Friday, April 18, 2014

April PARADIGM BYTES

PARADIGM BYTES

Newsletter for Paradigm 97
April 17, 2014
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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SNIPPET
Updated Guidelines on Hepatitis B Protection for Health Care Personnel
AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000445677.22059.3f
ABSTRACT
The rate of acute hepatitis B virus (HBV) infection in the United States has decreased, but health care personnel remain at risk for occupationally acquired infections, primarily from exposure to patients with chronic HBV infection. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has updated its guidelines on prevention and postexposure management of HBV in health care workers (http://1.usa.gov/1mrRx6l), emphasizing the importance of vaccinating all health care personnel who may be exposed to blood or body fluids.
In 1991, the ACIP recommended that postvaccination serologic testing for antibody to hepatitis B surface antigen (HBsAg) be considered for all health care personnel at risk for needlestick exposures.
In 2011, the ACIP reaffirmed its recommendation that unvaccinated and incompletely vaccinated health care personnel at “reasonably anticipated” risk for blood or body fluid exposure be vaccinated against HBV and that those at high risk receive serologic testing one to two months after completion of the vaccine series.
The new report also provides guidance for all those working, training, or volunteering in health care settings who received (documented) hepatitis B vaccination years before beginning work at a facility. Because vaccine-induced HBsAg weakens over time, the CDC recommends preexposure assessment of HBsAg when workers are taken on, followed by one or more additional doses of vaccine in those whose serum HBsAg level is less than 10 mIU/mL (the minimum value considered to be protective).
The CDC also advises all health care institutions to ensure that personnel receive training in recognizing and reporting exposures; have systems in place to facilitate reporting and postexposure assessment; and provide readily accessible prophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, which should be administered as soon after exposure as possible to exposed personnel who are thought to be susceptible to HBV infection.
No postexposure HBV management is necessary in exposed personnel who have documentation indicating receipt of a complete hepatitis B vaccine series and subsequent HBsAg levels of 10 mIU/mL or greater.—Karen Rosenberg
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Could half of all breast cancers be prevented? (Reuters Health) -
If girls and women of all ages adopted healthier lifestyle behaviors and the highest-risk women took preventive drugs like tamoxifen, the authors of a new report say fully half of breast cancers in the U.S. might be avoided.
"We really need to go back and work at breast cancer prevention starting at a young age," Dr. Graham Colditz, associated director for prevention and control at Siteman Cancer Center and Washington University in St. Louis, a co-author of the report, told Reuters Health.
"Women need to have better access to understanding how breast cancer risk accumulates and how these lifestyle factors add up over the years to increase risk," he said.
In addition to researching effective treatments and methods of catching cancers early, Colditz and his Washington University colleague Dr. Kari Bohlke argue that more emphasis should be on using what's already known about what raises breast cancer risk. ...
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In less than two centuries the term "OK" has evolved into a central part of the American language and, far more than that, the language of the world. No phrase is more internationally understood. But where did it come from?

RANDOM FACT:

In 1839 the editor of the Boston Post was inspired to invent the phrase "o.k.," which he defined as "all correct." It was supposed to be a joke, perhaps on the literary competency of the Post's readership, but whether or not readers found it funny the phrase was picked up by another newspaper, the Evening Transcript, and o.k. was on the road to immortality.
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Bonus Fact:

Outside of New England o.k. really didn't become famous until the presidential candidacy of Martin Van Buren in 1840 and the invention of the telegraph. The first was important because Van Buren acquired the nickname "Old Kinderhook" after his home town in Upstate New York: "OK now could have a double meaning: Old Kinderhook was all correct."

