PARADIGM BYTES Newsletter

PARADIGM BYTES Newsletter for Paradigm 97
March 12, 2011

PARADIGM DEFINED:1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.

MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPETS
New Monograph Aims to Increase Tdap Vaccination of Adults and Adolescents
OAKBROOK TERRACE, Ill. – February 1, 2011) Pertussis rates have increased over the last two decades, primarily in adolescents and adults who have waning immunity from previous pertussis vaccinations or infection; however, it is infants who are too young to be vaccinated that bear the burden of severe pertussis. Low vaccination rates against pertussis among adolescents and adults are a contributing factor to the rise of the highly contagious and sometimes deadly disease, commonly known as whooping cough.

A new monograph from The Joint Commission, “Tdap Vaccination Strategies for Adolescents and Adults, Including Health Care Personnel – Strategies from Research and Practice,” aims to help health care organizations implement or enhance tetanus, diphtheria and acellular pertussis (Tdap) vaccination programs for adolescents and adults, including health care workers who can both acquire pertussis from and spread it to patients, other staff and family members.

Pertussis is the most common vaccine-preventable childhood disease and can be more severe than often assumed. Most pertussis-related deaths occur in infants younger than 4 months. All infants less than 6 months of age, and any infant who has not yet received three doses of pertussis-containing vaccine, are especially vulnerable to pertussis infection and often require hospitalization for supportive care for coughing spasms and feeding difficulties. Adolescents and adults with pertussis generally have mild symptoms that do not require hospitalization.

The Tdap vaccine has been available only since 2005 and information from the Centers for Disease Control and Prevention (CDC) shows that vaccination rates for adults are very low. Tdap vaccination rates among health care workers stands at about 16 percent, according to the CDC, despite the evidence that Tdap improves patient outcomes and reduces staff illness and absenteeism.

The CDC reports that adults may not realize that some of the vaccines they received in childhood will not protect them throughout their lives or that newer vaccines have been developed since they were first immunized. In addition, some adults simply were never vaccinated. These adolescents and adults play a significant role in the transmission of pertussis to vulnerable infants at home, in the community, and in health care and day care settings.

The monograph, which was supported by an educational grant from sanofi pasteur, was produced and published in partnership with infection prevention and infectious disease leaders from the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA) and the National Foundation for Infectious Diseases (NFID).

“Recent pertussis outbreaks should be a reminder of how serious and contagious pertussis can be and the value of Tdap vaccination,” said Jerod M. Loeb, Ph.D., executive vice president, Division of Healthcare Quality Evaluation, The Joint Commission. “This monograph includes strategies that organizations can implement and provides a foundation to improve vaccination rates among key populations. It is also a timely reminder that vaccinations save lives.”

The monograph includes:

Information about pertussis and the Tdap vaccine;
Barriers to successful Tdap vaccination programs and strategies for overcoming them.
Evidence-based guidelines and literature that highlight practical Tdap vaccination strategies.
Examples of initiatives that organizations have used to establish or enhance their Tdap vaccination programs.
The Joint Commission solicited leading practices to incorporate into the monograph and received more than 80 submissions from health care organizations. A subset of submissions was evaluated by the project’s editorial review panel; ultimately, 17 submissions were included in the monograph.

Electronic copies of the monograph are available on The Joint Commission’s website and can be downloaded free of charge.

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Where's the Evidence?

Kennedy, Maureen Shawn AJN, American Journal of Nursing. 110(4):7, April 2010.

doi: 10.1097/01.NAJ.0000370131.78964.17

In my first job on a critical care unit at a busy urban hospital, RNs and nurse's aides coming on duty received shift reports during walking rounds with the charge nurse of the outgoing shift. On the medical–surgical floors, nurses going off duty gave report to their head nurse, who in turn reported to the incoming head nurse, who then reported to her staff. At another facility, all outgoing RNs gave report to all incoming RNs (aides weren't included) at the same time at the nurses' station. And on the units that practiced primary nursing, outgoing primary nurses audiotaped reports; their incoming counterparts listened to the tapes but rarely interacted with the nurses going off duty, although they had that option. These four methods for giving shift report shared two similarities. First, none was based on evidence demonstrating its effectiveness over any other. And second, none specified what patient information was to be included; that critical aspect was left up to the individual giving the report.

It's been well documented that poor communication during patient handoffs is a major contributor to medical errors. Indeed, since 2008, the Joint Commission has required that hospitals have a standardized approach to handoffs. But is there evidence supporting one approach over another?

In this issue, Lee Ann Riesenberg and colleagues from the Christiana Care Health System in Newark, Delaware, report the results of their systematic review of research regarding nursing handoffs, which seeks "to identify features of structured handoffs that have been shown to be effective." While the authors conclude that most of the studies they reviewed lacked rigor and call for higher quality research in this area, they did identify and categorize numerous barriers to and strategies for effective patient handoffs. These thought-provoking categories suggest several areas for further inquiry.

Patient handoffs are fundamental to the delivery of safe care. Surely it's within nursing's purview to study and improve the handoff process. Of course, this is just one of many areas being investigated by clinicians and institutions as part of evidence-based quality improvement (QI) efforts. AJN has published several reports on QI projects, notably in our Transforming Care at the Bedside series (September 2008 through August 2009) and more recently in our Cultivating Quality column. (We welcome manuscripts about QI projects, but require that they follow the Standards for Quality Improvement Reporting Excellence [SQUIRE] guidelines, available at www.squire-statement.org.)


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FROM THE MEMBERS

One of our members--Bob Hess--was at the White House two weeks ago (end of January). He had a session with Kathleen Sebelius. Check it out: http://www.whitehouse.gov/photos-and-video/video/2011/01/27/open-questions-state-union-and-health-care . Quite an honor, Bob!
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(In answer to this Random Fact, Wendie (WAHowland) wrote " I have a great recipe for dandelion pesto-- it's yummy and the major ingredient is FREE and pesticide-free in my yard.

If you are interested in getting the recipe, please write me, I have it . The Random Fact was: According to the U.S. Department of Agriculture, dandelions are more nutritious than broccoli or spinach, contain more cancer-fighting beta-carotene than carrots, and are a rich source of calcium, iron, magnesium, potassium, thiamine, riboflavin, lecithin, and dietary fiber!
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The Truth About Nursing will hold its first conference in the lively and historic city of New Orleans on April 15-17, 2011. Empowering Nurses and Improving Care Through Better Understanding of Nursing will help nursing leaders develop and focus their skills in interacting with others in ways that enhance respect for the profession. For a full agenda : http://www.truthaboutnursing.org/conferences/2011/events.html

To register: https://www.truthaboutnursing.org/sunshop/

To contact Sandy Summers for other info: ssummers@truthaboutnursing.org
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MEDICAL NEWS

Breast Implants: FDA Review Indicates Possible Association With A Rare Cancer FDA announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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Quadrivalent HPV Vaccine found effective in Males The quadrivalent human papillomavirus vaccine prevents the infection as well as the development of external anogenital lesions associated with the virus in boys and men, according to a report in the Feb. 3 issue of the New England Journal of Medicine.

It is likely that the vaccine will similarly cut down on human papillomavirus (HPV) transmission and prevent the anogenital cancer, intraepithelial neoplasia, recurrent respiratory papillomatosis, and cancer of the oropharynx that eventually arise from HPV infection, but "each of these potential outcomes must be directly demonstrated" in future studies, said Anna R. Giuliano, Ph.D., of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., and her associates.

Cause to Celebrate

This report "undoubtedly gives us cause to celebrate the extraordinary potential for HPV vaccination to improve health in both women and men," said Jane J. Kim, Ph.D.

The quadrivalent HPV vaccine prevented infections with the four strains covered by the vaccine and also prevented the development of external genital lesions, primarily genital warts. So not only can vaccination of boys and men bolster health benefits in girls and women by reducing transmission, "but there is now clear evidence that boys and men themselves can benefit directly," she said.

Vaccinating boys and men also is desirable because it distributes the burden of obtaining protection to people of both sexes, which is only fair, as both sexes are responsible for HPV transmission. And it would be particularly valuable for the high-risk subgroup of men who have sex with men, she noted.

