Friday, August 8, 2008

PARADIGM BYTES......August 8, 2008

PARADIGM BYTES
Newsletter for Paradigm 97
August 8, 2008


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/

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

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Please drop in . the Paradigm97 chatroom is always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends in for a little chat. Let me know if you want others involved. PARADIGM97

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SNIPPETS

Overweight and Obesity in nurses, advanced practice nurses, and nurse educators ( A summary)
Purpose: To quantify the incidence of overweight and obesity in nursing professionals and assess nurses’ knowledge of obesity and associated health risks.

Data sources: A mailed survey to 4980 randomly selected registered nurses from one state in each of six geographic regions. Response rate was 15.5% (n = 760). Descriptive statistics were calculated for continuous variables; categorical variables were summarized with frequency counts.

Results: The grand mean body mass index (BMI) of nurses surveyed was 27.2. Almost 54% were overweight or obese. Fifty-three percent of these nurses report that they are overweight but lack the motivation to make lifestyle changes. Forty percent are unable to lose weight despite healthy diet and exercise habits. Only 26% of respondents use BMI to make clinical judgments of overweight and obesity. Although 93% of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, 76% do not pursue the topic with overweight and obese patients.

Discussion: Many nurses provide weight-related health information to the public. These data suggest that they may benefit from continuing education on obesity and its risks. Because 76% of nurses do not pursue the topic of obesity with patients, they may benefit from education on pursuing sensitive topics during a professional encounter. Nurse practitioners may play a key role in the education of both patients and registered nurses....

Reference: Miller SK et al. - The grand mean body mass index (BMI) of nurses surveyed was 27.2. Almost 54% were overweight or obese. Fifty-three percent of these nurses report that they are overweight but lack the motivation to make lifestyle changes. Forty percent are unable to lose weight despite healthy diet and exercise habits. Only 26% of respondents use BMI to make clinical judgments of overweight and obesity. Although 93% of nurses acknowledge that overweight and obesity are diagnoses requiring intervention, 76% do not pursue the topic with overweight and obese patients. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1745-7599.2008.00319.x

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FROM A MEMBER

I would appreciate your help with spreading the word about the opportunities. Bender Consulting has a deep commitment to employing people with disabilities. I did a radio interview with Joyce Bender, the founder, on her radio show "Disability Matters". I have been working with Bender for quite a while in
an effort to find more positions for nurses with disabilities. Donna

Bender Consulting is actively recruiting nurses with disabilities for Telephone Triage Positions

Immediate need for nurses in IN, CA, GA, CT, OH, TN , St. Louis and Denver area (positions are available in other states as well). Applicant must have a current RN license with no restrictions and be willing
to work 40 hrs/week at the job site. Excellent telephone/voice skills needed. Starting salary is 30,000 – 45,000 with full benefits paid by the employer.
Nurses need to call Brandon Kazmierczak at (412) 446-4451.
_BKazmierczak@benderconsult.com_ (mailto:BKazmierczak@benderconsult.com)
_www.benderconsult.com_ (http://www.benderconsult.com )

Donna Maheady, Ed.D., ARNP (561) 627-9872, (561) 776-9254 (Fax), (561) 776-9442 (TTY)
Founder and President (http://www.exceptionalnurse.com/ ) Donations accepted with "Exceptional" thanks! Author of Nursing Students with Disabilities Change the Course, winner of the AJN 2004 Book of the Year Award, available at _www.epbookstore.com_ (http://www.eplibrary.com/) and Leave No Nurse Behind: Nurses Working with disAbilities available at _www.iuniverse.com_ (http://www.iuniverse.com/) .

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INTERESTING READING

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

ABSTRACT This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.
http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2338330/?user_id=157159&email=rnfrankie@aol.com&news_id=414&subspec_id=59
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TODAY'S RANDOM FACT... The smallest island with country status is Pitcairn in Polynesia,
at just 1.75 sq. miles/4,53 sq. km.
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Workplace Safety and Needlestick Injuries Are Top Concerns for Nurses News release from the American Nurses Association
http://www.nursingworld.org /FunctionalMenuCategories/MediaResources/PressReleases/
2008PR/WorkplaceSafetyTopConcerns.aspx
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LONDON (Reuters 6/24) - Study shows benefits of "sunshine vitamin. People with a vitamin D deficiency are as much as twice as likely to die compared to people whose blood contains higher amounts of the so-called sunshine vitamin, Austrian researchers said on Monday.
Their study -- the latest to suggest a health benefit from the vitamin -- showed death rates from any cause as well as from heart-related problems varied greatly depending on vitamin D.

"This is the first association study that shows vitamin D affects mortality regardless of the reason for death," said Harald Dobnig, an internist and endocrinologist at the University of Graz in Austria who led the study.... http://www.reuters.com/article/healthNews/idUSL2324003720080624?feedType=nl&feedName=ushealth1100

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Staff grocery store makes a difference at nursing home One weekend a couple of years ago, Barry Berman 's children were coming home from college. In preparation for their visit, his wife asked him to pick up extra boxes of cereal at the store on his way home. Unsure of what to buy, Berman grabbed six boxes and went to the checkout. When the bill came to $35, he couldn't believe it. This experience made Berman realize that buying something as basic as cereal might be a struggle for many employees at the Chelsea (MA) Jewish Nursing Home, where he has served as administrator for 30 years. "If an employee is making $18 an hour, [he or she] would have to work two hours to pay for the cereal I had just bought," he says. http://www.cltcmag.com/content_detail.cfm?content_id=214100
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Wisconsin sets up wound care certification program The state of Wisconsin announced the development of a collaborative effort between multiple organizations to certify 200 of the state's registered nurses (RNs) in long-term care to become certified pressure ulcer specialists, according to a state Department of Health and Family Service press release. RNs will be able to sign up for week-long certification courses beginning in the fall. The cost will be $1000 per RN—the rest of the cost, calculated to be $2,500, is covered by the multiple organizations sponsoring this initiative. http://tinyurl.com/6hs2a3 (I really wish this were nationwide)
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Evaluation of Online Education About Diabetes Management in the School Setting ABSTRACT: There are a variety of initiatives to provide education to improve the quality of care for children with diabetes in the school setting. This study piloted and evaluated an online continuing education program for school nurses about diabetes management for children in schools using current practice principles. The evaluation determined if objectives of the program were met, if participants believed the education provided would enhance their ability to manage children with diabetes, and participants' opinions about the online delivery method. Nineteen participants were recruited from among school nurses unable to attend statewide face-to-face diabetes workshops. The majority reported that the objectives were met, and 91% reported the education would enhance their ability to manage students with diabetes. Whereas 33% preferred online continuing education, 17% preferred face-to-face education, and 50% were unsure. Because of the increasing prevalence of diabetes in children, it is important that school nurses have access to continuing education that provides current principles for diabetes management for children. The method of delivery should be determined by the learner's learning style preferences. http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2297839/?user_id=157159&email=rnfrankie@aol.com&news_id=414&subspec_id=59
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TODAY'S RANDOM FACT... Cats have 30 vertebrae (humans have 33 vertebrae during early development; 26 after the sacral and coccygeal regions fuse).

