Thursday, November 12, 2015

November 2015

PARADIGM BYTES

Newsletter for Paradigm 97
November 12, 2015

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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FROM A MEMBER
You might think this odd, but I'd like to recommend that people check out the
June 2015 issue of the Journal of Legal Nurse Consulting. It's dedicated to
topics in electronic health records and will open your eyes no matter where you
work.  Available for free access and download (PDF) at www.aalnc.org >
Publications.    Wendie Howland   Editor JLNC

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SNIPPETS

Generic vs. Branded: The never ending battle


by Daisy Jane Antipuesto RN MN
The generic versus branded drugs battle is one hot issue that has been going on throughout the years in the health care industry. It has raised a lot of questions among patients and health care professionals and has served as a topic in various debates and discussions.
Beliefs
People tend to have more diligence when it comes to buying branded drugs than generic ones. Their choice when it comes to purchasing a specific brand of drug is affected after hearing opinions from others, like how it worked perfectly on a friend or relative of theirs. It is more of a psychological issue, like for example people feel a bit healthier after seeing a doctor even if they weren’t able to undergo any treatment yet.  They drink medicine and they instantly feel better. They believe a drug is effective because somebody told them so. It all boils down to one thought:  a procedure is thought to be effective because they believe in them.
It actually does not matter to them whether there are stacks of generic drugs available on the market claiming having the same effect as the branded drugs. They simply believe that drugs branded with a name are better and more effective than generic drugs. Even researches and science are not enough to convince the consumers that generic and branded medicines have the same effects.
Differences
  • Branded drugs tend to be more pricey that generics.
Generic drugs’ prices are often 50-95 percent less than branded ones. This is because companies that manufacture them do not need to pay out money on activities which is what brand-name drug manufacturers do. With this, hundreds of millions are being saved for just a single drug.
  • A generic drug is likely to be made in a diverse factory from the brand-name drug, with dissimilar quality-control methods.
Compared to generic drug companies, manufacturers of name brand drugs conduct a series of activities such as drug research and development, clinical trials, marketing, and advertising.
  • The size, shape and color of the two pills may differ.
  • They may have different inactive ingredients, like fillers and/or coloring agents.
Similarities
  • The active ingredients in generic drugs are the same as in brand-name drugs.
  • The Food and Drug Administration (FDA) holds strict standards in terms of strength, quality and purity that both generic and branded drugs must conform to in order for them to approved.
  • Each type of guideline that's applied to brand-name drugs by the FDA is also applied to FDA-approved generic drugs.
  • FDA also mandates that generic drugs must offer an identical or nearly matching blood level of the drug compared to name-branded ones.
The debate between the two has been raging on for years. Choosing the right drugs can be tricky, yet ending up with a wrong choice could be harmful to one’s health. In the end, it is best and wise to consult your doctor first when it comes to making drug choices, may it be generic or brand name. By doing so, you will be assured that whatever you will take is safe enough and do your health more good than harm. 
http://www.mayoclinic.org/medical-edge-newspaper-2012/feb-03b.html 
 
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 Implementing an evidence-based nursing dress code to enhance professional image   

Publication Date: October 2015 Vol. 10 No. 10
Author: Jennifer Sulanke, MS, RN, CNS, CNRN, and Kevin Shimp RN, MSN, CCRN, CNML 
In the clinical setting, nurses base their practice on evidence to improve patient outcomes. It’s just as important that our organizational policies are evidence based. After reviewing an article on the image of nursing in American Nurse Today, our organization began to question the professional image portrayed by our nursing staff. After much discussion among nursing leaders, our Nurse Recruitment and Retention Council was charged with evaluating various sources of evidence related to a nursing staff dress code and patient perception. Based on the evidence review, recommendations would be made as to whether the current dress code needed to be changed. 

Planning our approach   An Image of Nursing Subcommittee of the Recruitment and Retention Committee was quickly formed, and its members eagerly embraced the charge of reviewing, critiquing, and synthesizing the literature and leveling it for significance. Forty nurses from inpatient and outpatient areas across the health system volunteered for the subcommittee. Using an inquiry model adapted from the Johns Hopkins Evidence-Based Practice Model, the following PICO components and questions were identified: 

P (Problem): The professional image of the nurse
I (Intervention): Standardized nurse dress code
C (Comparison): No standardized dress code
O (Outcomes): Improved identification of nursing staff, improved professional image, higher patient satisfaction.
Our search questions were
Does a standardized nurse dress code impact the ability to identify the nurse?
Does attire influence the professional image of the nurse?
 Searching for evidence


A literature search of databases including Medline, Cochrane, and CINAHL was conducted using terms such as appearance, dress code, nursing attire, identification of staff, professionalism, piercings, patient perception, and infection control. We also queried other American Nurses Credentialing Center Magnet®-recognized organizations via a listserv regarding their policies on identification of nursing staff dress codes.

