battling a deadly disease can be said to have a silver lining, this might be it: Many forms of cancer appear to lower the risk for developing Alzheimer's disease, new research suggests.
After sifting through the health records of nearly 3.5 million patients, investigators concluded that most kinds of cancer seem to confer some degree of protection against Alzheimer's, reducing risk of the age-related brain disorder by anywhere from 9 percent to 51 percent.
And they have also linked a common form of cancer treatment — chemotherapy — to a lower risk for developing Alzheimer's-related dementia.
"We found that the majority of cancers were associated with a decreased risk of [Alzheimer's disease]," said study lead author Dr. Laura Frain, a geriatrician with the VA Boston Healthcare System. "This does not mean that if you have cancer you won't get [Alzheimer's], but that you may have a decreased risk, depending on the cancer type."  ...   

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Defining What Evidence is, Linking It to Patient Outcomes, and Making It Relevant to Practice: Insight from Clinical Nurses

ABSTRACT

BACKGROUND/ RATIONALE

Factors that impede or enable successful evidence based practice for nurses in their daily work is well documented. Less known is how nurses define evidence in their daily clinical practice and how this knowledge can inform strategies to enhance evidence based patient care and outcomes.

AIMS/ METHODS

A qualitative study was undertaken to explore nurses' perceptions of what constitutes evidence as part of EBP and how applicable evidence is to their daily practice. A qualitative design using semi-structured interviews was employed for this study. Data were analyzed using directed content analysis.

RESULTS
The following four key themes emerged: viewing evidence as research based and a proven practice; linking evidence to patient outcomes; basing evidence on experience; and making evidence relevant to practice.

IMPLICATIONS
Study findings point to having accessible, practical tools to make evidence credible and relevant for nurses tailored to their clinical contexts.
(The full study can be purchased for $14.00 and a PDF can be downloaded, if preferred)

http://www.appliednursingresearch.org/article/S0897-1897(13)00033-5/abstract?elsca1=etoc&elsca2=email&elsca3=0897-1897_201308_26_3&elsca4=saunders
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RANDOM FACT:

In 2003, there were approximately 42 million abortions per year worldwide, or 115,000 daily. This was a drop from 46 million in 1995.
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Bonus Fact:

In the 1973 Roe v. Wade case, the United States Supreme Court declared most states' abortion laws illegal, and that women, in consultation with their physicians, have a constitutional right to abortion before viability without interference from the government.

Norma McCorvey is the "Jane Roe" in the Roe vs. Wade case. She has since become pro-life and is the founder of "Roe No More," an organization that provides counseling for women seeking an abortion.
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Low-risk prostate cancer often gets advanced treatment, study finds  

(Reuters Health) - The proportion of U.S. men with early, slow-growing prostate cancer who received robotic surgery and other expensive treatments increased between 2004 and 2009, according to a new study.
Researchers found that use of those therapies also rose among men who were unlikely to die from prostate cancer because they were sick with other chronic diseases when their cancer was diagnosed.
"You can't get at what the right rate (of treatment use) is from our study, but what we did find was treatment with these advanced technologies increased over the past decade, and was fairly common," said Dr. Brent Hollenbeck, who worked on the study at the University of Michigan in Ann Arbor.
Evidence has been building that a wait-and-see approach might be most effective for men with low-risk prostate cancer that may or may not progress, rather than scheduling surgery or radiation right away (see Reuters Health story of June 17, 2013 here: reut.rs/12EX8fl).  ... 


