PARADIGM BYTES
Newsletter for Paradigm 97
January 11, 2016
We will be NINETEEN years old on the 20th of January 2016 !
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
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.
***~~~***~~~***~~~***
SNIPPET
Catheter-directed thrombolysis shows pulmonary embolism efficacy
MONTREAL – Catheter-directed thrombolysis surpassed systemic thrombolysis for minimizing in-hospital mortality of patients with an acute pulmonary embolism in a review of more than 1,500 U.S. patients.
The review also found evidence that U.S. pulmonary embolism (PE) patients increasingly undergo catheter-directed thrombolysis, with usage jumping by more than 50% from 2010 to 2012, although in 2012 U.S. clinicians performed catheter-directed thrombolysis on 160 patients with an acute pulmonary embolism (PE) who were included in a national U.S. registry of hospitalized patients, Dr. Amina Saqib said at the annual meeting of the American College of Chest Physicians.
Catheter-directed thrombolysis resulted in a 9% in-hospital mortality rate and a 10% combined rate of in-hospital mortality plus intracerebral hemorrhages, rates significantly below those tallied in propensity score–matched patients who underwent systemic thrombolysis of their acute PE. The matched group with systemic thrombolysis had a 17% in-hospital mortality rate and a 17% combined mortality plus intracerebral hemorrhage rate, said Dr. Saqib, a researcher at Staten Island (N.Y.) University Hospital. ...
http://www.copd-hub.com/conference-news/single-article/chest-catheter-directed-thrombolysis-shows-pulmonary-embolism-efficacy/43432f70c32e47cbb239c1342f764511.html?utm_source=Hubs_COPD_eNL_010116&utm_medium=email&utm_content=Top+conference+stories+from+2015
or http://tinyurl.com/p2gng5e
From A Member:
JBW912 @AOL.com wrote: " I have been living and working as an RN in Las Vegas for 9 years now and just want to pass along that the city is building its 9th hospital and has built additions on 4. There are lots of opportunity especially for ladder climbers interested in administrative positions......just sayin...."
~~**~~**~~**~~**~~**~~
INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Metformin as a prevention and treatment for preeclampsia
Preeclampsia is associated with placental ischemia/hypoxia and secretion of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sENG) into the maternal circulation. This causes widespread endothelial dysfunction manifesting clinically as hypertension and multisystem organ injury. Recently, small molecule inhibitors of hypoxic inducible factor 1α (HIF1α) have been found to reduce sFlt-1 and sENG secretion. However their safety profile in pregnancy is unknown. Metformin is safe in pregnancy and is also reported to inhibit HIF1α by reducing mitochondrial electron transport chain activity. ...
http://www.ajog.org/article/S0002-9378(15)02540-5/abstract?utm_source=BenchmarkEmail&utm_campaign=InfoBytes_Newsletter_122915&utm_medium=email
or:
http://tinyurl.com/jofnk2u
************************
Nurses rank as most honest, ethical profession for 14th straight year
Nursing continues to be rated the most trusted profession, according to the annual Gallup poll ranking of honesty and ethics in various fields.
For the past 14 years, the public has voted nurses as the most honest and ethical profession in America. This year, 85 percent of Americans rated nurses’ honesty and ethical standards as “very high” or “high,” tying a nurses’ high point on the Gallup poll and 17 percentage points above any other profession. Read more.
Nursing continues to be rated the most trusted profession, according to the annual Gallup poll ranking of honesty and ethics in various fields.
For the past 14 years, the public has voted nurses as the most honest and ethical profession in America. This year, 85 percent of Americans rated nurses’ honesty and ethical standards as “very high” or “high,” tying a nurses’ high point on the Gallup poll and 17 percentage points above any other profession. Read more.
******************
RANDOM FACTS:
It is one of the easiest things to do, with the greatest impact, but so many of us are unwilling to do it; recycle.
The United States makes up only 4 percent of the world's population, yet it is the number one producer of garbage. In 2006, Americans generated more than 250 million tons of garbage.
Random Fact:
Plastic bags are easier to recycle and require less energy to produce than paper bags.
Recycling one aluminum can saves enough energy to run a television for three hours.
Bonus Fact:
Cigarette butts and filters take 12 years to biodegrade. An aluminum can takes between 200 to 500 years to degrade. Plastic diapers and sanitary pads take between 500-800 years. Styrofoam takes more than 5,000 years. And it would take a glass bottle 1 million years to degrade.
****************
FDA approves Zurampic to treat high blood uric acid levels associated with gout
The U.S. Food and Drug Administration December 22nd approved Zurampic (lesinurad) to treat high levels of uric acid in the blood (hyperuricemia) associated with gout, when used in combination with a xanthine oxidase inhibitor (XOI), a type of drug approved to reduce the production of uric acid in the body.
Gout is a painful form of arthritis caused by the buildup of too much uric acid in the body, and usually appears first as redness, soreness, and swelling in the big toe. Uric acid in the blood is produced by the breakdown of substances called purines, which are found in all the body’s tissues. Uric acid usually dissolves in the blood then passes through the kidneys and out of the body in urine. Uric acid can build up in the blood, a condition called hyperuricemia. This occurs when the body increases the amount of uric acid it makes, the kidneys do not get rid of enough uric acid, or a person eats too many foods high in purines. Most people with hyperuricemia do not develop gout, but if uric acid forms crystals in the body, gout can develop. ...
