Saturday, March 12, 2016

March Paradigm Bytes

PARADIGM BYTES

Newsletter for Paradigm 97
March 12, 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
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPET

  Biliary Drainage: An overview
Biliary drainage is the insertion of a tube into the bile duct and is most commonly carried out when the bile ducts are blocked as it allows bile that has been blocked by a tumor to drain out of your body into a bag or inside your body to your small intestine. In simple words, biliary drainage allows bile to drain from your liver.
Normally, the bile ducts allow bile to drain from the liver to the small intestine. When the bile ducts are blocked, bile cannot leave the body and builds up, thus producing a yellow color in the skin called jaundice and can also cause itching and dark urine. Blockage may be due to several reasons such as gallstones impacted in the ducts, narrowings in the bile ducts after previous surgery and involvement of cancer in the ducts.
The biliary drain is inserted by an Interventional Radiologist and is placed through the patient’s skin and into his/her liver. Other terms for biliary drain are biliary stent and biliary catheter.
A biliary drain may be placed because of leakage or a hole that forms in the bile duct. This leakage can cause severe pain or infection. They may also be placed before surgery or for removal of a bile duct stone.
Preparation
The patient may be ordered to be on NPO at least 4 hours prior to the procedure since the procedure is carried out under sedation or general anesthetic, and if the stomach is full, stomach contents can involuntarily pass into the lungs.
If the patient is diabetic, he/she may be advised to check with the radiology practice before fasting.
The nurse and doctor may conduct a health history review including the medications that you take. Certain medications such as those that thin the blood may be advised to be stopped to decrease the risk of bleeding. Examples are warfarin, clopidogrel, heparin, enoxaparin sodium, etc.
During the Procedure
Placing the biliary drain will take at least 2 hours and is usually carried out with the assistance of either sedation or a general anesthetic. Intravenous antibiotics are also routinely given before the procedure.
The skin of the abdomen is washed with antiseptic and then a very fine needle is inserted through the skin to administer local anesthetic. A small cut is then made in the skin and a thin needle is passed through the skin into the liver and then into a bile duct inside the liver. X-ray dye or contrast medium is injected into the bile duct, thus allowing it to be seen on X-ray pictures. X-ray pictures or images are taken to see the path of the bile ducts.
After which, a thin wire is passed through the center of the needle so that it lies in the bile duct. A thin drain tube is then inserted over the top of the wire and into the bile duct.One end of the drain tube will remain in the bile duct and the other end sits outside the skin where it is attached to a bag into which the bile drains. It is therefore normal for this bag to fill up with green-brown bile.
After the procedure
After the procedure the patient will be monitored for 4 hours while recovering from the effects of any sedation or anesthetic medications that were used.
For those on out-patient basis, he/she may need someone to drive him/her home as the patient may feel sleepy, tired or dizzy for several hours from the medication he/she was given.
Sources:
                                                                               
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 ABR: An Overview
The auditory brainstem response (ABR) is a test that gives information about the inner ear or the cochlea and brain pathways for hearing. Also sometimes referred to as auditory evoked potential (AEP), this test can be used with children or others who have a difficult time with conventional behavioral methods of hearing screening. Furthermore, it is also indicated for a person with signs, symptoms, or complaints suggesting a type of hearing loss in the brain or a brain pathway.
In simpler words, ABR test measures the reaction of the parts of a child’s nervous system that affect hearing as it measures the hearing nerve’s response to sounds.
This test is often ordered if a newborn fails the hearing screening test given in the hospital shortly after birth, or for older children if there is a suspicion of hearing loss that was not confirmed through more conventional hearing tests. This test is safe and does not hurt. Also, it can be completed only if the child is sleeping or lying perfectly still, relaxed and with his or her eyes closed.
The test is performed by pasting 3-4 electrodes on the head (just like those electrodes placed around the heart when you do an electrocardiogram) and recording brain wave activity in response to sound. As sounds are made through the earphones, -the electrodes measure how the child’s hearing nerves respond to them.
The audiologist then looks for certain neurological "markers" as the child’s hearing nerves respond to sounds. Here, the softest intensity or loudness level at which these markers appear roughly corresponds to the child’s hearing level in that frequency range or pitch. By reading a computer printout of the child’s responses and interpreting these markers, the audiologist can tell if the child has a hearing problem.
The person being tested rests quietly or sleeps while the test is performed and no response is necessary. ABR can also be used as a screening test in newborn hearing screening programs. When used as a screening test, only one intensity or loudness level is checked, and the baby either passes or fails the screen.
Preparation
  • For those babies under 6 months, the mother may show up with a tired, hungry baby since most young babies will sleep through the entire test if they are brought to the appointment ready for a feeding and a nap.
  • For those children older than 6 months but younger than 7 years, they may usually need anesthesia medication in order to sleep throughout the test. However, when anesthesia medication is needed, there are important rules for eating and drinking that must be followed in the hours before the test.
  • For those children older than 7 years, they can be tested while they are awake if they relax and lie still during the test. But if the child is not able to cooperate, the test might need to be rescheduled so it can be done under anesthesia.
Sources:
 