In all, 63 sources of evidence, many patient perception surveys, and expert opinion were reviewed. A total of 27 institutions responded with their information regarding specific strategies used to identify nurses and whether the nursing staff wore standardized colors. We also used Survey Monkey to conduct an internal survey of our nursing staff, which gave us input regarding scrub color and holiday attire preferences. Although the survey didn’t ask for respondents’ opinions about whether a nurse dress code should be implemented, 778 staff members commented.
Reviewing the evidence  ... (this was too lengthy to continue; please go to website for rest of the research)
 

 http://www.americannursetoday.com/works-implementing-evidence-based-nursing-dress-code-enhance-professional-image/
 and lastly:
Overview of the JP Drain
A Jackson-Pratt (JP) drain is a type of drain that is placed in an incision during surgery. The drain is made up of a hollow tube that is connected to an egg-shaped bulb. The hollow tube begins inside the incision and exits the body and attached to the end of the tube outside of the body is the collection bulb, which collects fluid from the incision.
This drain helps drain excess blood and fluid from under the skin and the incision site. At first, the fluid collected is bloody. Then, as the wound heals, the fluid changes to light pink, light yellow, or clear. The drain will stay in place until less than 30 cc of fluid can be collected in a 24-hour period.
Care of the JP Drain
Depending on how much fluid drains from the surgical site, you will need to empty the bulb every 8 to 12 hours. The bulb should be emptied when it is half full.
Emptying the drain:
  1. Perform hand washing with soap and water.
  2. Hold the drain securely.
  3. Remove the drainage plug from the emptying port.
  4. Carefully turn the bulb upside down over the measuring cup, and gently squeeze all of the drainage into the measuring cup.
  5. Squeeze the middle of the bulb.
  6. While still squeezing the bulb, replace the drainage plug, to keep the drain sucking.
  7. Measure how much fluid you removed from the bulb.
  8. Write down the amount and color of the fluid you removed from the bulb. If there is more than one drain, keep a separate record for each one.
  9. Empty the fluid into the toilet and flush.
  10. Rinse the measuring cup, and wash your hands with soap and water.
The drain must be emptied at least two times each day, in the morning and at bedtime.
Changing the dressing
Materials:
  • A clean dressing (gauze pad)
  • Hydrogen peroxide
  • Cotton swabs or a piece of clean gauze
  • Scissors
  • Bandage tape
  • Paper towel
  1. Do hand washing with soap and water.
  2. Remove the dressing (gauze pad) from the skin.
  3. Wrap the old dressing in a paper towel and throw it away.
  4. Perform hand washing again.
  5. To clean around the drain site with hydrogen peroxide:
  • Pour a small amount of hydrogen peroxide onto a cotton swab or gauze pad. Do not dip the swab into the bottle of hydrogen peroxide.
  • Gently clean around the area where the drain exits the skin.
  1. Check the skin around the drain for any signs of infection, such as redness, tenderness, warmth, or a foul-smelling or pus-like discharge.
  2. Apply a small amount of antibiotic ointment (if necessary/ordered). The ointment should be squeezed onto a clean cotton swab, then applied to the skin around the drain.
  3. Apply a clean gauze dressing to the skin. On one side of the dressing, cut the dressing halfway across with clean scissors, to position the dressing around the drain.
  4. Tape all four sides of the dressing to the skin.
  5. Throw away any used materials, and wash your hands with soap and water.
 
Sources:
Liane Clores, RN | November 6, 2015 at 12:52 pm | Tags: Care of the JP Drain,Jackson Pratt Drain, JP Drain | Categories: Medical Surgical Nursing | URL:http://wp.me/p7CQB-4GA


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INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days
 
 U.S. agencies press food companies to prevent disease outbreaks   


 CDC: 3 foodborne germs responsible for 91% of multistate outbreaks cause more than half of all food poisoning deaths, even though they account for just 3 percent of all outbreaks.
The call to action comes amid multistate E. coli outbreaks involving 167,427 pounds (76,000 kg) of ground beef made by All American Meats of Omaha, Nebraska, and the closing of 43 Chipotle Mexican Grill Inc restaurants in Washington and Oregon. The outbreak is Chipotle's third this year.
Just three germs - Salmonella, E. coli, and Listeria - cause 91 percent of outbreaks, contaminate widely distributed foods such as vegetables, beef, chicken and fresh fruits, and end up sickening people in many states, according to a new report by the U.S. Centers for Disease Control and Prevention. ...
    http://www.reuters.com/article/2015/11/03/us-usa-foodsafety-companies-idUSKCN0SS26420151103#pGAW8sGM2OHXSfb2.97

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Bacon and other processed meats can cause cancer, experts say  Eating processed meats like hot dogs, sausages and bacon can cause colorectal cancer in humans, and red meat is also a likely cause of the disease, World Health Organization (WHO) experts said.
The review by WHO's International Agency for Research on Cancer (IARC), released on Monday, said additionally that there was some link between the consumption of red meat and pancreatic cancer and prostate cancer.
IARC classified processed meat as "carcinogenic to humans" on its group one list along with tobacco and asbestos, for which there is "sufficient evidence" of cancer links.
Each 50-gram (1.8-ounce) portion of processed meat eaten daily increases the risk of colorectal cancer by 18 percent, the agency estimated. ...
 http://www.reuters.com/article/2015/10/27/us-health-meat-idUSKCN0SK16P20151027#230wxOPHDhbxkJ4R.97

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The World Health Organization's cancer agency has classified processed meat as carcinogenic to humans.
Will you:
Change your advice to patients about meat consumption
Change your own eating behavior
Both
Neither
                                         For some excellent responses to this survey....read on:
http://www.medpagetoday.com/Surveys/?xid=nl_mpt_DHE_2015-10-31&eun=g379846d0r&userid=379846&mu_id=5373084
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STATISTICS: 

CDC facts about total knee replacements (TKRs) from 2000 to 2010 (released 2015):
99%:
Percent increase in TKRs for women (86% for men)
66.2:
Mean age for TKR in 2010 (68.9 in 2000)
69.8%:
Percent of men discharged home after TKA (54.1% of women)


AND:


Untreated hearing loss can isolate people and affect cognitive functioning. According to a report on self-reported hearing loss in adults aged 18 and over in the U.S. found the following:

1 in 6:
One in six adults reported trouble hearing without a hearing aid.
19%:
Percent of adults aged 40-69 who reported trouble
52.4%:
Percent of men aged 70 and older who reported trouble.
36.2%:
Percent of women aged 70 and older who reported trouble

 
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NIH researchers link single gene variation to obesity    Variation in the BDNF gene may affect brain’s regulation of appetite, study suggests.


