Saturday, July 13, 2013

LAST HALF of PARADIGM BYTES FOR JULY.........AOL did it again !


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

Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member.    
Please follow me on Twitter as Dr Robert Hess.

 
 Pay Only $34.99 for a full year of CONTACT HOURS  

www.nurse.com for CNE offerings.
 


  • Docs, Nurses Disagree Over Expanded Nurse Roles   
    Postings from the KHN and Human Capital blogs. Article from HealthDay. Free, full-text article and abstract from The New England Journal of Medicine.  http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fcapsules.kaiserhealthnews.org%2Findex.php%2F2013%2F05%2Fdoctors-nurse-practitioners-disagree-about-expanded-roles-for-nurses%2F&i=61&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com

  • The U.S. Nursing Workforce: Trends in Supply and Education
    Analysis from the HHS Health Resources and Services Administration.  http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fbhpr.hrsa.gov%2Fhealthworkforce%2Freports%2Fnursingworkforce%2Findex.html&i=66&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com

  • The American Academy of Nursing Applauds Senate Confirmation of Marilyn Tavenner, MHA, BSN, RN, as New CMS Administrator
    News release.  http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.aannet.org%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D500%3Aacademy-applauds-senate-confirmation-of-tavenner-as-new-cms-administrator%26catid%3D23%3Apressreleases%26Itemid%3D133&i=67&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com

  • California Weighs Expanded Role For Nurse Practitioners
    Article from Kaiser Health News

  • The Registered Nurse Safe Staffing Act of 2013 Is Introduced in Congress
    News item from the American Nurses Association web site.

  • Nurses More Prone To Being Bullied Than Other Workers
    News release from Sigma Theta Tau International, Honor Society of Nursing.

  • Will Dr. Robot Open New Doors for Nurses?
    Posting from the Human Capital blog.. 

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    WEBSITES/ LINKS
    Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.
     
    This is an excellent nursing site, check it out:  http://nursingpub.com/
     
     
    Robert Hess, RN, PhD, FAAN  
    (856) 424-4270  (610) 805-8635 (cell) Founder, Forum for Shared Governance
     
    info@sharedgovernance.org    www.sharedgovernance.org  
       
     
     
    RNs launch a national safe staffing campaign   http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm
     
      
    Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment        http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263 
     
     
     
     
     If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood  
     
     Rozalfaro's website: 
    http://www.alfaroteachsmart.com/articles.htm

    Metric conversion calculators and tables for metric conversions
     
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    *
    MEDICAL RECALLS
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    Medtronic SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps – Feed Through Failure  and/ or  Failure of Priming Bolus   Class 1 recall

    SynchroMed II and SynchroMed EL Implantable Drug Infusion Pumps
    • SynchroMed II, Model 8637 (20 ml or 40 ml reservoir size)
    • SynchroMed EL Programmable Pumps, Models 8626, 8626L, 8627, 8627L (10 ml or 18 ml reservoir size)
    This recall does not affect Medtronic external insulin pumps for diabetes.
    These recalled products were manufactured from May 1998 through June, 2013 and distributed from April 1999 through June 2013.

                                                                          
    There are many more device recalls at the above website ....

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    Methotrexate Sodium, USP Injectable Vials by Sandoz US: Recall - Particulate Matter In Vials  
     

    Sandoz is conducting a voluntary nationwide recall to the hospital/user level of two lots of its Methotrexate Sodium, USP, 25 mg/mL, 40 mL vial injectable product in the US, due to the discovery of particulate matter in vials during routine quality examination of retention samples at the manufacturer. Parenteral injection of drug from the affected lots can lead to microembolisation in areas where the particles lodge. Clinical symptoms are not to be expected from these microemboli and Sandoz is not aware of any reports of related adverse events. ...

    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm353266.htm
                                                                
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    All Sterile Drug Products Made and Distributed By NuVision Pharmacy Dallas Facility: Recall - Lack Of Sterility Assurance

     
    FDA is alerting health care providers of concerns about a lack of sterility assurance of all sterile drug products made and distributed by NuVision Pharmacy of Dallas, Texas. The FDA is basing this expanded alert on a recent inspection of the NuVision Dallas facility, during which FDA investigators observed poor sterile production practices that raise concerns about a lack of sterility assurance of the company’s sterile drug products. The agency is not aware of any additional adverse event reports associated with other sterile products from NuVision. ...  
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm352949.htm

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     Compounded Prescription Therapies By Pentec Health Inc.: Recall - Lack Of Sterility Assurance    

      
    Pentec Health, Inc. initiated a limited, voluntary recall of in-date nutritional prescriptions for renal patients due to lack of sterility assurance associated with one of its laminar flow hoods used in compounding. Pentec Health has received no reports of injury or illness associated with any of the prescriptions subject to this recall. However, because patients are at increased risk of infection in the event a sterile product is compromised, the pharmacy is recalling any unused product whose beyond-use date has not passed. ...
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm352939.htm

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    Nephron Pharmaceuticals Corp. EZ Breathe Atomizer: Class 1 Recall - Washer Could Become Dislodged

    A Medical Device Recall was issued due to a manufacturing defect which could result in the washer ("Plate A") becoming dislodged from the EZ Breathe Atomizer. If this occurs, users may accidentally swallow the washer or choke on it, which can lead to serious adverse health consequences or death.

    The EZ Breathe Atomizer is a device that is intended to spray liquid medication in aerosol form into the air that a person will breathe. Devices were distributed between August 2012 and April 2013.
    The EZ Breathe Atomizer is manufactured by Health & Life Co., LTD and sold to Nephron Pharmaceuticals Corporation. Nephron Pharmaceuticals Corporation distributes the EZ Breathe Atomizer for sale and use in the Asthmanefrin Starter Kit.
    The EZ Breathe Atomizer was also sold by Nephron Pharmaceuticals Corporation as an individual device in a carton labeled EZ Breathe Atomizer, Model #EZ-100.  
    http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm355037.htm
                                                                          
                                                                                          ********************

    Fresenius Kabi USA notified health professionals of a voluntary recall of one lot – Lot 6103882 – of Magnesium Sulfate Injection, USP due to the potential presence of glass particles in the vials. The recalled product is labeled with Product Code 6450 and packaged as 500mg/mL strength in 50mL glass vials (25 vials per tray). The product was shipped in the United States between May 30, 2012 and June 6, 2012 and has an expiration date of October 31, 2014.  ...  http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm354329.htm
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    ADVERTISEMENTS
    from the members

    This ad is from Decubqueen (Gerry)..........Accuruler        Accurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accuruler.com/.

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

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    NOTICE:
    I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address. So, be certain to let me know when you change your address.   RNFrankie@AOL.com
     
                                                                                               
      OLD ADDRESS:  BJB 1561@AOL.com
     
           NEW ADDRESS:   heartrn9090@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

    "Time is the coin of your life. It is the only coin you have,
     and only you can determine how it will be spent.
     Be careful lest you let other people spend it for you.”

    - Carl Sandburg
     
     Please write...would really like to hear from you !   Frankie
     

    Answer to Quiz Time:

    Correct answer
    : d. Systemic corticosteroids should be used for long-term control only in patients with the most severe, hard-to-control asthma.

    The Paradigm Bytes Newsletter is published once a month and placed on our website. If you no longer enjoy receiving my notices about the publication, it you may stop at any time by contacting me  ( RNFrankie@AOL.com )  or just hitting reply when my notice to you appears in your inbox.  We'll be sad to see you go, but your request will be honored immediately.

    Wednesday, July 10, 2013

    SNIPPET for July; Newsletter to follow.

      Fecal microbiota transplantation: Breaking the chain of recurrent C. difficile infection


    More than 3 million new cases of Clostridium difficile infection (CDI) occur each year in acute-care and long-term care facilities in this country. A spore-forming bacterium most commonly found in the GI tract, C. difficile produces toxins noxious to the intestinal lining, where it alters epithelial cells. Disturbance of these cells can cause a wide range of signs and symptoms, from mild abdominal pain with watery diarrhea to painful abdominal cramping, fever, and bloody stool, possibly progressing to toxic megacolon. CDI accounts for roughly 14,000 deaths each year in the United States.
    Traditional treatment varies with disease severity. For mild CDI, initial treatment includes metronidazole; for severe CDI, patients typically receive vancomycin. The newest drug used in CDI therapy is fidaxomicin. This drug may be superior to vancomycin in decreasing CDI recurrence, although it’s significantly more expensive.  