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                                                        INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days
 
 

Data Again Show Nurse Staffing Improves Outcomes in a Variety of Settings 

As new models of care delivery arise in the wake of health care reform, and as U.S. nurses continue the battle for safe-staffing regulations, three new studies add to the significant body of evidence that better work environments, reasonable workloads, and better-educated nursing staff equal better outcomes for patients. Cardiac events were the focus of one study, which examined the relationship between nurse staffing and survival of in-hospital cardiac arrest (IHCA). The researchers, noting that fewer than a quarter of patients who experience an IHCA survive to discharge, wondered why some hospitals had significantly better outcomes than others. Few previous studies have sought to determine whether this disparity might be related to nurse staffing and nurses’ work environments. ...

http://journals.lww.com/ajnonline/Fulltext/2016/03000/Data_Again_Show_Nurse_Staffing_Improves_Outcomes.4.aspx  

http://tinyurl.com/zcbdtk6


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  Low-cost mosquito netting flies high in test to repair groin hernias


 (Reuters Health) - Don't want to pay $125 for a piece of implantable plastic mesh to repair a groin hernia? Less than a dollar's worth of plastic mosquito netting can work just as well, according to a new study.
The result, reported in the New England Journal of Medicine, is expected to cause a buzz in poor countries where people live on under $2 a day, making conventional surgical mesh expensive.
The double-blind trial, conducted in Uganda, was the first rigorous test of the mosquito netting.
"The mosquito mesh in groin hernia surgery is a frugal innovation with great potential for millions," chief author Dr. Jenny Lofgren of Umea University in Sweden told Reuters Health in an email. "The study shows that high quality surgery (on par with western surgical quality) can be provided to an underserved population at low cost in a low income setting."  ...

http://www.reuters.com/article/us-health-herniarepair-mosquito-netting-idUSKCN0UR2XZ20160114?feedType=nl&feedName=healthNews

 
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  LITTLE  KNOWN  FACTS:
 
A sneeze travels out of the mouth at more than 100 mph 

A raisin dropped in a glass of fresh champagne will bounce up and down continuously from the bottom of the glass to the top.

Office desks have 400 times more bacteria than toilet seats.

The oldest recipe in existence is a recipe for beer.

Researchers have found that imagining doing exercises actually increases muscle strength.

So far, man has survived on earth for 2 million ears.  The dinosaurs lasted 150 million years.
    
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FDA Panel Backs Implant for Female Fecal Incontinence

 BETHESDA, Md. -- An FDA advisory committee unanimously agreed at a Thursday meeting that the benefits of an implantable surgical mesh device for women with fecal incontinence outweigh the risks.
The so-called TOPAS device, developed by ASTORA Women's Health (a subsidiary of Endo International), is intended for women who have failed more conservative treatment options, such as diet changes, pharmacologic therapies, or pelvic floor muscle training. It is a "non-bioabsorbable mesh device" approximately 45 cm in length that's inserted parallel to the puborectalis muscle below the anorectum, according to FDA briefing documents. ...
 http://www.medpagetoday.com/Gastroenterology/GeneralGastroenterology/56420?xid=nl_mpt_DHE_2016-02-27&eun=g379846d0r: 
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Proton Pump Inhibitors Linked to Dementia
A new study has confirmed an association between proton pump inhibitors (PPIs) — drugs that treat heartburn, peptic ulcers, and other acid-related disorders of the upper gastrointestinal tract — and increased risk for dementia in older patients.
An earlier study by the same researchers found the same connection between PPI use and dementia risk, although the current study is larger and based on information from a pharmaceutical database rather than on medical records, as the previous one was.
The new study, by Willy Gomm, PhD, from the German Center for Neurodegenerative Diseases, Bonn, Germany, and colleagues and published online February 15 in JAMA Neurology, is important, as PPIs are among the most frequently prescribed drugs and their use has been increasing sharply, especially among the elderly.
"Unfortunately, overprescribing of PPIs is reported frequently," said study coauthor Britta Haenisch, PhD, also from the German Center for Neurodegenerative Diseases. ...    http://www.medscape.com/viewarticle/858909  
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 Thanks to BAcello (Barbara)  this example of stupidity...     

  Commonwealth Court (PA) blocks lifetime ban on nursing home work for those convicted  ...

