Friday, October 11, 2013

October PARADIGM BYTES

PARADIGM BYTES

Newsletter for Paradigm 97
October 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
How to Stay Energized Throughout Your Nursing Shift By Megan Murdock Krischke, contributor
August 26, 2013 - Working a 12-hour shift is challenging in any field, and nurses specifically must deal with physical, emotional and relational stressors that can deplete their energy more than many other workers.
A number of factors can also determine how taxing a nurse’s shift is, including:
• Patient load and acuity levels;
• Amount of ancillary staff support;
Documentation requirements;
• Level of co-worker/provider engagement;
• Ability to take breaks and make nutritious food choices;
• Personal health status;
• Ergonomics of the work environment;
• Type of flooring and shoes worn;
• Available patient handling assistance devices; and
• Shift schedule.
With so many factors at play, what can a nurse do to survive and thrive through a long and challenging shift? NurseZone.com spoke to some clinical health and wellness experts who offer these tips:
1. Control what you can control
“While you may not have any control over your patient load or acuity, you can make use of any assistance devices available to you. You may not get to choose what shift you work, but you can do your best to maintain a regular routine. Likewise, you probably don’t get to choose the flooring at your facility, but you can invest in a good pair of running shoes,” remarked Dan Donahue, MEd, director of employee health and wellness at Providence St. Peter Hospital in Olympia, Wash.
2. Focus on eating and movement
“In order to keep their energy up, nurses should especially pay attention to their eating and their movement,” offered Cathy Turner, MS, director of health promotion at Virginia Hospital Center in Arlington. “It is ideal to eat both regular meals and to have an energy-boosting snack between meals such as a piece of fruit and some cheese. I recommend that every time you eat that you include a protein source because protein takes longer to digest and it is what feeds our energy levels over the long haul.”
“Often people think they have to have a 30-minute, heart-rate-increasing workout for it to count for anything. But research is showing that just 5-10 minutes of exercise can boost your energy levels.” Turner explained. “There are yoga poses you can do at your workstation, do a quick stairs workout, or even some seated chair exercises if you just need to get off your feet.”
3. Be wise about caffeine and energy drinks
When it comes to caffeine consumption, Donahue said that moderation is key.
“In the right amount and time, caffeine can be beneficial and help improve mood, attention, concentration and energy levels. Too much sugar or caffeine [>400mg] early or through mid-shift will have a negative effect later when the consumer will experience a drop in their energy level. It's better to have a little bit throughout the shift,” he said.
“Nurses should be aware that energy drinks can also contain high levels of taurine and guarana and other ingredients that may boost the caffeine levels and have other undetermined effects,” Donahue added. “Instead of looking to caffeine to boost energy, nurses should be concentrating on staying hydrated. I recommend trying to drink 90 ounces of water a day.”
4. Realign your attitude, reinforce your team
“An important part of having a successful shift is about attitude and remembering what you are there for--your calling and desire to go in and help these patients,” offered Christine Slohe, RN, BSN, PHN, emergency room nurse at St. Mary Medical Center in Apple Valley, Calif.
“Also, I think it is often overlooked how important co-workers are to the success of a shift,” Slohe continued. “When I have some downtime, I go and help another team member, then they reciprocate later--it helps to keep the flow instead of having highs and lows throughout the shift. I am fortunate to work with a great group. Our motto is: If you see a need, fill a need.”
5. Make breaks count
While the “ideal” schedule for nurses’ breaks would be approximately every three hours throughout a 12-hour shift, Donahue knows that in reality most nurses try to work a break in whenever they can get it.
“The most important thing is they at least get some sort of break and it would be nice if they could remove themselves from their work environment and get their mind, eyes and body in a whole different state,” he said.
Turner recommends deep, mindful breaths as a way to come back to your center and to reenergize.
“When you are taking your break, it is a mental recharge to sit there and have your mind focus on something different,” reflected Slohe. “I like to go outside and get out of the enclosed environment. That is more rejuvenating than just sitting in the break room.”
6. Don’t forget the long run
Getting through a single nursing shift shouldn’t be the only focus, though.
“Nurses should be looking at their long-term health and energy levels and making an investment there, not just figuring out how to make it through the next shift,” encouraged Turner. “Being an effective caregiver means caring for yourself.”
“I always tell people to seek balanced input for the body, mind and spirit. I believe we need input on all three levels to feel whole and healthy and have a good outlook and positive energies,” Donahue said. “I believe we also need to schedule body/mind/spirit ‘time’ in order for it to consistently happen and to gain the benefits.”