Then, the invention of the telegraph made the use of OK as shorthand for "all right" commonplace.
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Radiation improves odds for some women after mastectomy
(Reuters Health) - Women who have their breasts removed because of cancer may benefit from receiving radiation if they still have traces of cancer in their lymph nodes, suggests a new analysis.
Radiation reduced the risk of death and of cancer returning among women who had cancer cells detected in the cluster of nodes under the arms after a mastectomy. The nodes are part of the lymphatic system, a conduit for immune and other cells.
"It has been clear for some time that women in whom the disease has not spread to the lymph nodes in the armpits will not benefit from radiotherapy," Sarah Darby told Reuters Health.
"It's been unclear what the benefit is for women with one, two or three positive lymph nodes," she said. ...
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U.S. advisers back DNA-based colon cancer test
(Reuters) - A colon cancer screening method that analyzes DNA from stool samples won the unanimous backing of a U.S. advisory panel on Thursday, paving the way for potential regulatory approval of the non-invasive test.
A panel of outside experts advising the Food and Drug Administration voted 10-0 to recommend approval of the Cologuard screening test made by Exact Sciences Corp.
The company said a large clinical trial found that its test detected 92.3 percent of colorectal cancers in average-risk patients based on a combination of DNA and hemoglobin markers.
While a colonoscopy is considered the most accurate method of detecting colon cancer and polyps, many people avoid the test, which involves inserting a flexible tube into the colon.
If Cologuard is approved by the FDA, patients who have a positive cancer finding with the test, which identifies abnormal cells shed in the stool, would then undergo a colonoscopy.
The FDA usually follows panel recommendations, although it is not required to.
The American Cancer Society estimates about 50,000 deaths from colorectal cancer in the United States this year. It is the third leading cause of cancer-related deaths in the United It is the third leading cause of cancer-related deaths in the United States when men and women are considered separately, and the second leading cause when both sexes are combined. ...
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Statistics on corneal transplantation:
 
$6 billion:
Corneal transplants performed in the United States in one year result in nearly $6 billion in total net benefits over the lifetime of the recipients.
5:
Eye disorders are the fifth costliest to the U.S. economy after heart disease, cancer, emotional disorders, and pulmonary conditions.
$16,300:
Estimated per-patient average cost of corneal transplants
1 million:
Since the Eye Bank Association of America was founded in 1961, more than 1 million people have received corneal transplantation.
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Quiz Time
A valid strategy for managing poor secretion control in a person at end of life is to:
a. place a scopolamine patch behind the ear, as ordered.
b. administer morphine or hydromorphone, as ordered.
c. suction the patient every 2 hours.
d. suction the patient every 4 hours.
Answer at end of newsletter:
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Alzheimer's takes heavy toll on women
Alzheimer's takes a disproportionate toll on women, according to a report released Wednesday from the Alzheimer's Association.
Women are far more likely to develop the fatal disease than men: one in six women over 65 will get it during their lifetime, compared with one in 11 men.
And, not surprisingly, women are more likely to be caregivers for someone with Alzheimer's, and to pay a bigger personal and professional price for that care than men do.
"This burden is felt across the board," said Angela Geiger, chief strategy officer for the Alzheimer's Association, which will soon launch an advertising campaign to raise awareness about the cost of Alzheimer's on women. ... 
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For Heart Failure Patients, Shortness of Breath When Bending May Signal Problem
THURSDAY, March 20, 2014 (HealthDay News) --
Shortness of breath while bending over is a newly identified symptom of advanced heart failure, researchers say.
This obvious symptom can help alert doctors that heart failure patients have excessive fluid retention, according to cardiologists from the UT Southwestern Medical Center, in Dallas.
"Some patients thought they were short of breath because they were out of shape or overweight, but we wondered if there was something more to it," study first author Dr. Jennifer Thibodeau said in a medical center news release.
"So we developed this study to further investigate this symptom," said Thibodeau, an assistant professor of internal medicine in the center's division of cardiology.
The researchers identified the condition -- which they called bendopnea -- after assessing 102 heart patients.
"We discovered that patients with bendopnea had too much fluid in their bodies, causing elevated pressures," Thibodeau said. When they bent forward, these pressures increased even more." ...
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Thank you, Barbara!!      She writes: "This video clip aired on our local (Dallas-Ft Worth) news this AM. I emailed to request a link. They responded that it originated with the Philadelphia NBC affiliate. Wow. This is great." ...Barbara (BAcello)