HARRISBURG — The Commonwealth Court has blocked Pennsylvania from enforcing a lifetime ban on work in nursing homes and other health care facilities for people convicted of certain crimes.

The court found last week that a lifetime employment ban in the state’s Older Adults Protective Services Act violates the due process protections of the Pennsylvania Constitution.

The prohibition applied to a list of convictions, including violent crimes, such as homicide and rape, but also drug-related felonies and offenses such as theft and forgery.Commonwealth Court blocks lifetime ban on nursing home work for those convicted of some crimes

The court opinion (pdf file) is here. 

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 Exfoliate your skin. 

The same properties that reportedly enable coffee to reduce the appearance of cellulite can smooth and tighten your skin, and the texture of ground coffee will buff away dead skin cells, too. Make your own coffee-based scrub by combining a tablespoon of coffee grounds with half a tablespoon of olive oil and, optionally, a drop of your favorite essential oil.

Touch up furniture scratches. 

Scratches on wood furniture disappear almost instantly by simply rubbing in a little bit of instant coffee dampened into a paste with hot water. Repeat if necessary until the scratch matches the surrounding wood.          

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 Zika infection may cause stillbirth, loss of brain tissue: report

A case study of a stillborn baby whose Brazilian mother was infected with Zika raises suspicions that the virus may be capable of doing more damage to fetal tissue than previously thought, researchers said on Thursday.
The study showed the baby's brain was absent, a condition known as hydranencephaly. Instead of tissue, the brain cavities were filled with fluid. The baby also had abnormal pools of fluid in other parts of its body.
The case, published in the journal PLOS Neglected Tropical Diseases, is the first to link Zika virus with damage to fetal tissues outside the central nervous system.
So far, birth defects associated with the rapidly spreading Zika virus have been almost entirely confined to Brazil and linked to microcephaly, a condition in which babies are born with abnormally small heads.
Brazil has confirmed more than 580 cases of microcephaly and is investigating more than 4,100 suspected cases.
Although Zika has not been proven to cause microcephaly, scientists say the evidence is growing stronger. On Feb. 1, the World Health Organization declared Zika a global health emergency. The WHO estimates Zika could eventually affect as many as 4 million people in the Americas and may spread to parts of Africa and Asia. ...
 http://www.reuters.com/article/us-health-zika-stillbirth-idUSKCN0VY2RL?feedType=nl&feedName=healthNews


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Zika mosquitoes’ habits may foil U.S. elimination efforts


 Health experts are bracing for Zika virus to spread to the United States by April or May, borne by a mosquito that craves human blood, feeds during the day and lives under beds and inside closets.
Until now, the best weapon against disease-carrying mosquitoes in the United States has been outdoor pesticide fog sprayed by truck and airplane. But health experts fear the typical approach will do little to eradicate the Aedes aegypti mosquito that carries Zika.
Controlling that mosquito requires pesticide sprayed under beds, on the walls and in closets, said Gonzalo Vazquez-Prokopec, who studies disease transmission patterns of mosquitoes at Emory's School of Public Health's Department of Environmental Sciences.
"We know fogging is not effective," Vazquez-Prokopec said.
Though there could be localized U.S. outbreaks, most likely along the Gulf Coast, federal officials said they hope the wide use of air conditioning, window screens and regular garbage collection will mitigate the risk.
The World Health Organization declared the Zika outbreak an international health emergency this week after evidence linking the virus to microcephaly, a devastating birth defect that can cause unusually small heads and permanent brain damage. Brazil has reported 3,700 suspected cases of microcephaly. The outbreak is now affecting at least 25 countries and territories, most of them in Latin American and the Caribbean, and could infect up to 4 million people in the Americas, according to the WHO. ...


http://www.reuters.com/article/us-health-zika-mosquitoes-insight-idUSKCN0VC04B?feedType=nl&feedName=healthNews

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 Zika Found in 9 U.S. Pregnancies, Outcomes Often Severe: CDC     

Four cases ended in either miscarriage or abortion, one involved severe  birth defect
   
Saturday, February 27, 2016
SATURDAY, Feb. 27, 2016 (HealthDay News) -- Five of nine pregnancies among U.S. women who were infected with the Zika virus have resulted in tragic outcomes, federal health officials said Friday.
All of the women contracted the mosquito-borne virus while traveling outside the United States, in regions experiencing Zika outbreaks, the officials said.
In four of the cases, the women lost their babies: Two to miscarriage and two to abortions after ultrasounds revealed birth defects, the U.S. Centers for Disease Control and Prevention reported.
A fifth woman gave birth in late 2015 to a child with severe microcephaly, a condition in which the brain and skull are significantly underdeveloped.
Since the Zika epidemic began last spring, it's believed there have been more than 5,600 suspected or confirmed cases of microcephaly in Brazil, the World Health Organization reported Friday.  ...