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MEDICAL NEWS
Human sex trafficking a real-life horror story for country’s youth
Many people think sex trafficking happens only in third-world countries, but it’s also pervasive in the U.S. Nurses are in a prime position to identify possible victims of sex trafficking when they seek medical treatment in the ED, free clinics, physician offices and other locations. But too often those opportunities are missed.
Human sex trafficking can be illustrated in one sentence: "I can sell a kilo of cocaine once and I'm out of product, but I can sell a woman over and over 25 times a night 365 days a year and make a quarter of a million dollars off one girl." That observation a pimp made to Mary de Chesnay, RN, DSN, PMHCNS-BC, FAAN, editor of the book "Sex Trafficking: A Clinical Guide for Nurses," sums up why human sex trafficking has become a growth industry.

"Trafficking is a $32 billion a year business, more than Starbucks, Nike and Google combined," said de Chesnay, a professor in the WellStar School of Nursing at Kennesaw (Ga.) State University. "It's the most lucrative criminal enterprise behind drugs."

Many people think sex trafficking happens only in third-world countries, but it's also pervasive in the U.S. "It's not just an international problem, it's a national problem," said Patricia Crane, RN, MSN, PhD, WHNP-BC, DF-IAFN, associate professor at University of Texas Medical Branch Galveston and a specialist in forensic nursing. Victims include U.S. citizens and people from countries such as Mexico, Eastern Europe, Asia and South America.

The early 1970s is when de Chesnay first met a child who was being trafficked. When she asked the 11-year-old girl with an ectopic pregnancy about the baby's father, the girl replied, "It could be my father, my four brothers, or the men who come to party on the weekend."

That child was the first in a long line of girls and women (and some boys and men) de Chesnay has seen during her career. Accurate numbers are hard to come by, but the Polaris Project, an advocacy group that combats human trafficking, estimates that 100,000 children are involved ...
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
New Report: Child neglect makes up 75 percent of abuse cases This report shows that physical and sexual abuse cases are down in the United States. But, troubling statistics show that child psychological and emotional abuse cases are on the rise.
The report, which was issued on Sept. 12, was completed by the Institute of Medicine (IOM) and National Research Council of the National Academies (NRC). The two non-profit organizations were created to advise the government on different issues.
Annually, Child Protective Services is made aware of cases involving six million children in the U.S., the report noted. Many more cases of neglect and abuse may go unreported.
Physical and sexual abuse make up 8 and 9 percent of cases respectively, according to the report. Overwhelmingly, child neglect makes up 75 percent of reported abuse cases in the U.S., and the majority involve children under the age of five. Only 20 percent of investigated cases of abuse resulted in a removal of the child from home. ...

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Status Limbo: Analysis of Nurse Faculty Member Reports of Administrator Response to Workplace Bullying Complaints

Abstract: Increasing concern about bullying among adults in workplaces is notable internationally. Unlike blatant physical bullying, workplace bullying often involves bullies' dismissive, demeaning, and typically surreptitious, one-on-one communications with their intended victims. These communications challenge recognition when they are examined beyond the interpersonal margins of the bully–victim dyad. Thus, they tend to elude formal, administrative reproach, despite the negative, long-term outcomes they herald for workplace employees—those immediately involved as victims and those who are bystanders—and for employing organizations and the consumers they serve. This article offers a hermeneutic analysis of workplace bullying victims' narrative reports of administrator responses to their complaints of having been bullied at work. Analysis demonstrated respondent perceptions of the variability and unevenness of administrative responses to their reports and, more broadly, respondents' collective sense of administrative abandonment. That sense is characterized in this report as status limbo, a term employed by Facebook users to represent a state of perceived neglect and oblivion. ...
Journal of Professional Nursing
Volume 29, Issue 5 , Pages e1-e9, September 2013
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Severe Blood Infections During Childbirth on Rise in U.S. Women
THURSDAY, Sept. 26 (HealthDay News) -- In a disturbing trend, rates of severe sepsis and deaths from sepsis during childbirth rose sharply in the United States over a 10-year period, a new study reveals.
The researchers said their findings show the need for improved detection of sepsis in all women during labor and delivery, even those with no apparent risk factors for sepsis, a severe illness in which bacteria overwhelm the bloodstream.
For the study, Dr. Melissa Bauer, of the University of Michigan Health System in Ann Arbor, and colleagues analyzed national data from 1998 through 2008 and found that, overall, sepsis occurred at a rate of one per every 3,333 women who were in a hospital to give birth. The rate did not change significantly over the study period.
Severe sepsis -- which can lead to multiple organ failure -- occurred in about one in 11,000 women. The rate of severe sepsis approximately doubled from 1998 to 2008: from about one in 15,400 to one in 7,250 women in labor....