SUSQUEHANNA VALLEY, Pa. -- A new program is aiming to put caregivers in the shoes of those who suffer from dementia. News 8's Lori Burkholder learned firsthand how the "Virtual Dementia Tour" works.
http://www.wgal.com/health/new-tool-gives-caregivers-idea-of-what-dementia-patients-experience/25036022
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This site shows which scrub to buy for one's figure type. Great idea !
                                                                                                                                                                                                                                    
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Project Smile : Have any like-new stuffed animals, coloring books, crayons, or stickers laying around your house? Don't toss them out, donate them!

Project Smile is a nonprofit organization that provides police officers, firefighters, and paramedics toys to give to children who have been through a trauma. Learn more here: Project Smile http://www.projectsmile.org/
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These numbers are from “Characteristics of operating room procedures in U.S. hospitals,” released February 2014 by the Agency for Healthcare Research and Quality
29%:
Percentage of the total 38.6 million hospital stays in 2011 that involved OR procedures.
20:
The 20 most common procedures accounted for more than half of all OR procedures.
2:
Hospitals stays that involved an OR procedure were about twice as costly as stays that did not.
20:
Twenty procedures accounted for more than half of all costs for stays involving OR procedures. Spinal fusion, knee arthroplasty, and percutaneous coronary angioplasty had the highest aggregate hospital costs.
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Most Nurse Informaticists ‘Highly Satisfied'
Nursing informatics growing, more nurses have post-graduate training according to HIMSS Nursing Informatics Workforce Survey
Good news for nurse informaticists - the field is “rapidly maturing” according to Joyce Sensmeier, Vice President of Informatics for HIMSS. The 2014 HIMSS Nursing Informatics Workforce Survey shows a great increase in the number of respondents with post-graduate degrees as well.
This comes as good thing for the profession explained Sensmeier in a statement. “Nearly two thirds of respondents have a post-graduate degree and 28 percent have a Master’s degree or PhD in informatics which points to the fact that the field is rapidly maturing. System optimization/utilization was a new option in the 2014 Survey and selected by 39 percent of respondents, suggesting that we may be moving beyond simply implementing systems towards leveraging their value.” ...
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Word Origins: Straining at a gnat...

As you might have guessed, it has a biblical origin. In Matthew 23 Jesus was chastising the Pharisees for observing the letter of the law but not practicing the spirit of the law.

He said, "Woe to you, teachers of the law and Pharisees, you hypocrites! You give a tenth of your spices�mint, dill and cummin. But you have neglected the more important matters of the law�-justice, mercy and faithfulness. You should have practiced the latter, without neglecting the former. You blind guides! You strain out a gnat but swallow a camel."
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More Evidence that Cutting Nursing Staff May Cost Lives
A study of data gathered in 300 European hospitals found that increasing nurses' workloads by one patient increased the likelihood of inpatient hospital death by 7%. Increasing the proportion of nurses with bachelor's degrees was associated with reduced likelihood of patient death. The authors concluded that both staffing ratios and nurses' educational levels affected patient outcomes. ...
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In recent years, both the incidence and severity of Clostridium difficile infection have increased, accompanied by an associated rise in mortality.1 This has largely been attributed to the emergence of a treatment-resistant, highly virulent strain that's capable of causing illnesses ranging from mild diarrhea to colitis and sepsis. Hospitalized patients are considered to be at especially high risk for infection, and among inpatient cases, antibiotic treatment has been an almost universal factor; however, in the past decade C. difficile has appeared with increased frequency in populations previously considered to be at low risk, including peripartum women and healthy people in the community.1
In terms of cost and lost productivity, this pathogen is a major burden to the health care system, comparable to that associated with methicillin-resistant Staphylococcus aureus.2 ...
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Eyes Wide Shut
It may be time to put the myth that a nurse can get by on just a few hours’ sleep to bed. A recent report is the latest of numerous studies showing that fatigue hinders nursing performance and puts patients at risk. Johnson and colleagues investigated whether sleep-deprived night-shift nurses made more patient-care errors than their better-rested colleagues. They examined demographic data and sleep diaries of licensed nurses working full-time on the night shift at three different urban hospitals. Of the 289 nurses, 162 reported being sleep deprived; 75% of those nurses got 4.7 hours’ or less sleep in 24 hours. The sleep-deprived nurses were significantly more likely than their colleagues to make patient-care errors.
“This study documents the importance of nurses’ sleep to providing safe patient care,” says Jeanne Geiger-Brown, associate professor at the University of Maryland School of Nursing in Baltimore, who has written extensively on the subject. “The results are consistent with other data that show relatively little sleep between shifts among night nurses.” ...