A single variation in the gene for brain-derived neurotropic factor (BDNF) may influence obesity in children and adults, according to a new study funded by the National Institutes of Health. The study suggests that a less common version of the BDNF gene may predispose people to obesity by producing lower levels of BDNF protein, a regulator of appetite, in the brain. The authors propose that boosting BDNF protein levels may offer a therapeutic strategy for people with the genetic variation, which tends to occur more frequently in African Americans and Hispanics, than in non-Hispanic Caucasians. The study is published in the journal Cell Reports.
Obesity in children and adults is a serious issue in the United States, contributing to health conditions such as heart disease, stroke and type 2 diabetes. Importantly, genetic factors can predispose a person to obesity, as well as influence the effectiveness of weight-loss strategies. The body relies on cells to process and store energy, and changes in genes that regulate these functions can cause an imbalance that leads to excessive energy storage and weight gain.   ...   

 http://www.nih.gov/news-events/news-releases/nih-researchers-link-single-gene-variation-obesity

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Medication errors, adverse drug events seen in half of surgeries  

 BOSTON, Oct. 26 (UPI) -- Researchers at Massachusetts General Hospital found a mistake or adverse event occurred during one out of every two surgeries and in five percent of drug administrations, according to a new study.
While medications are often triple or quadruple checked in normal hospital circumstances as they are passed from doctors to nurses for patients, during surgery there often is not time for that type of verification -- leading to inevitable errors.

Some operating rooms have electronic systems that allow for documentation and tracking of medications to reduce errors, said Dr. Karen Nanji, the lead author of the study.
"While the frequency of errors and adverse events is much higher than has previously been reported in perioperative settings, it is actually in line with rates found in inpatient wards and outpatient clinics, where error rates have been systematically measured for many years," Nanji, a researcher in the department of anesthesia, critical care and pain medicine at MGH, said in a press release. "We definitely have room for improvement in preventing perioperative medication errors, and now that we understand the types of errors that are being made and their frequencies, we can begin to develop targeted strategies to prevent them."  ...

http://www.upi.com/Health_News/2015/10/26/Medication-errors-adverse-drug-events-seen-in-half-of-surgeries/3751445878540/

 
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Teenage girl in Oregon hospitalized with bubonic plague

A teenage girl in Oregon has tested positive for bubonic plague, state health officials said on Thursday.
The girl was believed to have been infected by a flea bite during a hunting trip earlier this month, according to the Oregon Health Authority's Public Health Division and the Crook County Public Health Department.
The teen was in an intensive care unit at a hospital in Bend, in central Oregon, health officials said. Her condition was not known.
There were no other known infections in the state from the centuries-old scourge, health officials said. ...
 http://www.reuters.com/article/2015/10/30/us-oregon-plague-idUSKCN0SO0G420151030?feedType=nl&feedName=healthNews

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  RANDOM FACT:
As amazing and complex as the human body is, we are blind and deaf to most of the world around us. Consider...Humans can see less than 1 percent of the electromagnetic spectrum and hear less than 1 percent of the acoustic spectrum. 
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Bonus Fact:

The existence of the rainbow depends on the conical photoreceptors in your eyes. To animals without cones the rainbow does not exist. So you don't just look at a rainbow, you "create it." 
  
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American Nurse posted a picture of long ago nurses in white;  (feel free to give your opinion-- will publish anonymously, if you wish)

We posted this picture on Facebook and Twitter and here's what we heard. 

Pro all white, cap and cape:
  • At least then u knew who was the nurse, the cleaning person, the doctor etc...so confusing these days..everyone looks the same.
  • Why don't nurses wear hats anymore?
  • It is sad that the profession disgarded the proper nurses uniform. I loved wearing the starched nurses caps and proper uniforms.
  • @BSN_15 all white dress is my fav but white cap, no way #nurseforlife

Pro scrubs:
  • @ANANursingWorld: Good question. Scrubs. Definitely scrubs.
  • Nurse caps were found to spread bacteria and were notorious for catching on privacy curtains. ...I remember that well..
  • we've come a long way and need to go further. scrubs are much more practical then the silly hats and uniforms.
  • How were they able to move in those starched outfits?! 

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 Dense Breasts May Be Linked to Cancer Recurrence   THURSDAY, March 22, 2012 (HealthDay News) — 

But researchers say it's too soon for these preliminary findings to influence practice.

Breast cancer is more likely to recur in women over 50 who have denser breast tissue, researchers report, noting that doctors should take breast density into account when making initial treatment decisions.
The Swedish study found that women with denser breasts had nearly twice the risk of recurrence, either in the same breast or in the surrounding lymph nodes, than women with less dense breasts.
"We found that if you have a PD [percentage density] at diagnosis of 25 percent or more, you have an almost twofold increased risk of local recurrence in the breast and surrounding lymph nodes than women with a PD of less than 25 percent," said Dr. Louise Eriksson and colleagues from the Karolinska Institute in Stockholm. ...
http://www.everydayhealth.com/cancer/breast-cancer/0322/dense-breasts-may-be-linked-to-cancer-recurrence.aspx?xid=aol_eh-gen_9_20151109_&aolcat=HLT
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For those who think humans don't have a considerable impact on the environment, consider that of the 11 known species of baleen whales, nine are officially endangered with population numbers that are just a small fraction of what they were 100 years ago. This is due exclusively to their popularity with commercial whalers in the nineteenth and early twentieth centuries. 