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Stem Cells Might Treat Tough Fractures June 17 (HealthDay News) -- Adult stem cell transplants can help improve healing of fractures, a finding that may lead to new treatments for the 10 percent to 20 percent of people whose broken bones fail to mend, say researchers at the University of North Carolina at Chapel Hill.

Adult stems cells are specialized cells that can regenerate damaged tissue, but many patients lack sufficient numbers of these cells, which means they can't heal properly, the researchers explained.

The UNC team used adult stem cells to heal fractures of the tibia in mice. The bone marrow-derived stem cells were engineered to express insulin-like growth factor 1 (IGF-1), which help bones grow in strength and size. The transplanted stem cells migrated to the site of the fracture and improved healing by increasing the bone and cartilage that bridged the break. ... http://yourtotalhealth.ivillage.com/Stem+Cells+Might+Treat+Tough+Fractures.html?nlcid=pa06-25-2008 ********************
New Weapon for Fibromyalgia Only One Other Drug Cleared for This Common Condition The U.S. Food and Drug Administration has just approved an antidepressant to treat fibromyalgia.(cymbalta) Only one other drug, an anticonvulsant, has been specifically approved for this common chronic pain condition. Sometimes doctors prescribe other medications, such as painkillers or sleeping pills. The many other treatment options include exercise, nutrition, massage, heat and biofeedback. Learn more about fibromyalgia and its treatment, and the benefits and risks of antidepressants. And get advice from the Fibromyalgia & Chronic Fatigue Syndrome and Pain Issues Support message boards. http://yourtotalhealth.ivillage.com/Cymbalta+Approved+for+Fibromyalgia.html?nlcid=pa06-25-2008
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(Reuters 7/8 ) - Cancer Death drop tied to Education Levels Declines in death rates from the four leading types of cancer in the United States since the early 1990s have been driven largely by progress among college-educated men and women, researchers said on Tuesday.
The study, published in the Journal of the National Cancer Institute, was the latest to illustrate how a person's health can be closely tied to socioeconomic factors such as education and income level.Declines in death rates from the four leading types of cancer in the United States since the early 1990s have been driven largely by progress among college-educated men and women, researchers said on Tuesday.... http://www.reuters.com/article/healthNews/idUSN0830394220080708?feedType=nl&feedName=ushealth1100
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Human genome changes with age WASHINGTON (AFP) - Individual human genomes change throughout a person's life influenced by environmental or nutritional factors which may explain why illnesses such as cancer come with age, a study said Tuesday. Researchers at Johns Hopkins University found that the so-called epigenetic marks on the sequence of a person's DNA modify over the course of their life and the extent of such changes is similar among family members.
"We're beginning to see that epigenetics stands at the center of modern medicine because epigenetic changes, unlike DNA sequence which is the same in every cell, can occur as a result of dietary and other environmental exposure," said Andrew Feinberg, professor of molecular biology and genetics at the university.... http://news.yahoo.com/s/afp/20080624/hl_afp/healthusgenome_080624200559

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Internet-based care aids blood pressure control NEW YORK (Reuters 6/24 ) - Advice and medications delivered via the internet, along with home blood pressure (BP) monitoring, lets people with high blood pressure get their condition under control, researchers have report in this week's Journal of the American Medical Association.

Dr. Beverly B. Green, at the University of Washington in Seattle, and colleagues tested whether high blood pressure could be managed over the Internet without the need for visits to a doctor.

"Our demographic was middle-aged, working people for whom Web-based care is particularly convenient, particularly for reporting BP numbers and simple or structured communications," Green told Reuters Health.... http://news.yahoo.com/s/nm/20080624/hl_nm/blood_pressure_control_dc

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TODAY'S RANDOM FACT... The highest point in Pennsylvania is lower than the lowest point in Colorado.

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The Los Angeles poetry magazine RATTLE has placed a remarkable "Tribute to Nurses" in its Winter 2007 issue. The 45-page tribute includes only work by nurses: 24 poems and four essays. The essays discuss the relation between nursing and poetry, and how the writer has come to pursue both. Calling this material a "tribute" almost does it a disservice.... http://www.nursingadvocacy.org/media/books/rattle.html

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New Safety standards set for baby formula and nuts GENEVA (Reuters 7/1) - Diplomats in Geneva have agreed new limits for bacteria in baby formula and natural toxins in nuts, setting safety standards to apply for internationally shipped food, the World Health Organisation said on Tuesday. At a meeting of the Codex Alimentarius Commission, a joint body of the WHO and the Food and Agriculture Organisation (FAO), officials also set benchmarks for producing gluten-free foods.

Peter Ben Embarek, a scientist in the WHO's food safety division, said the adoption of the "landmark" code of hygienic practices for powdered formula could reduce contamination from two bacteria that can cause severe illness and death in babies.... http://www.reuters.com/article/healthNews/idUSL0166682420080701?feedType=nl&feedName=ushealth1100

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TODAY'S RANDOM FACT... It's estimated that at any one time amount 0.7% of the world's population is drunk.
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(Reuters 7/8/08) - Keeping a food diary -- a detailed account of what you eat and drink and the calories it packs -- is a powerful tool in helping people lose weight, U.S. researchers said on Tuesday. The study involving 1,685 middle-aged men and women over six months found those who kept such a diary just about every day lost about twice as much weight as those who did not.

The findings buttressed earlier research that endorsed the value of food diaries in helping people lose weight. Companies including Weight Watchers International Inc use food diaries in their weight-loss programs.... http://www.reuters.com/article/healthNews/idUSN0741885020080708?feedType=nl&feedName=ushealth1100

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ATLANTA, Georgia (CNN) -- Teen pregnancies rose in the United States for the first time since 1991, the National Institutes of Health reported Friday.The new data also show that eighth-graders smoke less, according to the report "America's Children in Brief: Key National Indicators of Well-Being 2008."

The report comes after a spate of high-profile teen pregnancies: that of 17-year-old TV star Jamie Lynn Spears, who recently gave birth to a daughter, as well as the pregnancies of numerous students at Gloucester High School in Massachusetts.

Federal health experts said they don't know why the teen pregnancy numbers went up from 2005 to 2006, and that not enough data have been collected to say whether it's a trend.

"It may be a blip in the data, and it may come down," Edward J. Sondik, Director of the National Center for Health Statistics in the Centers for Disease Control and Prevention, said.... http://www.cnn.com/2008/HEALTH/07/10/teen.pregnancy/index.html

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ACLU urges Congress to define medical privacy as patient control of electronic health records The American Civil Liberties Union today urges the House Energy and Commerce Committee to require patient control of medical records and compensation for privacy breaches to be a part of the standards set for converting to electronic patient records.... http://www.news-medical.net/?id=40219

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Many Women Struggle with Uncontrolled blood Pressure (HealthDay News) -- Nearly one in three Americans suffers from high blood pressure -- more than 73 million adults.But half of them -- women -- face unique challenges in controlling their blood pressure.