     Emerging concerns

    CDI commonly follows exposure to antibiotics, which alter the intestinal flora and cause an imbalance of the natural gut flora. Initial treatment involves discontinuing the suspected causative antibiotic and starting oral vancomycin, metronidazole, or fidaxomicin.
    Unfortunately, more than 1 million CDI patients who receive these drugs experience treatment failure. One possible explanation is the emergence of multiple-relapse CDI (MR-CDI). Relapse rates are nearing 30% in patients with first-time CDI and exceed 65% for patients with a history of recurrent CDI.
    To make matters worse, a hypervirulent strain of C. difficile, known as BI/NAP1/027, recently emerged. Experts believe this strain accounts largely for the increased CDI incidence. First noted in the early 2000s in North America and Europe, this strain differs from other C. difficile strains in four dangerous ways:
    • causes increased toxin production
    • leads to more severe diarrhea
    • involves increased spore production
    • causes fluoroquinolone resistance.
    Emergence of the new strain underscores the importance of prevention. (See the box below.)
     
     Crucial preventive measures
    Preventing the spread of C. difficile is crucial to reducing the incidence of CDI. Prevention requires a threefold approach: preventing person-to-person transmission, minimizing risk factors, and practicing antimicrobial stewardardship through the following measures:
    • hand hygiene with soap and water to rinse off C. difficile spores
    • early contact precautions for patients with diarrhea (isolation in a private room, gloves and gowns worn by visitors and healthcare personnel)
    • environmental cleaning and disinfection (single-patient-use equipment or bleach cleaning of shared equipment)
    • CDI education for healthcare workers and environmental personnel
    • CDI education for patient and families
    • decreased overall use and duration of antibiotic therapy.

     Reviving an old treatment  

    An old treatment may be the answer to the current MR-CDI epidemic.  Fecal microbiota transplantation (FMT), also called fecal bacteriotherapy, was described as long ago as the 17th century.  The similar veterinary practice of transfaunation (transfer of symbiotic fauna from one host to another) was used to cure colitis in farm animals.  In 1958, before C.difficile was discovered as a causative pathogen, FMT was used successfully to treat patients with antibiotic-associated pseudomembranous colitis.  (See the box below.)
     
    More than 500 bacterial species inhabit the intestinal tract, creating a symbiotic environment within this microbial organ. Scientists are starting to recognize this symbiosis as an important element in immunity; the gut provides protection from pathogens and promotes epithelial-cell proliferation and nutrient production and metabolism.
    C. difficile flourishes in the environment around us. Intestinal flora protect us from it, but antibiotics can disturb the balance, allowing C. difficile to proliferate, overgrow, and cause infection. FMT reconstitutes the normal intestinal flora, which explains its overwhelming success in treating CDI.
    Candidates for FMT include patients who:
    • have had three episodes of recurring CDI with 6 to 8 weeks of antibiotic failure, or two recurrent CDIs requiring hospitalization
    • have moderate CDI but haven’t responded to antibiotic therapy
    • have severe colitis from C. difficile and are decompensating and unresponsive to antibiotics.
    Ineligible patients typically include those receiving immunosuppressant agents or chemotherapy, those who’ve had a recent bone marrow transplant, and those with advanced HIV/AIDS. Patients with toxic megacolon aren’t eligible for FMT because that condition is a surgical emergency.
    FMT isn’t limited to patients with CDI. It also has been used successfully in patients with chronic severe constipation and in those with inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis) who’ve failed other therapies. 

     Fecal donor selection

    FMT requires a healthy donor to provide stool for transplantation. Donors are recommended by the patient; they may be healthy relatives or close friends. Potential donors must undergo an extensive interview to assess lifestyle and health history, as certain laboratory tests may not detect early infection. Exclusionary criteria include tattoos or body piercings within the last 6 months, a history of incarceration, high-risk sexual behaviors, communicable illnesses or antibiotic treatment within the past 3 months, and such GI conditions as irritable bowel syndrome or chronic diarrhea. Donor stool is tested extensively for pathogens, including C. difficile, ova and parasites, Helicobacter pylori, Giardia, and Cryptosporidium. Donor blood is tested for human immunodeficiency virus, syphilis, and hepatitis A, B, and C.
    For 5 days before stool collection, donors must refrain from eating foods to which the recipient may be allergic. They should notify the physician if they become ill with fever, diarrhea, or vomiting between screening time and donation. They are given a urine collection hat, a stool specimen cup prelabeled with their name, a tongue depressor, and a biohazard bag for transporting stool to the hospital.  

    Patient preparation and education

    The notion of placing someone else’s feces into one’s body sounds unappealing—unless you’ve been suffering for month or years with recurrent CDI. Many patients are willing to try anything. For them, FMT is a welcome option. The goal of FMT is to reduce diarrhea frequency and decrease the infectious burden.
    FMT usually is done in the inpatient setting. The physician explains the procedure to the patient and obtains informed consent. For 3 days before FMT, the patient is pretreated with oral vancomycin 125 mg three times daily; the drug is discontinued the day before the procedure. The patient receives a proton-pump inhibitor the evening before and morning of the procedure to reduce gastric acid in the stomach.
    When providing patient education, be sure to include the FMT process, donor selection, and the method that will be used to instill the stool. Also teach the patient and family how to prevent spread of CDI at home, including proper hand hygiene with soap and water and use of bleach to clean environmental surfaces. Encourage the patient to notify all treating healthcare providers of their history and CDI treatment, and urge them to question any antibiotic prescription.  

    Prior to Procedure  
    Donor stool preparation is done using standard precautions. Usually, donor stool is instilled within 6 hours of the donor’s bowel movement. First it’s diluted using preservative-free sterile saline solution. Next, a fecal slurry is made by manually stirring it or using a blender until the stool is of a consistency that allows for aspiration. The fecal slurry is filtered using gauze or a mesh strainer to remove as much particulate as possible, and is instilled immediately.
    Several methods can be used to deposit the slurry—colonoscopy, retention enema, or nasogastric (NG) tube. No established guidelines exist for the best instillation method or amount of slurry to instill; clinicians should consider the patient’s size and instillation method. For an average-size adult, 50 to 200 mL are instilled via NGT; for colonoscopic instillation, 250 mL to 500 mL are instilled.
    If the patient is receiving the slurry through an NG tube, additional nursing considerations apply. Once the physician prepares and filters the stool, the nurse draws up the slurry into a clean 60-mL syringe and injects the prescribed amount slowly (50 mL over 2 to 3 minutes) into the NG tube, followed by a 50-mL flush of saline solution.    

    Postprocedure care
    For at least 2 hours after the procedure, keep the head of the bed elevated at least 30 degrees to reduce reflux and aspiration. Patients may experience belching, abdominal cramping, and nausea, but these symptoms should last only a few hours. They may resume their normal diet or tube feedings 2 hours after the procedure.
    Many patients report feeling better within 24 hours of FMT. Be sure to
    include the FMT process, donor selection, and the method that will be used to instill the stool. Also teach the patient and family how to prevent spread of CDI at home, including proper hand hygiene with soap and water and use of bleach to clean environmental surfaces. Encourage the patient to notify all treating healthcare providers of their history and CDI treatment, and urge them to question any antibiotic prescription.  

     Procedure
    Donor stool preparation is done using standard precautions. Usually, donor stool is instilled within 6 hours of the donor’s bowel movement. First it’s diluted using preservative-free sterile saline solution. Next, a fecal slurry is made by manually stirring it or using a blender until the stool is of a consistency that allows for aspiration. The fecal slurry is filtered using gauze or a mesh strainer to remove as much particulate as possible, and is instilled immediately.
    Several methods can be used to deposit the slurry—colonoscopy, retention enema, or nasogastric (NG) tube. No established guidelines exist for the best instillation method or amount of slurry to instill; clinicians should consider the patient’s size and instillation method. For an average-size adult, 50 to 200 mL are instilled via NGT; for colonoscopic instillation, 250 mL to 500 mL are instilled.
    If the patient is receiving the slurry through an NG tube, additional nursing considerations apply. Once the physician prepares and filters the stool, the nurse draws up the slurry into a clean 60-mL syringe and injects the prescribed amount slowly (50 mL over 2 to 3 minutes) into the NG tube, followed by a 50-mL flush of saline solution.  

    Postprocedure care
    For at least 2 hours after the procedure, keep the head of the bed elevated at least 30 degrees to reduce reflux and aspiration. Patients may experience belching, abdominal cramping, and nausea, but these symptoms should last only a few hours. They may resume their normal diet or tube feedings 2 hours after the procedure.
    Many patients report feeling better within 24 hours of FMT. Be sure to document continued diarrhea, as FMT may need to be repeated after 5 days if the diarrhea continues. FMT is deemed successful if symptoms resolve and don’t recur for 8 weeks; at that point, the patient is considered clinically cured. Patients don’t need to be retested for C. difficile, as they’re likely to remain colonized with the bacteria but not infected. Patients are tested only if they’re symptomatic.
    In patients who’ve undergone FMT, the cure rate for MR-CDI is nearly 90%. Yet barriers to this procedure persist; for instance, most insurance companies don’t cover donor screening costs. Also, few hospitals have FMT protocols, making preparation and administration difficult.
    As a nurse, you may come in contact with patients who have MR-CDI. You can play a crucial role in reducing MR-CDI by disseminating information about FMT. The next time you encounter a patient with MR-CDI, consider recommending FMT to the healthcare team.