Dr. Kim is in the department of health policy and management at Harvard School of Public Health, Boston. She reported no financial conflicts of interest. These comments were taken from her Perspective piece that accompanied Dr. Giuliano’s report (N. Engl. J. Med. 2011;364:393-5).

http://www.internalmedicinenews.com/newsletter/internal-medicine-news-e-newsletter/singleview40577/quadrivalent-hpv-vaccine-found-effective-in-males/fdc16c27dd.html

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


Sent in by Kurt Ullman ( kurtullman@SPRINTMAIL.COM ) Thanks !
After three years of exhaustive analysis led by a University of Alberta researcher, the list of known compounds in human blood has exploded from just a handful to more than 4,000. Right now a medical doctor analyzing the blood of an ailing patient looks at something like 10 to 20 chemicals," said University of Alberta biochemist David Wishart. "We've identified 4,229 blood chemicals that doctors can potentially look at to diagnose and treat health problems." ...
http://www.sciencedaily.com/releases/2011/02/110224145609.htm

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Heart failure therapy twice as effective in women (Reuters) Women derive twice the benefit from a device to treat heart failure in men, U.S. researchers said, underscoring the different ways in which men and women experience heart disease.
Women treated with a combination pacemaker and defibrillator device had a 70 percent reduction in heart failure compared with a 35 percent decline in men, they said. ... http://www.reuters.com/article/2011/02/07/us-heart-failure-device-idUSTRE71660R20110207?feedType=nl&feedName=ushealth1100
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RANDOM FACT: New York taxi drivers collectively speak 60 languages.
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FDA Approves First Drug to Prevent Premature Births - the drug is a reissue of an earlier drug and received accelerated approval, the agency says. (HealthDay News) -- The U.S. Food and Drug Administration has approved the first drug to help prevent premature birth in women who have had at least one previous preterm delivery.
The drug -- called Makena (hydroxyprogesterone caproate) -- is expected to reduce the risk of premature delivery, which experts say raises the risk of infant complications at birth, lifelong disabilities such as cerebral palsy, and even death. ... http://consumer.healthday.com/Article.asp?AID=649631

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Harsh Medicine Protective gear is a must for oncology nurses. It's the treacherous irony of oncology: the things that kill cancer can also cause it. One example is radiation. Given at too high a dose in CT scans in an attempt to find cancer, or beamed off-target at healthy tissue in an attempt to treat it, radiation can precipitate the very disease it is intended to diagnose and eradicate. ... http://nursing.advanceweb.com/Features/Articles/Harsh-Medicine.aspx

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Preventing Ventilator Alarm Fatigue Ventilator alarm fatigue continues to be a serious problem that directly affects patient safety. Frequent ventilator alarms often desensitize healthcare providers, or the alarms can blend in with other accustomed sounds in the ICU. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death.
The ICU can be a stressful and noisy environment that can distract healthcare providers because of the many different monitoring systems because of the many different monitoring systems. For example, a typical ICU may have more than 40 alarm sources such as ventilators, electrocardiograms, arterial pressure, pulse oximetry, perfusion pumps, nutrition pumps, automatic syringes, dialysis systems and bed monitoring alert systems. One ventilator on the market has 111 different alarm features listed in the operator's manual. ... http://nursing.advanceweb.com/Regional-Content/Articles/Preventing-Ventilator-Alarm-Fatigue.aspx

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RANDOM FACT: The strike note of The Liberty Bell is E flat.
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Nurse: Patients' needs go beyond what can be charted Oncology nurse Theresa Brown says a nurse's task to keep records on everything from fall prevention efforts to conversations with lab techs and doctors to medication details can result in "a mishmash of confusing and oppressive paperwork." She says the principle of "if it isn't charted, it isn't done" may lead to a neglect of patient needs that can't be recorded in a chart, such as empathy. NYTimes.com/Well blog http://well.blogs.nytimes.com/2011/02/02/caring-for-the-chart-or-the-patient/?ref=health
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Academic skills: using literature to support your discussion Kerri Wright , Paul Street, Mamood Gousy British Journal of Nursing, Vol. 20, Iss. 2, 25 Jan 2011, pp 101 - 106 A good academic piece of work aims to locate itself within the available body of knowledge on the subject area. Knowledge can come from a range of different sources, each contributing to the body of knowledge on the subject. The final article in this three-part series discusses the importance of appraising and making sense of literature when considering the knowledge relating to a particular subject area. Guidelines and methods are described to help organize, collate and make sense of the knowledge obtained, so that a logical plan can be created to structure academic work. The academic requirements of different levels are then briefly explained to give guidance on how best to use the literature to support and inform discussions. ... http://www.britishjournalofnursing.com/cgi-bin/go.pl/library/article.html?uid=81534;article=BJN_020_2_101
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Shoveling snow bad for your heart? For blizzard vets, checking in with your doctor before shoveling the sidewalk may seem like overkill. But consider this: According to an ABC News study, the heart attack rate jumps by 20 percent the week after a snowstorm!

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Obesity epidemic risks heart disease "tsunami" CHICAGO/LONDON (Reuters) - More than half a billion people, or one in 10 adults worldwide, are obese -- more than double the number in 1980 -- as the obesity epidemic spills over from wealthy into poorer nations, researchers said on Thursday. ... http://www.reuters.com/article/2011/02/04/us-heart-obesity-idUSTRE71300Y20110204?feedType=nl&feedName=ushealth1100
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Simple life changes could stop millions of cancers LONDON (Reuters) - About a third of all common cancers in the United States, China and Britain could be prevented each year if people ate healthier food, drank less alcohol and exercised more, health experts said on Friday. ... http://www.reuters.com/article/2011/02/04/us-cancer-prevention-idUSTRE71300S20110204?feedType=nl&feedName=ushealth1100
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Thank you, Barbara (BAcello) The IOM below is a free download. See the bottom right corner of the page.
Clinical Data as the Basic Staple for Health Learning - Workshop Summary Successful development of clinical data as an engine for knowledge generation has the potential to transform health and health care in America. As part of its Learning Health System Series , the Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss expanding the access to and use of clinical data as a foundation for care improvement.
http://www.iom.edu/Reports/2011/Clinical-Data-as-the-Basic-Staple-for-Health-Learning.aspx
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RANDOM FACT: Camel's milk does not curdle.
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U.S. stroke belt also hit by heart failure (Reuters Health) - People who live in the southeastern U.S., already dubbed the nation's "stroke belt," may have a higher-than-average rate of death from heart failure as well, a new study finds.
Researchers found that across the six contiguous southeastern states -- Alabama, Arkansas, Georgia, Louisiana, Mississippi and Oklahoma -- the rate of death from heart failure was 31 per 100,000 people.

That was 69 percent higher than the national average of 18 heart-failure deaths per 100,000 people, the researchers report in the American Journal of Cardiology. And the regional disparity was seen among both whites and African Americans. The southeastern U.S. has long been known as the nation's "stroke belt" because stroke death rates are about 50 percent higher there compared with the rest of the country.

But the current study appears to be the first to I.D. the southeast as the nation's "heart failure belt," according to Marjan Mujib and colleagues at the University of Alabama at Birmingham. ... http://www.reuters.com/article/2011/02/02/us-stroke-belt-idUSTRE7119DO20110202?feedType=nl&feedName=ushealth1100

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Psychotropic Drugs and Falls in the Elderly People: Updated Literature Review and Meta-Analysis. To carry out meta-analyses on psychotropic drugs and to provide an update of the risk of falling in the elderly people related to psychotropic drugs. Design: Meta-analyses of studies on psychotropic drugs. Results: 177 studies are included, of which 71 have data on risk factors associated with psychotropic drugs. The odds ratio and 95% Cl for associations between use of psychotropic drugs and fall are 1.78 and 1.57-2.01, respectively. This result is statistically heterogeneous. This heterogeneity disappears in the group of very old participants for each class. Conclusion: Our study confirms the association between falls in the elderly people and psychotropic drugs. These results are similar to those of former meta-analyses but with different methods. It shows that these meta-analyses on psychotropic drugs have a small impact on prescribing habits. They only give evidence to support the association between psychotropic drugs and falls even if there is no proven link.
Published online before print October 14, 2010, doi: 10.1177/0898264310381277 J Aging Health March 2011 vol. 23 no. 2 329-346 (Full Text PDF)
http://jah.sagepub.com/content/23/2/329.abstract
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The Implants Loophole New York Times (12/16/2010) Barry Meier While new drugs must undergo rigorous clinical trials before receiving Food and Drug Administration (FDA) marketing approval, new implants that are substantially similar to devices already approved may be sold without such testing. The process allows manufacturers to make small improvements rapidly. Many experts say it also creates a loophole by allowing producers to include aspects of unapproved devices into existing designs.