RANDOM TIDBITS

There are eight main Hawaiian islands: Ni'ihau, Kaua'i, O'ahu, Moloka'i, Lana'i, Maui, Kaho'olawe, and Hawaii.

The earliest written account of surfing tells of Hawaiians surfing on wooden planks. Surfing was an integral part of the society, religion, and myth of Hawaii.

The islands were formed by volcanoes which were created when the tectonic plate moved over a hot spot. One of the volcanoes on the Big Island, Kilaue'a, is the longest erupting volcano in the world having continuously flown for nearly 30 years.

Neither Hawaii nor Arizona observe Daylight Savings Time.

After the beginning of World War II, the island of Kaho'olawe was used by the military to conduct live ammunition testing.

The state motto is "Ua mau ke ea o ka aina i ka pono," which means "The life of the land is perpetuated in righteousness."
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Spotting the Signs of Skin Cancer A picture may be worth a thousand words and it may now also save your life. Viewing images of skin cancer — the most common form of cancer in the United States — prompted people to examine their own skin for signs of the malady more frequently and more precisely, according to a new study published in the Journal of the American Academy of Dermatology.
"Visual images capture our attention and are persuasive," said study coauthor Laurie Hoffman-Goetz, PhD, a professor at the University of Waterloo in Canada, in a university news release. "They also help us to learn and remember."
Researchers hope this proactive response to skin cancer images will help to promote early detection. "Incorporating images into clinical practice when educating patients can be a powerful tool in the fight against skin cancer," Dr. Hoffman-Goetz added.
Click through to learn more about skin cancer recognition. ...

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The Microbiome and IBD: A Hot Spot for Research
If you haven't already heard about something called the microbiome, you probably will soon. The human microbiome has become one of the hottest areas of medical research, and findings could lead to a revolution in human health. For people with IBD (inflammatory bowel disease), the research could hold the key to future treatment and even prevention.
“The human microbiome is all the microbes that normally live inside the human digestive system," said Keith Sultan, MD, an assistant professor at Hofstra North Shore-LIJ School of Medicine and a gastroenterologist at North Shore University Hospital in Manhasset, N.Y. "For doctors who treat IBD, the big interest is in bacteria that live inside the colon and small intestine. These bacteria may be the key to controlling IBD."
Everyone has trillions of microbes living inside their digestive tract. These microbes, collectively known as the microbiome, help the body digest food, produce vitamins, prevent digestive tract infections, and control the immune system. Research is showing that a healthy balance of these microbes is essential for maintaining good health.
When the balance of the microbiome gets upset, it is called dysbiosis. Researchers believe that dysbiosis may be the trigger for IBDs, such as Crohn’s disease and ulcerative colitis. Preventing dysbiosis, then, could be the key to controlling IBD, which is thought to affect more than a million Americans. ...