 RANDOM FACT:

There are two suborders of whales to which all species of whales belong: toothed whales and baleen whales. Toothed whales include sperm, killer, and beluga whales, and they prey on large fish in deep waters as their main source of food. Baleen whales include blue and humpback whales, and they are filter feeders that feed on small organisms such as krill and plankton by straining large amounts of sea water through a comb-like structure in their mouth called a baleen.
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Bonus Fact:

While ancient fishermen used the meat of whales for food, in the modern era whales were primarily hunted for oil and whalebone, a term used for the baleen. Whalebone was used to make corsets, umbrella ribs, handles, and brushes, while the oil was used for cooking, candle wax and, much later, making margarine. 

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What is a human chimera?
  • When the human body absorbs the DNA of an unborn twin 
     It is said that it actually happens in 1 in 8 pregnancies. Sometimes, in the womb, two or more fetuses begin to form, when only one develops, it takes on the DNA of a "ghost twin". It is usually not a big deal and it goes completely undetected in most people, that is until you take a paternity test and you fail because the DNA in your sperm doesn't match the DNA in your saliva making you the father and the uncle of your own child. Yes, that actually happened.
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Review:   Intensive Blood-Pressure Lowering Improves Outcomes
Intensive blood-pressure reduction below currently recommended targets provides greater vascular protection, particularly for people at high risk for cardiovascular outcomes, the results of a new systemic review and meta-analysis suggest.
The findings were published online November 6 in the Lancetby Dr Xinfang Xie, of the renal division, department of medicine, Peking University First Hospital, Beijing, China, and colleagues.
The review, of 19 trials involving nearly 45,000 participants, showed that intensive blood-pressure lowering achieved in the trials significantly reduced major cardiovascular events (composite), stroke, myocardial infarction (MI), albuminuria, and retinopathy progression, but had no impact on heart failure, cardiovascular death, total mortality, or end-stage kidney disease compared with less intensive regimens.
The new data call into question the recent loosening of blood-pressure targets for some high-risk populations in recent guidelines from the Eighth Joint National Committee (JNC8) and the European Society of Cardiology/European Society of Hypertension among others, Xie and colleagues say.
"This review and meta-analysis provides clear evidence of the benefits of more intensive blood-pressure lowering, including in high-risk patients whose systolic blood pressure is lower than 140 mm Hg. Existing clinical guidelines should be revised accordingly, to recommend more intensive blood-pressure–lowering treatment in high-risk patient groups," the authors write.
The paper was published on a "fast-tracked" basis ahead of the American Heart Association 2015 Scientific Sessions that begins on November 7, 2015 in Orlando, Florida. On November 9, results of anadditional trial showing benefit of intensive blood-pressure lowering, the National Institutes of Health-sponsored Systolic Blood Pressure Intervention Trial (SPRINT), will be presented.
Top-line SPRINT results released in September showed that treating high-risk hypertensive adults 50 years of age and older to a systolic target of 120 mm Hg significantly reduced cardiovascular events by 30% and reduced all-cause mortality by nearly 25% when compared with patients treated to a target of 140 mm Hg.
That study, which included hypertensive patients with one additional cardiovascular risk factor or preexisting kidney disease, was stopped earlier than the planned 2018 completion date because of the benefit of the intensive strategy, according to investigators.
In an editorial, Drs Mattias Brunström and Bo Carlberg, both of the department of public health and clinical medicine, division of medicine, Umeå University, Sweden, caution that while the current systemic review/meta-analysis "is the most comprehensive compilation" so far of trials comparing different blood-pressure targets, "the results of the review still do not represent all the available evidence for blood-pressure lowering." ...
 http://www.medscape.com/viewarticle/854059
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New guidelines for pediatric pulmonary hypertension

The American Heart Association and American Thoracic Society released the first-ever guidelines for diagnosing and treating pediatric pulmonary hypertension. The guidelines, published in the journal Circulation, include information on the different types of the disorder, suitable and approved treatments and dosages, and the role of pulmonary hypertension centers that offer specialized treatment.  Existing guidelines for diagnosis and treatment of pulmonaryhypertension in adults are not considered applicable to children because of the different underlying causes of the disease.
Children with pulmonary hypertension typically have blockages in their pulmonary arteries, making it harder for the heart's right ventricle to pump blood through the lungs.
They may experience shortness of breath and fainting, and may appear blue due to lack of oxygen.
While pulmonary hypertension can be an isolated condition caused by circulatory problems in the lungs, it often occurs as a complication of other serious heart or lung health issues. These include congenital heart disease, bronchopulmonary dysplasia, which is a form of chronic lung disease, and congenital diaphragmatic hernia. ...    Medical News Today (10/27) 

http://www.medicalnewstoday.com/articles/301548.php

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Senators urge FTC to investigate saline solution makers   Thank you , Laregis  (Laura)

 A bipartisan group of U.S. senators yesterday urged the Federal Trade Commission to investigate possible illegal collusion by saline solution manufacturers. “Since the saline shortage began in late 2013, suppliers are reported to have increased their prices by 200%-300%,” Sens. Richard Blumenthal (D-CT), Mike Lee (R-UT), Amy Klobuchar (D-MN) and Orrin Hatch (R-UT) said in a letter to FTC Chairwoman Edith Ramirez. “This equates to increased annual costs to individual hospitals in the range of hundreds of thousands to millions of dollars. One health care expert has claimed that this could make the saline solution shortage the most expensive drug shortage in U.S. history. ...  