    Amy Marinski is an infection control practitioner at Orlando Regional Medical Center in Orlando, Florida.
    http://healthcommedia.benchmarkmails26.com/c/l?u=26498B3&e=2DBE85&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o

    Saturday, June 15, 2013

    Paradigm Bytes Newsletter for June 2013

    PARADIGM BYTES Newsletter for Paradigm 97 June 15, 2013 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. ***~~~***~~~***~~~*** SNIPPETS Do You Wash Your hands? (We nurses know how to wash the hands....especially between the fingers for the correct period of time. But we have all seen people leave the restroom doing just as the following research shows. How can we teach the correct method...to children, it would be easy. However, how about teaching adults?) In fascinating news, new research shows that most people don't wash their hands properly after using the bathroom. The study from Michigan State University found that a staggering 95 percent of people don't wash their hands long enough to kill illness-causing bacteria. Yep, that makes you just about as dirty as the person who walks out of the bathroom without stopping at the sink first. For the study, the research team trained 12 research assistants to unobtrusively watch people's behavior in public restrooms in a college town. The assistants recorded whether and how people washed their hands—if they left the bathroom without washing their hands at all, if they just wetted their hands without using soap, or if they washed their hands with soap. They also recorded how long people's hands were placed under running water during the washing process. In total, 3,749 people were observed. The findings, published in the April 2013 issue of Journal of Environmental Health, showed that only two out of three people use soap and that one out of 10 people skip the sink altogether. While women significantly wash their hands better than men, many still don't do right. "These findings were surprising to us because past research suggested that proper hand washing is occurring at a much higher rate," said Carl Borchgrevink, one of the study's authors and a Michigan State associate professor of hospitality business, in a statement. To prevent the spread of disease, the U.S. Centers for Disease Control and Prevention recommends washing hands under running water and with soap for at least 20 seconds. (Don't want to count in your head? Silently sing the "Happy Birthday" song twice.) Then, leaving the water running, dry your hands with a paper towel and use the towel to turn the faucet off and open the door, before tossing it into the trash. Tell us: Do you always remember to wash your hands properly? (We, as nurses, were taught the proper procedure of washing hands. Do you teach this procedure to your patients? If so, how? It is easy to teach children...but adults?) ****************************** (I just had to add this....didn't know just where to put it........chose this spot. Let me know if you like the Random Fact, please). With the ubiquitousness of the Internet it is easy to forget that once upon a time the recording and passing on of knowledge was a monumentally important, even sacred task and books were frequently more valuable than gold. Now, many books aren't even worth the paper they are printed on, but those rare examples of historic publications in antiquity that are still in good condition can fetch kingly prices. Some of the most expensive books ever sold at auction are... RANDOM FACTS: Traite Des Arbres Fruitiers The "Treatise on Fruit Trees" is a five volume set written in 1750. It contains illustrations and descriptions of sixteen different varieties of fruit trees. With a 2006 purchase price of $4.5 million, it has the distinction of being the most expensive book about fruit trees ever sold. The Gutenberg Bible There are 48 Gutenberg Bibles left of the original 180 believed to have been produced. They were printed in 1456 and were the first books produced with moveable type. A copy sold in 1987 for $4.9 million at Christie's New York. First Folio This book, a collection of William Shakespeare's plays, was published after his death in 1623. Seven hundred and fifty copies were published, but only 228 survived. Microsoft co-founder Paul Allen purchased a copy for around $6.1 million in 2001. The Canterbury Tales There are only 12 known first edition copies left since its publishing in 1477, and only one is in a private collection. The book was originally purchased in 1776 and not sold again until 1998 with a purchase price of $7.5 million by Christie's of London. Birds Of America This three and a half foot tall book depicts 400 life size North American bird species known to the Audubon Society in the 19th century. Only 200 complete first editions were produced, and 120 exist today. In 2010, one was sold for $11.5 million, but a 2012 copy sold for only $7.9 million. The Gospels Of Henry The Lion Commissioned by Henry the Lion for the alter of the Virgin Mary at Brunswick Cathedral, the German government purchased this 266 page book in 1983 for $11.7 million. The Codex Leicester Da Vinci wasn't only an artist, but also a scientist. This 72 page notebook is a handwritten journal chronicling his thoughts on everything from fossils to what makes the moon glow. Microsoft founder Bill Gates purchased the book for $30.8 million and had it scanned to use as a screensaver for Windows 95. ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS Thank you, Laura for the following links: Nursing-related News Docs, Nurses Disagree Over Expanded Nurse Roles Postings from the KHN and Human Capital blogs. Article from HealthDay. Free, full-text article and abstract from The New England Journal of Medicine. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fcapsules.kaiserhealthnews.org%2Findex.php%2F2013%2F05%2Fdoctors-nurse-practitioners-disagree-about-expanded-roles-for-nurses%2F&i=61&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com The U.S. Nursing Workforce: Trends in Supply and Education Analysis from the HHS Health Resources and Services Administration. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fbhpr.hrsa.gov%2Fhealthworkforce%2Freports%2Fnursingworkforce%2Findex.html&i=66&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com The American Academy of Nursing Applauds Senate Confirmation of Marilyn Tavenner, MHA, BSN, RN, as New CMS Administrator News release. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.aannet.org%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D500%3Aacademy-applauds-senate-confirmation-of-tavenner-as-new-cms-administrator%26catid%3D23%3Apressreleases%26Itemid%3D133&i=67&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com California Weighs Expanded Role For Nurse Practitioners Article from Kaiser Health News. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.kaiserhealthnews.org%2FStories%2F2013%2FMay%2F09%2FCalifornia-expanded-role-nurse-practitioners.aspx&i=68&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com The Registered Nurse Safe Staffing Act of 2013 Is Introduced in Congress News item from the American Nurses Association web site. http://dmanalytics1.com/e3ds/mail_link.php?u=http%3A%2F%2Fwww.aannet.org%2Findex.php%3Foption%3Dcom_content%26view%3Darticle%26id%3D500%3Aacademy-applauds-senate-confirmation-of-tavenner-as-new-cms-administrator%26catid%3D23%3Apressreleases%26Itemid%3D133&i=67&d=U7548693-0980-4UXV-935U-18060749V09V&e=laregis@aol.com ~~**~~**~~**~~**~~**~~ MEDICAL NEWS The so-called Monsanto Protection Act signed into law earlier this year caused such an outrage that people around the world are planning to protest the biotech company later this month. Now a United States Senator is expected to try and repeal that law after mounting pressure. The notorious ‘Monsanto Protection Act’ rider stuffed into the non-related Senate spending bill may soon be repealed thanks to the massive amounts of activism and outrage that have now amounted into a legislative charge towards action. Action that has turned into legislation progress through Senator Jeff Merkley of Oregon, who has announced an amendment that would remove Section 735 (the Monsanto Protection Act as its known) from the Consolidated and Further Continuing Appropriations Act of 2013 Senate spending bill. The rider, which almost managed to slip incognito and pass by the alarm system of the alternative media, grants GMO juggernaut Monsanto full immunity from federal courts in the event that one of its genetically modified creations is found to be causing damage to health or the environment. Essentially, it grants Monsanto power over the United States federal government. Thankfully, I was able to get on the subject through news tips and covered the Monsanto Protection Act all the way up until the bill containing it was signed into law by Obama. Ultimately, as the Monsanto Protection Act became more a hot issue, we had an increasing amount of publicity — but the Senate vote came just too quickly for the attention to put a halt on the rider. But even after its passing, sources like Russia Today, NaturalNews, Infowars, and myself here at NaturalSociety were sounding the alarm big time. Enough so that it even led to an apology from the top Senator who actually ended up approving the bill containing the rider. Senator Barbara Mikulski of Maryland actually went and released a statement apologizing for allowing the Monsanto Protection Act through and vowing to fight against GMOs and Monsanto. Ultimately, multiple Senators had entered damage control after the jig was up. That is besides Senator Roy Blunt from Missouri, who actually worked with Monsanto (as in he let them write it while he received funding) on the Monsanto Protection Act rider. A rider he says is perfectly reasonable. After all, why not give Monsanto full immunity from the legal system the rest of us are subject to? Even Obama was getting blasted on his Facebook page following the approval of the Monsanto Protection Act, with the majority of comments coming into his page criticizing his signature on the bill that contained the rider. Thanks to this activism, it looks like the Monsanto Protection Act may soon be repealed after this new bill hits Washington. This time, we will have plenty of time to let the Senators know that they are voting against the public if they choose to side with Monsanto. And with such a specific agenda for this bill, I see it doing well in the Senate. Source: http://naturalsociety.com/monsanto-protection-act-soon-repealed-activism/ *********************** Los Angeles launches probe of alleged 'patient dumping' by Nevada (Reuters) - Nevada health officials acknowledged on Thursday that a state-run hospital improperly bused 10 newly discharged