https://www.nlm.nih.gov/medlineplus/news/fullstory_157505.html

 
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FDA issues guidelines to reduce risk of Zika blood transmission

 
The U.S. Food and Drug Administration on Tuesday recommended individuals delay donating blood if they have had a confirmed Zika infection or have been potentially exposed to the virus.
While there have been no reports of Zika entering the U.S. blood supply, the risk of blood transmission is considered likely based on scientific evidence of how Zika and similar viruses spread, the agency said. (1.usa.gov/1mFUbGX)
The FDA issued these guidelines to ensure that blood banks defer blood donations, since about four out of five of those infected do not show symptoms. ... 
http://www.reuters.com/article/us-health-zika-idUSKCN0VP2KP?feedType=nl&feedName=healthNews

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Zika alarm rises after U.S. sex link, more Brazil birth defects


 The World Health Organization voiced concern on Wednesday over the reported sexual transmission of the Zika virus in Texas amid worries that such infections could make efforts to combat the virus linked to severe birth defects in Brazil even tougher.
The virus, spreading quickly across the Americas, is usually transmitted by mosquitoes. But health officials in Dallas County reported on Tuesday that the first known case contracted in the United States was a person infected after having sex with somebody who had returned from Venezuela.
The WHO declared a global health emergency on Monday, citing a "strongly suspected" causal relationship between Zika infection in pregnancy and microcephaly, a condition marked by abnormally small head size that can cause permanent brain damage in newborns.
Health ministers from across South America gathered in Uruguay's capital, Montevideo, to discuss the public health emergency and how the region can coordinate its fight against the outbreak. ... 

http://www.reuters.com/article/health-zika-who-idUSKCN0VC1YS

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California 'shaken baby' case in vanguard of new legal challenges


After 17 years in prison for an infant's death at her San Diego daycare center, Suzanne Johnson is in the forefront of legal challenges to "shaken baby syndrome" as courts catch up with medical advances in understanding the mechanisms of childhood brain trauma.
A judge last month agreed Johnson deserved to be considered for a new trial in a case that hinged on the syndrome, a 1970s-era forensic diagnosis long accepted as sufficient to convict caretakers accused of harming and even killing babies.
Appeals such as Johnson's are occurring with greater frequency at both the federal and state level, said Deborah Tuerkheimer, a Northwestern University law professor who wrote a book on the subject. But legal bids to reverse guilty verdicts are long and grueling, the outcome far from guaranteed, Tuerkheimer said.
"Criminal convictions are final, and science moves on," she said.
"Abusive head trauma" - a newer, broader term - is the leading cause of fatal child abuse in the United States, according to the U.S. Centers for Disease Control and Prevention, and conviction rates are higher than for other violent crimes.
Of 1,800 resolved cases since 2001, roughly 1,600 resulted in convictions, the Washington Post reported in 2015 after a year-long investigation.
Because the accused are typically trusted caregivers or parents, the consequences of a wrongful conviction are especially devastating, not only for defendants but for their children and spouse.  ...  

 http://www.reuters.com/article/us-california-shakenbaby-idUSKCN0VI125?feedType=nl&feedName=healthNews

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Foreign-Born Students in U.S. Have Higher Case Rate of TB    Students identified by screening more likely to be diagnosed within six months of arrival in U.S.

MONDAY, Jan. 18, 2016 (HealthDay News) -- Foreign-born students in the United States have a higher case rate of tuberculosis (TB) than other foreign-born individuals, according to a study published online Jan. 5 in the Annals of the American Thoracic Society.

Jeffrey M. Collins, M.D., M.P.H., from the Emory University School of Medicine in Atlanta, and colleagues characterized the risk of TB in international students entering the United States using data collected by 18 TB control jurisdictions. The analysis included a cohort of 1,268 foreign-born patients of known visa status diagnosed with active TB between 2004 and 2007. ...

http://www.physiciansbriefing.com/Article.asp?AID=706995

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HUMANS HAVE A LOT MORE THAN FIVE SENSES

Humans have a lot more than five senses.  It turns out, there are at least nine senses and most researchers think there are more like twenty-one or so. Just for reference, the commonly held definition of a “sense” is “any system that consists of a group of sensory cell types that respond to a specific physical phenomenon and that corresponds to a particular group of regions within the brain where the signals are received and interpreted. 
Listing here briefly...full explanation on website.  Sight, taste, touch, pressure, itch, thermoception, sond, smell, propriception, tension sensors,nociception (pain), equilibriocetion,thirst, hunger, magnetoception,(weak), and time (debatable)....

http://www.todayifoundout.com/index.php/2010/07/humans-have-a-lot-more-than-five-senses/

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SNACK Suggestions..."on the run"...