http://news.aha.org/article/151027-senators-urge-ftc-to-investigate-saline-solution-makers

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Ebola Vaccine Update
Post-antibiotic era
According to the World Health Organization (WHO), in 2012, there were about 450,000 new cases of multidrug-resistant tuberculosis (MDR-TB) worldwide. And extensively drug-resistant tuberculosis (XDR-TB) has been identified in 92 countries.Many of the antibiotics used today were discovered decades ago, and since then, microbes have advanced into resistant strains that do not yield to them.
Because of this alarming scenario plus the fact that there are barely any new antibiotics in the pipeline, the WHO recently made a move to warn that we are approaching a "post-antibiotic era" where people could die from ordinary infections and minor injuries.
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A new discovery – Teixobactin
For the first time in about 30 years, a new antibiotic has been discovered. Not only that, it has also been hailed as a potential game changer in the fight against the growing resistance to drugs. In other words, scientists have come across a new class of antibiotic that is resistant to resistance.
Previously, 99 per cent of microbes will not grow in laboratory conditions. However, a team from Northeastern University in Boston, Massachusetts, have discovered a way of using an electronic chip to grow the microbes in the soil and then segregate their antibiotic chemical compounds. They found 25 potential antibiotics, of which one, teixobactin, appeared the most powerful. They discovered that Teixobactin, is highly effective against common bacterial infections Clostridium difficile, Mycobacterium tuberculous and Staphylococcus aureus. ...   
 http://nursingcrib.com/news-blog/ebola-vaccine-update/ 
 
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Effective ebola vaccine by the end of 2015
In recent years, the Ebola Virus has made itself known and has caused alarm amongst people as it claimed thousands of lives. As of the moment, there are no vaccines to protect against EVD licensed for use in humans. However, clinical trials for numerous candidate vaccines are in various phases and a safe and effective vaccine is anticipated by the end of 2015.
According to the World Health Organization, results from Phase I clinical trials for two vaccine candidates – ChAd3-ZEBOV, developed by GlaxoSmithKline (GSK) in collaboration with the US National Institute of Allergy and Infectious Diseases (NIAID), and VSV-EBOV, developed by NewLink Genetics and Merck Vaccines USA in collaboration with the Public Health Agency of Canada – were obtained in January. Both vaccine candidates have been shown to be safe and well tolerated in humans. The results from the trials were published in the New England Journal of Medicine.
Experts reveal that a vaccine against Ebola has been shown to be 100% successful in trials conducted during the outbreak in Guinea and is likely to bring the West African epidemic to an end. ...  http://nursingcrib.com/news-blog/ebola-vaccine-update/
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 Using transitional care coordinators to reduce hospital readmissions for dialysis patients  

Thank you , Laregis  (Laura)

 With the cost of a dialysis patient exceeding  $85,000 per year, which is about 10 times the yearly cost of an average Medicare patient, prevention of hospital admissions and readmissions is a top priority.  Health care delivery is changing, whether we like it or not. The-fee-for-service environment where quantity, not quality, is rewarded is not sustainable and contributes to fragmented care. In essence, patients are really the only ones accountable for their own care.
But this doesn’t work for a variety of reasons: lack of knowledge, access to care, or being in a state of denial about medical issues means care delivery can be delayed. If everyone was doing a great job educating patients about the dangers of poor health, obesity would be less of a risk and no one would smoke.  ...
http://www.nephrologynews.com/using-transitional-care-coordinators-reduce-hospital-readmissions-dialysis-patients-2/

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Researchers Say They've Identified 3 Type 2 Diabetes Subtypes

THURSDAY, Oct. 29, 2015 (HealthDay News) -- Medical data routinely gathered from millions of patients can be used to detect previously unseen patterns in chronic diseases such as type 2 diabetes, a new study suggests.
As a result, researchers say they've identified three distinct subgroups of type 2 diabetics by combing through the health records of more than 11,000 patients.
Each of the subgroups faces unique health problems related to type 2 diabetes, and shares common genetic traits that can explain those challenges, said senior study author Joel Dudley. Dudley is director of biomedical informatics and an assistant professor of genetics and genomic sciences at Mount Sinai School of Medicine in New York City. ... 

https://www.nlm.nih.gov/medlineplus/news/fullstory_155420.html

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Too Many Seniors With Diabetes Are Overtreated, Study Suggests  

THURSDAY, Oct. 29, 2015 (HealthDay News) 

Even when blood sugar, blood pressure levels dropped too low, doctors didn't cut back on meds  

-- When it comes to treating seniors with diabetes, new research suggests that doctors often don't cut back on medications, even when treatment goals are surpassed.
The study found that when people had potentially dangerous low blood sugar levels, just 27 percent had their medicines decreased. And when blood pressure treatments lowered blood pressure levels too much, just 19 percent saw a reduction in their medications. ... 
https://www.nlm.nih.gov/medlineplus/news/fullstory_155428.html

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Clinical Insights in Migraine Management:  Guidelines, Diagnosis, and Current and Emerging Treatment Strategies 


Migraine affects between 11% and 16% of US adults. This condition is associated with a significant societal and economic burden. On an individual level, chronic migraine is associated with reduced health-related quality of life and increased psychiatric and medical comorbidities. Clinicians face challenges in migraine diagnosis, including distinguishing migraine from other types of headaches. Treatments should be tailored to each patient and migraine subtype. There is not an established treatment regimen for acute and preventative treatments, and clinician knowledge of available and emerging therapies is critical in patient care. 

http://www.cmecorner.com/program_link.asp?audience=&ProductID=1159
 
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 More than 400 dead in southeast Congo measles outbreak: U.N. 