"You are basically testing these devices in an uncontrolled way on a large number of people," said Dr. Sidney M. Wolfe, director of Public Citizen's Health Research Group.

For patients receiving untested augmented devices, the consequences of device failure can be grave. Betty Jane Haak, 74, received a hip with a redesigned hip cup that had been approved because of the similar design, the A.S.R. cup designed by DePuy Orthopaedics, a division of Johnson and Johnson, but the hip is faulty and many recipients need replacements. Though her hip cup is painful and has highly elevated her blood colbalt levels, Ms. Haak is medically unable to receive a replacement due to a heart attack she suffered after the initial implant. Ms. Haak summarized her situation, "Do I risk a heart attack, or do I risk
poisoning myself?"

Current rules do not require FDA notification when producers bundle together components from approved and unapproved devices, said Mark Melkerson, an agency official. An internal agency review recently
released, however, found problems with the process and the FDA is proposing changes.
http://www.nytimes.com/2010/12/17/business/17hip.html?_r=1
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Before dialing, check out DialAHuman.com or GetHuman.com, which list customer service numbers and give instructions on how to bypass automated prompts to reach a LIVE representative. With another free service, LucyPhone.com, you can avoid being placed on hold. You enter the company's name of phone number and your number and hit "start". Lucy-phone connects you to the company's line, where you pick an option for getting a live rep. You hang up and get a callback when a person is actually on the line. I checked out DialAHuman.com ( http://dialahuman.com/ ) ---- looks to be very good. I did not try the Lucy suggestion. I hate the automated recordings......they take forever . ****************

This is from Sandy Summers (news_alerts@truthaboutnursing.org) October 11, 2010 -- Today The Washington Post ran an excellent op-ed by Veneta Masson, the Washington, D.C. nurse practitioner and writer, based on an article she wrote for this month's Health Affairs . Explaining why she no longer gets annual mammograms, Masson discusses the research about the flawed test, finding no evidence that it actually saves lives. And she points to downsides including the severe harm many suffer from unnecessary treatment following false positives. The Post rightly describes Masson as a "nurse practitioner," even though she no longer practices, because nursing is a profession. But a story on the mammogram debate that aired today on National Public Radio's Morning Edition was not so good for nursing. Richard Knox's piece includes a brief statement by Masson, but it refers to her as a "former nurse practitioner." ... http://www.truthaboutnursing.org/news/2010/oct/11_masson.html
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Posted: Mar 2, 11 - CMS Recognizes The Joint Commission’s Accreditation of Psychiatric Hospitals - The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has granted The Joint Commission deeming authority for psychiatric hospitals. The four-year CMS designation means that psychiatric hospitals accredited by The Joint Commission will be “deemed” as meeting Medicare and Medicaid’s health and safety requirements.
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RANDOM FACT: Your thumb is the same length as your nose (eek).
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Pregnancy in women who have corrected tetralogy of Fallot: Occurrence and predictors of adverse events Background: In women with corrected tetralogy of Fallot (ToF), pregnancy is associated with maternal cardiac, obstetric, and offspring complications. Our aim is to investigate the magnitude and determinants of pregnancy outcome in women with corrected ToF. ... http://www.ahjonline.com/article/PIIS0002870310009270/abstract?rss=yes

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Survey: NPs salaries increased in 2010 Full-time nurse practitioners earned an average of $90,770 last year, up from $81,397 in 2007 and $89,579 in 2009, according to the National Salary Survey of Nurse Practitioners. The average annual pay for full-time NPs has increased by more than $25,000 since 2001, the survey found. http://www.beckershospitalreview.com/compensation-issues/nurse-practitioner-physician-assistant-average-salaries-jump-25k-since-2001.html
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Half of Adults have Hypertension or High Cholesterol: CDC Despite some improvements, far too many Americans have out-of-control blood pressure and cholesterol levels -- both primary risk factors for heart disease, federal health officials warn.
According to the latest report from the U.S. Centers for Disease Control and Prevention, one-third of U.S. adults have hypertension (high blood pressure), about the same proportion as 10 years ago.

Perhaps more distressing, only 46 percent had the condition controlled, despite the fact that the majority have some form of health insurance -- meaning they could be accessing care -- and 70 percent were actually being treated with blood pressure-lowering drugs. ... http://consumer.healthday.com/Article.asp?AID=649499 **************



More doubts about acupuncture for labor pain (Reuters) While many women may want a drug-free way to ease the pain of childbirth, a new study suggests that acupuncture is not the answer.
The findings, published in the obstetrics journal BJOG, add to evidence that acupuncture is not effective for relieving labor pain. Researchers found that among 105 first-time moms having a labor induction, those given acupuncture before their contractions started showed no benefit when it came to pain. ... http://www.reuters.com/article/2011/02/01/us-acupuncture-labor-idUSTRE71098S20110201?feedType=nl&feedName=ushealth1100

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RANDOM FACT: Tourists visiting Iceland should know that tipping at a restaurant is considered an insult!
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Study finds way to predict when cancer will spread (Reuters)
Researchers have found a compound that tumors make when they are likely to spread, and said they hope to use to it predict which patients are most at risk of dying from their cancers.
And experiments in mice show there may be a way to block the protein, preventing cancer from spreading and becoming deadly.

The findings, published in the Journal of Clinical Investigation, are at a very early stage. But a team at the National Institutes of Health, the University of Hong Kong and elsewhere said on Tuesday they will work to develop both a test and, perhaps, a treatment. ... http://www.reuters.com/article/2011/02/01/us-cancer-spread-idUSTRE71065D20110201?feedType=nl&feedName=ushealth1100
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HINT: Wipe the leaves of your plants with the soft inside of a banana skin to bring shine and remove dust.
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HINT: To clean paint off your hands, use olive oil--it softens the paint and makes it easy to remove.
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Plague Kills U.S. Lab Worker THURSDAY, Feb. 24 (HealthDay News) -- While experts stress that epidemics of plague will probably remain a scourge of centuries past, isolated cases still appear, even in the United States.

In fact, according to a just-released government report, an American lab worker died from plague in 2009 -- the first case of plague from a laboratory-acquired infection since 1959 and the first known death from a weakened form of the germ.

The report appears in the February 25 issue of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Not only are cases of the plague "unusual," said Dr. Steven Hinrichs, chairman of the department of pathology and microbiology at the University of Nebraska Medical Center in Omaha, but "it's unusual to have laboratory accidents. I would say there are less than 10 cases of laboratory accidents involving infectious diseases per year."

Yersinia pestis, the cause of plague, is the microbe that was harbored by fleas-on-rats in the Middle Ages and created the Black Plague, which wiped out a third of Europe's population. The case of the lab worker is particularly intriguing because he was working with a weakened strain of Y. pestis, one that has not been known to cause harm to humans. ... http://consumer.healthday.com/Article.asp?AID=650281

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Study: Gender doesn't affect survival after severe heart attack Women who had in-hospital procedures for ST-elevation myocardial infarction had a higher risk of dying compared with men, a study in the American Heart Journal found. But researchers found the disparity was not because of gender but to the fact women generally were older and had more comorbidities when they were treated. U.S. News & World Report/HealthDay News http://tinyurl.com/5rwwtng
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HealthGrades names 50 best U.S. hospitals HealthGrades' annual list of the 50 top-performing U.S. hospitals found they had a 28.59% lower mortality rate and a 3.45% lower risk of complications than those that didn't make the cut. Researchers said if all hospitals had achieved the quality of care seen in hospitals on the list, more than 500,000 Medicare deaths could have been prevented over the past
decade. Modern Healthcare (free registration) http://tinyurl.com/5rleaym
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More errors result of physicians not listening: study Great effort goes into stopping preventable errors such as wrong-site surgeries, but authors of a study on unwanted variation in elective
procedures say that many more errors are taking place Advertisement | View Media Kit because physicians are not listening to their patients. Modern Healthcare (free reg.) http://tinyurl.com/65xtcd3
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Gallup: Nurses Top Honesty and Ethics List for 11th year
http://www.gallup.com/poll/145043/Nurses-Top-Honesty-Ethics-List-11- Year.asp ************
HINT: Spray the bottom of your shoes with hairspray and they will have more grip on slippery floors.
Not sure about this hint...don't want spray build-up. : )
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7 tips to improve your professional etiquette By Kathleen D. Pagana, PhD, RN
Etiquette is more than just please and thank-you. Knowing how to present yourself in a professional manner helps you stand out and increases your chance for career success. ... http://www.nursingcenter.com//upload/static/403753/NMIEeNews_Bonus_Dec09.htm


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HUMOR SECTION
QUESTION: A black dog is sleeping in the middle of a black road that has no streetlights and there is no moon. A car coming down the road with its lights off steers around the dog. How did
the driver know the dog was there?