For instance, women with high blood pressure are more likely to be obese and have high cholesterol levels. They're also less likely than men to meet target goals for their blood pressure. And they're also less likely than men to receive medications such as aspirin, blood pressure-lowering drugs or cholesterol-lowering drugs, compared to men, recent research found.... (http://news.yahoo.com/s/hsn/20080716/hl_hsn/manywomenstrugglewithuncontrolled
bloodpressure)

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TODAY'S RANDOM FACT... A pound of potato chips costs 200 times more than a pound of potatoes.

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(Please note the previous item about teenage pregnancies lol )
Risky Sexual Behaviors Decreasing Among U.S. Teens THURSDAY, July 31 (HealthDay News) -- In the past 17 years, there has been an overall decrease in risky sexual behaviors among U.S. teens, a new government study shows.

The rates of having sexual intercourse or multiple sex partners have been dropping, while the use of condoms has been increasing, U.S. health officials reported Thursday.

However, the rates of risky sexual behaviors among some groups, including blacks and Hispanic students, hasn't changed since the 1990s, according to this week's issue of Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.

"Progress has been made in the last 17 years in decreasing kids' risk for HIV- and STD-related infections," said study co-author Laura Kann, chief of CDC's Surveillance and Evaluation Research Branch in the Division of Adolescent School Health. "However, despite the positive changes, many students still engage in HIV- and STD-related risk behaviors." ... http://www.forbes.com/forbeslife/health/feeds/hscout/2008/07/31/hscout618020.html

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Announcement From the National Nurse Organization - We are pleased to announce yesterday’s publication of “Nurses and the Public Say It Is Time for Change” Here is the direct link for those of you who subscribe to Medscape. http://cmsprepub.medscape.com/viewarticle/576695 This article is likely to reach several hundred thousand nurses who may not be familiar with the Office of the National Nurse initiative. Please share it with your political leaders to assure nurse-led prevention is a priority that is included in their healthcare platforms. Also, please be sure to vote in the Medscape poll, asking whether an Office of the National Nurse, similar to the Surgeon General’s position should be developed, and add your a comment of your own. ... www.nationalnurse.org

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Viagra May Boost Female Libido in Some Cases (HealthDay News) -- The drug that turned around the sex lives of many older men has proven in a small trial to also help women on antidepressants who experience sexual dysfunction. The eight-week study found that Viagra, also known as sildenafil, helped women achieve orgasm.
"In this study population, sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects," the study's authors wrote. Results of the study are in the July 23/30 issue of the Journal of the American Medical Association. The lead author of the study, Dr. H. George Nurnberg, of the University of New Mexico School of Medicine, in Albuquerque, declined to be interviewed for this article.

Selective and nonselective serotonin reuptake inhibitors, such as Prozac, Paxil, Zoloft and Effexor, comprise up to 90 percent of the 180 million antidepressant prescriptions filled in the United States each year, according to the study. But while these medications are very effective at treating clinical depression, one of their known drawbacks are sexual side effects .... http://yourtotalhealth.ivillage.com/viagra-may-boost-female-libido-in-some-cases.html?nlcid=wh07-29-2008

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TODAY'S RANDOM FACT... Oak trees do not have acorns until they are fifty years old or older.

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NEW YORK (Reuters 7/14) - Scientists have found evidence that a mutation in a gene called CALHM1 that results in abnormal calcium signaling influences the risk of Alzheimer's disease, a devastating neurodegenerative disease that affects nearly 18 million people in the world.

"CALHM1 is an attractive new drug target," Dr. Fabien Campagne from Weill Medical College of Cornell University, New York, told Reuters Health. "The design of drugs that activate CALHM1 could have a beneficial effect in patients who do not have the polymorphism (mutation), as well as in patients who carry the polymorphism."

The CALHM1 mutation is associated with the late-onset form of Alzheimer's disease. This form of the disease affects people age 65 and older and represents about 90 percent of Alzheimer's cases. The rarer early-onset inherited form of the disease affects people from about age 30 to 65.... http://www.reuters.com/article/healthNews/idUSCOL16744020080714?feedType=nl&feedName=ushealth1100

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NEW YORK (Reuters 7/11) - Children adopted from overseas may harbor tuberculosis infection even if they test negative for TB upon arriving on US soil, a new report warns. "It's important to get that repeat tuberculosis skin test done so you don't miss those children with TB infection that could go on to develop disease," Dr. Mary Allen Staat of the Cincinnati Children's Hospital Medical Center told Reuters Health.

People with latent (dormant) TB infection, she explained, are not sick and are not contagious, and treatment with a nine-month course of isoniazid will usually clear the infection. But once infection progresses to active disease, a person may become ill and can spread the disease to others. At this point, treatment is much more complex, requiring as many as four drugs.

The American Academy of Pediatrics recommends that all children adopted from countries where TB is endemic be tested soon after they arrive in the US, and suggests that children who test negative be retested later on if they are malnourished, Staat and her team point out in an article in Pediatrics this month. However, they also point out that no specific evidence justifying this recommendation has been published.... http://www.reuters.com/article/healthNews/idUSCOL16726820080711?feedType=nl&feedName=ushealth1100

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NEW YORK (Reuters 7/11) - Swiss pharmaceutical company Roche Holding AG will suspend its HIV research because none of its pending medicines represent significant improvement over existing drugs, a company spokeswoman said on Friday.

"Research scientists currently working in HIV will be reassigned to other activities," Linda Dyson, a spokeswoman in Roche's U.S. office in New Jersey, said in an e-mail.

Dyson confirmed an e-mail sent on Wednesday to some activists informing them of the decision. In that e-mail, the company said it "decided to refocus our resources within virology on diseases in which we can deliver substantial improvements over existing medications."

The company said in the e-mail to some activists that it initially had been excited about the potential for drugs in pre-clinical testing, but it has "concluded that none would provide a true incremental benefit for patients compared to medicines currently on the market."

Roche said it would continue to support its molecular diagnostic tests and drugs already on the market, including the fusion-inhibitor Fuzeon.... http://www.reuters.com/article/healthNews/idUSN1135940720080711?feedType=nl&feedName=ushealth1100

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MOSCOW (Reuters 7/14) - Dozens of partygoers at an outdoor rave near Moscow last week have lost partial vision after a laser light show burned their retinas, Russian health officials said on Monday. Moscow city health department officials confirmed 12 cases of laser-blindness at the Central Ophthalmological Clinic, and daily newspaper Kommersant said another 17 were registered at City Hospital 32 in the centre of the capital.