A measles outbreak in Democratic Republic of Congo's copper-mining southeast has killed 428 people and infected about 30,000 since the start of the year, the United Nations said on Friday.
More than 100 deaths and 10,000 additional cases have been recorded since mid-August, when the United Nations committed $2.4 million to fight the outbreak in the former province of Katanga, which was recently divided into four.
Humanitarian groups said the money was not enough and poor roads and health services in the region were hindering vaccination drives.
"We have contained the disease somewhat in the short term," Yvon Edoumou, spokesman for the U.N. Office for the Coordination of Humanitarian Affairs (OCHA), told Reuters. "But it's sad to see that the disease is still progressing." ... 

http://www.reuters.com/article/2015/10/16/us-congodemocratic-health-idUSKCN0SA1UR20151016?feedType=nl&feedName=healthNews
 

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 The theory of evolution suggests that ultimately every living thing can trace its ancestry to a bacterium that lived billions of years ago.
Charles Darwin did not come up with his theory of evolution while at the Galapagos Islands. His ideas came later, after his return from the voyage.


  RANDOM FACT:

Bears, seals, and dogs are closely related carnivores but are on a different branch of the evolutionary tree than cats and hyenas.

Some snakes have hipbones, which shows they once had four legs like lizards, their close cousins.

Inside some whales and dolphins are small bones that show they once had back legs and that their ancestors walked on land. These occasionally reappear as tiny rear flippers.
***

Bonus Fact:

Darwin did not argue that humans came from monkeys. Rather he wrote only that monkeys, apes, and humans have a common ancestor.

A hobbit-like species of human lived about 18,000 years ago. About the size of a 3-year-old, they lived with pygmy elephants and 10-foot-long lizards *****************
 
 
 Clinical Leadership Development Program    Thank you , Laregis  (Laura)

AMSN (Academy of Medical-Surgical Nurses) has developed a program to empower nurses like you to become leaders in their practice environment and help deliver evidence-based quality care. We've partnered with HealthStream to develop a 10-module program to help you become a force of change and inspiration.

The program

  • Helps you understand why your leadership is needed and essential.
  • Identifies for you the dimensions of clinical leadership.
  • Highlights the competencies you need as a nurse leader at the bedside.
                          (for purchase of $165)
 
https://www.amsn.org/practice-resources/clinical-leadership-development-program

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Hint 1:    Similar to the way it can help strengthen your head of hair, coconut oil can also help strengthen lashes�and that's especially good news considering it's all too easy to damage those short hairs. Just apply some oil to a cotton swab and spread it onto your lashes before going to bed.


__________________________________________

Hint 2: Remove splinters. 

Place a piece of tape or adhesive bandage over a small piece of raw onion and lay on top of a splinter. Keep the onion there for about an hour. Once you remove it, the splinter should be loosened and easier to pull out.


__________________________________________


Hint 3:  Banana mask (anti aging)

Crushing a ripe banana until it is smooth and apply a thin
layer on the surface. Leave for 10 minutes, then rinse with 
warm water and pat dry. Your skin is soft and smooth!
 
If you try this ...let me know your opinion...

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 QUIZ TIME  
 
Mrs. Smith, who has had heart failure for the past year, typically consumes a 2,000-calorie/day diet. You should instruct her to limit her saturated fat intake to:
a.  less than 14 g.
b.  less than 18 g.
c.  less than 20 g.
d. less than 24 g.
Answer at end of Newsletter

 
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Survey shows importance of hand washing for infection prevention  (remember to wash between fingers and thumbs...(the webbing)  for a thorough hand washing; lots of friction)

Did you know that there are 75,000 deaths per year due to healthcare-associated infections (HAIs)? Infection prevention remains a critical aspect of nursing practice to control unnecessary morbidity and mortality, while providing high-quality nursing care. Interventions include using state-of-the-art equipment and personal protective gear, but hand hygiene remains the cornerstone for keeping HAIs at a minimum. Hand hygiene is not just for healthcare providers, but also for patients and visitors coming in contact with patients.  ...   

http://www.americannursetoday.com/survey-shows-importance-hand-washing-infection-prevention/

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  Cervical length good predictor of labor