                          http://r.smartbrief.com/resp/eAdHDrrXoMfQwHcofDcXdUfCQSIQ?format=standard
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 Patient Assignments for Float Nurses
Many hospitals have nurses that make up "float pools."  These nurses float from unit to unit, based on staffing needs created on units due to medical leave, sick calls, increased patient acuity and surges in census. 
The nurses who work in these float pools generally have years of nursing experience and tend to be well-rounded in their nursing expertise. Their nursing backgrounds can include medical, surgical, cardiology, etc. They also tend to have good time management skills and can handle changes in their assignments with ease. 
The independence and understanding of the organization in which they work are also qualities many float nurses possess.  In order to build upon these strengths, it is crucial to consider appropriate patient assignments. 
                                       
                                    http://nursing.advanceweb.com/Features/Articles/Patient-Assignments-for-Float-Nurses.aspx                                                                                                                                                                                                                                                   ******************************


 Detecting decompensated heart failure   Seright, Teresa PhD, RN, CCRN 

Nursing Made Incredibly Easy!:
doi: 10.1097/01.NME.0000428437.31415.03
Department: Heart Matters


Acute decompensated heart failure, marked by pulmonary edema, is a medical emergency that requires urgent interventions for overt pulmonary edema and shock. Chronic decompensation is less obvious and often presents as lethargy and malaise, a reduction in exercise tolerance, and increasing breathlessness on exertion. If left untreated, chronic decompensated heart failure will also progress to breathing problems, often but not always due to pulmonary edema, and eventual shock from prolonged low cardiac output.
The cause or causes of decompensation must be identified to guide treatment. Causes may include recurrent ischemia, arrhythmias (such atrial fibrillation), infections, electrolyte disturbances, nonadherence to medications, and changes in diet.
 
http://email.lww.com/t?r=1483&c=3558049&l=39825&ctl=479529D:B54AB34282EDAD0076F5A9C102FF849AD7FC46C6A110684B&
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How to handle Stress:

These days, it seems that everyone is stressed. We all have too much to do and too little time to do it. Times are tough, money is tight, and deadlines are imminent.

What happens when you're stressed? You tend to eat more, sleep less, skip the gym and feel rundown. Additionally, stress is linked to a number of illnesses, such as heart disease, high blood pressure and an increased risk for cancer.

No wonder so many of us are gaining weight. A study in the July 2009 issue of the American Journal of Epidemiology studied stress related work demands, difficulty paying bills, strained family relationships, and depression or anxiety disorders in a nationally representative group of 1,355 men and women for more than nine years. The overall result?    ...

http://www.sparkpeople.com/email_click.asp?sn=2914656880&un
=12844256&sm=11998674&em=RNFRANKIE@AOL.COM&li=0&rd=
http://www.sparkpeople.com/resource/wellness_articles.asp?id=1482
                     
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WORD ORIGIN:   "nothing is certain but death and taxes"...  The familiar form of this maxim owes to Benjamin Franklin, but he borrowed it from one of his favorite writes, Daniel Defoe of Robinson Crusoe fame.  In 1726 Defoe wrote: " Things are certain as death and taxes, can be more firmly believed " than more ethereal things like the existence of an afterlife.  Franklin's statement, from 1789, is, "in this world nothing can be said to be certain, except death and taxes."            
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    AHA/ASA Heart Disease and Stroke Statistics—2013 Update  
  • Rates of death attributable to cardiovascular disease (CVD) have declined, yet the burden of disease remains high. Based on 2009 data:
    • The overall rate of death attributable to CVD was 236.1 per 100,000.
    • More than 2150 Americans die of CVD each day, an average of 1 death every 40 seconds.
    • Stroke accounted for ≈1 of every 19 deaths in the United States.
               Prevalence and control of traditional risk factors remains an issue for many Americans:
    • 33.0% of US adults have hypertension. That's 78 million adults.
    • An estimated 31.9 million adults have total serum cholesterol levels ≥240 mg/dL.
    • An estimated 19.7 million Americans had diagnosed diabetes mellitus, representing 8.3% of the adult population.
  • Expanded data coverage of the obesity epidemic:
    • The estimated prevalence of overweight and obesity in US adults is 154.7 million.
    • Among children (2 to 19 years of age), 23.9 million are overweight or obese and 12.7 million are obese.
  • The 2013 Statistical Update includes critical data about cardiovascular health, health factors, health behaviors and other risk factors, cardiovascular conditions and diseases, cardiovascular quality of care, procedure utilization, and costs.
http://click.email.mylwwjournals.com/?qs=6c23e1c97cff4bea1acd0ab91d7f970aaca8ecb95da189b2d28bb7a045418c52
                                                                                  **********************************    