ANSWER: It was daytime.
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The graveside service just barely finished, when there was massive clap of thunder, followed by a tremendous bolt of lightning, accompanied by even more thunder rumbling in the distance...

The little old man looked at the pastor and calmly said, 'Well, she's There.'

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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

Over 400 hours of Nursing CEs Available with NetCE
CME Resource provides NetCE as a continuing education resource for nurse professionals. We are an ANCC-Accredited provider of continuing nursing education and have additional approvals through many state boards of nursing. With over 400 hours available online, completing your required continuing education couldn’t be easier.

http://www.netce.com/search.php?type=courses
This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/

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

Just pass your cursor over the area of the map to learn about that area's weather. http://www.wrh.noaa.gov/zoa/mwmap3.php?

Sent in by Kurt Ullman....thanks
Ready or not? Protecting the public's health from diseases,
disasters, and bioterrorism - 2010
http://healthyamericans.org/assets/files/TFAH2010ReadyorNot%20FINAL.pdf
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Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)

Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org

Decubqueen's website: www.accu-ruler.com

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2


http://www.nationalnurse3.blogspot.com/

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

The Nursing Site http://thenursingsite.com .

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website


http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

National Do Not Call Registry

If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Critical Thinking is More Than Problem Solving Critical Thinking: Not Usually Rapid Fire

Should Clinical Courses Get a Letter Grade?

Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/

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MEDICAL RECALLS
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Hydrocodone Bitartrate And Acetaminophen Tablets, Phenobarbital Tablets by Qualitest: Recall - Incorrect Package Labeling An individual bottle of Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10mg / 500mg, NDC 0603-3888-20, 60 count was found incorrectly labeled with a Phenobarbital Tablets, USP 32.4 mg, NDC 0603-5166-32, 1000 count label, printed with Lot Number T150G10B. Both products are manufactured by Qualitest Pharmaceuticals.
The recall includes:
Hydrocodone Bitartrate and Acetaminophen Tablets, USP 10mg / 500mg, NDC 0603-3888-20, 60 count, Lot Numbers T150G10B, T120J10E and T023M10A
Phenobarbital Tablets, USP 32.4 mg, NDC 0603-5166-32, 1000 count, Lot Numbers T150G10B, T120J10E and T023M10A
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm242527.htm

*************************** American Regent Injectable Products: Recall - Visible Particulates in Products Recall initiated because some vials exhibit translucent visible particles consistent with glass delamination. Potential adverse events after intravenous administration include damage to blood vessels in the lung, localized swelling, and granuloma formation. (Sodium Thiosulfate Injection USP 10% ; Potassium Phosphates Injection, USP ) http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm242365.htm

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Merit Prelude Short Sheath Catheter Introducer: Class I Recall - Tip May Detach Introducer tip may detach during use, causing arterial injury, hemorrhaging, or other serious events, while introducer tip material may enter into the bloodstream, causing blood clots (thrombosis). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm242343.htm
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B. Braun Outlook 400ES Safety Infusion System, Model Number 621-400ES: Class I Recall - Hardware May Become Unresponsive Infusion systems upgraded with the Motorola compact flash hardware and supporting software, when used in a network environment that utilizes Temporal Key Integrity Protocol (TKIP) authentication, can potentially induce a memory leak that can cause the Management Processor to become non-responsive. This causes normal operation to stop, which is signaled by an audible backup alarm indicating that the pump is not delivering the medicine. There is no visual error warning to alert the user that the pump is not working. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm241637.htm
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Morphine Sulfate Oral Solution 100 mg per 5 mL. (20 mg/mL): Medication use Error Reports of accidental overdose Roxane Laboratories and FDA notified healthcare professionals of serious adverse events and deaths resulting from accidental overdose of morphine sulfate oral solutions, especially when using the high potency 100 mg/5mL product. In most of these cases, morphine sulfate oral solutions ordered in milligrams (mg) were mistakenly interchanged for milliliters (mL) of the product. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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NURSING HINTS CORNER

Lung Assessment: I've found a good way to demonstrate the sound of rales (crackles) to new staff nurses (also student nurses). I pour a carbonated soft drink into a paper cup and tell the nurses to listen to the soft drink as it fizzes. They will hear a good imitation of rales (crackles). Joe Niemczura, RN, MS

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.119, Springhouse Corporation/www.springnetcom.

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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.


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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:


ellenjoykramer@gmail.com (Ellen) February 14, 2011

clydecg6@msn.com (Clyde) February 14, 2011

lauren_hagins@yahoo.com (Lauren) February 15, 2011


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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; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com
OLD ADDRESS:
ozrn@hotkey.net.au

NEW ADDRESS:
ozrn2@bigpond.com (Janine)


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

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

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

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THOUGHT FOR THE DAY


“No person was ever honored for what he received. He
was honored for what he gave.”

Calvin Coolidge.



Would really like to hear from you...suggestions, criticism (preferably constructive-- lol) Frankie
RNFrankie@AOL.com

Paradigm Bytes for Paradigm97

PARADIGM BYTES
Newsletter for Paradigm 97
February 12, 2011

PARADIGM DEFINED:1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.

Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.

MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPETS

DEATH BY DISRESPECT October 2010 -- The cover story in this month's Reader's Digest offers a fairly strong look at hospital errors, relying mainly on short personal essays by five health professionals. Three are physicians, and the feature has other physician-centric elements, including the title on the magazine's cover, "Doctors Confess Their Fatal Mistakes." But the final essay is by nurse Sunnie Bell, who gives a powerful account of how a patient died because a physician ignored Bell's warnings. Bell then urges several specific improvements in nurses' working conditions. Her essay vividly illustrates how disrespect for nursing can kill, and it at least suggests the role nurses should play as patient advocates. Another piece, a sad story by a pharmacist who was criminally prosecuted for a deadly error, also shows that physicians are not the only health professionals whose work matters. One of the physician pieces is by Johns Hopkins's Peter Pronovost, a health care errors expert who has become well known for his efforts to promote the use of checklists and other safety measures. Pronovost makes a point, as he often does, to include nursing empowerment as a key element of reform. And a sidebar with short descriptions of some new patient safety ideas includes one about Boston's Brigham and Women's Hospital, where "WalkRounds" are done by "senior executives," a category that reportedly includes the chief nursing officer! Some publications would have mentioned only the CEO and the chief of medicine. Unfortunately, an essay by University of California San Francisco physician Robert Wachter indicates a distressing lack of awareness of the role nurses play in monitoring patient conditions and in hospital care generally, as the author attributes a failure to detect an impending pulmonary embolism 30 years ago solely to himself (as a second year medical student) and the hierarchy of physicians on duty. On the whole, though, Joe Kita's cover story includes nursing to an extent that is unusual for such an influential publication. We commend him and Reader's Digest.
The 12-page feature's general introductory material is somewhat more inclusive of nurses than the magazine cover. The table of contents describes the article, "White Coat Confessions," this way: "Doctors, nurses, and pharmacists hold your life in their hands. Here, their shocking stories of what can go wrong--and what must change to keep us safe." Of course, it's far from widely understood that nurses are among those who hold patients' lives in their hands, so this is helpful. The feature begins with a short introduction by Kita, who briefly explains the prevalence of hospital errors. As an example, Kita uses a diagnostic error by one of the physician essayists, University of Nevada ED physician Bryan Bledsoe. And Kita relies on Pronovost for expert input on the need to talk about the errors problem despite practitioners' fear of doing so. This part of the feature gives the general impression that physician errors are what matter, and that we need better systems to prevent them. However, Kita does at least note that the traditional reluctance to admit errors is changing because "doctors, nurses, and pharmacists" all stepped forward for this piece to say "I'm sorry," and more importantly to address the flawed systems that make the errors possible. http://www.truthaboutnursing.org/news/2010/oct/rd.html

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ABSTRACT Background: Sickness absence leads to understaffing and interferes with nursing efficiency and quality. It has been reported in literature that managerial leadership is associated with self-reported sickness absence in the working population.
Purposes: This study investigated the relationship between managerial leadership and sickness absence in health care by associating nurse managers' leadership styles with registered sickness absence among their nursing staff.