A routine screening could help narrow the estimated date of delivery

Newswise — (PHILADELPHIA) – To the frustration of busy pregnant women everywhere, estimates of when she'll actually give birth can be off by as much as two to three weeks, early or late. This leaves women with a window of more than a month in which carefully laid plans can be thrown into disarray, with only 5 percent of women delivering exactly on their due date. A new meta-analysis suggests that one routine screening test could help mothers narrow that window to seven days from the time of the test, in research published October 28th in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG.
"Measuring cervical length via ultrasound at around 37-39 weeks can give us a better sense of whether a mother deliver soon or not," says senior author Vincenzo Berghella, M.D., Director of Maternal Fetal Medicine at Thomas Jefferson University Hospital, and Professor of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University.
Until now, measuring cervical length has been used to help detect women with a high chance of premature labor – the shorter the cervix, the more likely labor is imminent. Since the method is considered the gold standard for detecting preterm birth, a number of researchers have investigated whether it could be used to help predict birth at term as well. The results have produced debate in the field, with some studies showing poor predictive value, others showing stronger value. The aim of the current analysis by Dr. Berghella and colleagues was to pool the data from comparable studies using transvaginal ultrasound to test cervical length and come to a consensus on the topic.
The researchers pooled data from five prospective studies, including 735 women with single-child pregnancies who had babies in the proper head-down position. The researchers found that when the cervix measured more than 30 millimeters at a woman's due date, she had a less than a 50 percent chance of delivering within seven days. However, when the cervix measures 10 mm or less, women had more than an 85 percent chance of delivering within seven days.
Cervical length is a good predictor of labor because it tracks the natural progress of a woman's body toward labor. When a woman's body prepares for labor, a number of changes start to take place. The cervix, which has kept the baby from descending down the birth canal for the nine months of pregnancy, begins to soften. It changes its usual cone shape – imagine an ice cream cone held upright – to a shorter cone, whose top becomes flattened out against the curve of the uterus. When this process begins too early, it signals the start of preterm birth, which, when caught in time can be delayed with certain medications.
"Women always ask for a better sense of their delivery date in order to help them prepare for work leave, or to make contingency plans for sibling-care during labor. These are plans which help reduce a woman's anxiety about the onset of labor," says Dr. Berghella. "But having a better sense can also help obstetricians provide information that could help improve or even save a mother or baby's life," adds Dr. Berghella. Women with a higher risk of stillbirth may be better off receiving a labor induction if the cervix is still long at her due date, since the chances of timely spontaneous birth are low, for example.
The authors report no conflicts of interest.
Article Reference: G. Saccone et al., "Transvaginal ultrasound cervical length for prediction of spontaneous labor at term: a systematic review and meta-analysis," BJOG, DOI: 10.1111/1471-0528.13724, 2015.
http://www.newswise.com/articles/more-precise-due-dates-for-pregnant-mothers?
 
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 A UK Review Corroborates the Negative Consequences of 12-Hour Workdays    Wallis, Laura   AJN,   American Journal of Nursing:

doi: 10.1097/01.NAJ.0000473299.41404.5f     In the News

Is it okay to work 12-hour shifts? That's the question asked by 12-Hour Shifts: Prevalence, Views, and Impact, a report released by the National Nursing Research Unit (part of the National Health Service) in the United Kingdom this August. Noting an increase in the prevalence of the 12-hour shift in nursing over the past 20 years and concerns over possible threats to patient safety, researchers reviewed existing studies on shift length from the United Kingdom, North America, and Europe, as well as UK employment and nurse surveys. They found, unsurprisingly, a “big increase” in the use of 12-hour shifts in the National Health Service, with 31% of staff nurses on wards reporting working 12-hour shifts in 2005, compared with 52% in 2009 (the most recent data available). “On balance, the majority of the studies reviewed showed some degree of negativity, either for nurses, patients, or both, towards 12-hour shifts,” the report concludes, with many adverse outcomes being fatigue related. ...
http://journals.lww.com/ajnonline/Fulltext/2015/11000/A_UK_Review_Corroborates_the_Negative_Consequences.8.aspx  
 
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  Kaiser Bans 13 Antimicrobial Additives from Surfaces in Its Facilities   Thank you , Laregis  (Laura)

Kaiser Permanente has banned the use of 13 antimicrobial chemicals and elements added to fabrics, furniture and finishes in its building projects going forward, according to an Oct. 13 bulletin. Officials of the health system, with 38 hospitals and 619 medical offices and outpatient facilities, state that this latest move is part of an overall mission to make its facilities healthier for patients and staff.
The decision, which follows a commitment Kaiser made last year to remove furniture containing toxic flame-retardent chemicals from its facilities, is not retroactive and affects only Kaiser’s future projects, and current construction and renovation projects that are not yet in the purchasing phase.  ...

http://www.hhnmag.com/articles/6655-kaiser-bans-13-antimicrobial-additives-from-surfaces-in-its-facilities

 
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 Tuberculosis now rivals AIDS as leading cause of death: WHO    

For the first time, tuberculosis infections rivaled HIV/AIDS as a leading cause of death from infectious diseases, the World Health Organization said in a report released on Wednesday.
It found that during 2014, 1.1 million people died of TB in 2014. During the same period, HIV/AIDS killed 1.2 million people globally, including 400,000 who were infected with both HIV and TB.
Dr. Mario Raviglione, director of the WHO TB program, said the report reflects the dramatic gains in access to HIV/AIDS treatment in the past decade, which has helped many people survive their infections. But it also reflects disparities in funding for the two global killers.
"The good news is that TB intervention has saved some 43 million lives since 2000," but given that most cases of TB can be successfully treated, the death rate remained "unacceptably high," Raviglione said in a telephone interview.
The report features data from 205 countries and territories on all aspects of TB, including drug-resistant forms, research and development and financing.
It found that 6 million new cases of TB were reported to the WHO in 2014, fewer than two-thirds of the 9.6 million people worldwide estimated to have fallen sick with TB last year. ...    http://www.reuters.com/article/2015/10/28/us-health-tuberculosis-global-idUSKCN0SM1Z520151028?feedType=nl&feedName=healthNews
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 HINTS: 
  
 Hint 1:   A study from Journal of Sleep says women who climb into bed with cold feet take 10 - some times 20 - minutes longer to fall asleep. A warmer skin temperature triggers mechanisms in your body that tell it to go to sleep. Don't just throw socks on. Throw them in the dryer for 5 minutes first. The journal Physiology & Behavior reports
women who wear toasty socks to bed fall asleep significantly faster than those in non-heated socks. The warmth sends 'go-to-sleep; signals faster to the brain.

Hint 2: Coconut oil can help restore you old worn leather jacket or vest.  If you're saving a leather coat or some sweet leather pants, give the leather apparel new life by rubbing them down with coconut oil to clean and condition and restore lost sheen.
 