Few jobs are as physically demanding as nursing. You’re on your feet all day long, and when your patients need you, it’s hard to find time to take a break for lunch or a snack. 

When you’re pressed for time, it can be tempting to reach for convenience foods, but junk food doesn’t give you the nutrition and energy you need to make it through the workday. Instead of grabbing a candy bar, try these seven healthy – and delicious – snacks instead.

Steamed Salads

Raw veggies are fast, but sometimes they’re heard to digest. Try steaming healthy vegetables like carrots, broccoli and cauliflower and tossing them together for a unique salad. Top with a warm mustard dressing and zap for 15 seconds in the microwave to reheat for a delicious, wintery take on the typical salad.

Mixed Skewers

When you don’t have time to cook, fruit and cheese skewers are a great way to get your fiber and protein in one great snack. Small fruits like grapes, strawberries or cubed melon hold up to being impaled on a skewer. Alternate fruits with cubes of your favorite cheeses. Cheddar, Gruyere and Monterrey jack all work well.

DIY Snack Mix

Mix up a bowl of your favorite nuts, dried fruits and granola for a personalized snack mix that you can munch on whenever you have a minute. The trick to a great snack mix is a balance of salty and sweet elements. Try adding wasabi peas for an extra kick, or toss in some chocolate or butterscotch chips for a sweet surprise.

Mexican Popcorn

Lighten up your popcorn by eating it Mexican style. Instead of dousing it in melted butter, add a squeeze of lime to lightly salted popcorn just before you eat it. The flavor is out of this world, and there’s no added fat.

Pita Pizzas

Who says you need an oven for a pizza? Try a cold take on take-out by stuffing mini whole-wheat pitas with fresh mozzarella, sun dried tomatoes and some fresh basil. You can also add olives or red pepper flakes to kick up the flavor a notch.


http://www.thenursingsiteblog.com/2016/02/7-healthy-snacks-for-nurses-on-go.html


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 Surgery patients do better when hospitals are good to nurses  (Hospitals take note...just another laud )

Surgery patients do better when nurses have better working environments, according to a new study.
Hospitals with well-staffed, top-notch nursing departments had fewer deaths after surgery than hospitals without those high-quality nursing departments, researchers found.
"This study is for the person, referring doctor or health policy analyst asking, 'Would I be better off at this hospital or that hospital?'" said lead author Dr. Jeffrey Silber, who is the Nancy Abramson Wolfson Professor in Health Services Research at the Children’s Hospital of Philadelphia.
Hospitals with the better nursing departments also had fewer patients die after a surgical complication, the researchers report in JAMA Surgery.
Hospitals were considered to have good nursing environments if they had more than one nurse for every hospital bed and so-called Magnet status, which is a special accreditation from the American Nurses Credentialing Center.
For the study, the researchers matched 25,752 surgical patients at 35 hospitals with good nursing environments to 25,752 similarly-aged and equally sick patients at 293 hospitals without those nursing environments.
Patients were also matched by insurance status, race and surgery type. Everyone in the study was at least 65 years old. ... 


http://www.reuters.com/article/us-health-nursing-surgery-idUSKCN0UZ2XL?feedType=nl&feedName=healthNews

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Ankle Steroid Shots Tied to Post-Op Infections      Study showed doubled rate of infections with intra-articular injections

 ORLANDO -- The use of intra-articular corticosteroid injections during ankle arthroscopy was associated with an increased rate of postoperative infections, a researcher reported here.
During the 6 months following the arthroscopy, the incidence of infection among patients who had a steroid injection was 3.9% compared with an incidence of 1.8% among controls, according to Brian C. Werner, MD, of the Hospital for Special Surgery in New York City.  ...

http://www.medpagetoday.com/MeetingCoverage/AAOS/56594?xid=nl_mpt_DHE_2016-03-07&eun=g379846d0r
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Drug-coated ring cuts HIV risk by more than half in some women


(Reuters Health) - An experimental drug-infused ring inserted in the vagina once a month cut the odds of becoming infected with HIV by more than half among women who used the device consistently, in a study in four African countries where the risk of AIDS is high.
"Use of the product was enough to demonstrate HIV protection of 27 percent" over placebo, chief author Dr. Jared Baeten, a professor of medicine and global health at the University of Washington in Seattle, told Reuters Health by phone. "And in some groups of women who appeared to use it better, such as women over age 21, the risk of HIV was reduced by more than half."
Such silicone rings, infused with a different drug, are already used for birth control.
Results of the study, known as ASPIRE, were presented Monday at the Conference on Retroviruses and Opportunistic Infections in Boston. Results were also published online in the New England Journal of Medicine. ...