Methodology: The cross-sectional study included 699 nurses working in six wards (staff range = 91-140 employees) of a Dutch somatic hospital employing a total of 1,153 persons. The nurse managers heading the wards were asked to complete the Leadership Effectiveness and Adaptability Description questionnaire for situational leadership. The Leadership Effectiveness and Adaptability Description scores were linked to employer-registered nursing staff sickness absence.

Findings: High relationship-high task behavior (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.65-0.85) and high relationship-low task behavior (OR = 0.37, 95% CI = 0.14 -0.98) were inversely related to the number of short (one to seven consecutive days) episodes of sickness absence among the staff. Low relationship-high task styles (OR = 2.44, 95% CI = 1.14-5.22) as well as low relationship-low task styles (OR = 2.44, 95% CI = 1.26-4.71) were positively associated with the number of short episodes of sickness absence. However, the leadership styles only explained 10% of the variance in short episodes of sickness absence.

Practice Implications: Leadership styles are associated with registered sickness absence. The nursing staff of relationship-oriented nurse managers has fewer short episodes of sickness absence than the staff of task-oriented managers. Training nurse managers in relational leadership styles may reduce understaffing and improve nursing efficiency and quality. (unfortunately, this is only the abstract; the full article has to be purchased)

http://journals.lww.com/hcmrjournal/Abstract/2011/01000/ Leadership_styles_of_nurse_managers_and_registered.9.aspx

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

Being a good nurse and doing the right thing: A replication study Nurs Ethics February 1, 2011 vol. 18 no. 1 54-63 This qualitative research study, a replication of a study published in 2002, investigated the qualities of a good nurse and the role ethics plays in decision making. After reviewing the limitations of the published work, the current study implemented modifications related to the research questions, sample selection, data collection, and use of software for data analysis. The original study identified seven categories that related to being a good nurse and doing the right thing. In the present study, the use of relational analysis led to the recognition of four categories: (1) personal traits and attributes; (2) technical skills and management of care; (3) work environment and co-workers; and (4) caring and caring behaviors. To understand what it means to be a good nurse and do the right thing is a complex task; however, this research adds to the small amount of empirical data that exists to describe those characteristics. Full text is free....in PDF form. available on the site:
http://nej.sagepub.com/content/18/1/54.abstract
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Monitoring by Nurses Aids Chronic Illness care-- Patients with chronic illnesses and coexisting depression had significantly better control of both conditions when medically supervised nurses provided guideline-based care, data from a randomized trial showed.

Outcomes related to diabetes, hypertension, and dyslipidemia all improved significantly more with the nursing-based care versus usual care (P<0.001), and depression scores declined significantly (P<0.001).

Patients received care that was more consistent with guidelines (P=0.006 to P<0.001), and they had better quality of life and were more satisfied with their care compared with patients in the usual-care arm (P<0.001), as reported in the Dec. 30 issue of the New England Journal of Medicine.

"The intervention was associated with improved outcomes among the joint primary disease-control measures in depressed patients with poorly controlled diabetes, coronary heart disease, or both," Wayne J. Katon, MD, of the University of Washington in Seattle, and co-authors wrote. ... http://www.medpagetoday.com/Psychiatry/Depression/24132

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RANDOM FACT: A 2005 National Household Survey on Drug Use and Health indicates that 46 percent of U.S. residents 12 years of age and older have tried marijuana one or more times.
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( Why don't hospital CEO's etc. take note of these studies and consider the financial impact if any suits would be filed by the patients?)

Nurses' Long Shifts "may" (my quotation marks) Put Hospital Patients at Risk: Study WEDNESDAY, Jan. 19 (HealthDay News) -- Patients in hospitals where nurses work long hours are much more likely to die of pneumonia and heart attack, researchers have found.

In most U.S. hospitals, nurses work 12-hour shifts exclusively, a trend that began during the 1980s due to nationwide nursing shortages, the authors of the new study explained.

"Although many nurses like these schedules because of the compressed nature of the work week, the long schedule, as well as shift work in general, leads to sleep deprivation," study author Alison Trinkoff, a professor at the University of Maryland School of Nursing, said in a university news release. ... http://consumer.healthday.com/Article.asp?AID=648964

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RANDOM FACT: A study done by a mathematician showed that getting in the shorter grocery store line is usually faster than the longer express line, even if the people in the shorter line have a lot more items.

Each extra person in line adds 48 seconds to the line length without even considering the items in the cart. Meanwhile, an extra item only costs you an extra 2.8 seconds. Therefore, you'd rather add 17 more items to the line than one extra person! (I tried this, and it really worked !)
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7 tips to improve your professional etiquette By Kathleen D. Pagana, PhD, RN
Etiquette is more than just please and thank-you. Knowing how to present yourself in a professional manner helps you stand out and increases your chance for career success. ... http://www.nursingcenter.com//upload/static/403753/NMIEeNews_Bonus_Dec09.htm
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Can adjustable glasses help kids in poor countries? Reuters For many children in poor nations, a simple pair of glasses can be out of reach. But a new study suggests relatively cheap specs that people can adjust themselves hold some promise.
The study, reported in the journal Ophthalmology, looked at the usefulness of "self-refracting" glasses for adolescents with vision problems, mostly nearsightedness.

The glasses are designed so that the wearer can adjust them to the right strength without the need for eye professionals, who are scarce in developing parts of the world. In parts of sub-Saharan Africa, for example, there is just one optometrist for every 1 million people. ... (hopefully, this innovation is for USA poor children, also.) http://www.reuters.com/article/2011/01/27/us-adjustable-glasses-idUSTRE70Q6G920110127?feedType=nl&feedName=ushealth1100

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HANDY HINT: If you've been yanking on a cork in a wine bottle and it just simply won't budge, here's a quick tip: Take a hot, wet towel and wrap it around the neck of the bottle. The heat will cause the glass to expand a little so the cork will pop right out.
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Artificial pancreas shows promise in pregnancy Reuters Scientists have shown how an "artificial pancreas" can help pregnant women with type 1 diabetes and say their finding could significantly reduce cases of stillbirth and death among diabetic expectant mothers.

British researchers used a so-called "closed-loop insulin delivery system" or artificial pancreas, in 10 pregnant women with Type 1 diabetes and found it provided the right amount of insulin at the right time, maintained near normal blood sugar, and prevented dangerous drops in blood sugar levels at night. ... http://www.reuters.com/article/2011/01/31/us-pancreas-diabetes-idUSTRE70U00N20110131?feedType=nl&feedName=ushealth1100

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CDC Offers Guidance for HIV Prophylaxis--in HIV/AIDS, So-called pre-exposure prophylaxis (PrEP) for HIV appears safe and at least partly effective, but clinicians and patients need to take care to avoid possible problems, the CDC said in an interim guidance.

A recent study showed that taking a daily antiretroviral pill containing two drugs could significantly reduce the risk of acquiring HIV, the agency noted in the Jan. 28 issue of Morbidity and Mortality Weekly Report.
But the agency cautioned that the finding applies only to people in the same circumstances as those in the trial -- men who have sex with men and who are at high risk of acquiring the virus -- and only if other aspects of the study are also translated. ... http://www.medpagetoday.com/HIVAIDS/HIVAIDS/24561

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The Importance of Nurses in Medication AdherenceMedications taken as prescribed can make a significant difference in people’s health, yet, time and again, nurses hear from patients that they have stopped taking a medication. The reasons often given are that: they felt better, so didn’t feel they needed the medicine anymore; they felt worse and blamed it on the drug; or they could not see the value in spending good money on something that seemingly offers little effect, even if it was controlling their blood pressure.

Adherence to medication regimens remains a challenge to improving outcomes. A recent article in The New England Journal of Medicine reported that as many as half of all patients do not take their medications as prescribed. The New England Healthcare Institute, a nonprofit health policy organization, estimates non-adherence costs the health care system up to $290 billion a year in avoidable medical spending. Many hospitalizations ... http://w3.rn.com/News/news_features_details.aspx?Id=36024

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RANDOM FACT According to the U.S. Department of Agriculture, dandelions are more nutritious than broccoli or spinach, contain more cancer-fighting beta-carotene than carrots, and are a rich source of calcium, iron, magnesium, potassium, thiamine, riboflavin, lecithin, and dietary fiber!
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The Association Between Shift Work and Unhealthy Weight: A Cross-Sectional Analysis From the Nurses and Midwives e-Cohort Study Journal of Occupational & Environmental Medicine:
February 2011 - Volume 53 - Issue 2 - p 153–158 doi: 10.1097/JOM.0b013e318205e1e8
Original Article
Objective: To examine the association between shift work and unhealthy weight among female nurses and midwives.