 Paradoxical Association of Enhanced Cholesterol Efflux With Increased Incident Cardiovascular Risks  (Abstract)

Objective—Diminished cholesterol efflux activity of apolipoprotein B (apoB)–depleted serum is associated with prevalent coronary artery disease, but its prognostic value for incident cardiovascular events is unclear. We investigated the relationship of cholesterol efflux activity with both prevalent coronary artery disease and incident development of major adverse cardiovascular events (death, myocardial infarction, or stroke).

http://click.email.mylwwjournals.com/?qs=f2a4246e9a74f722257bcc0ee3904b9244798fc49b7390b92fa51ac430717d95


                                                                               ********************************
Statin Use May Reduce Parkinson's Risk, Study Says

WEDNESDAY, July 24 (HealthDay News) -- Millions of Americans take statins to lower their stroke and heart attack risks, but new research from Taiwan suggests the drug may offer another health benefit: cutting the odds of developing Parkinson's disease.
Analyzing nearly 44,000 patients, scientists found that those who discontinued taking fat-soluble statins such as simvastatin (Zocor) or atorvastatin (Lipitor) were about 58 percent more likely to develop Parkinson's than those who kept taking the drugs.
Fat-soluble statins are believed to cross the blood-brain barrier, unlike water-soluble statins such as rosuvastatin (Crestor) and pravastatin (Pravachol). The drugs may decrease inflammation and even modify dopamine pathways in the brain, which are linked to Parkinson's, the study authors suggested.

"We are more glad than surprised to demonstrate the relationship," said study author Dr. Jou-Wei Lin, a cardiologist at National Taiwan University Hospital. "Our analysis is observational . . . and further clinical trials targeting the association between statin use and Parkinson's disease are still needed."
The study is published online July 24 in the journal Neurology.  ...

 http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNzI1LjIxNDcwNjQxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDcyNS4yMTQ3MDY0MSZkYX
RhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MjA1MDUyJmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY
29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&120&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_139012.html
                                                                                                                   
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THURSDAY, July 25 (HealthDay News) -- About one-fourth of operating room errors are caused by technology and equipment problems, but a preoperative surgical checklist could halve the error rate, a new study says.

Researchers reviewed 28 published studies on operating room errors and found that technology/equipment issues were cited in about 15 percent of malpractice claims. An average of 2.4 errors occurred in each procedure, and technology/equipment issues accounted for 23.5 percent of these errors.

Eight studies listed the different types of technology/equipment errors. The configuration or settings of a device/machine caused problems in about 43 percent of cases, availability of a device/machine was an issue in about 37 percent of cases, and the device/machine wasn't working properly in nearly a third of cases.

Four studies examined the severity of operating room errors and classified one-fifth of errors as "major." Equipment failures accounted for 20 percent of these major errors, compared with 13 percent for technical failures and 8 percent for communication.
The type and rate of equipment failures varied widely, depending on the study and the type of surgery. But overall, surgery that relied heavily on technology had higher rates of problems, according to the findings, published online July 25 in the journal BMJ Quality & Safety.

Three studies found that using an equipment/technology checklist before surgery could halve the error rate, according to a journal news release. Review authors Colin Bicknell, of Imperial College London, and colleagues recommended that a generic equipment checklist should become routine practice and be included in the current World Health Organization Surgical Safety Checklist.  ...

http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNzI2LjIxNTA3NDQxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDcyNi4yMTUwNzQ0MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MjA2MTgyJmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&102&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_139061.html
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While pollution isn't a new phenomenon, the modern, industrialized world has ramped pollution up to critical, deadly levels. Every year, the United States alone creates 11 billion tons of solid waste. How else are we slowly killing ourselves?