psychiatric patients out of the state with deficient plans for their care, while Los Angeles launched a criminal probe into the alleged "patient dumping." Rawson-Neal Psychiatric Hospital has been under fire since last month, after a Sacramento Bee investigative series reported that hospital staff gave as many as 1,500 patients one-way Greyhound bus tickets from Las Vegas to California and 46 other states over the past five years. "If the conduct is true as alleged, it's no less than human trafficking," Los Angeles City Attorney Carmen Trutanich told Reuters, adding he was working with San Francisco City Attorney Dennis Herrera, who last month opened an investigation into the practice. http://www.reuters.com/ ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Gut bugs are implicated in heart attacks and stroke NEW YORK (Reuters) - Thousands of heart attack victims every year have none of the notorious risk factors before their crisis - not high cholesterol, not unhealthy triglycerides. Now the search for the mystery culprits has turned up some surprising suspects: the trillions of bacteria and other microbes living in the human gut. In a study released on Wednesday, scientists discovered that some of the bugs turn lecithin - a nutrient in egg yolks, liver, beef, pork and wheat germ - into an artery-clogging compound called TMAO. They also found that blood levels of TMAO predict heart attack, stroke or death, and do so "independent of other risk factors," said Dr Stanley Hazen, chairman of cellular and molecular medicine at the Cleveland Clinic's Lerner Research Institute, who led the study. That suggests a TMAO test could enter the arsenal of blood tests that signal possible cardiovascular problems ahead. "TMAO might identify people who are at risk (for heart attacks and strokes) despite having no other risk factors," Hazen said. The discovery also suggests a new approach to preventing these cardiovascular events: altering gut bacteria so they churn out less TMAO.... http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNDI1LjE4MTUzMzYxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDQyNS4xODE1MzM2MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTAxNjM1JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&113&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_136236.html *************** Fluid and electrolyte imbalances can quickly turn into life-threatening situations and it is critical to be able to recognize subtle signs and symptoms and intervene appropriately. Test your knowledge of fluids and electrolytes by answering the following questions: What are the major organs involved in electrolyte and fluid homeostasis? What medications can cause hypernatremia? What are the recommended treatments for dilutional hyponatremia? What is the relationship between calcium level and phosphorous level? Which medication, commonly given in CCUs, is contraindicated in patients with hypokalemia? Check your answers and learn more by exploring the articles in More Resources. Also, we now have a new collection, Focus On: Fluids & Electrolytes, which includes a variety of articles, CE, and special features all about fluid and electrolytes! http://email.lww.com/t?r=1483&c=3480712&l=59027&ctl=4661F84:B54AB34282EDAD00F9F852C93A3ECCCEBB9E742C260FE2D0&; ******************** In 1970, Americans spent about $6 billion on fast food. In 2006, the spending rose to nearly $142 billion. It is not surprising that every month, approximately nine out of 10 American children visit a McDonald's restaurant. What are some other not so surprising facts about America's fast food industry. RANDOM FACTS: McDonald's is the largest purchaser of beef, pork, and potatoes and the second largest purchaser of chicken in the world. Its annual orders for french fries constitute 7.5 percent of America's entire potato crop. *** Bonus Fact: Due to anti-German sentiment during WWI, an alternative name for a hamburger (which was derived from the Hamburg steak sandwiches eaten on immigrant ships between Hamburg, Germany, and America in the 1800s) was "salisbury steak." It was named after Dr. Salisbury who prescribed ground beef for patients suffering from anemia, asthma, and other illnesses. ****************** Earlier, The Joint Commission issued a Sentinel Event Alert entitled Medical device alarm safety in hospitals to address the issues presented due to providers becoming desensitized or immune to the beeping of medical devices. We'd like to share several resources available on Lippincott's NursingCenter.com to bring attention to this important issue. http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F63:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& Creating cultures of safety: Risk management challenges and strategies Nursing Management, December 2010 http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F64:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& Increasing the Use of 'Smart' Pump Drug Libraries by Nurses: A Continuous Quality Improvement Project AJN, American Journal of Nursing, January 2012 http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F65:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& ECG Challenges: Monitor Alarms and Alarm Fatigue AACN Advanced Critical Care, December 2011 Alarms are a necessary part of monitoring and caring for patients. Awareness of the technological and human factors associated with alarm fatigue is a first step in recognizing and remedying this issue. http://email.lww.com/t?r=1483&c=3509676&l=49052&ctl=46D5F66:B54AB34282EDAD008407A52733B0335AABC62CF4A2E7FFFB& Thank you, Lisa M. Bonsall, MSN, RN, CRNP Clinical Editor, Lippincott's NursingCenter.com ****************** FDA finds fungus, bacteria in recalled pain shots The Food and Drug Administration has found bacteria and fungus in vials of pain shots made by a Tennessee pharmacy whose products have been linked to infections. FDA said it found the contaminants in two sealed vials of steroids made by Main Street Family Pharmacy, which has recalled all its products nationwide after 24 people in Arkansas, Florida, Illinois and North Carolina developed abscesses at the sites where they got the injections. “FDA, in partnership with the Centers for Disease Control and Prevention, is working to identify the exact species of fungus and bacteria observed in the vials. FDA has received reports of adverse events, including skin and soft tissue abscesses,” FDA said in a statement.... http://vitals.nbcnews.com/_news/2013/06/07/18829371-fda-finds-fungus-bacteria-in-recalled-pain-shots?lite ************************ Super Glue*** A kind of extra-sticky adhesive, or cyanoacrylate, "Super Glue" was invented during World War II by a scientist named Harry Coover, who was experimenting with sealants for aircraft turrets. In the 1950s, he went to work for Eastman Kodak, a chemical and film manufacturer, and put a product on the market with the uncatchy name Eastman 910. The company licensed the product to another manufacturer, which renamed it "Super Glue" and made a fortune. ***************** Quiz Time For elderly patients recovering from surgery, you should anticipate which of the following? a. They will require higher opioid dosages than younger patients to experience the same analgesic effect. b. They will require lower opioid dosages than younger patients to experience the same analgesic effect. c. They will require longer opioid dosing intervals and will respond more slowly to opioids. d. They are likely to have differences in genetic makeup that affect opioid response. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 *************** Preventing catheter-related bloodstream infections related to I.V. connectors A year-long national effort to minimize catheter-related bloodstream infections (CR-BSIs) has produced only modest results. The Centers for Disease Control and Prevention (CDC) compared data from January through June 2009 to data from 2006 through 2008, and found these infections had decreased only 18%. The statistics are troubling, especially given the current intense focus on preventing hospital-acquired infections. Why do CR-BSIs still kill patients every year? Some experts believe I.V. connector design is a contributing factor. The Food and Drug Administration (FDA) requires all manufacturers of positive-displacement (PD) I.V. connectors to conduct postmarketing surveillance studies to assess whether they could be linked to a higher CR-BSI rate than other types and to assess factors that may contribute to the possible increased risk. FDA has taken this step because it has received information on possible safety problems linked to PD needleless connectors, including three reports of deaths. But despite mounting evidence against these connectors, they’re still used widely. William Jarvis, MD, an internationally recognized infection control expert, notes that studies also link negative-displacement (ND) connectors with increased CR-BSIs. As primary caregivers, nurses are responsible for the care and maintenance of central venous catheters. This article describes the various I.V. connector designs available and explains why some designs are more effective than others in preventing infections. Because I.V. connectors are attached to catheter hubs, they serve as gatekeepers of the intraluminal fluid pathway (the inside of the catheter). Their design plays a critical role in supporting—or thwarting—your care and maintenance efforts. If their design makes them hard to disinfect with thorough swabbing and flushing, infections are more likely. If their design promotes thorough swabbing and flushing, they can help minimize infections.... http://www.americannursetoday.com/Article.aspx?id=9354&fid=9326&utm_source=BenchmarkEmail&utm_campaign=Weekly_eNewsletter_September_3rd_2012&utm_medium=email#comments ****************** Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted THURSDAY, May 2 (HealthDay News) -- Women who have a breast biopsy that turns out to be benign are typically told to undergo another imaging test, such as a mammogram, in six to 12 months. Now, a new study suggests that the longer interval might be better. Researchers who followed women who had benign breast biopsies say having that test less than a year later finds few cancers and is a drain on health care dollars. ''Doing a follow-up imaging study six months after a benign needle breast biopsy has a low likelihood of finding breast cancer at the biopsy site," said study author Dr. Andrea Barrio, an attending breast surgeon at Bryn Mawr Hospital, in Pennsylvania. Most of these women, she said, can wait longer than six months before repeating the mammogram, ultrasound or MRI. Dr. Demitra Manjoros, a breast fellow at Bryn Mawr, is due to present the research