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm478791.htm?utm_source=BenchmarkEmail&utm_campaign=InfoBytes_Newsletter_122915&utm_medium=email
or
http://tinyurl.com/hflqyyk
| ******************* |
Thank you , Barbara.... for this article:
Becker's Hospital Review readers were interested in hand hygiene videos and posters as well as advancements in hand hygiene and what causes noncompliance. -
There are links to all 10 here--a variety of info:
http://www.beckershospitalreview.com/quality/10-most-popular-hand-hygiene-stories-of-2015.html
or http://tinyurl.com/hq47vuz
*******************
What's almost as satisfying as cracking your knuckles? Settling the age-old question of what makes that sound.
Canadian researchers used an MRI movie technology to answer whether it is the formation of a cavitation bubble within a joint's synovial fluid or the collapse of the bubble. Verdict: it's the former, wrote Gregory Kawchuk, PhD, a professor of rehabilitation medicine at the University of Alberta in Edmonton, and colleagues in PLOS One.
They observed that the cracking sounds emitted from metacarpophalangeal (MCP) joints corresponded to the formation of a cavity within the synovial fluid.
Though the researchers still don't know "if the cavity makes the sound ... they do occur at the same time," Kawchuk told MedPage Today in an email.
The theory that bubble formation causes a cracking sound was first put forth in 1947, when researchers used serial radiography to visualize MCP joints.
As force is applied, joint surfaces resist separation but after a critical point rapidly separate. This increase in volume results in a decrease in pressure, causing dissolved gas in synovial fluid to come out of solution and form a bubble. Researchers linked the emission of a cracking sound to the formation of this clear space seen on x-ray. ...
http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/51028?xid=nl_mpt_DHE_2015-04-17&eun=g379846d0r&userid=379846&mu_id=5373084
or
http://tinyurl.com/qd3gm5g
*******************************
Nurse-led early discharge planning for chronic disease reduces hospital readmission rates and all-cause mortality
- The study found that nurse-led early discharge planning programmes (DPPs) are effective in reducing hospital readmissions by 28%, hospital readmission lengths of stay by slightly more than 2 days and all-cause mortality by 30% compared to standard care defined as non-nurse led DPPs not initiated early.
- Nurse-led early DPPs may reduce total and readmission costs. ...
(there are several interesting subjects with this article....not the same subject)
http://ebn.bmj.com/content/early/2015/12/23/eb-2015-102197?papetoc
*******************
STATISTICS:
Winter can be hard for those suffering from seasonal affective disorder (SAD).
Here are some facts about SAD:
4:
People who suffer from SAD may increase their sleep by as many as four hours a night.
People who suffer from SAD may increase their sleep by as many as four hours a night.
11 million:
Estimated number of people in the U.S. affected by SAD
Estimated number of people in the U.S. affected by SAD
8:
People in Canada or the northern U.S. are eight times more likely experience SAD than those living in sunny, more temperate areas like Florida.
People in Canada or the northern U.S. are eight times more likely experience SAD than those living in sunny, more temperate areas like Florida.
*******************************
Is Pin Care really necessary?
First, to give us an overview, there are two types of external fixators. One is the monolateral fixator and the other is the ring fixator. Both of them are special devices that hold an arm or leg in place with pins or wires while the bone mends or lengthens and help to straighten, lengthen or turn the bone as well.
The device is fitted to the outside of the arm or leg and is held in place with pins or wires that pass through the skin and into the bone. Some devices also may have rods and clamps that help hold broken bones in place while they heal. Because of this, and because germs live on the outside of the fixator, pins or skin, they can cause an infection at the pin site since a pin makes a direct pathway to the bone. It can cause pain and swelling and prevent the bone from healing, and can even cause a deeper infection close to or in the bone itself.
Pin care is the process of cleaning a pin and the skin around where the pin enters the body. By performing pin care, we are preventing infection.
Preparation
Pin care may be done 1-3 times a day, depending on the doctor’s orders. Before performing the procedure, the nurse must first make sure that all needed equipment and materials are ready, such as:
- A clean, 4- to 8-ounce container with lid
- Normal saline and hydrogen peroxide
- A pen or marker
- Blue pads or a clean towel
- Clean cotton swabs
- 4×4 gauze pads (if there is drainage)
- Betadine or antibiotic ointment, if ordered by the doctor
- New soft bristle brush
- 2 clean dry towels
- Foam sponges for ring fixator device if ordered by your doctor
- Roll of surgical tape
In the container, mix equal amounts of hydrogen peroxide and normal saline. Mix 1/4 cup of hydrogen peroxide with 1/4 cup of normal saline. Mark the container with the name of the solution and the date it was mixed. The same solution may be saved and used for up to 24 hours.
Steps in Cleaning Pin sites and wound
- Gather all of the supplies.
- Wash your hands well with soap and water for 15 seconds.
- Before starting to clean, place a clean, dry towel under the leg.
- Wipe any drainage or loose crust from around the pin with a clean cotton swab.
- Dip a clean cotton swab into the sterile saline. Clean the skin around the pin in a circular motion.
- Push the skin down and away from the pin.
This prevents the drainage from building up at the pin sites. It also keeps the skin from sticking to the pins. Make sure no crust is left at the pin site or on the skin around the pin. Repeat these steps for each pin and wire site. Use a clean cotton swab for each pin site. Do not touch or use the same swab from one site to another.
- If the patient has an incision or wound where the bone was cut:
- Stitches or steri-strips may be used to close the wound.
- Check the site closely for any signs of infection. Change the bandage only if there is excess drainage, if it has fallen off or as your doctor instructs you to do.