  RANDOM FACT:  One of the more common and dangerous pollutants in the environment is cadmium, which kills human fetal sex organ cells. Its widespread presence means it is in almost everything we eat and drink.

***
Bonus Fact:  Pollution in China alters the weather in the United States. It takes just five days for the jet stream to carry heavy air pollution from China to the U.S. Once in the atmosphere over the U.S., the pollution stops clouds from producing rain and snow--i.e., more pollution equals less precipitation.
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Silky Brain Implants May Help Stop Spread of Epilepsy  Silk has walked straight off the runway and into the lab. According to a new study published in the Journal of Clinical Investigation, silk implants placed in the brain of laboratory animals and designed to release a specific chemical, adenosine, may help stop the progression of epilepsy. The research was supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute of Biomedical Imaging and Bioengineering (NIBIB), which are part of the National Institutes of Health.
The epilepsies are a group of neurological disorders associated with recurring seizures that tend to become more frequent and severe over time. Adenosine decreases neuronal excitability and helps stop seizures. Earlier studies have suggested abnormally low levels of adenosine may be linked to epilepsy.
Rebecca L. Williams-Karnesky, Ph.D. and her colleagues from Legacy Research Institute, Portland, Ore., Oregon Health and Sciences University (OHSU), Portland, and Tufts University, Boston, looked at long-term effects of an adenosine-releasing silk-implant therapy in rats and examined the role of adenosine in causing epigenetic changes that may be associated with the development of epilepsy.
The investigators argue that adenosine’s beneficial effects are due to epigenetic modifications (chemical reactions that change the way genes are turned on or off without altering the DNA code, the letters that make up our genetic background). Specifically, these changes happen when a molecule known as a methyl group blocks a portion of DNA, affecting which genes are accessible and can be turned on. If methyl groups have been taken away (demethylated), genes are more likely to turn on.
The results reported in the paper provided evidence that changing adenosine levels affects DNA methylation in the brain. Specifically, greater amounts of adenosine were associated with lower levels of DNA methylation. The investigators also demonstrate that rats induced to develop epilepsy have higher levels of methylated DNA. Of particular note, epileptic rat brains that had received the adenosine-releasing silk implants exhibited DNA methylation levels close to brains of normal rats and this significantly lessened the worsening of the epilepsy over time.

http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNzI2LjIxNTA3NDQxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDcyNi4yMTUwNzQ0MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MjA2MTgyJmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&112&&&http://www.nih.gov/news/health/jul2013/ninds-25.htm
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Smoking in pregnancy tied to kids' conduct problems
(Reuters Health) - Children of women who smoked cigarettes during pregnancy are more likely to have behavioral problems than those whose mothers didn't light up, says a new analysis.
"The evidence is emerging that smoking in pregnancy and the frequency of smoking in pregnancy is correlated with developmental outcomes after (children) are born," said Gordon Harold, the study's senior author from the University of Leicester in the UK.
Previous research has tied smoking cigarettes during pregnancy to behavior problems among children later on, but those studies couldn't rule out the influence of other factors, such as genetics or parenting techniques, researchers said.  ...

http://links.reuters.com/r/99L0Y/DCYMS/QNGEAP/PRF0R5/OFNAYW/YT/h?a=http://links.reuters.com/r/99L0Y/DCYMS/QNGEAP/PRF0R5/SU157N/YT/h

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Women With Lupus Seem at Higher Risk for Hip Fractures 