Thursday at the American Society of Breast Surgeons' annual meeting, in Chicago. ... http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNTAzLjE4NDE1MDAxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDUwMy4xODQxNTAwMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MTEwNDM0JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&126&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_136464.html ********************* NICU treatments linked to intellectual disabilities (Reuters Health) - Neonatal intensive care unit (NICU) interventions for babies born very small and early have drastically reduced infant deaths in the United States, but in doing so they've contributed to more intellectual disabilities, according to a new study. Past research has shown such disabilities have been reduced in recent years through vaccines and newborn screening, for example. But disability rates may also be rising due to procedures that save the lives of children who go on to have limitations in social and practical skills, according to researchers led by Dr. Jeffrey Brosco. "We actually through medical interventions, in some sense, cause a fair amount of intellectual disability as well (as preventing it)," said Brosco, from the University of Miami Miller School of Medicine. Of course, that doesn't mean doctors should stop performing life-saving procedures in the NICU and elsewhere, Brosco told Reuters Health. But the findings are part of a larger trend suggesting researchers and policymakers not focus all of their attention on new medical interventions as the best way to prevent disabilities, but start looking toward public health efforts, he added. "There's a great debate regarding the value of medical versus public health and social interventions in improving child health," said Dr. Jeffrey Baker, a medical historian who studies medical technology, ethics and child health and the Duke University School of Medicine in Durham. "What this study does is to show that medical intervention has been a two-edged sword," he said. http://links.reuters.com/r/8Q1OD/G2T0C/II35GQ/ZBG8RN/4VC4RT/YT/h?a=http://links.reuters.com/r/8Q1OD/G2T0C/II35GQ/ZBG8RN/EKXSHH/YT/h ~~**~~**~~**~~**~~**~~ HUMOR SECTION The brilliant lawyer F. E. Smith once defended a bus driver against claims that his negligence had caused injury to a young man's arm: "Will you please show us how high you can lift your arm now?" Smith asked the plaintiff. The young man obediently raised his arm to shoulder level, his face contorted with apparent pain. "Thank you," said Smith. "And now, please, will you show us how high you could lift it before the accident?" The man's arm shot above his head. ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as Dr Robert Hess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. 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/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.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 (to verify the veracity of a rumor) 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 Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** (Considering the seriousness of both these Class I recalls, there will be only these two in this Newsletter) Symbios GOPump and GOBlock Kits Recall Class: Class I Date Recall Initiated: June 6, 2013 Product(s): Symbios GOPump in the GoPump Rapid Recovery System Kits Symbios GOBlock Kits Lot numbers: All lots of GOPumps in the GoPump Rapid Recovery System kits and GOBlock kits manufactured with flow control components before July 2012. Please see the chart below listing all the lot numbers. Manufacturing and Distribution Dates: The affected products were manufactured before July 2012 and distributed from April 27, 2011 to April 30, 2013. Use: The Symbios GOPump Rapid Recovery System is a disposable local pain management system that consists of a small balloon that is inflated with a local anesthetic medication. The medication is delivered slowly through tubes from the balloon to the surgical site. Recalling Firm: Symbios Medical Products, LLC 7301 Georgetown Road, Suite 150 Indianapolis, Indiana 46268 Distributor: B. Braun Medical Inc. 901 Marcon Blvd. Allentown, Pennsylvania 18109 Reason for Recall: The affected products may have excessively high flow rates. As a result, medications could be delivered too quickly from the balloon to the surgical site and cause patient toxicity due to the rapid influx of medication. This can lead to serious illness, including seizure, abnormal heart rhythms and death. Elderly patients and patients with low body mass are at high risk of these complications. ***************** Class I Recall and Safety Investigation of Counterfeit Polypropylene Surgical Mesh: Updated June 10, 2010 This is an update of FDA's Initial Communication on counterfeit polypropylene surgical mesh, which was issued on March 11, 2010. It contains additional information about the recall of this product and updates FDA's recommendations and activities. Audiences: Healthcare Professionals, Patients, Hospitals and Surgical Centers, Operating Rooms, Operating Room Nurses, Purchasing Departments, Risk Managers Medical Specialty: Surgery Product: Various sizes of counterfeit flat sheets of polypropylene surgical mesh have been marketed in the United States labeled with the C. R. Bard/Davol brand name. These meshes, specifically identified below, are NOT Bard-manufactured products. Surgical meshes of this kind are used to reinforce soft tissue where weakness exists, such as in the repair of hernias and chest wall defects. Summary of Problem and Scope: FDA's and Bard's investigations found the counterfeit product is labeled with the following product codes, sizes and lots of Bard Flat Mesh (commonly known as Marlex mesh). Investigations found most of the counterfeit product is labeled with genuine Bard lot numbers. To date, four product sizes have been identified: Product Codes and Sizes Lot Numbers 0112650 – Bard Flat Mesh 2" x 4" Lot 48HVS036 Lot 43APD007 0112660 – Bard Flat Mesh 10" x 14" Lot HUSD0629 Lot HURL0336 0112680 – Bard Flat Mesh 3" x 6" Lot 43HPD027 Lot 43HPD032 Lot 43HPD034 Lot HUSG0540 Lot 43HDP027 Lot HUSE0532 Lot 43LPD507 Lot HUSF0763 Lot 43IOD011 Lot 43IPD038 0112720 – Bard Flat Mesh 6" x 6" Lot 43FQD327 These counterfeit products were distributed from October 21, 2008 to October 27, 2009. Although counterfeiting of surgical mesh has occurred in the past, we are not aware of any other counterfeit mesh products being distributed at this time. Voluntary Recall: RAM Medical, Inc., a medical product distributor located in Wayne, New Jersey, initiated a voluntary recall of one lot of the counterfeit surgical mesh on March 5, 2010. RAM Medical expanded the recall on March 15, 2010 to include all of the above lots. RAM Medical sold the counterfeit products to the distributors below, who then distributed them to hospitals or possibly other distributors: Amerimed Corporation Henry Schein Inc. Marathon Medical Corporation Medline Industries MMS - A Medical Supply Company Q-Med Corporation Recommendations/Actions: Healthcare professionals and facilities Do NOT use any surgical mesh from the lots listed above. Contact RAM Medical at 973-633-0400 for further instructions about returning it. Contact Bard at 1-800-556-6275 if you received one of the recalled lots from a distributor not listed above, as Bard might be able to confirm if the product is authentic. Carefully examine all manufacturers' polypropylene surgical mesh products, packaging and labeling for anything unusual that might indicate they are counterfeit. If you notice anything unusual or suspicious with any brand of surgical mesh product, including its packaging or labeling, contact the manufacturer. If you suspect that a counterfeit product was implanted in a patient, continue to monitor the patient for adverse events as you would any patient with an authentic polypropylene surgical mesh implant. Report any adverse events to FDA as instructed in the “Reporting Problems to FDA” section below. If you believe you have received counterfeit or suspect product, contact FDA's Office of Criminal Investigations by calling 800-551-3989 or by visiting the Office of Criminal Investigations website. FDA Activities: On June 2, 2010, FDA classified the distributor's voluntary recall as a Class I recall. Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of the product will cause serious adverse health consequences or death. An FDA recall notice was posted on the Medical Devices website. Here is what FDA has found in its laboratory analysis of the counterfeit mesh samples to date: The counterfeit samples are not sterile although labeled as sterile,which may mean increased risk for infection if implanted in a patient. They have a weave pattern and structure that is different from the authentic mesh. For example, the counterfeit mesh weave openings are larger than the authentic mesh. The counterfeit mesh does not have properly finished selvage edges as compared to the authentic mesh, which may allow the counterfeit mesh to unravel. The counterfeit mesh edges appear to be cut using heat, as the edge is fused or melted together. The packaging of the counterfeit samples is different from that of the authentic mesh. The expiration dates shown on the labeling of some of the counterfeit product samples do not match. The counterfeit mesh may not meet the authentic product's specifications, including strength and clinical performance. FDA is continuing to test samples of the counterfeit mesh and will update this communication if additional information becomes available. FDA is also investigating to determine who is responsible for the counterfeiting and how the counterfeiting and distribution occurred. ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: ccpierce62@live.com (Cecilia) May 22, 2013 Johnsie.Newman@gmail.com (Johnsie) June 8, 2013 fsdbuckley@hotmail.com (Farrar) June 12, 2013 Peggylee1.ps@gmail.com (Peggy) June 13, 2013 ~~**~~**~~**~~**~~**~~ NOTICE: I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address. So, be certain to let me know when you change your address. If, for personal reasons, you want to opt out...let me know, also. RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY The strongest reason for the people to retain the right to keep and bear arms is, as a last resort, to protect themselves against tyranny in government. --Thomas Jefferson Answer to Quiz Time: Correct answer: b. Increased age has a linear correlation to increased opioid sensitivity. Thus, elderly patients require lower opioid dosages than younger patients to experience the same analgesic effect. Take time out to write me...with suggestions/criticisms AN "atta girl" is always appreciated Frankie RNFrankie@AOL.com