Cleaning the wires and pins
- Dip a clean cotton swab and soft bristle toothbrush into the sterile saline.
- Clean the exposed metal parts of each pin and wire all the way up to the fixator and down to the skin.
- Remove all crust, dried blood and scabs from the pins and wires.
- If the crusts are hard to remove with the cotton swab, gently scrub the pins and wires with the soft bristle toothbrush.
- Wipe clean with a new cotton swab. Extra cleaning may be needed on pins with threads or screw lines.
- Rinse the toothbrush and container with sterile saline after each cleaning. Wipe them dry and store in a clean area.
Cleaning the external fixator device
- Use a clean cotton swab or clean washcloth soaked with sterile saline to clean the device. Remove all dust or dirt.
- Dry with a clean towel.
- The patient may shower once your doctor gives a signal that it is okay. In the shower, gently clean the fixator with soap and water.
- Dry with a clean towel.
- The pin sites and pins must still be cleansed. The shower does not replace cleaning the pin sites and pins.
During each pin site cleaning, signs of infection must also be checked as evidenced by the following:
- Changes in skin color, increased redness or streaking of the skin around the pin
- Swelling
- Increased tenderness, pain or hardness at the pin site
- Increased drainage
- Change in color or smell of drainage
- Increased warmth to touch at the pin site
- Fever over 100.3°
Sources:
- https://choa.org/Menus/Documents/Wellness/teachingsheets/pincare.pdf
- http://www.upmc.com/patients-visitors/education/orthopaedics/Pages/pin-care.aspx
************************
Blood proteins 'may show dementia'
Proteins in blood may help detect if a person is suffering from dementia a decade before they experience troubling symptoms, scientists have said.
For the study, blood samples were taken from 20 people who later developed Alzheimer's disease, up to 10 years before they were diagnosed and then after they were diagnosed.
Blood was also taken once from 26 people with Alzheimer's disease and 16 people with frontotemporal dementia, which leads to changes in personality or behaviour, and also may affect the memory.
Samples were also taken from 46 healthy people who did not have any problems with thinking or memory skills.
American scientists found the level of protein was significantly different for the healthy controls than for those with dementia, both before and after symptoms developed.
The findings are published in Neurology, the medical journal of the American Academy of Neurology.
Gordon Wilcock, emeritus professor of clinical geratology at the University of Oxford, said: "This is important as it suggests that altered blood proteins may be a marker of early Alzheimer's disease, possibly 10 years before significant memory problems develop. ...
****************************
Thank you, Barbara ( msedrn@gmail.com)
New long-term care nursing group to debut in 2016 Leaders of an association for nurse assessment coordinators have announced they will be rolling out a new organization for long-term care directors of nursing in 2016. A “soft” opening will occur in March, with a full rollout expected to occur at a conference in September, they told McKnight's.
The effort is being led by leaders of the American Association of Nurse Assessment Coordination (AANAC), which in July announced that it had acquired the assets of the American Association of Long-Term Care Nursing (AALTCN).
“It makes sense. We have the staff and the infrastructure,” said AANAC President and CEO Diane Carter, RN, MSN, RAC-CT, C-NE, FAAN. “We have 15,000 members in AANAC and about half of them are directors of nursing.”
Carter said that AANAC also recently attempted to acquire the National Association of Directors of Nursing in Long Term Care (NADONA) but the offer was rebuffed. Attempts to obtain comment from NADONA's executive director on Friday were unsuccessful. ... http://tinyurl.com/nhjqpnk
( http://www.mcknights.com/news/new-long-term-care-nursing-group-to-debut-in-2016/article/452445/?DCMP=EMC-MCK_Weekly&spMailingID=12947958&spUserID=NjMzODkyMDYxNzAS1&spJobID=660883989&spReportId=NjYwODgzOTg5S0 )
******************************
Courage in Everyday Nursing Practice
Courage is an important attribute in life and in your nursing practice. As Helen Keller said,
"Security is mostly a superstition. It does not exist in nature nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing."
Nursing is a noble profession that is not for the faint of heart. Opportunities to choose courageous acts present themselves on a regular basis because risk is everywhere. You can attempt to minimize the risks by playing it safe but there are risks to yourself, your colleagues, your profession, and those you serve when you don't take risks in showing up, speaking up, or practicing according to the highest standards of evidence-based practice. Choosing to practice courageously, consistent with your personal and professional values, will cause some discomfort, bumps, and bruises to you and your career. It will also bring professional and personal fulfillment, strengthen the profession, and improve patient outcomes. You will know that you are making a difference in your daily practice and throughout your nursing career. ...
http://www.medscape.com/viewarticle/853476
***********************
FDA Approves Fluad for Seasonal Influenza
Seqirus announced that FDA has approved Fluad adjuvanted influenza vaccine to help protect those aged 65 years and older against seasonal influenza. Fluad is an inactivated influenza vaccine indicated for active immunization of adults aged 65 and older caused by influenza virus subtypes A and B contained in the vaccine.
Adverse reactions: The most common (≥ 10%) injection site adverse reactions observed in clinical studies were injection site pain (25%) and tenderness (21%). The most common (≥ 10%) systemic adverse reactions observed in clinical studies were myalgia (15%), headache (13%) and fatigue (13%).