http://www.reuters.com/article/us-hiv-protection-women-idUSKCN0VV2FQ?feedType=nl&feedName=healthNews
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Quiz Time

The growth in the number of jobs for registered nurses from 2010 to 2020 is expected to be faster than average.
False

Answer at end of Newsletter.
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Strategies for preventing another MI      According to the American Heart Association, each year an estimated 635,000 Americans have a new myocardial infarction (MI) and an estimated 300,000 of them have a recurrent attack. Secondary prevention is essential for reducing this number; recurrent MI puts patients at risk for reduced quality of life, heart failure, and death.
As a nurse working on a cardiac progressive care unit, I’m a member of the team that teaches the patients about what they can do to reduce their risk of having a future MI. Our team typically consists of the physician, nurse, and a member of the cardiac rehabilitation team. After talking with the physician, I am usually the first person who speaks with the patient and his or her family about secondary prevention. I am also the person who answers the questions they did not initially think to ask the physician.  ...   
http://www.americannursetoday.com/strategies-preventing-another-mi/
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QUIZ TIME

Which statement about nonventilator hospital-acquired pneumonia pathogenesis is accurate?
a. Within 48 hours of admission, critically ill patients experience changes in oral bacterial colonization, including more virulent gram-positive organisms.
b. Healthy adults do not experience microaspirations.
c. Microaspirations may be caused by drugs that stimulate the central nervous system.
d. Within 48 hours of admission, critically ill patients experience changes in oral bacterial colonization, including more virulent gram-negative organisms. 
 

Answer at end of newsletter, also.
  
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 Random Fact:

Did anyone tell you when you were a kid that too many carrot sticks would turn your skin orange? It's true! (Sort of). Hypercarotenemia, or carotenosis, is a yellowy orange discoloration of the skin caused by high levels of carotene in the blood, the result of eating a LOT of vitamin A.


'Pink' once meant 'yellow.' We know, it's confusing. See, Dutch 'pink' was a yellow pigment; but because 'pink' also means a frilled edge, it became closely associated with the dianthus flower, which has notched petals. And what's the most common color for dianthus flowers? You guessed it: pink.
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Bonus Fact:

For thousands of years, green was a tricky pigment to nail down, but the 19th century saw the rise of two stable and incredibly popular green dyes. There was just one problem: Both were laced with arsenic. At the time, the health risks of arsenic exposure were unknown, but before long, doctors and newspapers began attributing illnesses to green-wallpapered rooms. (There is even a theory that arsenic-laced wallpaper helped do in Napoleon.)


Isn't indigo basically blue? Why is it even in Roy G. Biv? We have Isaac Newton to thank for this one: He wanted the number of colors in the spectrum to match Rene Descartes' seven-tone musical scale, and indigo brought the color count to seven.
  
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 Fact: 96% of homeless in Australia own a mobile device. 

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    Running on Empty: Compassion Fatigue Among Nurses  Every day we face stressful situations. From gory scenarios, to toxic co-workers, a heavy workload and demanding folks. Nursing burnout is not new to most anymore, and is often talked about in discussions and even various sites. The term “compassion fatigue,” however, has started to emerge these past few years.
What is compassion fatigue?
Compassion fatigue has been defined as a combination of physical, emotional, and spiritual depletion associated with caring for patients in significant emotional pain and physical distress. According to Joinson (1992) as she described the concept in her work with emergency room personnel, “compassion fatigue is a unique form of burnout that affects individuals in caregiving roles.”
Breaking it down, “compassion” is defined as an emotion whereby nurses enter into the world of the client, become aware of his suffering and, upon feeling his pain, take action to ease it. It is a "feeling of deep sympathy and sorrow for another who is stricken by suffering or misfortune, accompanied by a strong desire to alleviate the pain or remove its cause.”
According to Mcholm (2006), “although the ability to be compassionate and have empathy is a desirable quality that contributes to establishing trust and therapeutic effectiveness with patients, it is exactly this sensitivity that makes nurses vulnerable.” Over time, what makes us unique and is considered as one of our strengths – compassion, can become an emotional toll.  ... 
http://nursingcrib.com/news-blog/running-on-empty-compassion-fatigue-among-nurses/
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 An AHRQ report released last month reported the following facts about hysterectomy as a treatment for benign uterine fibroids from 2005 to 2013:

20%
Percent drop in hysterectomies to treat benign uterine fibroids.
5
Hysterectomies performed in hospital-based ambulatory surgery settings increased more than fivefold.

50%
Hysterectomies performed in hospitals decreased by half.