    Friday, May 17, 2013

    May 16, 2013 Newsletter

    PARADIGM BYTES Newsletter for Paradigm 97 May 16, 2013 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. ***~~~***~~~***~~~*** SNIPPETS (This is from Kurt Ullman, a member--- Thank you, Kurt) Nurses more prone to being bullied than other workers New book Toxic Nursing addresses workplace incivility INDIANAPOLIS — Twice as many nurses as other working Americans have experienced bullying in the workplace. According to a recent study in the Journal of Nursing Management, among 612 staff nurses, 67.5 percent had experienced bullying from their supervisors, while a whopping 77.6 percent had been bullied by their co-workers. Outside the health care industry, just 35 percent of Americans had reported workplace incivility, revealed a recent survey by the Workplace Bullying Institute. Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil, published by the Honor Society of Nursing, Sigma Theta Tau International (STTI), directly addresses the issue. Written by Cheryl Dellasega, PhD, RN, CRNP, author of Surviving Ophelia and When Nurses Hurt Nurses, and Rebecca L. Volpe, PhD, Toxic Nursing gives nurse managers and administrators the tools they need to defuse conflict and create a positive work environment. Nurse managers and nurse administrators at all levels are frequently confronted by the need to manage employee issues arising from interpersonal relationships, including conflict, cynicism, and unnecessary drama. As a follow-up to When Nurses Hurt Nurses, this book offers concrete strategies for dealing with common employee challenges that nurse supervisors face. “Toxic Nursing is a must-read for nurse managers, nurse preceptors, and new nurses,” said Anita J. Tarzian, PhD, RN, associate professor and program coordinator at the University of Maryland School of Nursing. “Dellasega and Volpe provide a comprehensive toolkit of approaches to address destructive workplace behaviors among nurses. The combination of vignettes based on cases gleaned from blog postings and thorough literature review is novel and effective. It will broaden the reader’s view of bullying, how it harms nurses and those they serve, and what to do about it.” Purchase the book at www.nursingknowledge.org. Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil By Cheryl Dellasega, PhD, RN, CRNP, and Rebecca L. Volpe, PhD Published by the Honor Society of Nursing, Sigma Theta Tau International ISBN-13: 9781-937554-42-2 Price: US $34.95 Trade paperback, 336 pages Trim size: 53/8 x 73/8 Available at www.nursingknowledge.org/STTIbooks About the authors Cheryl Dellasega, PhD, RN, CRNP, author of When Nurses Hurt Nurses (STTI, 2011), Mean Girls Grown Up (Wiley, 2005), Girl Wars (Simon & Schuster, 2003), and Surviving Ophelia (Perseus, 2001), is a professor of humanities in the College of Medicine and a professor of women’s studies at Pennsylvania State University. As the founder of Club and Camp Ophelia, she has helped girls confront and overcome relational aggression. She has worked clinically as a nurse practitioner and is an international expert on family relationships. Rebecca L. Volpe, PhD, is an assistant professor in the department of humanities in the College of Medicine at Pennsylvania State University. She is also coordinator of the Clinical Ethics Consultation Service for the Penn State Hershey Medical Center. Dr. Volpe earned her PhD from Saint Louis University’s Center for Health Care Ethics and went on to complete a Clinical Ethics Fellowship at California Pacific Medical Center. http://www.nursingknowledge.org/ ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Number of Endorsers Tops 110! for HR 485 (To establish the position of National Nurse for Public Health, to be filled by the same individual serving as the Chief Nurse Officer of the Public Health Service). Support continues to pour in from around the country for H.R. 485, The National Nurse Act of 2013. This past month, the American Federation of State, County, and Municipal Employees (AFSCME) joined over 110 organizations and prominent individuals who have signed on the support letter being delivered to members of Congress. Many chose to vote by email so that they could provide the NNNO with a quick decision regarding support, and several mentioned that the decision was unanimous. If your organization is interested in exploring how to add on to the list of endorsers please contact the National Nursing Network Organization's Board of Directors. ******************* (Please contribute your opinion...the article will give you your rep's name) The American Nurses Association applauds Congresswoman Lois Capps (D-CA) and Congressman David Joyce (R-OH) for introducing the Registered Nurse Safe Staffing Act of 2013 (H.R. 1821). As you know, insufficient nurse staffing can be a life-or-death issue for patients. Federal legislation is needed to ensure that hospitals set upwardly adjustable minimum nurse to patient ratios. The Safe Staffing Bill would require hospitals that participate in Medicare to create staffing committees. Committees would be comprised of a majority of staff nurses and would be responsible for developing and publicly reporting nurse staffing plans for each unit. It would place limits on the practice of “floating” nurses by ensuring that RNs are not forced to work on units if they lack the education and experience in that specialty. The bill also calls for holding hospitals accountable for safe nurse staffing by requiring the development of procedures for receiving and investigating complaints, allowing imposition of civil monetary penalties for knowing violations, and providing whistle-blower protections for those who file a complaint about staffing Please urge your Representatives to support this important piece of legislation today. http://www.rnaction.org/site/R?i=sIoJYvrVn-CszZrPmbnc_w ******************** Residency Program for New Nurses Healthcare professionals across Iowa, led by the Iowa Action Coalition, are pushing for increased residency programs for new nurses. The programs will help new graduates make a successful transition from school to the work force and help keep new nurses from leaving the profession. The Iowa Action Coalition is working on developing a residency program that can be adopted by any hospital or healthcare facility. The program is funded by a grant from the Robert Wood Johnson Foundation. Iowa, along with 19 other states, will receive two-year grants of up to $150,000. Read more: http://thegazette.com/2013/04/17/iowa-hospitals-push-nurse-residency-programs) http://r20.rs6.net/tn.jsp?e=001GPVjCEn9qP_6ZmAvifSMHWsUDyNTe88pGRLgLT30D9NtB-0BL0CBssM5IDRAPBTAVRMmN7zmYFy0Pi8xyQYGsPLlb5ZUTtdWHq0RPa1XM91atorGVV7ILG3oibXthQHmrxirswdrg-YmMPOaGnVH-vf05JNJlPHKJN8WLdjutz1TTAsCa8_VkoHmZB3Pb2t6XeofDyG-tDQ= ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Brain 'Pacemaker' May Help Ease Tough-to-Treat Anorexia WEDNESDAY, March 6 (HealthDay News) -- For people suffering from severe, tough-to-treat anorexia, having a biological "pacemaker" implanted in their brain may help ease the disorder, a small new study suggests. The researchers noted that anorexia is the psychiatric disorder with the highest mortality rate and, although therapies exist, not everyone benefits in the long term. The disorder is among the most common psychiatric ills diagnosed among teenage women. Up to 20 percent of patients do not respond to available treatments, which usually focus on behavioral change. The new study examined the effectiveness of an approach called deep brain stimulation (DBS), sometimes called a brain pacemaker. Brain 'Pacemaker' May Help Ease Tough-to-Treat Anorexia ********************* Anorexics Can't Judge Own Body Size: Study THURSDAY, Aug. 23 (HealthDay News) -- People with the eating disorder anorexia have difficulty judging their own body size but are able to size up others accurately, a small new study finds. The study included 25 people with anorexia and 25 people without the disorder who were shown a door-like opening and asked to judge whether they or other people in the room could pass through it. In earlier experiments, people with anorexia felt they could not pass through the door even if it was easily wide enough. In this study, people with anorexia were more accurate at judging whether other people could fit through the door than whether they could. The researchers also found a link between the anorexia patients' ability to fit through the door and their body size prior to becoming anorexic. This suggests that people with anorexia may still think of themselves as having their previous size, said study author Dewi Guardia, of the University Hospital of Lille in France. The study was published Aug. 22 in the journal PLoS One. Anorexics Can't Judge Own Body Size: Study ********************* On April 29, the U.S. Food and Drug Administration (FDA) approved Kcentra (Prothrombin Complex Concentrate, Human) for the urgent reversal of vitamin K antagonist (VKA) anticoagulation in adults with acute major bleeding. Plasma is the only other product approved for this use in the United States; Kcentra doesn’t require blood group typing or thawing, so it can be administered more quickly than frozen plasma. http://healthcommedia.benchmarkmails26.com/c/l?u=2494C69&e=2C4B2E&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ********************** Most teens well down road to heart disease, study finds A stunning 80 percent of U.S. teenagers are eating diets that put them on a clear path to heart disease, researchers reported on Monday. They’re eating too much fat, salt and sugar and not eating enough fruits and vegetables, the American Heart Association study found. Just 1 percent ate what the Heart Association considers a perfectly healthy diet. Plus they don’t exercise enough, says Christina Shay of the the University of Oklahoma Health