Citation: Seqirus receives FDA approval for FLUAD™ (Influenza Vaccine, Adjuvanted) for adults aged 65
years and older. [news release]. Cambridge, MA: Seqiris; November 25, 2015.
www.seqirus.com/newsroom/Seqirus-receives-FDA-approval-for-FLUAD-for-adults-aged-65-years-and-older.
or
http://tinyurl.com/q983977
**********************
LifeVest Wearable Defibrillator Approved for Children For heart patients who can't have device implanted
THURSDAY, Dec. 17, 2015 (HealthDay News) -- The LifeVest wearable defibrillator has been approved by the U.S. Food and Drug Administration for children at risk for cardiac arrest who can't have a defibrillator implanted.
A defibrillator shocks an abnormally beating heart back into its normal rhythm. While there are a number of implanted defibrillators approved for children, some patients can't have the devices implanted for medical reasons or because parents won't consent to them, the FDA said Thursday in a news release. The device is already approved for adults.
"The pediatric medical community is often forced to use adult devices off-label without appropriate labeling or instructions for use in pediatric patients," said Dr. Vasum Peiris, chief medical officer of pediatrics and special populations in the FDA's Center for Devices and Radiological Health.
"Doctors now have important information that may help them safely prescribe this life-saving device to young patients who may benefit from the device," Peiris added. ...
https://www.nlm.nih.gov/medlineplus/news/fullstory_156289.html
****************************
Emergency department nurses report high workload and management pressure to meet 4 h treatment targets
Implications for practice and research
There is a dissonance between providing minimal and adequate nursing care in emergency units and meeting
4 h treatment targets.
- Qualitative research can add important information about the impact for patients and nurses on meeting 4 h treatment targets.
- Future research needs to focus on factors that impact on emergency practice and the relationship to targets such as triage, access and bed block.
Many emergency departments (ED) are expected to discharge patients within a set time frame, usually 4 h; referred to as waiting targets. These targets were introduced to resolve perceived excessive waiting times in the ED. These targets do not take into consideration increases in ED presentations and the complexity of patient problems. Overcrowding in EDs often results in patients waiting in ambulances, and therefore other ambulances may be unable to gain …
Hoyle L, Grant A. Treatment targets in emergency departments: nurses’ views of how they affect clinical practice. J Clin Nurs 2015;24:2211–18.
http://ebn.bmj.com/content/early/2015/12/18/eb-2015-102160?papetoc
****************************
Is Nurse Practitioner Care Cost-Effective? Measuring Outcomes of Nurse Practitioner Care
The primary outcomes of this systematic literature review were objective measures of health system utilization, including use of services (eg, length of visit, referrals, emergency department visits, hospitalizations), costs of healthcare (eg, personnel costs, medications, family costs) and health resource use (eg, diagnostic tests) of nurse practitioners (NPs) delivering primary and specialized care in the ambulatory setting. Nearly 4400 articles were identified from 1980 to 2013, with 11 of these meeting all of the criteria to be reviewed. Seven studies came from the United States, and two each from the United Kingdom and The Netherlands.
Two roles of NPs were reviewed: alternative roles and complementary roles. Alternative roles were those in which NPs provide similar services to those for whom they are "substituting" (eg, physicians). In complementary roles, NPs provide services that are "intended to complement existing services." ...
http://www.medscape.com/viewarticle/854581
**************************
SIMPLE DRUG REGIMEN CURES HEPATITIS C VIRUS IN PATIENTS AFTER 12 WEEKS
Toronto, Canada) – Researchers at the Toronto Western Hospital (TWH) Liver Clinic have found that a simple drug regimen delivered over 12 weeks achieved sustained eradication of several genotypes of the hepatitis C virus (HCV) in 99 per cent of the trial's patients.
The study, released today in the New England Journal of Medicine, showed that receiving a once daily drug combination of sofosbuvir-velpatasvir for a 12 week period was effective in both treatment-naïve and previously treated patients with HCV genotype 1, 2, 4, 5, or 6, including those with compensated cirrhosis (where scarring of the liver has occurred but patients have yet to experience symptoms as a result of it).
"This drug regimen changes the standard of care in treating patients with HCV – we can now cure almost everyone with a very simple treatment," said Dr. Jordan Feld, Hepatologist, Francis Family Liver Clinic, TWH and the first author of the study. "It's incredibly gratifying to be part of research where we not only cure a disease but can also think about eliminating HCV in Canada." ...
http://www.uhn.ca/corporate/News/PressReleases/Pages/simple_drug_regimen_cures_hepatitis_C_virus_in_patients_after_12_weeks.aspx?utm_source=BenchmarkEmail&utm_campaign=AMNT_Elec_Dec15_House_2nd&utm_medium=email
or http://tinyurl.com/ne55wg6
*****************************
Integrative review: Midwifery training needs identified when caring for women with female genital mutilation
- More studies are needed to examine the experiences and needs of midwives to help guide the design of interventions for optimal care for women with female genital mutilation (FGM).
- Multidisciplinary and integrated programmes involving midwives and their professional associations and other sectors, should develop strategies to help abandon and advocate against FGM.
Context
FGM is a practice occurring in low and middle income countries (LMIC) and high income countries (HIC) and is associated with adverse obstetric outcomes, as well as a range of immediate and long-term complications for girls and women. Complications might include urinary tract infections, …
http://ebn.bmj.com/content/19/1/7?etoc
*********************************
Minority of U.S. hospitals mandate flu vaccination
Less than 50% of U.S. hospitals require health care workers to receive annual flu shots, according to a survey study with responses from nearly 500 facilities.
The study, published online in Infection Control & Hospital Epidemiology (2015 Nov 27. doi: 10.1017/ice.2015.277), also found that only 1.3% of U.S. Veterans Affairs hospitals mandate flu shots, despite no law preventing them from doing so.