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Why Nurses Aren't Being Hired from New Grad to Experienced Nurse
There is an excellent article today on Scrubs Magazine Weekly Best. It's a frank discussion with HR about why they didn't hire nurses and provides a great checklist of the top reasons for not hiring candidates.
Anyone looking for that new or next job should take a long hard look. Just a few years back nurses were writing their own ticket to almost any job they wanted because employers were desperate to hire nurses and sometimes just a warm body would do. Today the scene has changed radically and employers can be and are being very choosy.

Year after year nurses have been voted by the Gallup Poll to be the most trusted honest and ethical professionals. And nurses are being held to a very high bar. Nurses have much more responsibility now for patient's health care and need to come to job prepared to provide the best care possible. If you can't show up to an interview with all of your paperwork in hand, you probably won't get the highest points for being hired. If you come dressed for exercising or lounging on your day off, you're not going to make your best impression. And if you have been careless with your own life in the past, you're going to be very hard pressed to prove that you can value the lives of others. ... http://networkedblogs.com/VBPEu
(I tried three times to access Scrubs and failed. Good luck)
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Nurse-led oncology research makes impact on practice Part I

Enhanced patient care and improved patient outcomes often are the ultimate goals when engaging in nursing research, and the HUP nursing staff and their colleagues have seen improved patient satisfaction scores and requests from physicians to work on the unit because of the calm atmosphere, Maloney said. Staff became more aware of how noisy hospitals are and learned that simple noises — such as opening and closing of patient doors — ranked high on a noise-level scale, according to Maloney. She said quiet-time measures including lowered voices, dimmed lights and no overhead paging have been instituted on the unit after 10 p.m.

Carrie Daly, RN, MS, APN, AOCN, oncology nurse manager and advanced practice nurse, radiation/oncology, Rush University Medical Center in Chicago, keeps these same two goals at the forefront of her work.

After 32 years in nursing, Daly still possesses a passion to help patients with cancer, and for the past nine years has been at Rush caring for patients in radiology/oncology.

“Mucositis is one of the most toxic side effects for patients who undergo head and neck radiation,” Daly said. “Unfortunately, over the years companies made promises that their products would reduce or improve the toxic side effects of mucositis, but the products just didn’t deliver improved patient outcomes.” ...
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Nurses' practice interests pay off in oncology research Part II
Marilyn Haas, RN, PhD, CNS, ANP-BC, Mission Health, Asheville, N.C., and her colleagues investigated the effects on the parasympathetic nervous system of four holistic nursing modalities — healing touch, aroma therapy, guided imagery and massage — on oncology patients by certified holistic nurses. Secondarily, the investigators looked at which of the four modalities would be chosen by oncology patients during hospitalization or radiation treatments, examined the changes in vital signs and correlated participants’ self-reported evaluation of anxiety, nausea or pain.

With 442 participants, all modalities were statistically significant with the exception of aromatherapy, which did not decrease diastolic blood pressure.