Sciences Center, who led the study. “The far less-than-optimal physical activity levels and dietary intake of current U.S. teenagers, is translating into obesity and overweight that, in turn, is likely influencing worsening rates of high blood pressure, high cholesterol and blood glucose at these young ages,” Shay said in a statement. ... http://vitals.nbcnews.com/_news/2013/04/01/17553021-most-teens-well-down-road-to-heart-disease-study-finds?lite ; **************** Infections Tied to Cognitive Decline A new study adds to the evidence that chronic infection, known to be associated with vascular disease, is also associated with poorer performance on tests of mental ability. Researchers studied 1,625 people in northern Manhattan with an average age of 69, testing them with two well-validated tests of mental acuity. They also tested their blood for “infectious burden” — their degree of exposure to five common viruses and bacteria: cytomegalovirus, herpes 1 and 2, Helicobacter pylori, and Chlamydia pneumoniae. The study appeared online in Neurology. ... http://well.blogs.nytimes.com/2013/03/29/infections-tied-to-cognitive-decline/ ****************** FDA warns of potentially fatal arrhythmias with azithromycin On March 12, 2013, the U.S. Food and Drug Administration (FDA) strengthened the warning for QT interval prolongation and torsades de pointes, a potentially fatal heart rhythm, associated with azithromycin (Zithromax or Zmax). http://healthcommedia.benchmarkmails26.com/c/l?u=21DC719&e=2944BF&c=F275&t=0&l=242D6A&email =khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ******************* (Since I am so very late with the Newsletter, I am not sure if any of the below still is available. Should be on time in June) National Nurses Week page each day from May 6th to May 12th for details on offers such as: Free CE credits, including a Joanna Briggs Institute Best Practice CE activity Free articles Free Take5 resource on laboratory values related to fluids and electrolytes http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52C6:B54AB34282EDAD004590D7C92BFD7A5A50CB97921045BA00&; It is not enough to base practice on one research study. A critical analysis of available research, putting the findings in the context of your organization, and adding the perspectives and judgment of clinicians and patients is imperative for true evidence-based practice. New articles have been added to help you in Understanding Evidence-Based Practice. http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52D4:B54AB34282EDAD004590D7C92BFD7A5A50CB97921045BA00&; ********************* Robotic Surgery Tied to Temporary Nerve Injuries (Reuters Health) - One in 15 people undergoing robot-assisted prostate, kidney or bladder surgery develops a nerve injury related to pressure from positioning on the operating table, a new study suggests. Patients on the table getting those types of robotic surgery need to be tilted steeply - with their head by the floor and their feet in the air - to give the surgeon better traction, researchers explained. "When somebody is in that position, there's a chance they could slide down - it's like a big ramp," said lead author Dr. Tracey Krupski, from the University of Virginia School of Medicine in Charlottesville. "When you slide, you then could be pulling, or having the drag on some of the nerves. It's like a constant pulling on the muscle." Earlier this month, the Food and Drug Administration announced it would be taking a closer look into safety reports regarding da Vinci surgical robots, made by Intuitive Surgical. The robots cost about $1.5 million each. http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNDAxLjE3MjQ4NzQxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDQwMS4xNzI0ODc0MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MDYzMTQ2JmVtYWlsaWQ9cm5mcmFua2llQGFvbC5jb20mdXNlcmlkPXJuZnJhbmtpZUBhb2wuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&134&&&http://www.nlm.nih.gov/medlineplus/news/fullstory_135431.html ******************** (If someone tries this.........please let me know. It sounds good, but ....) Chinese herbs may reduce hot flashes (Reuters Health) - Women taking a Chinese herbal formula experienced less than half the number of menopausal hot flashes they had before the treatment, according to a new study from Hong Kong. Among women taking an herbal mix called Er-xian decoction (EXD), the frequency of daily hot flashes dropped by 62 percent, compared to a 52-percent drop seen among women taking a placebo. "It's a modest effect, but not a zero effect," said Katherine Newton, a researcher who has studied herbal menopause therapies at the Group Health Research Institute in Seattle. Newton, who was not involved in the research, said she'd want to see more, long-term studies demonstrating that these herbs are safe before she would recommend them to women, but that the current study makes EXD look promising as an alternative menopause treatment. ... http://links.reuters.com/r/ASTCI/UQ6Q6/ZGZPD6/TPPRXR/OFJ8OY/YT/h?a=http://links.reuters.com/r/ASTCI/UQ6Q6/ZGZPD6/TPPRXR/LSQHBQ/YT/h ******************** RANDOM FACT: Why do dimes, quarters and half dollars have notches around their edges, while pennies and nickels do not? The US Mint began putting notches on the edges of coins containing gold and silver to discourage holders from shaving off small quantities of the precious metals. Dimes, quarters and half dollars are notched because they used to contain silver. Pennies and nickels aren't notched because the metals they contain are not valuable enough to shave. ************ Bonus Fact: Why are zero scores in tennis called 'love'? In France, where tennis first became popular, a big, round zero on scoreboard looked like an egg and was called 'l'oeuf,' which is French for 'egg.' When tennis was introduced in the U.S., Americans pronounced it 'love.' ************** (Found this poem, and just had to share it) Not how did he die, but how did he live Not what did he gain, but what did he give? These are the units to measure the worth Of a man as a man, regardless of birth. Not what was his church, nor what was his creed? But had he befriended those really in need? Was he ever ready, with word of good cheer, To bring back a smile, to banish a tear? Not what did the sketch in the newspaper say, But how many were sorry when he passed away? ----Author Unknown---- ******************* This year’s theme is “Patient Safety 7/365: 7 days of recognition, 365 days of commitment to safe care.” Here are some patient safety facts from the World Health Organization (WHO): 1 in 10: As many as one in 10 patients in developed countries is harmed while receiving hospital care. 20: The risk of healthcare-associated infection in some developing countries is as much as 20 times higher than in developed countries. 1.4 million: At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals. 50%: Problems associated with surgical safety in developed countries account for half of the avoidable adverse events that result in death or disability. 1 in 1,000,000: The chance of a traveller being harmed while in an aircraft. 1 in 300: The chance of a patient being harmed during health care. Source: World Health Organization Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ********************* Chick-fil-A *** In 1946, an Atlanta-area restaurant called the Dwarf Grill began to serve chicken breast sandwiches, which, surprisingly, seems not to have been done elsewhere or earlier. Proprietor Truett Cathy thus holds claim to being the inventor of the treat, which he called "Chick-fil-A," a play on the work "fillet." Cathy established the first restaurant to bear the name in an Atlanta Mall. Today, there are more than 1,500 outlets across the country. ********************* Thank you , Laregis for this great link! She writes: "It's amazing what they are doing these days with these smart phones...." Click: iDoctor http://www.youtube.com/watch_popup?v=r13uYs7jglg ************* Quiz Time When taking clopidogrel, patients who are poor CYP2C19 metabolizers are at increased risk for: a. rhabdomyolysis. b. stroke. c. dyslipidemia. d. lung cancer. Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 (Answer at end of Newsletter) ******************* Fluid and electrolyte imbalances can quickly turn into life-threatening situations and it is critical to be able to recognize subtle signs and symptoms and intervene appropriately. Test your knowledge of fluids and electrolytes by answering the following questions: What are the major organs involved in electrolyte and fluid homeostasis? What medications can cause hypernatremia? What are the recommended treatments for dilutional hyponatremia? What is the relationship between calcium level and phosphorous level? Which medication, commonly given in CCUs, is contraindicated in patients with hypokalemia? Check your answers and learn more by exploring the articles in More Resources. Also, we now have a new collection, Focus On: Fluids & Electrolytes, which includes a variety of articles, CE, and special features all about fluid and electrolytes! http://email.lww.com/t?r=1483&c=3480712&l=59027&ctl=4661F84:B54AB34282EDAD00F9F852C93A3ECCCEBB9E742C260FE2D0&; ******************** The vernal equinox happens every March 20 or 21. RANDOM FACT: "Vernal" is Latin for "spring" and "equinox" is Latin for "equal night." There are two equinoxes every year � vernal and autumnal. Those two days are the only times during the year when the sunrise is due east and the sunset is due west. *** Bonus Facts: Ancient Egyptians built the Great Sphinx to point directly East toward the sunrise on the vernal equinox. Stonehenge in England also marks the position of the rising sun on the vernal equinox. ********************* An Important Step Forward in Addressing the Rare Disease Health Crisis April 23, 2013 (Huffington Post) - We have a health crisis on our