THURSDAY, July 4 (HealthDay News) -- Women with lupus -- the autoimmune disease that can damage skin, joints and organs -- also are at higher risk of a hip fracture known as a cervical fracture, new research from Taiwan suggests.
Dr. Shu-Hung Wang, of the Taipei Veterans General Hospital, and his colleagues evaluated nearly 15,000 adults -- 90 percent of them women -- who had lupus. They followed them for an average of six years.
During that time, 75 suffered a hip fracture. Of those, 57 were cervical fractures of the hip; the other 18 were trochanteric fractures of the hip.
"Anatomically, cervical hip fractures involve the [uppermost area of the thighbone]," said Dr. Shu-Hung Wang, a rheumatology fellow at the hospital and a co-author of the study. "Trochanteric hip fracture occurs between the lesser and greater trochanters." Trochanters are the bony prominences near the end of the thighbone.
The researchers compared the women and men with lupus to the same number of healthy people without lupus. In the healthy group, 43 had hip fractures during the follow-up period, and they were evenly divided between the two types.
Having lupus, the researchers concluded, raised the risk for cervical fractures compared to the general population, but not for the other fracture type. And women with lupus got cervical fractures at younger ages, the researchers said.  ...

http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNzA1LjIwODEwODExJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDcwNS4yMDgxMDgxMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTg1MTczJmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&119&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_138436.html
            
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  Women with history of kidney stones may face increased CVD risk
Kidney stones appear to be associated with an elevated risk of cardiovascular disease in women but not men, according to a study in the Journal of the American Medical Association. Data on more than 240,000 participants showed female patients with a history of kidney stones faced a 30% higher risk than men of developing heart disease, suffering a heart attack or being treated with a procedure to address an arterial blockage. U.S. News & World Report/HealthDay News

                                                                    ********************************
The World Health Organization’s fact sheet on tobacco includes the following:
50%:
Up to half of current tobacco users will die of a tobacco-related disease.
6 million:
Approximate number of people who die from tobacco use or exposure each year
80%:
Percentage of smokers who live in low- and middle-income countries
1 every 6 seconds:
About one person dies every six seconds due to tobacco.
59:
Number of countries in the world that monitor tobacco use
600,000:
Second-had smoke causes more than 600,000 premature deaths per year.


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

I used to work in an art supply store. We sold artists' canvas by the yard, and you could get it in either of two widths: 36 inches or 48 inches.

Customer: "Can you please cut some canvas for me?"

Me: "Certainly, what width?"

Customer: (confused and slightly annoyed) "Scissors?"

                                                                                        *** ***  ***** ***

  A recent article in the Kentucky Post reported that a woman, one Anne Maynard, has sued St Lukes  hospital, saying that after her husband was treated there recently, he had lost all interest in sex.

A hospital spokesman replied, "Mr Maynard was actually admitted to Ophthalmology - all we did was correct his eyesight..."
                                                                                     

                                                                              ~~**~~**~~**~~**~~**~~
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,

Robert Hess, RN, PhD, FAAN   (856) 424-4270  (610) 805-8635 (cell) Founder, Forum for Shared Governance
 info@sharedgovernance.org    www.sharedgovernance.org    
 
To obtain CE credit, we've bundled this collection at a special price of $19.99 for these 3 CE articles worth a total of 7.3 contact hours - that's a savings of more than $70 if purchased individually!
Understanding the New Emerging Oral Anticoagulants for Venous Thromboembolism Prophylaxis
Orthopaedic Nursing, September/October 2012
(3 contact hours)
Using Anticoagulants to Steer Clear of Clots
Nursing2012, February 2012
(2 contact hours)
Stop that Clot! Anticoagulant Medications 101
Nursing Made Incredibly Easy!, September/October 2010
(2.3 contact hours)

http://email.lww.com/t?r=1483&c=3559733&l=49052&ctl=479B984:B54AB34282EDAD00E32BFBB45EC054C41B63B76AC757E9D3&
                 ***************************** 
 
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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/

  Medication adherence improves with better doc-patient communication
  Recent research has found that the patient-physician relationship  
matters when it comes to medication adherence.
http://www.fiercehealthcare.com/story/medication-adherence-improves-better-doc-patient-communication/