“After our analysis of the data, we were able to show to our nursing and interprofessional colleagues that the four HN modalities are effective in relieving pain, nausea and anxiety symptoms and in lowering blood pressure, pulse and respiration,” said Haas, who wants to examine other outcomes, such as whether the HN modalities decrease length of stay or the use of other medications. ...
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Nurses throughout U.S. use honey to treat wounds
Patrice Dillow, RN, MSN, CWOCN, APRN, wouldn’t blame others for questioning honey’s place among the ranks of antibiotics, anti-inflammatories and other medications used to promote healing in clinical settings. But Dillow, a wound care specialist at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Ill., said many of those questions often disappear as quickly as the pain, odor and other effects of the persistent, open wounds Dillow regularly uses honey to treat while helping oncology patients. ...http://news.nurse.com/article/20140310/PA01/303100069#.UzGUxVeRceU
(As a wound care nurse, I have doubts about this form of treatment...would other wound care nurses please write in with your opinion?)
                                                                          
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Routine Mammograms Found Not Helpful for Most Women Over 70
FRIDAY, March 21, 2014 (HealthDay News) -- Mammogram breast cancer screenings for women aged 70 and older may cause more harm than good, according to a large new study.
The screenings don't decrease the number of advanced breast cancer cases diagnosed in these older women. But the tests can lead to overtreatment in a large number of women and put them at risk from the harmful side effects of breast cancer treatment, the researchers said.
The researchers examined data from the Netherlands, where a mammogram breast cancer screening program was extended in 1998 to include women up to age 75. The study included more than 25,000 women, aged 70 to 75, who were diagnosed with breast cancer between 1995 and 2011. ...
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Study shows significant reduction in falls and medication errors when nurses are scheduled based on the anticipated needs of patients. Benefits of Acuity-Based Nurse Staffing
In today's healthcare environment, nurses' roles within the care team are becoming increasingly more important as value-based care models tie hospital reimbursement to patient outcomes.
This has led many healthcare organizations to seek strategies for enhancing nurse care delivery.
In the past, many nurse leaders hypothesized that nurse staffing was one factor that could impact the quality of nurse care delivery, and subsequently, patient outcomes.
Today, researchers have confirmed this hypothesis through the first nurse staffing study leveraging unit-by-unit and shift-by-shift data to examine the relationships between staffing and patient outcomes.
The study, "Nurse Staffing and Patient Outcomes: Bridging Research into Evidenced-Based Practice," found significant relationships between staffing and nurse-sensitive outcomes on more than half the units studied. ...
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Doctor Priorities vs. Patient Priorities (ie different viewpoints need to be recognized)
(a patient came in with four times normal BS...and wasn't worried) For my patient, his wide-angle lens took in the whole of his life, of which diabetes was one small part. For me, in the 20 minutes allotted, my lens was narrowly focused on the disease that posed the gravest and most immediate risk to his health.
The challenge that lay ahead of us was to help each other adjust the angles of our respective lenses so that our visions could come into common focus. Otherwise, we’d slip into futile haranguing.
The diabetes algorithm taped to the wall could tell me exactly how much insulin to administer for his staggering high sugar level. But my patient didn’t need me to tell him; he was perfectly aware of the algorithm himself.
What the algorithm couldn’t tell us was how to understand the disease from different perspectives, how to tease apart the elements that had led up to the current situation, and how come up with a workable plan to prevent an otherwise healthy man from ending up blind, impotent, on dialysis and in a wheelchair from foot amputations. ...
http://well.blogs.nytimes.com/2014/03/27/doctor-priorities-vs-patient-priorities/