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(Reuters) - Health authorities in northeast Thailand plan to screen people for fluke worms to detect early signs of bile duct cancer, a deadly disease linked to eating uncooked freshwater fish.
Rivers in northeast Thailand, Vietnam, Laos, Cambodia, the Koreas and China are infested with the tiny parasitic worms which find their way into the human body when seafood is eaten raw.
According to the World Health Organization, 67 million people are at risk of this worm and 9 million are infected in Cambodia, Laos and the northeastern parts of Thailand and Vietnam.
Most of the infected people are men and they can develop bile duct cancer by the time they are 40 or 50. ...
Home remedies for treatment of burns.......
Keep in mind this treatment of burns is being included in teaching beginner fireman. First Aid consists of first spraying cold water on the affected area until the heat is reduced which stops the continued burning of all layers of the skin. Then, spread the egg whites onto the affected area.
One woman burned a large part of her hand with boiling water. In spite of the pain, she ran cold faucet water on her hand, separated 2 egg whites from the yolks, beat them slightly and dipped her hand in the solution. The whites then dried and formed a protective layer.
She later learned that the egg white is a natural collagen and continued during at least one hour to apply layer upon layer of beaten egg white. By afternoon she no longer felt any pain and the next day there was hardly a trace of the burn. 10 days later, no trace was left at all and her skin had regained its normal color. The burned area was totally regenerated thanks to the collagen in the egg whites, a placenta full of vitamins.
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Strategies for asking questions in the workplace can give you a leg up There's no harm in asking. Really.
With reduced workforces, longer shifts and individuals covering ever-increasing job duties, it's wholly understandable that questions will arise on the job.
So why do we hesitate and regress to a grade-school fear of admitting - in front of peers and authority figures - that we, um, don't understand? What we didn't know in those schoolhouse days of lurking dunce caps were the strategies that could turn questions into golden opportunities and teaching moments.
Smart Questions
In fact, asking a question in the professional arena can be interpreted as an intelligent thing to do. Not only does seeking answers increase your job performance and work IQ, it also allows you to connect and collaborate with other providers.
"Asking for help, in theory, sets you up for success," said Jodi Glickman, author of "Great on the Job, What to Say, How to Say It, The Secrets of Getting Ahead" and a faculty member of Cornell University's Johnson School Leadership Program. "Asking for help the right way can show that you are very smart and thoughtful." ...
************************ The following was sent in by a reader....Let me know what you think of the sites, please.
The nursing home comparison tool: http://www.medicare.gov/NHCompare. However, the
link as you have it (on this page: http://paradigm97.blogspot.com/2009_01_01_archive.html)
doesn’t take you to the right tool. I believe it should be: http://www.medicare.gov/quality-care-finder/#nursing-home-compare.
Just thought you’d want to know, as that’s a great tool to offer but as it now stands, isn’t directing as promised.
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New coating may reduce blood clot risk inside stents
DALLAS, Sept. 5, 2013 — Coating artery-opening stents with a new compound may someday eliminate a common side effect of the treatment, according to preliminary research in the American Heart Association journal Arteriosclerosis, Thrombosis, and Vascular Biology.
Stents are tiny mesh tubes that prop open clogged arteries so blood will flow freely to heart muscle, relieving chest pain and reducing the risk of heart attack. But implanting a stent damages the inner lining of the artery, triggering overgrowth of smooth muscle in the middle layer of the artery, a process that can re-narrow the passageway as the vessel wall thickens. To prevent this, stents are frequently coated with one of several medications that block smooth muscle growth.
However, the drugs that inhibit re-narrowing don’t prevent another possible problem — blood clots forming inside the vessel with the stent — and make the side effect more likely. This happens because the medications also interfere with the repair and regrowth of a smooth and healthy endothelium of the blood vessel lining cells in the area of the stent.
In animal experiments of blood vessel injury, researchers found that a compound called a CTP synthase inhibitor successfully blocked smooth muscle growth and either promoted or didn’t interfere with the growth of endothelial cells. ... http://newsroom.heart.org/news/new-coating-may-reduce-blood-clot-risk-inside-stents

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 Head and neck cancer surgery patients at risk of venous thromboembolism
(dailyRx News) One of the things doctors look for after surgery is the possibility of blood clots forming. Most cancer surgery patients have a high risk of blood clots. Head and neck cancer surgery patients were believed to be at low risk for blood clots. New research suggests otherwise.
Hospitalized patients who had undergone surgery for head and neck cancer had an increased risk of venous thromboembolism (VTE) — blood clots that can form anywhere in the body. As a result of these findings, the authors suggested that head and neck cancer surgery patients should receive medications to prevent VTE.
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Gene discovery could lead to new types of HIV treatments (Reuters) -
Scientists have identified a gene which they say may have the ability to prevent HIV, the virus that causes AIDS, from spreading after it enters the body.
In an early-stage study in the journal Nature, researchers said the gene, called MX2, appears to play a key role in how HIV is controlled in human cells, so using it could lead to the development of new, less toxic treatments that harness the body's natural defenses and mobilize them against the virus.
Although there are many more years of research ahead, Mike Malim, who co-led the research at King's College London, described the finding as "extremely exciting" and said it advanced scientists' understanding of how the HIV virus interacts with the immune system.
"Until now we knew very little about the MX2 gene, but now we recognize both its potent anti-viral function and a key point of vulnerability in the life cycle of HIV," he said in a statement about the study, published on Wednesday. ...
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This past summer, two men, both HIV positive, underwent bone marrow transplants to treat lymphoma. As a result, both men are currently free of the AIDS virus. What does this mean for HIV treatment? This remains to be seen, but it is surely something that will be studied further.
Many of us care for patients with HIV in our practice, whether we work in a setting dedicated to treating this patient population or not. We've created a new collection of articles, all available for CE credit, that will keep your knowledge and skills up-to-date. The collection is now available at a special price of $19.99 for these 3 CE articles worth a total of 6.9 contact hours - that's a savings of close to $50 if purchased individually!http://nursing.ceconnection.com/nu/public/collections/18
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Skin drug shows 'promising' results on type 1 diabetes
The small trial on US patients suggests that alefacept (a drug that was used to treat a skin disorder--psoriasis) helps the body produce its own insulin, which is key for people with type 1 diabetes. Type 1 diabetes affects around 400,000 people in the UK.
Researchers said the drug could be better than other treatments because it protects the immune system - but more research was needed.
The findings are published in The Lancet Diabetes & Endocrinology.
Alefacept (sold as Amevive) was used to treat the skin disorder psoriasis in the US before it was withdrawn by its manufacturer in 2011. The drug was never approved for the European drug market.
Psoriasis, like type 1 diabetes, is an autoimmune disorder that occurs when the immune system attacks healthy skin cells.
In clinical trials of the drug on psoriasis, the drug was found to attack specific types of T-cells that were also involved in attacking insulin-producing cells in type 1 diabetes.
So researchers, led by a team at Indiana University, Indianapolis, decided to investigate if it could have any effect on newly diagnosed type 1 patients. ...http://www.bbc.co.uk/news/health-24177519