Methods: A cross-sectional study. Measurement outcomes included shift work, unhealthy weight (underweight: body mass index [BMI] < 18.5; overweight: BMI 25.0 to 29.9; obesity: BMI > 30.0), diet quality, physical-activity level, alcohol consumption, and smoking status.

Results: Among the 2494 participants (1259 day and 1235 shift workers), only 1% of the participants were underweight, 31.8% were overweight, and 26.9% were obese. After adjusting the selected confounders, shift workers were 1.15 times more likely to be overweight/obese than day workers (P = 0.013, 95% confidence interval, 1.03 to 1.28; P = 0.02, 95% confidence interval, 1.02 to 1.30, respectively).

Conclusions: Shift work is associated with higher risk of being overweight/obese. Longitudinal studies are being undertaken to better understand the causal relationship between shift work and unhealthy weight. (The full article may be purchased) http://journals.lww.com/joem/Abstract/2011/02000/The_ Association_Between_Shift_Work_and_Unhealthy.8.aspx

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Studies show swift impact of rotavirus vaccines Countries that vaccinate babies against rotavirus, which can cause severe diarrhea and kill in days, have significantly reduced the number of children admitted to hospitals with the disease, a report showed on Thursday.
Data from the United States, Australia, Mexico and El Salvador, where rotavirus vaccines have recently become part of routine childhood immunizations, show steep and swift falls in the number of children under five becoming ill with the virus.

The studies published in a supplement to The Pediatric Infectious Disease Journal, also show large reductions in rotavirus disease among older, unvaccinated children, suggesting that vaccination of babies may also limit the overall amount of virus transmission, giving what is known as "herd immunity." ... http://www.reuters.com/article/2011/01/20/us-rotavirus-vaccines-idUSTRE70J5MB20110120?feedType=nl&feedName=ushealth1100

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TRIVIA: The oceans cover 71% (and rising) of the Earth's surface and contain 97% of the Earth's water. Less than 1% is fresh water, and 2-3% is contained in glaciers and ice caps (and decreasing).
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The pressure at the deepest point in the ocean is more than 22 thousand pounds, or the equivalent of one person trying to support 50 jumbo jets.
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The highest tides in the world are at the Bay of Fundy, which separates New Brunswick from Nova Scotia. At some times of the year the difference between high and low tide is taller than a three-story building.
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The lowest known point on Earth, called the Challenger Deep, is 36,201 feet deep, in the Marianas Trench in the western Pacific. To get an idea of how deep that is, if you could take Mt. Everest and place it at the bottom of the trench there would still be over a mile of ocean above it.
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The Pacific Ocean, the world's largest water body, occupies a third of the Earth's surface. The Pacific contains about 25,000 islands (more than the total number in the rest of the world's oceans combined), almost all of which are found south of the equator.
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A mouthful of seawater may contain millions of bacterial cells, hundreds of thousands of phytoplankton and tens of thousands of zooplankton.
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Quality of Life and Urinary incontinence in Women Urinary incontinence greatly diminishes quality of life. It is important to diagnose the three main types of urinary incontinence correctly – stress, urge or mixed incontinence – and to evaluate the impact of incontinence on quality of life. After a detailed history, a bladder diary and questionnaires are the most useful tools with which to determine what aspects of quality of life are most impaired – daily, work-related, recreational or sexual activities. In general, urgency and urge incontinence have a worse effect on quality of life than stress urinary incontinence. Measures of quality of life have become essential in developing management plans and in follow-up. Maturitas Volume 68, Issue 2, Pages 137-142 (February 2011) Full text available http://www.maturitas.org/article/PIIS0378512210004172/abstract?rss=yes
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Effectiveness of Patient Simulation Manikins in Teaching Clinical Reasoning Skills to Undergraduate Nursing Students Human patient simulation manikins (HPSMs) are being used extensively in the education of health professionals, but their effectiveness in the teaching of clinical reasoning skills to undergraduate nursing students is not clear. The aim of this systematic review is to identify the best available evidence for their effectiveness in this regard. ...
http://www.mdlinx.com/read-article.cfm/3362966
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Get with the Guidelines: A Nurse's Quick-start Guide to Best Practices in Patient Safety : January 14, 2010 - Nurses are familiar with evidence-based care and the importance of following specific procedures that are based on “best practices” in health care delivery. But how can you keep up with all of the latest research, weed out the extraneous information and make sure you are following the most effective practices for you and your patients?

To help you get started, NurseZone has put together a list of current care guidelines from some of the most influential health care organizations and governing bodies, highlighting those that are most important to nurses.

Use this as your “guide to the guidelines” that are most likely to impact your daily nursing activities: #'s 1 through 7 ... http://www.nursezone.com/nursing-news-events/more-news.aspx?articleid=36008

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RANDOM FACT: The Andromeda galaxy is on a collision course with our galaxy, speeding at 720,000 mph. The catastrophic clash will likely occur in 3 billion years.
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Study debunks need for aggressive breast cancer surgery... Many breast cancer patients can skip aggressive lymph node surgery without increasing their chances of a recurrence or death if their disease shows limited spread, according to a study that has prompted changes in practice.

Under current guidelines, the often-debilitating surgery is done if the cancer has spread outside the breast to any lymph nodes.

In the study, rates of survival and of patients' remaining cancer-free were just as good whether the women with limited spread -- in one or two nearby nodes -- had lots more underarm nodes removed or skipped that major surgery.

At least 24,000 of the 180,000 U.S. women diagnosed every year with breast cancer have limited spread to lymph nodes. Under the standard approach, they would have a chunk of underarm tissue removed to check for further cancer spread, said Dr. Thomas Julian, a breast cancer specialist with West Penn Allegheny Healthcare System in Pittsburgh. He was not involved in the study. ...

That operation often leaves women with lasting arm swelling, stiffness and pain.

http://www.aolhealth.com/2011/02/09/study-debunks-need-for-aggressive-breast-cancer-surgery/?icid=main%7Chtmlws-main-n%7Cdl1%7Csec1_lnk3%7C200246
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Sandy Summers is a highly respected webmaster --- we nurses should support her site financially because she IS our voice to the media. Every little bit helps maintain her site. Please help. January 25, 2011 -- Much of the press coverage of the tragic January 8 shooting of U.S. Rep. Gabrielle Giffords and others in Tucson, Arizona, has focused on the responses of the local health care system. Unfortunately, as is generally the case in reporting about such mass casualty events, only physicians have been consulted about the victims' status, and the coverage has given the impression that physicians provided all the hospital care that mattered. A typical example is a 3,500-word report by Denise Grady and Jennifer Medina that ran on the front page of The New York Times on January 15. The long piece describes the experiences of a paramedic and the husband of one victim, but otherwise it is devoted to the actions, opinions, and feelings of five University of Arizona Medical Center (UMC) physicians, sending the message that physicians alone were responsible for the skilled hospital care the victims got, even though expert nurses kept them alive from the moment they arrived. No nurse is identified or quoted. This is not just a matter of fairness and accuracy. When millions of people are told, in riveting terms, that physicians alone save lives, it confirms that only physicians are worthy of real respect and resources to do their work. We did see one minor counter-example: a 565-word piece that ran today in the Arizona Daily Star and was aptly titled, "UMC nurses who staffed ICU called 'unsung heroes.'" more at: http://www.truthaboutnursing.org/news/2011/jan/25_tucson.html
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2010 Awards Rank Best and Worst Media Portrayals of Nursing (Please take a time out...and read these) -- The Truth About Nursing Awards rank the best and worst media portrayals of nursing that we've seen in 2010:
Ten Best Portrayals
Honorable Mention
Ten Worst Portrayals
I'm Saving the World, So It's OK If I Trample Nurses on the Way! Awards
news_alerts@truthaboutnursing.org

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Diabetes Soaring Among American Adults: Report The Agency for Healthcare Research and Quality reported that the number of Americans treated for diabetes increased from about 9 million to 19 million from 1996 to 2007, with rates increasing for all age groups studied. The agency's analysis also showed an increase of diabetes treatment costs -- from $18.5 billion to about $41 billion during the same period. http://consumer.healthday.com/Article.asp?AID=648552
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Autism-vaccine researcher a "fraud": medical journal WASHINGTON (Reuters) - Dr. Andrew Wakefield, the-now disgraced British doctor who published studies linking vaccines with autism, committed an "elaborate fraud" by faking data, the British Medical Journal said on Wednesday. ... http://www.reuters.com/article/2011/01/06/us-autism-vaccines-idUSTRE7050J420110106?feedType=nl&feedName=ushealth1100
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IDSA Targets MRSA With New Guidelines The Infectious Diseases Society of America rolled out its first-ever guidelines for treating methicillin-resistant Staphylococcus aureus – including recommendations to battle the growing threat posed by MRSA-related skin and soft-tissue infections.