Attendees at the July 5 Aquamarine Open Air Festival in Kirzhach, 80 km (50 miles) northeast of Moscow, began seeking medical help days after the show, complaining of eye and vision problems, health officials told Reuters. "They all have retinal burns,... http://www.reuters.com/article/healthNews/idUSL1452972520080714?feedType=nl&feedName=ushealth1100

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Does Intestinal Resection affect the Absorption of Essential Vitamins, Minerals, and Bile Salts? An Overview of the Literature. Geraldine M. Lambert, RN, DBA, CWOCN

As the number of persons living long lives following ostomy and bowel resection surgery increases, so do their questions about the effect of surgery on chronic conditions commonly associated with aging. The literature was reviewed to evaluate current evidence about the effect of bowel resection on the absorption of vitamins and minerals and related health concerns such as osteoporosis, gallstones, and renal calculi. Present knowledge about the process of vitamin and mineral absorption in the intestine and clinical study results suggest that chronic inflammation and corticosteroid use may adversely affect absorption. In general, a history of bowel resection does not appear to increase the risk of developing osteoporosis, gallstones, or renal calculi and the body can adjust to losing significant sections of intestine. Strategies to help prevent the majority of long-term complications should be encouraged, including monitoring hydration and transit time, consuming low-digestible carbohydrates, and avoiding processed foods as well as agents with chelating properties. KEYWORDS: ostomy, nutrient absorption, osteoporosis, gallstones http://www.o-wm.com/article/8891

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Total Contact Casting as Part of an Adaptive Care Approach: A Case Study Karen Farid, RN, MA, CWON, CNS/ET; Mark Farid, MA, CO, BCP; and Claire M. Andrews, PhD, CNM, FAAN

Although total contact casting provides pressure relief and a moist wound-healing modality that allows patients to resume mobility while the wound is healing, it is not as widely used as it should be, in part because Board-certified pedorthists with relevant skills are scarce. As a result, clinicians may not appreciate the positive impact total contact casting has on the patient’s overall condition. This case study of a 75-year-old woman with a potentially life-threatening diabetic foot ulcer offers a comprehensive picture of pervasive physiological changes in a context of challenging comorbidities. This multifaceted case is presented against a backdrop of Sister Callista Roy’s nursing theory of adaptation and a total patient care approach to illustrate the cascading effects of diabetes on the patient’s well-being, as well as to show that total contact casting is not only an effective intervention in the management of the patient’s diabetic foot ulcer, but also a way to improve the patient’s overall condition by maximizing the benefits of mobility. KEYWORDS: total contact casting, Charcot foot, adaptational theory http://www.o-wm.com/article/8892

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The Essentials of HIV: A Review for Nurses Journal of Infusion Nursing 07/28/08 Petroll A et al. - This article describes epidemiologic trends in HIV and reviews HIV transmission, testing, and treatment. It also discusses the risk of HIV transmission to healthcare workers from occupational exposures and reviews the principles of postexposure prophylaxis used to reduce the likelihood of HIV transmission in appropriate circumstances.... Full Text available at:
. http://www.journalofinfusionnursing.com/pt/re/jinfusionnurse/abstract.00129804-200807000-00009.htm;jsessionid=LJdV0vjLHGCDcG2v9lMhWqx9yZsZZn3hL7mYhyqGNPyH8prvTSdn!932896411!181195628!8091!-1

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CHICAGO (Reuters 7/21) - Drug restores speech in Alzheimer's; experts worry Alzheimer's patients given a popular rheumatoid arthritis drug showed seemingly dramatic improvements in a small study, but some doctors worried that the early findings will raise premature hopes in patients and their families.

The study, reported on Sunday in the journal BioMed Central BMC Neurology, involved 12 patients who had greatly improved language recall shortly after treatment with Enbrel, or etanercept, an anti-inflammatory drug co-marketed by Amgen and Wyeth.

"We often see verbal effects within a few minutes of the first dose," said Dr. Edward Tobinick, director of the Institute for Neurological Research, a private medical group inc., in Los Angeles, who led the study.Alzheimer's patients given a popular rheumatoid arthritis drug showed seemingly dramatic improvements in a small study, but some doctors worried that the early findings will raise premature hopes in patients and their families.... http://www.reuters.com/article/healthNews/idUSN2033413820080721?feedType=nl&feedName=ushealth1100

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TODAY'S RANDOM FACT...A raisin dropped in a glass of fresh champagne will bounce up and down continuously from the bottom of the glsss to the top.

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CHICAGO (Reuters 7/14) - People age 75 or older recover just as well as younger patients from knee or hip replacements to correct the ravages of arthritis, researchers said on Monday. The finding adds to a growing body of evidence that age is not a barrier to such surgery, though the investigators found that many patients are not well-informed about this. The poor, they said, are often shut out... http://www.reuters.com/article/healthNews/idUSN1443018220080714?feedType=nl&feedName=ushealth1100

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Hand-washing kits help train staff to do a thorough job University Community Hospital in Tampa is using Medline's new portable Hand Washing Competency Validation Kit to help train staff to wash their hands properly. The kit uses a fluorescent marker with a waterless sanitizer: Staff clean their hands then put them under a black light to see if they missed any spots. Nurse.com (7/14) http://include.nurse.com/apps/pbcs.dll/article?AID=/20080714/FL02/107140030
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Comparison of Forearm and Upper Arm: Automatic, Noninvasive Blood Pressures in College Students Internet Journal of Advanced Nursing Practice, 07/22/08 Schell KA et al. - Despite placing the forearm and upper arm at heart level and using the proper sized BP cuff, forearm BP was not interchangeable with upper arm BP in college students. This finding suggests that differences found in upper arm and forearm BPs in earlier studies were not due to older age, obesity, or poor health status. These findings suggest that further research is needed to identify predictors of significant forearm-upper arm BP differences so that advanced practice nurses and other practitioners can correctly interpret forearm BPs. Free full text @
http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2335396/?user_id=157159&email=rnfrankie@aol.com&news_id=399&subspec_id=44
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TODAY'S RANDOM FACT... By recycling just one glass bottle, the amount of energy that is being saved is enough to light a 100 watt bulb for four hours.


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HUMOR SECTION
These are from a book called Disorder in the American courts, and are things people actually said in court, word for word, taken down and now published by court reporters that had the torment of staying calm while these exchanges were actually taking place.