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Experts tie calcium concentrations to diabetes risks
Data on 863 participants indicated that those with the highest serum calcium concentrations had higher odds of developing type 2 diabetes. Researchers found that only those with the highest concentrations showed a significant increase in incident diabetes after adjusting for factors including family history, insulin sensitivity
BARCELONA, SPAIN - High concentrations of serum calcium—but not necessarily calcium intake—are associated with an increased risk of developing type 2 diabetes, results from the Insulin Resistance Atherosclerosis Study(IRAS) show. Moreover, calcium concentration appears to act independently of glucose, insulin secretion, and insulin resistance, according to Dr Carlos Lorenzo (University of Texas Health Science Center, San Antonio).
Lorenzo presented the IRAS results here at the European Association for the Study of Diabetes (EASD) 2013 Meeting. and plasma glucose levels. The results were presented at the European Association for the Study of Diabetes meeting.(you have to register with Medscape in order to see the full article...easy)

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Diabetes tied to higher risk of breast, colon cancer An analysis of data from 20 studies showed that patients with type 2 diabetes were 23% more likely to develop breast cancer and 26% more likely to develop colon cancer. Diabetes patients also had a higher risk of death from these diseases compared with people without diabetes, researchers reported at the European Cancer Congress...
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PCV13 vaccine is just as effective as previous version in babies
When administered along with other childhood vaccines, the 13-valent pneumococcal conjugate vaccine yielded the same immune responses in babies compared with the 7-valent vaccine, U.S. researchers reported in the Pediatric Infectious Disease Journal. They noted that PCV13 was just as safe as PCV7, with similar rates of adverse effects following vaccination. DailyRx.com

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Tylenol to carry acetaminophen warning on cap
Beginning in October, Extra Strength Tylenol bottles sold in the U.S. will carry a red warning label on the cap stating that its pain-relieving ingredient, acetaminophen, is the nation's leading cause of sudden liver failure, said manufacturer Johnson & Johnson. Acetaminophen overdoses in the U.S. send 55,000 to 80,000 people to emergency rooms and result in approximately 500 deaths each year, according to the FDA and the CDC. More than 600 OTC and prescription products contain acetaminophen. New York Posthttp://r.smartbrief.com/resp/eJaEDrrXoMfXmsegfDcXdUfCtRAh?format=standard

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This week in FDA regulations: 40 states ask for E-Cig rules.
(FindLaw's In House) - E-cigarettes seem to be the hot topic in federal regulation, and for good reason. The tobacco alternative,
which delivers nicotine-laced vapor into the lungs, has exploded in popularity while regulations have languished far behind. Prime
example: Cigarettes cannot be flavored (even menthol may be on the way out), while e-cigarettes can come in such delightful flavors as cherry, rocky road, or chocolate. ... http://tinyurl.com/rules-for-ecigs