2013-01-03?utm_medium=nl&utm_source=internal

  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

Legal Tools (Refers to 2 paragraphs below)
http://www.cdc.gov/phlp/news/current.html#legal1

Sodium reduction tools. To support Americans' New Year's health and nutrition goals and in advance of 


American Heart Month, the Public  Health Law Program (PHLP) has released a series of legal resources on 


dietary sodium reduction. According to CDC, excess dietary sodium  
raises the risk for high blood pressure and its cardiovascular health consequences, including heart disease 


and stroke, the first and fourth  
leading causes of death in the United States. 

As part of a longstanding collaboration with the Division for Heart Disease and Stroke Prevention in CDC's 


National Center for Chronic Disease Prevention and Health Promotion, PHLP highlights six legal resources 


and six policy toolkits for practitioners seeking to reduce dietary  
sodium in discrete populations. Access the policy resources and  toolkits.
http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
 
 
RNs launch a national safe staffing campaign   http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
 
 
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 
 
 

 If you're buying a used car, it is recommended having a mechanic inspect it first.
 Screen the car's VIN through the free database at carfax.com/flood  

 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm

Metric conversion calculators and tables for metric conversions
 
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*
MEDICAL RECALLS
*
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******************************************************
Nizoral (ketoconazole): Drug Safety Communication - Potentially Fatal Liver Injury, Risk of Drug Interactions and Adrenal Gland Problems

FDA is taking several actions related to Nizoral (ketoconazole) oral tablets, including limiting the drug’s use, warning that it can cause severe liver injuries and adrenal gland problems, and advising that it can lead to harmful drug interactions with other medications. FDA has approved label changes and added a new Medication Guide to address these safety issues. As a result, Nizoral oral tablets should not be a first-line treatment for any fungal infection. Nizoral should be used for the treatment of certain fungal infections, known as endemic mycoses, only when alternative antifungal therapies are not available or tolerated.

Http://www.fda.gov/Safety/Med/Watch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm362672.htm
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eMaitre Vascular, Inc., Albograft Vascular Graft: Class I Recall - Blood Leak

Models: AMC1408,AMC1506,AMC1608,AMC1810,AMC2010,AMC4007,AMC4008,AMC6006,AMC6007,AMC6008,ATC1526,ATC1526,ATC1526,ATC1530,ATC3016,
ATC3018,AATC30018,ATC3024,Batch56890A

LeMaitre Vascular, Inc. recalled the Albograft Vascular Graft due to blood leaking from the surface of the graft after implantation.  This product may cause serious adverse health consequences, including death. This product was only distributed in Pennsylvania from April 2011 through June 2013. Http://www.fda.gov/SafetyMedWatch/SafetyInformation/SafetyAlertsfor Human MedicalProducts/ucm362217.htm
 
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ADVERTISEMENTS
from the members

This ad is from Decubqueen (Gerry)..........Accuruler   Accurate 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.accuruler.com/.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
 
WELCOME TO:
 
jsoule89@yahoo.com   (Julie)         July 15, 2013

     SKbrown2@dhr.state.ga.us  ( Sarah )   July 13, 2013

   L.Copeland@Hotmail.com,   (Laural)  July 20, 2013

pshaw@hotmail.com   (Prafull)           July 20, 2013
               
                        js814@bellsouth.net   (Jennifer)          July 29, 2013                      

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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. So, be certain to let me know when you change your address.   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)

~~**~~**~~**~~**~~**~~
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

“Age is not important unless you’re a cheese.”

  - Helen Hayes 

Hope to hear from you..... Frankie
 

The Paradigm Bytes Newsletter is published once a month and placed on our website. If you no longer enjoy receiving my notices about the publication, it you may stop at any time by contacting me  ( RNFrankie@AOL.com )  or just hitting reply when my notice to you appears in your inbox.  We'll be sad to see you go, but your request will be honored immediately.

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