hands, and we're finally taking strides to make a difference. The way we are doing so: The Rare Disease Impact Report. http://enews.hcplive.com/c.html?ufl=4&rtr=on&s=lwo0yi,112aj,1qvv,bzse,22yh,6o8t,78ko ********************* White Paper Lists Several Recommendations To Speed Up Orphan Drug Approval April 24, 2013 (Rare Disease Report) - A search of orphan drugs designated by the FDA for the treatment of duchenne muscular dystrophy (DMD) yields 27 drugs. When you repeat the search for approved orphan drugs for the treatment of DMD, zero drugs appear. And that discrepancy was the stimulus for the patient organization Parent Project Muscular Dystrophy (PPMD) to issue a white paper ... http://enews.hcplive.com/c.html?ufl=4&rtr=on&s=lwo0yi,112aj,1qvv,7ns7,ork,6o8t,78ko ********************* No difference in survival rates between teaching and nonteaching hospitals for patients with acute MI A study published in Academic Medicine has found no survival benefit for patients with acute myocardial infarction (MI) who are admitted to teaching hospitals, rather than nonteaching hospitals. Read more. http://healthcommedia.benchmarkmails26.com/c/l?u=242EDCA&e=2BEA28&c=F275&t=0&l=242D6A&email=khDcrWqjAkeIKbHcHZqq5QSXAE%2FMRK6o ********************** Posted: Apr 29, 2013 - Joint Commission Announces Accreditation of DaVita Inpatient Dialysis Units - For the first time, The Joint Commission has awarded Ambulatory Health Care Accreditation to an inpatient kidney care provider DaVita Hospital Services. Denver based DaVita, with nearly 700 sites located in Joint Commission-accredited hospitals across the U.S., is a division of DaVita HealthCare Partners Inc. http://www.jointcommission.org/joint_commission_announces_accreditation_davita_inpatient_dialysis_units/ ************ (If anyone has encountered Naval Corpsmen, as I have, you know their knowledge and their capabilities are excellent) HHS launches nursing program for veterans HHS' Health Resources and Services Administration has introduced a program aimed at training military medics and other veterans with medical backgrounds for careers in nursing. The agency will provide as much as $350,000 each to as many as nine nursing schools annually. The program "helps veterans formalize their skills to get jobs, while strengthening Americans’ access to care," HHS Secretary Kathleen Sebelius said. Nurse.com http://r.smartbrief.com/resp/eudTDrrXoMfJaTkgfDcXdUfCZVrR?format=standard ~~**~~**~~**~~**~~**~~ HUMOR SECTION All of us, at one time or other, have had difficult patients who could never be satisfied. This nurse had such a patient and the patient's doctor was sympathetic with the nurse. He ordered ... soapsuds enema..an enema that the nurse detested. Seeing her face, he asked what was the problem. Once he heard her explanation, he asked her when was her shift over. "1900 hrs", she answered. The doc then ordered the SS enema at HS (Hour of sleep). (what a perfect solution) ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as Dr Robert Hess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx Your role in redesigning health care http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52C8:B54AB34282EDAD004590D 7C92BFD7A5A50CB97921045BA00& Advancing the science of nursing and improving the quality of care: http://email.lww.com/t?r=1483&c=3517191&l=59027&ctl=46F52C9:B54AB34282EDAD004590D 7C92BFD7A5A50CB97921045BA00& ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.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/ The Nursing Site http://thenursingsite.com . http://www.snopes.com http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Anticoagulant Citrate Phosphate Dextrose Solution, USP (CPD) BLOOD-PACK Unit By Fenwal: Recall - Labeling Issue Identified Fenwal has initiated a voluntary Urgent Product Recall of one lot (FM13A15027) of product code 4R1584, Anticoagulant Citrate Phosphate Dextrose Solution, USP (CPD) BLOOD-PACK unit. Fenwal identified a labeling issue with this batch of Product Code 4R1584 in which the platelet container is incorrectly labeled as “AS-1 Red Blood Cell Adenine-Saline added”. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350275.htm ******************** Samsca (Tolvaptan): Drug Safety Communication - FDA Limits Duration and Usage Due To Possible Liver Injury Leading to Organ Transplant or Death. FDA has determined that the drug Samsca (tolvaptan) should not be used for longer than 30 days and should not be used in patients with underlying liver disease because it can cause liver injury, potentially leading to liver transplant or death. FDA has worked with the manufacturer to revise the Samsca drug label to include new limitations. BACKGROUND: Samsca is a selective vasopression V2-receptor antagonist indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia, including patients with heart failure and Syndrome of Inappropriate Antidiuretic Hormone (SIADH). An increased risk of liver injury was observed in recent large clinical trials evaluating Samsca for a new use in patients with autosomal dominant polycystic kidney disease (ADPKD). http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350185.htm ******************** Piperacillin and Tazobactam for Injection, USP 40.5 grams: Recall - Precipitation or Crystallization in IV Bag or IV Line Upon Reconstitution Apotex Corp. notified healthcare professionals it is conducting, on behalf of the manufacturer Hospira, Inc., a voluntary nationwide recall of 15 lots of Piperacillin and Tazobactam for Injection, USP 40.5 grams, to the hospital/healthcare provider/user level. The impacted lots may show precipitation/ crystallization in IV bag or IV line after reconstitution. The product can also be identified by NDC number 60505-0773-00 and UPC 360505077304. The product was distributed nationwide in the United States to wholesalers, distributors, HMOs, home infusion and long term care service providers. See Press Release for a list of affected lot numbers Hospira stated that administration of precipitated Piperacillin/Tazobactam in an IV bag or IV line may result in local reactions such as phlebitis, renal impairment, end-organ embolism and ischemia, and/or vasculitis (because the precipitate was visible, its particles may be large enough to cause these adverse events). In addition, the precipitation of the drug may not allow delivering a needed therapeutic dose of piperacillin and tazobactam, thus resulting in inadequate treatment of the targeted infection. This could result in adverse health consequences that could range from transient and minor impairment or complaints to permanent impairment of a body function or permanent damage to a body structure. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm350085.htm ******************** CareFusion Corporation, Alaris PC Unit (Model 8015) with Software Version 9.12 Recall Class: Class I Date Recall Initiated: March 6, 2013 Product: Alaris PC Unit (Model 8015) with Software Version 9.12 This product was distributed from Sept. 21, 2012 through March 5, 2013. Use: The Alaris PC unit (model 8015) is part of the Alaris electronic infusion pump. An electronic infusion pump delivers controlled amounts of medications or other fluids to patients through intravenous (IV), intra-arterial (IA), epidural, and other acceptable routes of administration. Recalling Firm: CareFusion Corporation 3750 Torrey View Court San Diego, California 92130-2622 Reason for Recall: CareFusion has received reports of a communication error on the Alaris PC unit (model 8015) with software version 9.12 when the Alaris EtCO2 module or Alaris SpO2 module is attached. Use of this product may cause serious adverse health consequences, including death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm349002.htm ************* Potiga (Ezogabine): Drug Safety Communication - Linked To Retinal Abnormalities And Blue Skin Discoloration FDA is warning the public that the anti-seizure medication Potiga (Ezogabine) can cause blue skin discoloration and eye abnormalities characterized by pigment changes in the retina. FDA does not currently know if these changes are reversible. FDA is working with the manufacturer to gather and evaluate all available information to better understand these events. FDA will update the public when more information is available. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm349847.htm ************* Eba Multivitamin Supplement By Saratoga Therapeutics LLC: Recall - Allergy Alert On Undeclared Milk Components Saratoga Therapeutics, LLC of North Wales, PA recalled 900 bottles of ebA Multivitamin Supplement because they may contain undeclared milk components – milk protein(s) and lactose. The label lists the product as being free of milk components. People with an allergy or severe sensitivity to milk run the risk of a serious or life-threatening allergic reaction and people who have lactose intolerance run the risk of gastrointestinal symptoms if they consume ebA Multivitamin Supplement. Affected lot numbers include #0912164 expiration date 12/12 and #1110354 expiration date 10/14. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm349706.htm ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ NOTICE: I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number. So please send me your new name/address, okay? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY "Time is the coin of your life. It is the only coin you have, and only you can determine how it will be spent. Be careful lest you let other people spend it for you.” - Carl Sandburg Answer to Quiz Time: Correct answer: b. Drug effectiveness for clopidogrel depends on activation of the drug to an active metabolite by a CYP45O enzyme called CYP2C19. Poor CYP2C19 metabolizers are at increased risk for major cardiovascular events such as heart attack, stroke, and cardiovascular death. Hey, why don't you write? ..... Frankie RNFrankie@AOL.com