U.S. approves first artificial pancreas system for Diabetics (Reuters) - The U.S. Food and Drug Administration has approved the first artificial pancreas system for diabetics that reads blood sugar levels and automatically shuts off the flow of insulin. ...http://tinyurl.com/pancreas-approved
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U.S. FDA issues final rule on medical device identifier codes
(Reuters) - The U.S. Food and Drug Administration issued a long-awaited rule last week requiring companies to include codes on
medical devices that will allow regulators to track the products, monitor them for safety and expedite recalls. ...http://tinyurl.com/Identify-medical-devices
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FDA lays out rules for some smartphone health apps
(AP) - Food and Drug Administration officials say they will begin regulating a new wave of applications and gadgets that work with
smartphones to take medical readings and help users monitor their health. ...http://tinyurl.com/Regulate-health-apps
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FDA strengthens Hepatitis B warning on two cancer drugs
(Reuters) - U.S. health regulators have strengthened the warnings on two blood cancer drugs to reflect the risk that they may reactivate the hepatitis B virus in patients previously infected with the disease. ... http://tinyurl.com/HBV-Warning
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Dementia, sex worrisome mix Nursing homes grapple with proper response
CORALVILLE, Iowa – On Christmas Day 2009, nurse Tiffany Gourley was called to a room at the Windmill Manor nursing home. She found a 78-year-old male resident who had just had intercourse with an 87-year-old woman. The man was divorced. The woman was married. Both had dementia.

What followed illustrates one of the most complex and unexamined issues facing elderly care facilities as the baby boom generation
enters old age: How to determine whether residents with dementia have the mental capacity to consent to sex. The incident and its lengthy aftermath also show that nursing homes, regulators and families are not prepared to deal with that question.

“It ruined my life,” the director of nursing at the time, Karen Etter, said in an interview. She was fired.

“It’s the most difficult thing I’ have ever had to live through,” said Steve Drobot, the former Windmill Manor administrator.
He was fired, too.

Sex among the elderly, especially those with Alzheimer’s or other types of dementia, is a subject that many of the nation’s 16,000
elderly care facilities have largely been able to ignore. The aging of the baby boomers will force more facilities and families to confront
the sorts of legal, ethical and moral questions that arose at Windmill Manor. http://tinyurl.com/sex-and-dementia
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Antiviral Drug May Extend Brain Cancer Survival, Researchers Say
WEDNESDAY, Sept. 4 (HealthDay News) -- A drug used against a common virus may lengthen the lives of people with a deadly form of brain cancer, a preliminary study suggests.
Writing in the Sept. 5 issue of the New England Journal of Medicine, researchers reported on 50 patients who were given the antiviral drug valganciclovir (Valcyte) to help treat glioblastoma. The cancer is the most common form of brain tumor in adults, and it carries a dismal prognosis -- with a typical survival of just over a year.
These 50 patients, however, fared far better, researchers found.
After two years, 62 percent were still alive. Of the 25 who took the antiviral continuously, 90 percent were still alive. That compared with just 18 percent of patients who received most of the same treatments -- including surgery and chemotherapy -- but did not take Valcyte.
"These data are by far the best ever seen for these patients," said lead researcher Dr. Cecilia Soderberg-Naucler, of the Karolinska Institute in Stockholm, Sweden. ...http://www.nlm.nih.gov/medlineplus/news/fullstory_140357.html
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Thirteen New England patients possibly exposed to fatal brain disease
(Reuters) - Thirteen people who recently underwent neurosurgery in Massachusetts and New Hampshire may have been exposed to a rare and fatal brain condition similar to "mad cow" disease because of potentially infected surgical instruments.
The Massachusetts Department of Public Health said on Thursday that five patients treated at Cape Cod Hospital between June and August are at low risk of infection for the disease, called Creutzfeldt-Jakob disease (CJD). On Wednesday, New Hampshire announced eight patients treated at a hospital in New Hampshire may also have been exposed.
Surgical instruments used on the patients may have become infected with the microscopic protein that causes CJD after they were initially used on someone now suspected of having carried the disease.
Normal sterilization procedures at hospitals reduce, but do not eradicate, the protein that causes CJD. ...