Hint 3 : Don't throw out those rusty knives out just yet, try restoring them first.  To clean rusty knives: jab a dirty knife into a large raw onion and -- presto! -- no more rust!

and from Rozalfaro who writes: " I also remind home care nurses of the benefits of throwing a towel in the dryer for 5 minutes and giving it to a cold (wet or dry) client." 
 
  

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

You've all heard of the Air Force's ultra-high-security, super-secret base in Nevada, known simply as "Area 51?"

Well, late one afternoon, the Air Force folks out at Area 51 were very surprised to see a Cessna landing at their "secret" base. They immediately impounded the aircraft and hauled the pilot into an interrogation room. 

The pilot's story was that he took off from Vegas, got lost, and spotted the Base just as he was about to run out of fuel. The Air Force started a full FBI background check on the pilot and held him overnight during the investigation. 

By the next day, they were finally convinced that the pilot really was lost and wasn't a spy. They gassed up his airplane, gave him a terrifying "you-did-not-see-a-base" briefing, told him Vegas was that-a-way and sent him on his way. 

The next day, to the total disbelief of the Air Force, the same Cessna showed up again. Once again, the MP's surrounded the plane...only this time there were two people in the plane. 

The same pilot jumped out and said, "Do anything you want to me, but my wife is in the plane and you have to tell her where I was last night." 



   
~**~**~~**~~**~~**~~**~~
CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Go to www.sharedgovernance.org for access to a 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. info@sharedgovernance.orgwww.sharedgovernance.org 
Pay Only $34.99 for a full year of CONTACT HOURS 
www.nurse.com for CNE offerings.
~~**~~**~~**~~**~~**~~
WEBSITES/ LINKS

Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com.

This is an excellent nursing site, check it out:http://nursingpub.com/

Decubqueen's website: www.accuruler.com.



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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 FDA MedWatch - Entacapone: Drug Safety Communication - FDA Review Found No Increased Cardiovascular Risks

An FDA safety review has found no clear evidence of an increased risk of heart attacks, stroke, or other cardiovascular events associated with the use of entacapone for the treatment of Parkinson’s disease. As a result, recommendations for using Comtan (entacapone) and Stalevo (a combination of entacapone, carbidopa, and levodopa) will remain the same in the drug labels.
FDA alerted patients and health care professionals about a possible increased risk for cardiovascular events and death with Stalevo in August 2010. This possible safety issue was observed in a clinical trial called the Stalevo Reduction in Dyskinesia Evaluation in Parkinson’s Disease (STRIDE-PD) and in a meta-analysis that combined the cardiovascular-related findings from 15 clinical trials comparing Stalevo to carbidopa/levodopa. Carbidopa and levodopa have been used extensively and have not been shown to have an increased cardiovascular risk. FDA was concerned that the entacapone in Stalevo was responsible for these cardiovascular risks because the comparison drugs do not contain this ingredient. ... 


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 Auvi-Q (epinephrine injection, USP): Recall - Potential Inaccurate Dosage Delivery     Sanofi US is voluntarily recalling all Auvi-Q (epinephrine injection, USP). The recall involves all Auvi-Q currently on the market and includes both the 0.15 mg and 0.3 mg strengths for hospitals, retailers and consumers. This includes lot number 2299596 through 3037230, which expire March 2016 through December 2016. The products have been found to potentially have inaccurate dosage delivery. See the Press Release for product photos.
As of October 26, 2015, Sanofi has received 26 reports of suspected device malfunctions in the US and Canada. None of these device malfunction reports have been confirmed. In these reports, patients have described symptoms of the underlying hypersensitivity reaction. No fatal outcomes have been reported among these cases.
If a patient experiencing a serious allergic reaction (i.e., anaphylaxis) did not receive the intended dose, there could be significant health consequences, including death because anaphylaxis is a potentially life-threatening condition. ...


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Myocardial Protection System (MPS) Delivery Sets by Quest Medical: Recall - Intermittent Seal Failure During Use  The identified lots of MPS Delivery sets have shown a possible seal failure along the blood source channel of main pump cassette, resulting in blood loss from the bypass circuit and interruption of cardioplegia solution delivery. The firm has received twenty complaints alleging this seal failure which have resulted in 16 instances of patient blood loss during surgery. There have been no reports of patient injuries as a result of the alleged issue to date.
Recalled Product(s) were manufactured from May 2015 to September 2015 and distributed from June 2015 to September 2015. See the Press Release for affected lot numbers. ... 


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Sanofi U.S. recalls Auvi-Q injections for severe allergy

 French drugmaker Sanofi SA said it was voluntarily recalling all its Auvi-Q injections in the United States to treat patients with severe allergic reactions.
The company said on Wednesday its U.S. unit was recalling the injections as they could potentially deliver an inaccurate dose.
Auvi-Q is designed to treat anaphylaxis, a potentially fatal allergic reaction, in patients who are at risk or who have a history of such reactions.
An incorrect dose could lead to significant health issues, Sanofi said.
The company has received 26 reports of suspected device malfunctions in the United States and Canada as of Oct. 26. ...
http://www.reuters.com/article/2015/10/28/us-sanofi-recall-idUSKCN0SM2RL20151028
 
                                                                    
                                                                        ~~**~~**~~**~~**~~**~~
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


WELCOME TO:

andrea_coots@hotmail.com   (Andrea)
 

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

Being in power is like being a lady. If you have to tell people you are, you aren't.

-- Margaret Thatcher 



Hope to hear from you..... Frankie

 
  a. Patients with heart failure should limit their saturated fat intake to less than 14 g in a 2,000-calorie/day diet.
Learn more by reading the continuing nursing education article “Recognizing heart failure symptoms can improve patient self-management.” 
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