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New Blood Pressure Guidelines may take Millions of Americans off of Medications
SATURDAY, March 29, 2014 (HealthDay News) -- About 5.8 million American adults may no longer be prescribed drugs to treat high blood pressure under recently revised guidelines, according to a new study.
In February, the Eighth Joint National Committee released controversial guidelines that relaxed blood pressure goals in adults 60 and older from 140/90 to 150/90. The guidelines also eased blood pressure targets for adults with diabetes and kidney disease.
In this study, researchers used blood pressure data collected from more than 16,000 Americans between 2005 and 2010 to assess the impact of the revised guidelines.
The proportion of adults considered eligible for medication to treat high blood pressure would fall from about 41 percent to 32 percent, the authors concluded in the study published online March 29 in the Journal of the American Medical Association and presented Saturday at the American College of Cardiology annual meeting in Washington, D.C.
The researchers also said that 13.5 million adults -- most of them older than 60 -- who were considered to have poorly controlled blood pressure would now be viewed as having adequately managed blood pressure. That includes 5.8 million adults who would no longer require blood pressure pills.
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The New Cholesterol and Blood Pressure Guidelines
After much delay, deliberation, and drama, the long-awaited updates of the cholesterol and blood pressure guidelines were released during the last 6 months.1,2 These guidelines were intended to distill the wisdom that emerged since the last versions of these authoritative documents were released more than a decade ago. In 2008, the National Institutes of Health (NIH) appointed some of the nation’s top experts to these respective committees and provided guidance throughout almost the entirety of their 5-year development. These documents were designed to provide instructions to the nation and the world about how to manage these common risk factors for cardiovascular disease. The decision by the NIH not to oversee the final release of the documents only intensified the interest in them. ...http://jama.jamanetwork.com/article.aspx?articleid=1853201
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One in 3 Patients Fail to Fill Initial Prescriptions‏
Nearly one third of all initial drug prescriptions were not filled within 9 months, with nonadherence highest for expensive drugs and chronic preventive therapies, according to a primary care network cohort study published in the 1 April issue of Annals of Internal Medicine.
"Many chronic conditions can be successfully managed with pharmaceutical interventions, but 2 common treatment barriers hinder optimal disease management," write Robyn Tamblyn, PhD, from McGill University, Montreal, Quebec, Canada, and colleagues. "First, there is a high prevalence of nonadherence with long-term therapy, a problem that is associated with an increase in emergency department (ED) visits and health care costs. Second, there is an underuse of preventive therapies, such as inhaled steroids for preventing asthma exacerbations, which has been attributed to health professionals' failure to follow evidence-based guidelines." ... http://www.medscape.com/viewarticle/822852
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Blood Test Shows Promise for Gauging Heart Attack Risk After Chest Pain
SUNDAY, March 30, 2014 (HealthDay News) -- Though more study needs to be done, new research suggests that a simple blood test could help predict the heart attack risk of patients experiencing chest pain.
The Swedish study found that patients with chest pain who have undetectable levels of a certain chemical signal in their blood called "high-sensitivity cardiac troponin T," plus no sign of reduced blood flow, are at very low risk for heart attack over the next month.
The authors of the study, which is to be presented Sunday in Washington, D.C., at the annual meeting of the American College of Cardiology, believe the test could help prevent many unnecessary hospital admissions.
"Chest pain is a potentially life-threatening symptom, as well as being a very common one," study lead author Dr. Nadia Bandstein, from the Karolinska Institute in Solna, Sweden, said in a meeting news release. "In our hospital it's the second most common symptom reported in the emergency department. Since there are no established ways to quickly rule out heart attack, many patients are admitted to the hospital unnecessarily, at a large cost to the patient and to society."
According to Bandstein, "using this blood test along with an ECG [electrocardiogram], we will save about 500 to 1,000 admissions per year in our hospital alone, allowing us to use the beds for sicker patients."
Still, more research is required. And experts note that studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal. ...

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Study: U.S. women don't know most stroke warning signs
According to a study in Stroke, many U.S. women don’t know most of the warning signs of stroke. Of the 1,205 women in the telephone survey, 51% identified sudden weakness or numbness on one side of the face, arms or legs as a warning sign of a stroke and 41% identified difficulty speaking or garbled speak. But less than a fourth identified other signs of stroke, including sudden severe headache (23%), unexplained dizziness (20%), and sudden vision loss (18%). Read study highlights.
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HUMOR SECTION

The proud father brought home a backyard swing set for his children and immediately started to assemble it with all the neighborhood children anxiously waiting to play on it.

After several hours of reading the directions, attempting to fit bolt A into slot B, etc., he finally gave up and called upon an old handyman working in a neighboring yard.