175%
Percent increase in the rate of uterine fibroid embolization in both ambulatory surgery and inpatient settings.

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RANDOM TIDBITS

The ancient Chinese and Greeks grew fruit trees, vegetables and herbs in gardens for food and for medicines.

In the 1500s there were five famous botanical gardens in Europe designed to study and grow herbs for medicine.

Carolus Clusius set up a famous flower garden in Leiden in Holland in the late 1500s. Here the first tulips from China were grown and the Dutch bulb industry began.

The Royal Botanic Gardens at Kew near London were made famous by Sir Joseph Banks in the late 1700s for their extensive collection of plants from around the world.

Lancelot 'Capability' Brown (1716-83) was a famous English landscape gardener. He got his nickname by telling clients that their gardens had excellent 'capabilities'.

The earliest flowerbeds were the borders of flower tufts Ancient Persians grew along pathways. 
           
 
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Huge racial disparities persist despite slow infant mortality drop

 FALLS CHURCH, Va. — Despite a 13% drop in the national infant mortality rate over nearly a decade, there remains a stubborn gap between the rates for black Americans and other racial groups as well as between some Southern states and the rest of the country.
The most proven and promising way to reduce the disparities in premature births that lead to death — home visits by nurses — got a boost in the Affordable Care Act, but is reaching only a fraction of those in need, policy experts say.
The ACA funding of nurse home visits covered just 115,000 families in 2014, while about 1.8 million births a year — nearly half — are covered by Medicaid, the health care program for low-income families. Still, a 2012 report by the Pew Charitable Trusts found fewer than a third of state Medicaid programs fully covered home visits.
Black infants overall continue to die at a rate more than twice that of white babies and some parts of the country have racial gaps that are far wider. Black mothers are also twice as likely to have costly premature births due to factors including poor access to health care and existing health problems, which contributes to the United States having one of the highest death rates among developed countries.  ...
http://www.usatoday.com/story/news/nation/2016/03/07/racial-disparities-infant-mortality/81003686/  
 
 
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Tree Bark Skin Disorder
You’ve seen people go all loco just to get rid of a single wart, well what about when your whole body is covered in them?
Epidermodysplasia verruciformisis an immune deficiency and a failed human response to the Human Papillomavirus (HPV) Type 2. More commonly known as the tree bark skin disorder, it is a hereditary skin disorder in which skin growths caused by the human papilloma virus (HPV) spread out of control.
One of the most severe cases is that of Dede Koswara, an Indonesian Man who has been called “Tree Man”. 95% of his warts were removed in 2008, but most of them grew back, making it clear that he will require 2 surgeries a year for the rest of his life to keep them at bay.
  • Bodies turned to stone
Fibrodysplasiaossificans progressive, is an extremely rare condition wherein there is a mutation of the body's repair mechanism, which then causes muscle, tendons and ligaments to ossify when damaged.
Operations do not seem to be an option for people with this condition as doing such on their injuries will only cause additional bone growth. In the most extreme cases, patients may be rendered completely immobile within decades.
  • Alien Hand Syndrome
Nope this ain’t fictional, for people who have this condition, their hand does have a mind of its own. The so-called 'alien' hands undo buttons, manipulate tools and even grope people without the awareness of those to whom the hands are attached. The individual affected has full sensation in the hand, however, it seems 'possessed'.
This is caused by a separation of the lobes of the brain whether through injury or surgery, and there’s no cure other than to distract the rowdy hand with an object to handle.
  • Alice in Wonderland Syndrome
You don’t have to follow the rabbit into the hole to experience a whole new world. The Alice in Wonderland Syndrome is a temporary condition that affects our perception of the world around us. Here, objects appear much small or larger than they should, take for example, dogs the size of mice, or ladybugs as big as a house.
Doctors believe that it may involve the brain's occipital lobe, which controls visual information. It may also be at times associated with migraines and often occurring at the edge of sleep, the disturbances affect sense of size, depth and even time.
  • Walking Corpse Syndrome
Braiiinnss. Braaiinns. This would just be like being put in the cast of the Walk of the Dead. Those with Cotard's Syndrome are convinced that they have died or lost some vital part of the body, but are still aware and walking the earth. This is a mental illness that can sometimes be brought about by a brain injury. In very rare cases, people with Walking Corpse Syndrome believe they're immortal and begin testing that theory, resulting in suicide.
  • Human Werewolf Syndrome
To wax? To shave? Or to get a laser treatment?
Severe Hypertrichosis, also known as the human werewolf syndrome, is a condition in which hair grows profusely in all sorts of unusual places. This excessive hair growth all over the body grows back even after laser treatments. Only about 50 living people are currently known to have this condition.
  • Blue Skin Disorder
Feeling blue? More like looking blue.
Methemoglobinemia is a rare blood disorder wherein the blood is less oxygenated and appears blue rather than red through the skin. But in some cases, people get a strange blue tinge to their skin even without this condition, such as in the case of argyria, a blue skin disorder associated with consumption of the health supplement colloidal silver.
  • Vampire Disease
Nope, this ain’t the sparkly vampire, Edward, you’ve come to know.
The Vampires disease or Porphyriais a set of genetic disorders in which an important part of hemoglobin called heme is not made properly which means there is malfunction of the hemoglobin production. People suffering from it face symptoms manifested by mythological vampires: their skin is sensitive to sunlight, their urine is reddish to purplish in color, the gums are shrunk making the teeth look more prominent and canine-like and they have an adverse reaction to garlic. Other major symptoms include abdominal pain or cramping (only in some forms of the disease), problems with the nervous system and muscles (seizures, mental disturbances, nerve damage).
Sources:
 