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Red grapes may help the digestive system protect itself from colitis,which is inflammation of the colon.
A new study suggests that everyday red table grapes contain tiny particles that allow stem cells in the intestine to continue to function and reproduce, even as colitis is introduced. These intestinal stem cells are typically damaged in colitis.
Researchers say it’s the first time these types of particles have been identified in an edible plant. Until now, they've been found only in mammals.
Other studies confirm these results, they say it could lead to new, safer, and more economical treatments for colitis by using edible plant-derived substances to deliver medicines to the intestines or as a medicine themselves.
Experts caution that these are only early findings from research involving mice, but the notion is promising.
“It’s very intriguing to recognize certain elements in our food that may in fact be protective and support the cells in our colon that are responsible for reproduction in mice models,” said David T. Rubin, MD, a professor of medicine and co-director of the Inflammatory Bowel Disease Center at University of Chicago Medicine....
http://www.everydayhealth.com/ulcerative-colitis/red-grapes-possible-protection-against-colitis.aspx?xid=aol_eh-digest_1_20130902_&aolcat=AHD&ncid=webmail5
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New formulation of Roche's Herceptin wins EU approval
(Reuters) - Swiss drugmaker Roche said on Monday the European Commission had approved a new formulation of its breast cancer drug Herceptin which allows the medicine to be administered more quickly.
Roche said it had won approval for a new injectable version of Herceptin which cuts down treatment time to just two to five minutes. It currently takes between 30 to 90 minutes to administer the drug intravenously.
Herceptin is used as a treatment for around a quarter of breast cancer patients who have tumors that generate a protein called HER2, which tends to make their disease more aggressive.
The drug, which goes off patent next year, is Roche's third-biggest seller and notched up global revenues of 3.08 billion Swiss francs ($3.30 billion) in the first half of the year.

http://www.reuters.com/article/2013/09/02/us-roche-herceptin-idUSBRE98103A20130902?feedType=RSS&feedName=healthNews

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Word Origins: Twitter --- Early in 2006, members of the board of a podcasting company called Odeo held a daylong brainstorming session to name a planned project that would use computer messaging to reach small groups rather than single recipients. The messages were confined to 140 character, for which reason the group finally hit on "Twttr," alluding to both the short burst of song from a bird and the photo site called Flickr. The company's "Twitter" site--- so spelled --- was unveiled later that year.
Quiz Time
Which sedation strategy for ICU patients on mechanical ventilation can help mitigate post-intensive care syndrome (PICS)?
a. Keep the patient heavily sedated.
b. Use the lightest level of sedation possible.
c. Do not awaken the patient during sedation.
d. Awaken the sedated patient every 3 days.
(Answer at end of Newsletter)
   Reprinted with permission from: Production/Electronic Channels CoordinatorHealthCom Media 259 Veterans Lane Doylestown, PA 18901
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Word Origin: askance*** The word "askance," is usually in the form "to look askance," has nothing to do with asking, but instead probably derives from an Italian phrase, a schiancio, that means "at a slant." The original sense means to look out of the corner of one's eye at someone or something, but it now carries a tone of disapproval.
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For the Boomers: this October brings the 109th World Series. Check out the difference in prices since 1946 to 2012:

1946                                             2012
World Series
Tickets $1.20 to $6.25          $110 to $1,050

Hot dog and
Beer 50 cents                          $10.25
Program 25 cents                     $15.00
Winning Player's
Bonus
$3,742.34                          $377,002.64
Ring $100                        $10,000 (est.)
AARP Bulletin/RealPossibilities October 2013
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HUMOR SECTION
After being drafted into the military, I wasn't a happy camper. At my initial physical, a nurse pointed to the eye chart and whispered very softly, "Can you read the letters on the wall?"

" What letters?" I answered slyly.

"Great, " said the nurse. "You passed the hearing test."

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Dr. Jones was driving past the state mental hospital when he got a flat tire. While he was changing the tire, a car ran over the hubcap in which Dr. Jones had placed the lug nuts. The nuts were knocked into a nearby storm drain.

At a loss for what to do, Dr. Jones was about to call a cab when he heard a shout from behind the hospital fence.

"Hey!" shouted one of the patients, "Just take one lug nut off each of the other three wheels. That will hold your tires on until you can get to a garage."

Dr. Jones was startled by the patient's seeming rationality. Realizing the plan would work, he installed the spare tire without incident. Before leaving, he called back to the patient, "That was pretty sharp thinking. Why do they have you in there?"

The patient smiled and said, "I'm here because of a few problems, not because I am stupid."
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In one of my classes, they were discussing the qualifications to be president of the United States. It was pretty simple - the candidate must be a natural born citizen of at least 35 years of age. However, one girl in the class immediately started in on how unfair was the requirement to be a natural born citizen.