ATTORNEY: Are you sexually active?
WITNESS: No, I just lie there.
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ATTORNEY: What gear were you in at the moment of the impact?
WITNESS: Gucci sweats and Reeboks.
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ATTORNEY: This myasthenia gravis, does it affect your memory at all?
WITNESS: Yes.
ATTORNEY: And in what ways does it affect your memory?
WITNESS: I forget.
ATTORNEY: You forget? Can you give us an example of something you forgot?
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ATTORNEY: What was the first thing your husband said to you that morning?
WITNESS: He said, 'Where am I, Cathy?'
ATTORNEY: And why did that upset you?
WITNESS: My name is Susan!
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ATTORNEY: Do you know if your daughter has ever been involved in voodoo?
WITNESS: We both do.
ATTORNEY: Voodoo?
WITNESS: We do.
ATTORNEY: You do?
WITNESS: Yes, voodoo.
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ATTORNEY: Now doctor, isn't it true that when a person dies in his sleep, he doesn't know about it until the next morning?
WITNESS: Did you actually pass the bar exam?
__________________________________ ________________________
ATTORNEY: The youngest son, the twenty-year-old, how old is he?
WITNESS: Uh, he's twenty.
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ATTORNEY: Were you present when y our picture was taken?
WITNESS: Are you shittin' me?
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ATTORNEY: So the date of conception (of the baby) was August 8th?
WITNESS: Yes.
ATTORNEY: And what were you doing at that time?
WITNESS: Uh.... I was gettin' laid!
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ATTORNEY: She had three children, right?
WITNESS: Yes.
ATTORNEY: How many were boys?
WITNESS: None.
ATTORNEY: Were there any girls?
WITNESS: Are you kiddin' me? Your Honor, I think I need a different attorney. Can I get a new attorney?
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ATTORNEY: How was your first marriage terminated?
WITNESS: By death.
ATTORNEY: And by whose death was it terminated?
WITNESS: Now whose death do you suppose terminated it?
__________________________________________________________
ATTORNEY: Can you describe the individual?
WITNESS: He was about medium height and had a beard.
ATTORNEY: Was this a male or a female?
WITNESS: Guess.
__________________________________________________________
ATTORNEY: Is your appearance here this morning pursuant to a deposition notice which I sent to your attorney? WITNESS: No, this is how I dress when I go to work.
__________________________________________________________
ATTORNEY: Doctor, how many of your autopsies have you performed on dead people?
WITNESS: All my autopsies are performed on dead people. Would you like to rephrase that?
_________________________________________________________
ATTORNEY: ALL your responses MUST be oral, OK? What school did you go to?
WITNESS: Oral.
_________________________________________ __________________
ATTORNEY: Do you recall the time that you examined the body?
WITNESS: The autopsy started around 8:30 p.m.
ATTORNEY: And Mr. Denton was dead at the time?
WITNESS: No, he was sitting on the table wondering why I was doing an autopsy on him!
_________________________________________________________
ATTORNEY: Are you qualified to give a urine sample?
WITNESS: Huh....are you qualified to ask that question?
____________________________ _____________________________
And the best for last:

ATTORNEY: Doctor, before you performed the autopsy, did you check for a pulse?
WITNESS: No.
ATTORNEY: Did you check for blood pressure?
WITNESS: No.
ATTORNEY: Did you check for breathing?
WITNESS: No.
ATTORNEY : So, then it is possible that the patient was alive when you began the autopsy?
WITNESS: No.
ATTORNEY: How can you be so sure, Doctor?
WITNESS: Because his brain was sitting on my desk in a jar.
ATTORNEY: I see, but could the patient have still been alive, nevertheless?
WITNESS: Yes, it is possible that he could have been alive and practicing law.

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

http://www.snopes.com/

www.nurse.com Pay Only $34.99 for a full year of CONTACT HOURS CE481 ·1.0 hr
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Heart failure: Managing systolic dysfunction (1 contact hour) Sherilyn A. Serdahl, RN, MS, CNP
The effective management of systolic dysfunction includes medication, lifestyle changes, and comprehensive patient education.

Pheochromocytoma: A rare tumor in adults and children (1 contact hour) Eden Tsegay, RN, MS, FNP-C; Grace Anyango, RN, MS, FNP-C; Sharon L. Van Sell, RN, EdD, PAHM; and Marilyn Miller-Anderson, RN, C, PhD This rare, life-threatening tumor requires quick recognition and intervention, including aggressive preoperative treatment to reduce mortality.
The danger next door: Methamphetamine (1 contact hour) Jason Clark, RN, CEN, PHRN
Crystal, glass, crank, ice, Tina. Patients who abuse methamphetamine add another dimension to nursing care. Here's making sure you're up to the challenge.

Beyond discharge: Impairment after critical illness (1 contact hour) Nancy Gruber, RN, BSN
Through assessment and education, we can help ensure that these problems are recognized, addressed, and perhaps averted.
12 months of unlimited CE from RN for a flat rate of $29.95!


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

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

http://www.snopes.com/

the National Nurse's new website: http://nationalnurse.org/

American Medical Directors Association Delirium and acute problematic behavior in the long-term care setting. This updates a previously published guideline summary.
http://www.guideline.gov:80/summary/summary.aspx?view_id=1&doc_id=12379

Diabetes management in the long-term care setting. This updates a previously published guideline summary. http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12382

Pressure ulcers in the long-term care setting. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12381

New Screening Tool for Dementia Checklist Gauges Ability of Older Adults to Perform Everyday Tasks Researchers have developed a quick and easy screening tool called Everyday Cognition (ECog), which can reveal changes in older adults' basic mental abilities over time based on information provided by the person's adult children, family members, or friends. By asking simple, but revealing questions relating to everyday life, the test can help doctors distinguish between adults with normal cognition, mild cognitive impairment, and dementia. http://www.webmd.com/alzheimers/news/20080702/new-screening-tool-for-dementia


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MEDICAL RECALLS
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FDA notified healthcare professionals that a BOXED WARNING and Medication Guide are to be added to the prescribing information to strengthen existing warnings about the increased risk of developing tendinitis and tendon rupture in patients taking fluoroquinolones for systemic use.

This risk of tendinitis and tendon rupture is further increased in those over age 60, in kidney, heart, and lung transplant recipients, and with use of concomitant steroid therapy. Physicians should advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their doctor about changing to a non-fluoroquinolone antimicrobial drug. Selection of a fluoroquinolone for the treatment or prevention of an infection should be limited to those conditions that are proven or strongly suspected to be caused by bacteria... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Fluoroquinolone

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Amgen and FDA informed healthcare professionals of modifications to certain sections of the Boxed Warnings, Indications and Usage, and Dosage and Administration sections of prescribing information for Erythropoiesis Stimulating Agents (ESAs). The changes clarify the FDA-approved conditions for use of ESAs in patients with cancer and revise directions for dosing to state the hemoglobin level at which treatment with an ESA should be initiated. Additional revisions to prescribing information that ESAs are not intended for use in patients receiving myelosuppressive therapy when the expected outcome is cure and when to initiate and discontinue ESA dosing will be forthcoming. FDA continues to encourage healthcare professionals to discuss with their patients before starting or continuing therapy with ESAs, the benefits of treatment with ESAs and the potential and demonstrated risks of ESAs for thrombovascular events, shortened time to tumor progression or recurrence, and shortened survival time.... http://www.fda.gov/medwatch/safety/2008/safety08.htm#ESA2

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EG Labs, LLC, notified consumers and healthcare professionals not to buy or use Viapro 375mg Capsules because one lot of the product was found to contain a potentially harmful undeclared ingredient, thio-methisosildenafil, an analog of sildenafil, a FDA approved product used to treat erectile dysfunction in men to enhance sexual performance. The undeclared ingredient may interact with nitrates found in some prescription drugs (such as nitroglycerin) and can lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take products containing nitrates. Consumers who have this product should discontinue using it and consult their healthcare professional if they experience any problems that may be related to taking Viapro. ... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Viapro

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Genentech informed healthcare professionals that an increased number of complaints were received regarding damaged and broken vials of Herceptin 440 mg and BWFI (bacteriostatic water for injection) diluent. The affected vials are NDC# 50242-0134-68, List # 15534. There is a risk that damaged vials may lead to a loss in sterility, which can cause infections in patients.