The comprehensive guidelines also outline evidence-based approaches on topics ranging from personal hygiene and wound care to antibiotic therapies for invasive MRSA, as well as options after vancomycin treatment failure.

The guidelines’ primary objective is "to provide recommendations on the management of some of the most common clinical syndromes encountered by adult and pediatric clinicians who care for patients with MRSA infections," according to the executive summary, published online Jan. 5 (Clin. Infect. Dis. 2010 [doi:10.1093/cid/ciq146]) Guidelines download:
http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full.pdf

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RANDOM FACT: Nonsmokers who are exposed to second hand smoke at home or in the work place face a 30 percent increase in their chances of developing heart disease or lung cancer.
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End-of-Life Caregiving Trajectories--Clin Nurs Res The purpose of this study is to illustrate variations in caregiving trajectories as described by informal family caregivers providing end-of-life care. Instrumental case study methodology is used to contrast the nature, course, and duration of the phases of caregiving across three distinct end-of-life trajectories: expected death trajectory , mixed death trajectory, and unexpected death trajectory. The sample includes informal family caregivers (n = 46) providing unpaid end-of-life care to others suffering varied conditions (e.g., cancer, organ failure, amyotrophic lateral sclerosis). The unifying theme of end-of-life caregiving is “seeking normal” as family caregivers worked toward achieving a steady state, or sense of normal during their caregiving experiences. Distinct variations in the caregiving experience correspond to the death trajectory. Understanding caregiving trajectories that are manifest in typical cases encountered in clinical practice will guide nurses to better support informal caregivers as they traverse complex trajectories of end-of-life care. AbstractFree Full Text (PDF) Free to you
http://cnr.sagepub.com/content/20/1/7.abstract Published online before print September 27, 2010, doi: 10.1177/1054773810384852 Clin Nurs Res February 2011 vol. 20 no. 1 7-24
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Make onions even healthier with this storage Trick... Onions are fairly bursting with antioxidants and other nutritious goodies. But you can get even more out of them if you tuck them away for a spell.
Storing red onions for several months may boost their levels of cancer-fighting, heart-disease-diminishing quercetin by up to 30 percent, according to a new study.

Know Your Onions Thick-skinned storage onions are the perfect pantry addition. Not only do they make a great addition to savory soups, spinach salads, and crusty-bread sandwiches, but they store well, too. So snap up whatever you can find this summer, and keep the extras until fall. Choose a cool, dry, dark location, and store them in a mesh bag, a nylon stocking, or a container that allows the onions to breathe. Quercetin and isorhamnetin in sweet and red cultivars of onion (Allium cepa L.) at harvest, after field curing, heat treatment, and storage. Olsson, M. E. et al., Journal of Agricultural and Food Chemistry 2010 Feb 24;58(4):2323-2330. http://www.realage.com/tips/make-onions-even-healthier-with-this-storage-trick?eid=7208&memberid=4687812

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The effect of intimate partner violence and other forms of violence against women on health Abstract
Background There are many studies concerning the health consequences of intimate partner violence (IPV). However, little research has been done on the health consequences of other forms of violence against women (VAW) such as the violence perpetrated by male relatives, friends or strangers. The aims of this paper were: (i) to analyze the prevalence of different forms of VAW perpetrated by males at home, workplace and other social environments in Spain and (ii) to analyze whether IPV and other forms of VAW have a different or similar negative impact on women's health.

Methods A sample of 13 094 women interviewed in the Spanish National Health Survey 2006 was included. Outcomes were physical and mental health indicators. Predictor variables were IPV and other VAW forms. Logistic regression models were fitted.

Results The likelihood of coronary heart disease [OR: 5.28 (1.45–19.25)], chronic neck [OR: 2.01 (1.35–2.97)] and back pain [OR: 2.34 (1.53–3.57)] was higher among women who reported IPV than among those who did not. Similar associations were found in the case of women affected by other forms of VAW. Mental health problems, with the exception of psychotropic drug use, were more frequent and more strongly associated with IPV than with other forms of VAW.

Conclusion There are health inequities between battered and non-battered women, which may be related to exposure to not only IPV but also other forms of VAW.
http://jpubhealth.oxfordjournals.org/content/early/2010/12/31/pubmed.fdq101.abstract
J Public Health (2010) doi: 10.1093/pubmed/fdq101 First published online: December 31, 2010
Full Text (HTML)Free
Full Text (PDF)Free
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Once is not enough with Endo AAA Repair--in Surgery/Thoracic Surgery Reinterventions and readmissions occur more frequently after endovascular abdominal aortic aneurysm (AAA) repair than after open repair -- partly explaining why the early survival benefit seen with the endovascular approach disappears over time, researchers found.

A study of more than 45,000 Medicare patients who underwent elective AAA repairs over a three year period found that major and minor reinterventions were more common with endovascular repair (0.4 versus 0.2 per 100 person-years, P<0.001), according to Marc Schermerhorn, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

Ruptures were uncommon, but also occurred at a higher rate following endovascular repair (0.5 verus 0.1 per 100 person-years, P<0.001), the researchers reported in the January issue of the Journal of Vascular Surgery. ... http://www.medpagetoday.com/Surgery/ThoracicSurgery/24151
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Put away your ABCs, and start learning your CAB — compressions, airway, and breathing. That’s the message from the American Heart Association for both adult and pediatric cardiopulmonary resuscitation in the “2010 American Heart Association Guidelines for CPR and ECC.” The AHA now says both laypeople and healthcare professionals should start CPR by compressing the chest at least 100 times a minute. “Look, listen and feel” is out of the basic life support algorithm for laypeople.


http://news.nurse.com/article/20101206/NATIONAL01/112060070/-1/frontpage
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Many women face cancer risk ' due to waistlines' BBC News Nearly half of women in England are at increased risk of some cancers because of their large waistlines, says a cancer charity.
The World Cancer Research Fund warning is based on data from the Health Survey for England suggesting 44% have a waist size exceeding 31.5 inches (80cm).

Research has found that these women are [also] particularly at risk from bowel and breast cancer.

A third of men had a larger than recommended waistline. The Health Survey for England, which monitors trends in the country's health and is commissioned by the Department of Health, was published earlier this month. ... http://www.bbc.co.uk/news/health-12068966

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HCG weight-loss products are fraudulent, FDA says A popular type of weight-loss products, heavily promoted on the Internet, is fraudulent and illegal, Food and Drug Administration officials say. HCG weight-loss products that promise dramatic results and claim to be homeopathic are sold as drops, pellets and sprays on the Web, in drugstores and at General Nutrition Centers. They are supposed to be used in combination with a very low-calorie diet of 500 calories a day.
Many of the labels indicate the products contain HCG, or human chorionic gonadotropin, a hormone made by the placenta during pregnancy. The hormone itself is approved as a prescription treatment for infertility and other conditions.

There is no evidence the oral over-the-counter products are effective for weight loss, says Elizabeth Miller, FDA's leader for the Internet and health fraud team. While they may not be dangerous, they're at least "economic fraud," she says.

Because the products do not seem to be "a serious direct health hazard or a serious indirect health hazard," they have been a lower priority for FDA action than other products. Still, Miller says, "they could be subject to enforcement at any time. ... http://www.usatoday.com/yourlife/fitness/weight-loss-challenge/2011-01-24-hcgdiet24_ST_N.htm

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Factors affecting Wound Healing... In an ideal world, the complex and sophisticated natural wound-healing processes that are initiated in response to skin trauma would take effect instantly and resolve every wound, every time. Unfortunately, anyone involved in wound care knows that this is simply not the case. There are a number of reasons why certain wounds prove more reluctant to heal than others, from the age of the patient to the location of the wound. In this article, we will look briefly at some of the factors that can inhibit wound healing.