In short, her opinion was that this requirement prevented many capable individuals from becoming president. The class was just taking it in and letting her rant, but everyone's jaw hit the floor when she wrapped up her argument by saying, "What makes a natural born citizen any more qualified to lead this country than one born by C-section?"
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.
Please follow me on Twitter as Dr Robert Hess.
Pay Only $34.99 for a full year of CONTACT HOURS

www.nurse.com for CNE offerings.
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
Thank you, Barbara (BAcello)

Malnutrition Screening Tools Use these tools to identify malnourished individuals and at-risk individuals in your care.

This booklet provides more information when weight and height cannot be measured, and when extra care in interpretation is needed. The booklet can also be used for training, is not designed to detect deficiencies or excessive intakes of vitamins and minerals, is of use
only in adults. http://tinyurl.com/Malnutrition-Screen
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Malnutrition Screening Tool (MST); This tool is designed to identify malnourished individuals and individuals at risk of malnutrition. It
does not require any anthropometric measurement such as weight or calculation (body mass index, percent weight loss). Any health worker can use this screening tool. It has been demonstrated to be simple, quick, valid and reliable.
http://www.bapen.org.uk/pdfs/must/must_full.pdf
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Malnutrition Universal Screening Tool This is a five-step screening tool to identify adults who are underweight and at risk of
malnutrition, as well as those who are obese.
http://www.bapen.org.uk/pdfs/must/must_explan.pdf
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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.orgwww.sharedgovernance.org

Decubqueen's website: www.accuruler.com
RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
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. And screen the car's VIN through the free database at carfax.com/flood

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm

Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Tygacil (tigecycline): Drug Safety Communication - Increased Risk of Death
FDA notified health professionals and their medical care organizations of a new Boxed Warning describing an increased risk of death when intravenous Tygacil is used for FDA-approved uses as well as for non-approved uses. These changes to the Tygacil Prescribing Information are based on an additional analysis that was conducted for FDA-approved uses after FDA issuing a Drug Safety Communication about this safety concern in September 2010.
This analysis showed a higher risk of death among patients receiving Tygacil compared to other antibacterial drugs: 2.5% (66/2640) vs. 1.8% (48/2628), respectively. The adjusted risk difference for death was 0.6% with corresponding 95% confidence interval (0.0%, 1.2%). In general, the deaths resulted from worsening infections, complications of infection, or other underlying medical conditions.
BACKGROUND: Tygacil is FDA-approved to treat complicated skin and skin structure infections (cSSSI), complicated intra-abdominal infections (cIAI), and community-acquired bacterial pneumonia (CABP).
*****************************
Do Not Use Budesonide Solution
UPDATED 09/27/2013. FDA alerted patients and health care providers that budesonide solution, used for nasal irrigation, from The Compounding Shop may be contaminated and should not be used or administered to patients. FDA observed a 1000 mL bottle of budesonide solution from The Compounding Shop that contained visible, white, floating material. FDA identified that material as a fungus and is concerned that contamination may be present in other budesonide solution products from The Compounding Shop that may currently be on the market.
FDA is alerting health care providers to immediately quarantine any budesonide solution products from The Compounding Shop, and not administer it to patients.
************************
HeartSine Technologies Samaritan 300/300P PAD Public Access Defibrillators: Recall - Power, Battery Issues
Certain Samaritan 300/300P PAD devices manufactured before December 2010 have been found to intermittently turn on and off, which may eventually deplete the battery. In addition and separately, certain Samaritan 300/300P PAD devices containing early versions of the battery management software may misinterpret a temporary drop in battery voltage as signaling a low battery and subsequently turn the device off. In certain instances, a device experiencing either condition could be unable to deliver therapy during a cardiac event.
Samaritan 300/300P PAD devices with the following serial numbers inclusive are affected by one or both of these issues:
  • 0400000501 to 0700032917
  • 08A00035000 to 10A00070753
  • 10C00200000 to 10C00210106
BACKGROUND: The potentially affected Samaritan 300/300P PADs were manufactured from August 2004 to December 2010 and have a warranted life of 7 years. Potentially affected devices were distributed globally.
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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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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)
~~**~~**~~**~~**~~**~~
NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
WELCOME TO:
Sewstone@gmail.com Sarah (September 17, 2013)
denese.davis@wiregrass.edu Denese (October 10, 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
~~**~~**~~**~~**~~**~~ CO-FOUNDERS:

MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie/Frances)
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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHT FOR THE DAY
Posterity! You will never know how much it cost the present generation to preserve
your freedom! I hope you will make good use of it!

John Adams (1735-1826) Second U.S. President
Letter to Abigail Adams, April 26, 1777

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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