Healthcare professionals should inspect cartons of the product for signs of leakage, cracks and other damage to the vials, observe the vials during reconstitution, and check for loss of vacuum in the vials. See the manufacturer's letter for specific details and recommendations, including instructions in the event a compromised vial is discovered.... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Herceptin

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Levitronix CentriMag Extracorporeal Blood Pumping System: CentriMag Primary Console (with v200 Application Software) Levitronix and FDA notified healthcare professionals of a Class 1 recall of the Levitronix CentriMag Extracorporeal Blood Pumping System and Primary & Backup Consoles manufactured by Levitronix, GmbH, Zurich, Switzerland and distributed from January, 2001 through March, 2008. The Blood Pumping System is used to provide short-term extracorporeal circulatory support during cardiac and other types of surgeries. This device temporarily replaces the function of the heart and lungs in order to maintain the appropriate circulation of blood and oxygen levels in the body during the surgical procedure. A July 24, 2008 Levitronix device correction letter informed physicians not to use Valleylab Force FX-C or SSE2L electrosurgery devices with the CentriMag Blood Pumping System because use may result in stoppage of the pump and may cause serious injury or death. This recall action is an interim fix while the firm further investigates the source of the problem.... http://www.fda.gov/medwatch/safety/2008/safety08.htm#CentriMag

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Genentech, Inc. informed healthcare professionals of reports of several cases of microangiopathic hemolytic anemia (MAHA) in patients with solid tumors receiving Avastin in combination with sunitinib malate. Avastin is not approved for use in combination with sunitinib malate and this combination is not recommended. Twenty-five patients were enrolled in a Phase I dose-escalation study combining Avastin and sunitinib malate. The study consisted of 3 cohorts using a fixed dose of Avastin at 10mg/kg/IV every 2 weeks and escalating doses of sunitinib that included 25, 37.5, and 50 mg orally daily given in a 4 weeks on/ 2 weeks off schedule. Five of 12 patients at the highest sunitinib dose level exhibited laboratory findings consistent with MAHA. Two of these cases were considered severe with evidence of thrombocytopenia, anemia, reticulocytosis, reductions in serum haptoglobin, schistocytes on peripheral smear, modest increases in serum creatinine levels, and severe hypertension, reversible posterior leukoencephalopathy syndrome, and proteinuria. The findings in these two cases were reversible within three weeks upon discontinuation of both drugs without additional interventions. Healthcare professionals should report cases of MAHA or any serious adverse events suspected to be associated with the use of Avastin. http://www.fda.gov/medwatch/safety/2008/safety08.htm#Avastin

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Roxane Laboratories, Inc. informed healthcare professionals of the recall of two lots of Sodium Polystyrene Sulfonate Suspension, USP, 15 g/60 mL Unit dose bottles (NDC 0054-0165-51; lot 856396A Exp April 2010, and lot 856693A Exp May 2010), a product used to treat hyperkalemia. A sample of one of the affected lots tested positive for a strain of yeast, which could potentially affect immunocompromised patients. Symptoms of a yeast infection range from thrush, skin rash, and blood infections. If patients develop an infection they should consult their physician. Pharmacists should determine if any of the referenced product has been dispensed and retrieve it. Additionally, pharmacists and wholesalers of the product should discontinue distribution and use of the referenced lots immediately and contact the manufacturer regarding returning the product. http://www.fda.gov/medwatch/safety/2008/safety08.htm#SPSS
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FDA informed healthcare professionals of the possibility that x-rays used during CT examinations may cause some implanted and external electronic medical devices to malfunction. Most patients with electronic medical devices undergo CT scans without any adverse consequences. However, the Agency has received a small number of reports of adverse events in which CT scans may have interfered with electronic medical devices, including pacemakers, defibrillators, neurostimulators, and implanted or externally worn drug infusion pumps. FDA is continuing to investigate the issue and is working with the manufacturer to raise awareness in the healthcare community. See the FDA Public Health Notification for a description of adverse event reports and recommendations regarding reducing the potential risk to patients. http://www.fda.gov/medwatch/safety/2008/safety08.htm#ElectronicMedical
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NURSING HINTS CORNER

No more numb tongues

When treating a patient's sore throat with an anesthetic antiseptic like chloraseptic, you can easily get some of the spray on the patient's tongue. then the patient's throat may feel better, but he has the discomfort of a numb tongue.
To prevent a numb tongue, invert the bowl of a teaspoon over the patient's tongue and then spray his throat. The spoon not only protects his tongue from the spray, but also depresses the tongue so you can see the area of the throat that is red and sore. Linda Barker, RN

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 60,
Springhouse Corporation/www.springnetcom .


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

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This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php
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This ad is from Wendie (The Inservice guru)
The eLifeCard can save your life when seconds count! Carry this life-saving card in your wallet in case of emergency at home, at work, at school, traveling, or on vacation! NEW online estate planning system membership makes it possible for you to buy, upload, change and securely store your health care directive, allergies and medication lists, emergency contacts, and more. Exceptional package of other benefits. Give yourself and your family the gift of peace of mind. For FREE information, email name & phone number. All responses kept confidential and answered promptly.
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508-564-9556 (office) 915-990-1367 (fax)
whowland1@mac.com www.thefoundationnetwork.com


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NEW MEMBERS
No new members this issue
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

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NOTICE:
I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.......lol So please send me your new name/address, ok? RNFrankie@AOL.com

OLD ADDRESS: mharris555@cs.com

NEW ADDRESS: mharris555@comcast.net

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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


“For we who nurse, our nursing is something which,
unless we are making progress every year, every month, every
week, we are going back. No system shall endure which does not march.”

Florence Nightingale

Hope to see you online..... Frankie
(RNFrankie@AOL.com)

Wednesday, July 9, 2008

July Newsletter for Paradigm97


PARADIGM BYTES
Newsletter for Paradigm 97
July 10, 2008

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

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Please drop in . the Paradigm97 chatroom is always there....door open, lights on, waiting for you to come in. Check your Buddy List.....and invite your friends in for a little chat. Let me know if you want others involved.
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SNIPPETS