Dr. M. Todd Greene of the University of Michigan, Ann Arbor, and the Veterans Affairs/University of Michigan Patient Safety Enhancement Program, led the study, which asked hospital infection specialists to report on their institutions’ policies regarding annual vaccines, the stated reasons behind these policies, and other efforts to promote vaccination or discourage nonvaccination in 2013. Only 42.7% of respondents from 386 non-VA hospitals said their institutions required universal vaccination of personnel. However, many reported policies promoting uptake and/or mandating declination forms and face masks for personnel who opted out. ...
http://www.pneumoniahub.com/news/news/article/minority-of-us-hospitals-mandate-flu-vaccination/ff82f712215384fbfc6fcf92475aa4ea.html?email=rnfrankie@aol.com&ocid=12712886&utm_source=Hubs_PNE_eNL_123015&utm_medium=email&utm_content=Minority%20of%20U%2ES%2E%20hospitals%20mandate%20flu%20vaccination
or http://tinyurl.com/gtzrz9g
******************************
RANDOM FACT:
There are approximately 78.2 million owned dogs in the United States. Twenty-one percent of owned dogs were adopted from an animal shelter. On average, dog owners spent $248 on veterinary visits annually.
***
Bonus Fact: There are approximately 86.4 million owned cats in the United States. Twenty-one percent of owned cats were adopted from an animal shelter. Cat owners spent an average of $219 on routine veterinary visits.
************
There are approximately 78.2 million owned dogs in the United States. Twenty-one percent of owned dogs were adopted from an animal shelter. On average, dog owners spent $248 on veterinary visits annually.
Bonus Fact: There are approximately 86.4 million owned cats in the United States. Twenty-one percent of owned cats were adopted from an animal shelter. Cat owners spent an average of $219 on routine veterinary visits.
(Sorry about the following article...it just won't behave)
A Retrospective Study to Evaluate Use of Negative Pressure Wound Therapy in Patients Undergoing Bilateral Internal Thoracic Artery Grafting
| Bilateral internal thoracic artery (BITA) grafting may be associated with a higher risk of postoperative deep sternal wound infection than monolateral internal thoracic artery grafting due to a limited blood supply to the thoracic chest wall. Because preliminary studies suggest negative pressure wound therapy (NPWT) may reduce the risk of infection, a retrospective chart review of 129 patients who underwent BITA between February 2003 and October 2014 was conducted. Read more. http://www.o-wm.com/article/retrospective-study-evaluate-use-negative-pressure-wound-therapy-patients-undergoing |
or:
http://tinyurl.com/nawdt4m
********************
| Quiz Time |
Which of the following suggests your patient is experiencing opioid-induced respiratory depression (OIRD)?
a. Respiratory rate of 11 breaths/minute
b. Pulse oximetry (Spo2) of 92%
c. Oxygen saturation of 95%
d. End-tidal carbon dioxide (ETco2) of 26 mm Hg
|
*************************
FDA approves the first reversal agent for the anticoagulant Pradaxa The U.S. Food and Drug Administration today granted accelerated approval to Praxbind (idarucizumab) for use in patients who are taking the anticoagulant Pradaxa (dabigatran) during emergency situations when there is a need to reverse Pradaxa’s blood-thinning effects.
The FDA approved Pradaxa in 2010 to prevent stroke and systemic blood clots in patients with atrial fibrillation, as well as for the treatment and prevention of deep venous thrombosis and pulmonary embolism. Praxbind is the first reversal agent approved specifically for Pradaxa and works by binding to the drug compound to neutralize its effect. Praxbind solution is for intravenous injection. Reversing the effect of Pradaxa exposes patients to the risk of blood clots and stroke from their underlying disease (such as atrial fibrillation). The Praxbind labeling recommends patients resume their anticoagulant therapy as soon as medically appropriate, as determined by their health care provider.
For more information, please visit: Praxbind
*****************************
The perceptions of job satisfaction and the experience of horizontal violence among registered nurses (RNs) are two key concerns that have been researched over several decades. Evidence has suggested that horizontal violence and job satisfaction among nurses are negatively associated with several factors including peer relationships. This study by Purpora and colleague specifically aimed to describe. …
Evid Based Nurs doi:10.1136/eb-2015-102235
http://ebn.bmj.com/content/early/2015/12/23/eb-2015-102235?papetoc
********************
QUESTION: (Now don't peek at the answer; remember nurses are HONEST)
What happened on Winter Soltice?
- The longest day and shortest night of the year
- There is no moon
- The shortest day and longest night of the year
- Temperatures drop 6 degrees Celsius
Now no peeking....
ANSWER:
**************************
I assume it is possible that the temperatures could drop 6 degrees and that there could be no moon but the point is more that it is the shortest day of the year. Here is how it works: The axial tilt of the Earth means that one side is facing always facing the sun and one side is always, well, not. The side not facing the sun is in winter and the side facing the sun is in summer, as Earth rotates the seasons change and so when you are the absolute furthest from the sun that you can possibly be then it is your winter solstice. Here in the U.S. that day falls on December 22nd.
*******************
TRIVIA:
BONUS TIP:
Most vehicles run just fine on regular-grade (87 octane) fuel. Using premium in these cars won't hurt, but it won't improve performance, either. A higher-octane number simply means that the fuel is less prone to pre-
ignition problems, so it's often specified for hotter running, high-compression engines. So if your car is designed for 87-octane fuel, don't waste money on premium.