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HUMOR SECTION

 On vacation, a man and his wife check into a hotel. The husband wants to have a snack at the restaurant, but his wife is extremely tired so she decides to go on up to their room to rest. 

She lies down on the bed... just then, a train passes by very close to the window and shakes the room so hard she's thrown out of the bed. 

Thinking this must be a freak occurrence, she lies down once more. But just a few minutes later a train again shakes the room so violently, she's pitched to the floor. 

Exasperated, she calls the front desk and asks for the manager who says he'll be right up. 

The manager is skeptical but the wife insists the story is true. 

"Look... lie here on the bed -- you'll be thrown right to the floor!" So he lies down next to the wife. 

Just then the husband walks in. He takes one look at the manager lying in bed with his wife and yells, "Hey! What are you doing in here!?" 

The manager calmly replies, "Would you believe I'm waiting for a train?" 

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 Within two weeks of moving into a new house, the homeowner had to call an electrician, a roofer and a carpenter. 
One afternoon he returned early from work and saw a plumber's truck in the driveway. 

"Lord," he pleaded, looking skyward, "please let her be having an affair."   

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

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

                               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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   Oxylog 2000 Plus, 3000, and 3000 Plus Emergency Transport Ventilators by Dräger Medical: Class I Recall - System Error May Lead to a Halt in Ventilation Therapy 
   
  Dräger is recalling the Oxylog Emergency Transport Ventilators because an electrical issue may cause the device to stop working if the control knobs (adjustment potentiometers) are not regularly used. See the Recall Notice for affected devices and catalog numbers.
If the device operator does not intervene, the patient may not receive enough oxygen and could suffer serious adverse health consequences, including injury or death. ...   

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm485807.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery

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0.9 Percent Sodium Chloride Solution for Irrigation by Baxter: Recall - Presence of Particulate Matter     Baxter International is voluntarily recalling one lot of 0.9% Sodium Chloride Irrigation, USP, 500 mL Plastic Pour Bottle solution - Lot G120162, expiration 11/30/2018 - to the hospital/user level. This product is being recalled due to a customer complaint prior to use for the presence of particulate matter, identified as an insect.
Sodium Chloride Irrigation solution with foreign material contamination potentially could result in a series of complications dependent in which anatomic location the irrigation is used, which could include inflammatory reaction, foreign body reaction, and infection which could be life-threatening. 
 http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm486748.htm 
                                                                    
          
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ADVERTISEMENTS
from the members

This ad is from Decubqueen (Gerry)..........AccuRuler Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:     thenursingsite@gmail.com  (Kathy) (Kathy Quan)

 
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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address. So, be certain to let me know when you change your address. RNFrankie@AOL.com

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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)


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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)

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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.
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THOUGHTS FOR THE DAY

 Most bad government has grown out of too much government.
--Thomas Jefferson

 

When the people fear their government, there is tyranny;
when the government fears the people,
 there is liberty.

  Thomas Jefferson



Hope to hear from you..... Frankie

 
d. Studies show that within 48 hours of admission, critically ill patients experience changes in oral bacterial colonization, including more virulent gram-negative organisms. Microaspirations typically don’t lead to disease, but in hospital patients, microaspirations combined with decreased mobility and changes in the oral flora create an ideal environment for microbes to flourish in the pulmonary tract.
Learn more by reading the continuing nursing education article “Using oral care to prevent nonventilator hospital-acquired pneumonia.”



Answer to Quiz Time: True. According to Bureau of Labor Statistics’ Employment Projections, the projected rate of change in employment for the 10-year timeframe between 2010 and 2020 is 26% for registered nurses. The average growth rate for all occupations is 14%, which means growth in registered nurse jobs will be faster than average. http://stats.bls.gov
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