The old-timer came over, threw the directions away, and in a short while had the set completely assembled.

It's beyond me," said the father, "how you got it together without even reading instructions."

"To tell the truth," replied the old-timer, "I can't read, and when you can't read, you've got to think."

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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.
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

 Metric conversion calculators and tables for metric conversions
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MEDICAL RECALLS
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Alli (60 mg orlistat capsules) by GlaxoSmithKline: Recall - Product Tampering
GlaxoSmithKline (GSK) Consumer Healthcare is voluntarily recalling all alli weight loss products from U.S. and Puerto Rico retailers as the company believes that some packages of the product were tampered with and may contain product that is not authentic Alli.
GSK received inquiries from consumers in seven states about bottles of alli that contained tablets and capsules that were not Alli. A range of tablets and capsules of various shapes and colors were reported to be found inside bottles. Additionally, some bottles inside the outer carton were missing labels and had tamper-evident seals that were not authentic. These tampered products were purchased in retail stores.
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Medical Device Safety and Recalls: Resuscitation Systems with Oxygen and Air inlet
The oxygen and air wall inlet fittings on the back panel of the resuscitation systems listed below were reversed during assembly. These recalled products may interfere with oxygen delivery resulting in inaccurate oxygen regulation in newborns (neonates) and may lead to low blood oxygen (hypoxia) or high blood oxygen (hyperoxia). This may cause death in neonates, particularly those who are critically ill. Preterm and low-birth weight babies are also at increased risk in terms of morbidity and mortality.
  • Giraffe Warmer with Resuscitation System
  • Panda Warmer with Resuscitation System
  • Giraffe Stand-Alone Infant Resuscitation System
  • Resuscitation System Upgrade Kits
  • Panda Freestanding with Resuscitation System
For more information, including the affected lot numbers, please see: http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm387700.htm
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Hospira Hemostat Dual Channel Plum Set: Recall-Risk of over-delivery of blood products
Hospira identified that an incorrect set component was supplied and used during the manufacturing process of the impacted product lots. The Hemostat Dual Channel Plum Set is designed to administer blood and blood products via the Plum infusion pump. If the Plum infusion pump is used with the affected product, the blood product will be delivered at its intended dosage and there is no risk of over-delivery. If the affected product is removed from the Plum infusion pump and used in a gravity infusion, there is a risk that over-delivery may occur. Over-delivery of blood products in the populations at greatest risk (e.g. neonates, patients with heart and/or kidney failure, and other patients with conditions associated with susceptibility to volume overload) may result in injuries that require medical intervention. These injuries are expected to fully resolve with medical intervention.
BACKGROUND: The blood sets impacted by the recall (list number 11241-03, lot numbers 28005-5H and 34100-5H) were distributed to U.S. healthcare and veterinary facilities from May 2013 through Dec. 2013.
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Revatio (sildenafil): Drug Safety Communication - FDA Clarifies Warning About Pediatric Use for Pulmonary Arterial Hypertension
FDA is clarifying its previous recommendation related to prescribing Revatio (sildenafil) for children with pulmonary arterial hypertension (PAH). Revatio is FDA-approved only to treat PAH in adults, not in children; however, health care professionals must consider whether the benefits of treatment with the drug are likely to outweigh its potential risks for each patient.
FDA revised the Revatio drug label in August 2012, adding a warning stating that “use of Revatio, particularly chronic use, is not recommended in children.” This recommendation was based on an observation of increasing mortality with increasing Revatio doses in a long-term clinical trial in pediatric patients with PAH. FDA issued a Drug Safety Communication at that time. There may be situations in which the benefit-risk profile of Revatio may be acceptable in individual children, for example, when other treatment options are limited and Revatio can be used with close monitoring.
 
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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.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
arodd@mcintoshclinic.com (Amber) NP March 25, 2014

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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)

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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
Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed.
--Dwight D. Eisenhower
Answer to Quiz Time:
Hope to hear from you..... Frankie

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