***************************
FDA approves first recombinant von Willebrand factor to treat bleeding episodes
The U.S. Food and Drug Administration today approved Vonvendi, von Willebrand factor (Recombinant), for use in adults 18 years of age and older who have von Willebrand disease (VWD). Vonvendi is the first FDA-approved recombinant von Willebrand factor, and is approved for the on-demand (as needed) treatment and control of bleeding episodes in adults diagnosed with VWD.
VWD is the most common inherited bleeding disorder, affecting approximately 1 percent of the U.S. population. Men and women are equally affected by VWD, which is caused by a deficiency or defect in von Willebrand factor, a protein that is critical for normal blood clotting. Patients with VWD can develop severe bleeding from the nose, gums, and intestines, as well as into muscles and joints. Women with VWD may have heavy menstrual periods lasting longer than average and may experience excessive bleeding after childbirth.
“Patients with heritable bleeding disorders should meet with their health care provider to discuss appropriate measures to reduce blood loss,” said Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research. “The approval of Vonvendi provides an additional therapeutic option for the treatment of bleeding episodes in patients with von Willebrand disease.” ...
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm476065.htm?utm_source=BenchmarkEmail&utm_campaign=InfoBytes_eNewsletter_121115&utm_medium=email
or http://tinyurl.com/pb2pv8v
******************
FDA Proposes Tanning Bed Age Limit
*******************************
The FDA proposed two regulations for tanning bed use today, one restricting use of sunlamp products to individuals 18 and older, and another requiring certain safety features on the equipment.
Under the proposed regulations, first-time users would have to sign a risk acknowledgment certification, stating that they have been told about the risks that come with use of sunlamp products. They would also be required to sign the certification every 6 months, said the FDA, which posted the announcement to their website.
http://www.medpagetoday.com/Dermatology/GeneralDermatology/55317?xid=nl_mpt_DHE_2015-12-19&eun=g379846d0r
or
http://tinyurl.com/pkmn3dr
Yogurt May Offer Positive Benefits For Diet Quality and Body Fat In Children
FDA allows marketing of cooling cap to reduce hair loss during chemotherapy
U.S. children are consuming diets too high in calories and lacking in important nutrients.1 In particular,
dietary intakes of calcium, vitamin D, and potassium, as well as fiber, are of public health concern in
children of all ages.1 In addition, more than 30% of U.S. children (ages 2–19) are overweight or
obese, with 17% of children being obese.1
Poor eating habits started in childhood may continue into later life; therefore,
early interventions are needed to help children adopt healthy nutrition.1 Two
recent reviews have found that consumption of yogurt may help improve diet
quality and lower body fat in children.2,3
A yogurt snack contains nutrients that are lacking in children's diets.
Most U.S. children consume snacks; but these snacks tend to be high in calories
and sugars and do not provide significant amounts of the nutrients of concern.2
A recent review examined data from both the 2009–2010 National Health and
Nutrition Examination Survey (NHANES) and the 2004–2005 and 2009–2010
School Nutrition Dietary Assessment Study (SNDA). This review found that
97% of children surveyed eat a daily snack, with half of children consuming
multiple snacks per day.2 Snacks contribute 37% of children's caloric intake,
but only 15–30% of vital micronutrients and nearly 40% of the added sugar
in children's diets.2
The authors of the review, and at least one other, have found that introducing
vitamin D-fortified yogurt to children's snack times may help increase dietary
intake of nutrients currently lacking in children's diets:2,3
References:
1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary
Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office,
December 2010.
2. Keast DR, Hill Gallant KM, Albertson AM, Gugger CK, Holschuh NM. Associations between
yogurt, dairy, calcium, and vitamin D intake and obesity among U.S. children aged 8-18 years:
NHANES, 2005-2008. Nutrients 2015;7:1577-1593.
http://www.oneyogurteveryday.com/news-bodyfat
*******************************
FDA allows marketing of cooling cap to reduce hair loss during chemotherapy
Today, the U.S. Food and Drug Administration cleared for marketing in the United States the first cooling cap to reduce hair loss (alopecia) in female breast cancer patients undergoing chemotherapy.
Hair loss is a common side effect of certain types of chemotherapy, commonly associated with the treatment of breast cancer. Hair may fall out entirely, gradually, in sections, or may become thin. Hair loss due to cancer treatment is usually temporary, but minimizing or relieving these kinds of side effects are considered important to overall treatment.
“We are pleased to see a product for breast cancer patients that can minimize chemotherapy-induced hair loss and contribute to the quality of life of these individuals,” said William Maisel, M.D., M.P.H., acting director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health. “Managing the side effects of chemotherapy is a critical component to overall health and recovery.”
The Dignitana DigniCap Cooling System is indicated to reduce the frequency and severity of alopecia during chemotherapy in breast cancer patients in which alopecia-inducing chemotherapeutic agents and doses are used. It is a computer-controlled system that circulates cooled liquid to a head-worn cooling cap during chemotherapy treatment. The cooling cap is covered by a second cap made from neoprene, which holds the cooling cap in place and acts as an insulation cover to prevent loss of cooling. ...
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm476216.htm?utm_source=BenchmarkEmail&utm_campaign=InfoBytes_eNewsletter_121115&utm_medium=email
or http://tinyurl.com/oxa83z6
***************************
In many cultures around the world -- including Celtic, Hindu and Egyptian weddings -- the hands of a bride and groom are literally tied together to demonstrate the couple's commitment to each other and their new bond as a married couple (giving us the popular phrase "tying the knot").
The Roman goddess Juno rules over marriage, the hearth, and childbirth, hence the popularity of June weddings.