Part Three of Four--- Nursing comes of age In the early 1990s, nursing research was ready to come into its own, led by Ada Sue Hinshaw, RN, PhD, FAAN, the first permanent director of the National Center of Nursing Research. In 1993, the center was elevated into the National Institute of Nursing Research (NINR) at the National Institutes of Health, a huge coup for the nursing profession.“Nursing research advanced rapidly because of its legitimacy and credibility, stable funding, and the sense that nursing is a science that the NIH [designation] gave it,” says Hinshaw, who is the recently appointed dean of the Uniformed Services University of the Health Sciences Graduate School of Nursing in Bethesda, Md.Today, the NINR collaborates with other NIH institutes and centers in investigations to improve the nation’s health. In this endeavor, nurses have an important contribution to make because they bring both clinical and research expertise to the research table, Hinshaw says.“The whole discovery process is exciting because there is an outcome and a contribution to make at the end,” says Hinshaw. NINR-funded scientists are currently impacting nursing practice and promoting good health through studying how to prevent and control high blood pressure in young African-American men, helping youth to control their diabetes, and assisting Spanish speakers in self-management of chronic diseases. They also are involved in researching symptom management, including improving quality of life after organ transplantation, determining the role of gender in easing pain, supporting family caregivers, and reducing end-of-life symptoms and stresses. She advises nurses who have an idea or topic they would like to investigate, but who do not have research experience or a doctoral education, to contact local schools of nursing and ask to partner with a nurse researcher.“It’s through staff nurses who work with nurse researchers that we gain strong research programs because they know the issues at the bedside and ask the questions that are important to patients and families,” she says.
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Part Four of Four Driving Genetics Studies Forward Under the leadership of the current NINR director, Patricia A. Grady, RN, PhD, FAAN, the NINR has more than doubled the institute’s budget and significantly increased the number of nursing research and training grants awarded. Grady has supported several major NINR initiatives, including pain management, end-of-life care, self-management of chronic illness, and caregiving or bedside research.Grady, an internationally recognized researcher on stroke prevention, also has supported the development of research and training opportunities, including the NINR Summer Genetics Institute (SGI). This hands-on program helps foster interest in genetics and related research for nursing faculty, graduate students, and advanced practice nurses and helps get nurses in on the ground floor of genetics research, which will become the foundation for personalized medicine in the future, Grady says.“Genetics is a new, exploding field that’s important in identifying genetic predispositions for conditions,” she says. “Nursing is at the cross-roads of becoming the most important force in driving this forward. We are getting in there early, and the students that finish this course are putting the information to work and are having a high success rate at getting research funding.”Grady also is dedicated to the goal of making the research process understandable and within the reach of nurses of all educational levels and backgrounds. “Then it becomes less mysterious and more attainable and becomes more a part of you and your practice,” she says.
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This is an excellent paper from BAcello@AOL.com (Barbara) I just had to include it here.
Challenging nursing's sacred cows Carol A. Rauen, MS, CCNS, PCCN; Kathleen Vollman, MS, MSN, CCNS; Richard B. Arbour, MSN, CCRN, CNRN; and Marianne Chulay, PhD, RN, FAAN
Until recently, healthcare practitioners have answered questions about clinical practices with their best guesses, intuition, and tradition. But evidence-based practice (EBP) compels us to use solid scientific evidence instead, and to base nursing protocols on this evidence. As defined by the Institute of Medicine, EBP is the integration of the best research, clinical expertise, and patient values when making decisions about patient care. This article discusses three commonly performed acute-care nursing practices that are not based on evidence:
• instilling normal saline solution (NSS) into the patient’s endotracheal tube before suctioning
• turning critically ill patients manually every 2 hours
• relying on the Glasgow Coma Scale (GCS) alone for routine neurologic assessment.
When these practices were introduced, no research supported them. Yet many practitioners keep performing them, despite recent research that suggests they should be changed. This article examines these three practices critically.Instilling NSS before ET suctioning: Helpful or harmful? For years, nurses and respiratory therapists have been taught to instill 5 ml of sterile NSS into a patient’s endotracheal (ET) tube before suctioning. According to the traditional theory, this practice decreases mucosal viscosity, eases secretion removal, and improves oxygenation. Although at one time the theory seemed to make sense, research from the past 20 years shows it’s incorrect. Here’s what current research (primarily involving adults) tells us:
• Instilling NSS before suctioning decreases oxygen saturation and forced expiratory volume (a sign of bronchospasm).
• This practice may increase the risk of hospital-acquired pneumonia (HAP), as bacteria from the nurse’s thumb may contaminate the rim of the NSS vial when the vial top is popped off. (even with gloves ?) • Successful humidification requires small particle size in the form of ultrasonic nebulization, not bolus administration.• No studies show that NSS instillation yields benefits. On the contrary, studies prove that this practice can lower oxygenation levels and increase the risk of HAP. Consequently, the current EBP recommendation is not to instill NSS during routine ET suctioning.
Mobility matters: Are we moving critically ill patients enough? For years, nurses have recognized that proper patient positioning helps prevent skin breakdown, mobilizes secretions, and provides comfort. But many nurses fail to consider the impact of various positioning strategies on pulmonary gas exchange, ventilator weaning outcomes, and prevention of muscle deconditioning in intensive care unit (ICU) patients. A busy healthcare environment can pose a challenge to frequent repositioning—especially with critically ill patients. One prospective longitudinal observational study of a critical care unit found that over an 8-hour period, only 2.7% of observed patients experienced position changes every 2 hours, and more than half were supine for 4 to 8 hours. The solution is to improve nurses’ awareness of the importance of proper positioning on both short- and long-term patient outcomes. If we don’t pay enough attention to this care activity, it’s likely to be neglected. Evidence shows that for many critically ill patients, turning every 2 hours isn’t frequent enough to preserve the lung’s oxygenating ability or prevent HAP. When a patient is at risk for HAP or ventilator-acquired pneumonia (VAP), continuous lateral rotation therapy (CLRT) should be used. Research on the positioning of critically ill patients tells us that:
• for patients with consolidated pneu­monia in one lung, positioning with the “good” lung down improves oxygenation. The goal is to match alveoli with perfused capillaries. Despite mechanical restriction in the downward position, the healthy lung has enough functioning alveoli to match gravity-dependent perfusion and thus promote effective gas exchange.
• mobilizing intubated patients progressively from a dangling position to standing and then to walking is safe.
• breathing and oxygenation improve at higher elevations of the head of the bed, as long as the elevation is hemodynamically tolerable.
• during ventilator weaning, patients with large abdomens seem to breathe more easily and have larger spontaneous tidal volumes when the head of the bed is elevated 45 degrees and the bed is in reverse Trendelenburg position.
• prone positioning improves oxygen­ation, but has not been shown to affect mortality risk. Consider prone positioning if conventional strategies for lung recruitment have failed.
• in ICU survivors, the deconditioning that occurs during hospitalization can lead to functional physical limitation that proves to be a major complication 1 year later. Barriers to mobility Hemodynamic instability is the main reason why critically ill patients stay in the supine position for extended periods. When you consider the factors that affect tolerance of position changes, you realize these patients are clearly at risk for such negative effects as hypo­tension. After a change in the body’s gravitational plane, the cardiovascular system normally tries to adjust in two ways: • The shift in plasma volume may send messages to the autonomic nervous system telling it to change vascular tone.• An inner ear or vestibular response affects the cardiovascular system. Critically ill patients commonly have poor vascular tone, a dysfunctional autonomic feedback loop, or low cardiovascular reserve. Also, they’ve established equilibrium in a single position over time. For those who become hemodynamically unstable after manual turning, the solution is to gradually retrain them, using CLRT, to tolerate a position change. Clearly, we don’t have all the answers on when and how often these patients should be turned, but we do know that ensuring patient mobility makes a difference. The evidence shows that making mobility a core component of care reduces patients’ feelings of powerlessness, promotes secretion management, helps prevent muscle wasting, improves gas exchange, and decreases the incidence of atelectasis and VAP.
Glasgow Coma Scale: Is it enough for a comprehensive neurologic assessment? For decades, we’ve known that neurologic assessment is the best way to detect onset or progression of brain injury. Assessment findings reflect pathophysiology and response to both progression of injury and therapeutic interventions. Optimally, earlier identification of responses to or progression of injury and to therapeutic interventions should guide the direction of care. The GCS was introduced in 1974 as a way to standardize patient evaluation and improve communication among healthcare workers about a patient’s neurologic status. Over the last few decades, the GCS has been used extensively and has been incorporated into many critical care flowsheets, emergency medicine documentation forms, and other clinical grouping systems. It’s widely used to predict neurologic and clinical outcomes. The GCS assigns a separate numerical value to a patient’s response in three spheres—motor response, verbal response, and eye opening. Such responses reflect how movement is stimulated in the extremities, the patient’s ability to interact, and the brain’s arousal mechanisms. Each response is scored individually; then the three scores are totaled. The lowest total score is 3; the highest is 15, which indicates the patient is alert; oriented to person, place, and time; and able to follow simple commands.Where the GCS falls short Although the GCS has distinct benefits, scoring hinges on the patient’s ability to respond to stimulation and interact with the clinician. The GCS doesn’t assess brainstem reflexes, and has limited value for patients with deep sedation, neuromuscular blockade, intubation and controlled ventilation, and some psychiatric or metabolic disorders. A patient receiving deep sedation and analgesia has a drug-induced depression of consciousness. In this case, relying solely on the GCS may lead to an incomplete neurologic evaluation. When given in appropriate doses, neuromuscular blocking agents produce a state of skeletal muscle relaxation in which the patient could be awake and responsive, yet appear to be otherwise because the drug prevents a response to stimulation. Depending on the GCS in this case is inadequate. Also, the GCS doesn’t uniformly assess verbal response in intubated patients. Tracheal intubation and controlled ventilation interfere with verbal response to the GCS, as the artificial airway impedes speech. Thus, a fully awake and interactive patient may have a misleadingly low verbal response score. To address this, clinicians should focus on arousal, consciousness, and patient interaction; if the patient is interactive and communicative, document this fact accordingly. Such disorders as delirium, catatonia, and psychogenic coma also can interfere with valid GCS determination. Delirium is a cognitive disorder; catatonia and psychogenic coma can occur in certain psychiatric disorders. The GCS may not even detect these states. To compensate for these shortcomings, other neurologic assessment tools have been developed. For instance, the FOUR (Full Outline of UnResponsiveness) Score scale evaluates eye response, motor response, brainstem reflexes, and respiration. Easy to use, it provides information the GCS doesn’t, yielding a more comprehensive picture of a patient’s degree of responsiveness. In particular, it recognizes such disorders as locked-in syndrome (in which the patient is aware but unable to respond except by tracking or blinking). It also can help predict in-hospital mortality. For optimal neurologic evaluation, the best EBP recommendation is to use the GCS with greater accuracy and consistency—while using additional neurologic assessment tools that yield information that the GCS alone can’t. More evidence means better outcomes, All nurses want to provide the best possible patient care. To do this, we must change our practices when the research shows that such a change would better serve patients. Nursing practice is always evolving. We must constantly ask ourselves whether we’re providing the best care possible given the current available evidence. If the answer is no, we must work to change that practice and implement protocols and standards that will bring greater patient benefit.
Selected references NSS instillation Ackerman M, Mick D. Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial. Am J Crit Care. 1998;7:261-266.Raymond S. Normal saline instillation before suctioning: helpful or harmful? A review of the literature. Am J Crit Care. 1995;2:467-473.Patient positioning Bailey P, Thomsen GE, Spuhler V, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35:139-145. Vollman K. Ventilator-associated pneumonia and pressure ulcer prevention as targets for quality improvement in the ICU. Crit Care Nurs Clin North Am. 2006;18:453-467. Glasgow Coma Scale Arbour R. Intracranial hypertension: monitoring and nursing assessment. Crit Care Nurse. 2004;24(5):19-34. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81-84.Visit www.AmericanNurseToday.com/journal for a complete list of selected references. Carol A. Rauen is an Independent Clinical Nurse Specialist and Education Consultant and a staff nurse at the Washington Hospital Center in Washington, D.C. Kathleen Vollman is a Clinical Nurse Specialist, educator, and consultant with Advancing Nursing, LLC in Northville, Mich. Richard B. Arbour is a Clinical Nurse Specialist at Albert Einstein Medical Center in Philadelphia, Pa. Marianne Chulay is a consultant in clinical research and critical care, as well as coeditor of AACN Advanced Critical Care, based in Gainesville, Fla.