The particular characteristics of an individual wound are one of the key factors which determine its speed of healing. The size of wound is clearly an important consideration, but so too is its shape. Linear wounds close more quickly than rectangular wounds, which are generally quicker to heal than circular wounds. Healing is also inhibited in wounds that are desiccated, infected or which contain necrotic tissue or foreign bodies. ... http://woundeducators.net/profiles/blogs/factors-affecting-wound

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Fruit Facts:

RANDOM FACT: Lemons are thought to have originated in the wild both in China and India and have been in existence for at least 4,000 years. They were taken to the Middle East between 400 and 600 BC and then to the Mediterranean where food historians say they have been in cultivation from as early as the first century AD.
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The kiwi fruit has its origins in China's Yangtze River valley. The fruit has been around for over 700 years and was a favourite in the courts of the great Khans.
In the early 1900s, New Zealand missionaries took the seeds from kiwi fruit home where the plant was named for the indigenous bird. Plants were later sent to the United States, Italy, South Africa and Chile.

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The watermelon is of the same botanical family as cucumbers, pumpkins and squash. They were first harvested in Egypt about 5,000 years ago and are now grown in almost 100
countries. Every part of a watermelon is edible, even the seeds, and the rinds which are often pickled.

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The papaya, or paw paw, is believed to have originated in southern Mexico or Central America and now grows in all tropical and subtropical countries as the plants need warmth throughout the year. Papayas are the only natural source of papain, an effective natural digestive aid, which breaks
down protein and cleanses the digestive track.

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RANDOM FACT: Once squeezed, the vitamin C in an orange quickly begins to dissipate. After eight hours at room temperature or 24 hours in the refrigerator, the orange will experience a 20 percent vitamin C loss. ~~**~~**~~**~~**~~**~~ ~~**~~**~~**~~

HUMOR SECTION

After doctors set my broken arm and put a cast on it, I paid the bill and went on my way. Shortly thereafter, I received a bill from the hospital, this time for the $1.57 they claimed I still owed.

Apparently to prove that this was a hospital with heart, they included a payment book. It had me paying 3 cents a month for four years.

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Five-year-old Becky answered the door when the census taker came by. She told the census taker that her daddy was a doctor and wasn't home, because he was performing an appendectomy.

"My," said the census taker, "that sure is a big word for such a little girl. Do you know what it means?"

"Sure! Fifteen hundred bucks, and that doesn't even include the anesthesiologist!"

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CEU SITES---(CME and CNE)Those that are-----Free and Otherwise..........

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !


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

Back issues of the ISMP Newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)

Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org

Decubqueen's website: www.accu-ruler.com

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2


Just pass your cursor over the area of the map to learn about that area's weather. http://www.wrh.noaa.gov/zoa/mwmap3.php?


http://www.nationalnurse3.blogspot.com/

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

The Nursing Site http://thenursingsite.com .

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website


http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3


National Do Not Call Registry

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

http://www.metric-conversions.org/

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MEDICAL RECALLS
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Fresenius Medical Care North America, CombiSet True Flow Series Hemodialysis Blood Tubing Set with Priming Set and Transducer Protectors for Use with the Blood Volume Monitor: Class I Recall - Potential for Kinking of Arterial Line
The hemodialysis blood tubing sets (The CombiSet Hemodialysis Blood Tubing Set) may develop kinking of the arterial line. Kinking can cause the destruction of red blood cells which may result in serious injury and/or death. This recall affects ONLY Part Number 03-2695-9 and Part Number 03-2795-7. These products were manufactured between June 11, 2010 and October 17, 2010. Part Number 03-2695-9 was distributed between August 2010 and November 2010. Part Number 03-2795-7 was distributed between August 2009 and November 2010. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm240588.htm

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Triad Alcohol Prep Pads, Alcohol Swabs, and Alcohol Swabsticks: Recall Due to Potential Microbial Contamination Sold by Cardinal Health, PSS Select, VersaPro, Boca/Ultilet, Moore Medical, Walgreens, CVS, Conzellin Triad Group, a manufacturer of over-the-counter products and FDA notified healthcare professionals and patients of the recall involving all lots of alcohol prep pads, alcohol swabs, and alcohol swabsticks manufactured by Triad but sold as private labels at the consumer level. This recall has been initiated due to concerns about potential contamination of the products with Bacillus cereus. This recall involves those products marked as STERILE as well as non-sterile products. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm239319.htm
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Metronidazole Tablets, 250mg: Recall - Underweight Tablets Teva Pharmaceuticals and FDA notified healthcare professionals and the public of a recall of Metronidazole Tablets USP, 250mg, lot #312566, expiration date 05/2012. This product lot is being recalled due to the presence of underweight tablets. Underweight tablets may not contain the full amount of active ingredient within a single tablet, and a consumer may not receive the prescribed dose. This may cause the infection the drug was intended to treat to worsen or recur, which could be life-threatening when treating severe infections. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm239312.htm
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AngioScore Inc., AngioSculpt Percutaneous Transluminal Angioplasty (PTA) Scoring Balloon Catheter OTW 0.018" Platform - Class I Recall The device was recalled because of a design defect causing unintended fracture and peeling, and has resulted in peeling of the bond and/or detachment of the distal end of the scoring element. Use of affected devices may lead to retained device fragments or significant arterial injury which may lead to death, or need for additional surgical intervention. This recall affects 17,682 units distributed from 09/2007 to 11/2010, including the following model part (REF) numbers and includes all sizes and lot codes for each model listed: 2076-4020, 2076-5020, 2076-6020, 2092-6020, 2105-6020. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm239029.htm
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Albuterol Sulfate Inhalation Solution 0.083%, 3 mL Unit Dose Vials: Recall - Mislabeled Unit Dose Vials The Ritedose Corporation is conducting a voluntary recall of 0.083% Albuterol Sulfate Inhalation Solution, 3 mL in 25, 30, and 60 unit dose vials. This product is being recalled because the 2.5 mg/3 mL single use vials are embossed with the wrong concentration of 0.5 mg/ 3 mL and therefore, represents a potential significant health hazard. Only the unit dose vials are incorrectly embossed as containing 0.5 mg/3 mL. The correct concentration of 2.5 mg/3 mL is labeled on the primary foil overwrap pouches and shelf cartons. Administration of this defective product could result in a range of potential health effects that spans from temporary and medically reversible to life threatening and death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm238624.htm
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Cumberland Pharmaceuticals Inc. recalled 6 lots of Acetadote (acetylcysteine--used in the emergency department, Acetadote is administered intravenously within 8 to 10 hours after ingestion of a potentially hepatotoxic quantity of acetaminophen) Injection, 20% solution (200mg/mL) in 30 mL single dose glass vials as a precautionary measure based on observed particulate matter found in a very small number of vials. The source of the particulate matter was from the glass vial produced by a former supplier. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm238494.htm
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NOTICE: Avastin (bevacizumab): Process for Removal of Breast Cancer Indication Begun FDA notified healthcare professionals and patients that it is recommending removing the breast cancer indication for Avastin (bevacizumab) because the drug has not been shown to be safe and effective for that use. The drug itself is not being removed from the market and today’s action will not have any immediate impact on its use in treating breast cancer. Today’s action will not affect the approvals for colon, kidney, brain, and lung cancers. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm237280.htm

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NURSING HINTS CORNER

Pinwheel Power: Here is a way to get a child to breathe deeply so that you can auscultate his lungs. Give him a colorful pinwheel to play with. You can auscultate his lungs as he takes deep breaths to make the wheel spin. Christine M. McGrath, RN
(if you have nursing hints...please send them in!!)

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.81, Springhouse Corporation/www.springnetcom.

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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.


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NEW MEMBER
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:

mirajosh@AOL.com (John) February 11, 2011


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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; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com

OLD ADDRESS: jahered@aol.com

NEW ADDRESS: jaherreid@q.com (JoAnn)

and

OLD ADDRESS: acp517@aol.com

NEW ADDRESS: APelosa@gmail (Agnes)

and

OLD ADDRESS: springns88@yahoo.com

NEW ADDRESS: springns88@aol.com

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

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

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

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THOUGHT FOR THE DAY

" Do not wait; the time will never be 'just right.'
Start where you stand, and work with
whatever tools you may have at your command,
and better tools will be found as you go along."


~George Herbert (1593-1633)


Hope to see you online---or you can always write !
RNFrankie@AOL.com