Princess Victoria established the tradition of playing Wagner's "Bridal Chorus" during her wedding processional in 1858.
The Catholic tradition of "posting the banns" to announce a marriage originated as a way to ensure the bride and groom were not related.
Stag parties were first held by ancient Spartan soldiers, who kissed their bachelor days goodbye with a raucous party.
The custom of tiered cakes emerged from a game where the bride and groom attempted to kiss over an ever-higher cake without knocking it over.
(www.theknot.com)
~~**~~**~~**~~**~~**~~
HUMOR SECTION
On a lonely, moonlit country road a young man's car engine started to cough. Immediately pulling over to a scenic little spot he said to the young lady next to him, "That's funny, I wonder what that knocking noise was?"
"I'll tell you one thing for sure," said the girl coolly, "It wasn't opportunity."
************************
I was very pregnant, and it was rotten luck when, several days before my due date, my husband fell from the porch roof, sprained both ankles and was restricted to crutches. So when I went into labor and he couldn't drive, I took the wheel, stopping every time I had a contraction.
Finally, we got to the hospital. I dropped him at the maternity entrance, and he hobbled off to the admitting desk, where the nurse told him to go to the emergency room.
No, it's my wife," he told her. "She's in Labor."
"Where is she?" the nurse asked.
"She's parking the car and bringing in the bags."
Finally, we got to the hospital. I dropped him at the maternity entrance, and he hobbled off to the admitting desk, where the nurse told him to go to the emergency room.
No, it's my wife," he told her. "She's in Labor."
"Where is she?" the nurse asked.
"She's parking the car and bringing in the bags."
~**~**~~**~~**~~**~~**~~
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
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.
www.nurse.com for CNE offerings.
Free CEs http://www.myfreece.com/welcome.asp
~~**~~**~~**~~**~~**~~
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/
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
Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions
*******************************************************
********************************************
*
MEDICAL RECALLS
*
*******************************************
******************************************************
New FDA Drug Safety Communication on Kayexalate (sodium polystyrene sulfonate)
The U.S. Food and Drug Administration (FDA) is requiring the Kayexalate manufacturer to conduct studies to investigate Kayexalate’s potential to bind to other medications administered by mouth – drug interactions that could affect how well the other medications work.
Kayexalate (sodium polystyrene sulfonate) and generic brands Kionex and SPS are used to treat hyperkalemia, a serious condition in which the amount of potassium in the blood is too high. They work by binding potassium in the large intestine so it can be removed from the body. Potassium is a mineral that helps the body function properly. When people have too much potassium in their blood it can cause problems with heart rhythm, which in rare cases can be fatal. Patients should not stop taking their potassium-lowering drugs without talking to their health care professional.
The approved labeling for Kayexalate describes its potential to decrease absorption of lithium and thyroxine; however, extensive drug-drug interaction studies with Kayexalate have not been performed. During FDA’s review of another potassium-lowering drug, Veltassa (patiromer), we found that Veltassa bound to about half of the medications tested, some of which are commonly used in patients who require potassium-lowering drugs. Such binding could decrease the effects of these medications. The label for Veltassa contains a warning not to take other orally administered medications within 6 hours of taking Veltassa. For more information, please visit: Kayexalate.
*****************************
FDA alerts health care professionals not to use sterile drug products from Qualgen
The U.S. Food and Drug Administration is alerting health care professionals and patients of a voluntary recall of lots 1 through 67 of non-expired drug products intended to be sterile produced and distributed nationwide by Qualgen LLC, in Edmond, Okla., due to lack of sterility and quality assurance. The recalled products were compounded prior to September 1, 2015.
Health care professionals should immediately check their medical supplies, quarantine any drug products marketed as sterile from Qualgen or Amerilab LLC, the facility’s former name, and not administer them to patients. Administration of a non-sterile drug product intended to be sterile may result in serious and potentially life-threatening infections or death.
During FDA’s recent inspection of Qualgen’s facility, investigators observed insanitary conditions, including poor sterile production practices, which raise concerns about Qualgen’s ability to assure the sterility of drug products that it produced.
On October 8, 2015, FDA recommended that Qualgen cease sterile operations until appropriate corrective actions have been implemented by the facility, and recall all non-expired drug products intended to be sterile. On October 9, 2015, Qualgen informed FDA that it would voluntarily recall certain lots of non-expired drug product marketed as sterile. However, the company refused to cease sterile compounding operations. Therefore FDA alerts health care professionals and patients not to use drug products marketed as sterile from Qualgen.
For more information, please visit: Qualgen
*********************
Acetaminophen Tablets by Medline Industries: Recall - Mislabeling with Incorrect Strength Medline Industries, Inc. announced that it will initiate a voluntary nationwide recall of lot # 45810 of Acetaminophen tablets, 500mg, uncoated compressed tablets to the consumer level. The Acetaminophen 500mg, Tab 100/BT (OTC20101) has been found to be mislabeled displaying “Acetaminophen 325mg” (OTC10101) instead of “Acetaminophen 500mg”. The Acetaminophen tablets, 500mg is incorrectly labeled as 325 mg tablets. This error is not easily identifiable by the user or prescriber. If the product is taken at the maximum labeled dose, every four hours, five doses a day, or with other medications containing acetaminophen, it may lead to liver toxicity or liver failure. See the firm Press Releasefor further details.
|
***************
Heater-Cooler Devices: FDA Safety Communication - Use of Devices Associated With Nontuberculous Mycobacteria Infections Including all heater-cooler devices providing heated and/or cooled water to:
- oxygenator heat exchangers,
- cardioplegia (paralysis of the heart) heat exchangers, and/or
- warming/cooling blankets.
AUDIENCE: Surgery, Infectious Disease, Risk Manager
ISSUE: Through analysis of adverse event reports, the medical literature, and information from national and international public health agencies, FDA is aware that the use of heater-cooler devices has been associated with Nontuberculous Mycobacteria (NTM) infections, primarily in patients undergoing cardiothoracic surgical procedures. NTM organisms are widespread in nature and can be found in soil and water, including tap water sources. They are typically not harmful, but in rare cases may cause infections in very ill patients and/or in individuals with compromised immune systems.
Between January 2010 and August 2015, the FDA received 32 Medical Device Reports (MDRs) of patient infections associated with heater-cooler devices or bacterial heater-cooler device contamination. Twenty-five of these MDRs were reported to the FDA in 2015. Some reports describe NTM infections related to cardiothoracic surgeries, but other reports do not specify the procedure the patient was undergoing. Eight reports were related to 3 events describing patient infections occurring in U.S. health care facilities. The remaining 24 reports involved health care facilities outside the United States, most of these in Western Europe. In some cases, patients presented with infections several months to years after their surgical procedures. It is important to note that half of the 32 reports submitted to the FDA describe bacterial contamination of the heater-cooler device without known patient involvement or infection. The FDA is not aware of NTM infections acquired by hospital staff.
It is possible that some cases have not been reported to the FDA. It is challenging for a health care facility, health care provider, manufacturer, or patient to recognize that infections, particularly NTM infections, may be associated with the use of or exposure to a particular medical device. The FDA continues to evaluate reports through follow up with health care facilities and manufacturers to determine which factors may have contributed to the reported events.
BACKGROUND: Heater-cooler devices are used during cardiothoracic surgeries, as well as other medical and surgical procedures to warm or cool a patient to optimize medical care and improve patient outcomes. Heater-cooler devices include water tanks that provide temperature-controlled water to external heat exchangers or warming/cooling blankets through closed circuits. Although the water in the circuits does not come into direct contact with the patient, there is the potential for contaminated water to enter other parts of the device or transmit bacteria through the air (aerosolize) through the device’s exhaust vent into the environment and to the patient.
RECOMMENDATION: In addition to following standard precautions, the FDA recommends that facilities and staff using heater-cooler devices consider implementing additional measures to reduce risk to patients: [see the FDA Safety Communication for more information]
- Strictly adhere to the cleaning and disinfection instructions provided in the manufacturer’s device labeling. Ensure you have the most current version of the manufacturers’ instructions for use readily available to promote adherence.
- Do not use tap water to rinse, fill, refill or top-off water tanks since this may introduce NTM organisms. Use only sterile water or water that has been passed through a filter of less than or equal to 0.22 microns. When making ice needed for patient cooling during surgical procedures use only sterile water or water that has been passed through a filter of less than or equal to 0.22 microns. Deionized water and sterile water created through reverse osmosis is not recommended because it may promote corrosion of the metal components of the system.
- Direct the heater-cooler’s vent exhaust away from the surgical field to mitigate the risk of aerosolizing heater-cooler tank water into the sterile field and exposing the patient.
- Establish regular cleaning, disinfection and maintenance schedules for heater-cooler devices according to the manufacturers’ instructions to minimize the risk of bacterial growth and subsequent patient infection.
- Develop and follow a comprehensive quality control program for maintenance, cleaning, and disinfection of heater-cooler devices. Your program may include written procedures for monitoring adherence to the program and documenting set up, cleaning, and disinfection processes before and after use.
- Immediately remove from service heater-cooler devices that show discoloration or cloudiness in the fluid lines/circuits, which may indicate bacterial growth. Consult your hospital infection control officials to perform the appropriate follow up measures and report events of device contamination to the manufacturer.
- Consider performing environmental, air, and water sampling and monitoring if heater-cooler contamination is suspected. Environmental monitoring requires specialized expertise and equipment to collect and process samples, which may not be feasible in all facilities.
- Health care facilities should follow their internal procedures for notifying and culturing patients if they suspect infection associated with heater-cooler devices.
Read the MedWatch safety alert, including a link to the FDA Safety Communication, at:
~~**~~**~~**~~**~~**~~
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.
~~**~~**~~**~~**~~**~~
NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
Welcome to: Debbie6280@AOL.com
~~**~~**~~**~~**~~**~~
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
ADDRESS CHANGE:
Old Address: leslie.evans@sgmc.org
New Address: lesliereginae@yahoo.com
and
Old Address: tkriewald@bellsouth.net
New Address: tmhartrn@gmail.com
~~**~~**~~**~~**~~**~~
EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
~~**~~**~~**~~**~~**~~
PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)
~~**~~**~~**~~**~~**~~
~~**~~**~~**~~**~~**~~
DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
~~**~~**~~**~~**~~**~~
~~**~~**~~**~~**~~**~~
THOUGHT FOR THE DAY
--Thomas Jefferson
Hope to hear from you..... Frankie
d. OIRD usually manifests as a respiratory rate between eight and
10 breaths/minute, Spo2 below 90%, and ETco2 below 30 mm Hg or above 50 mm Hg. However, OIRD may occur outside these parameters.
10 breaths/minute, Spo2 below 90%, and ETco2 below 30 mm Hg or above 50 mm Hg. However, OIRD may occur outside these parameters.
No comments:
Post a Comment