http://www.americannursetoday.com/ME2/dirmod.asp?sid=&nm=&type=Publishing&mod=Publications%3A%3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=54BA87F51E9D4D0FB4F353789D99BB1C
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FROM THE MEMBERS
JANNARN@AOL.com Janna has written the following:" As a school nurse now, I'd like to network with ER and other school nurses to compare notes and stay current". Please write her/ network with her especially anyone who is a school/ER nurse.......or if you think you can help her. That is what we are all here for ......support of one another !!! Thank you .
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Another communication from a member.....Please contact her/ the website
She writes: " Dear Frankie: This is one of our family of nurses with her son ..... Can you pass this web site so that maybe nurses around the area can help them get her child some help. I know you have a big address book of nurses. This is a friend of mine and the little boy is the most precious boy you could meet. www.helpbrendan.com Thanks, Annie Gadsdengirlie14@AOL.com

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In reference to the article in last month's newsletter, MarGerlach (Marlene) asks:
"What would happen to health care workers, doctors, nurses, lab people, etc...if they were found to be MRSA carriers? Would they lose their jobs, not be allowed to practice any more?"

You will remember the quote: One in Every 20 Healthcare Workers is a MRSA Carrier GENEVA, April 15 -- One in every 20 healthcare workers carries methicillin-resistant Staphylococcus aureus (MRSA), researchers here said. But the vast majority is without symptoms and only 5.1% have full-blown clinical infections, ... Are there any responses to her question???
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This is sent in by Veracidad@AOL.com Why do we not have enough nurses in FL ?!!

If everybody knows that this job is stressful per sé...If we are working short all the time...If the corporations are not paying enough......If we can be fired for any reason (Policy is observed or not depending also of your relationship with the "Bosses")...if we don't have administrative incentives since administrations change almost yearly and they usually prefer bringing somebody from outside known by them than promote the older employees...If the state during a survey follows a nurse and in order to have a good evaluation. it takes 20 min to give meds. through a GT to one patient, and another 20 min to take care of a patient with a trach., and 15 min to give Bp meds. and insulin to a third one (doing every thing "by the book"), and they already know that the nurse has an assignment of 26-30 patients (so is impossible to finish med pass, if we follow state regulations, in 2 hours) but in their survey conclusions all that is not even mentioned...if we work 9-10 hours taking no break...If we have to take care of Labs., Pharmx, Doctor's orders, family members, dining room, even the door; with little or no help ...If in the Nursing Homes & Rehab Centers, the acute level of care is higher every day...if the level of knowledge of the DONs is lower every day because in order to get out of the floor they accept less money that the fine prepared nurses......How in the world do we not have enough nurses in FL?? !!!

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INTERESTING READING

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

TODAY'S RANDOM FACTS ...

Despite its hump... camels have a straight spine. and they also have three eyelids.
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Sent in by FNPMSN....Cindy Thanks Nurse Practitioner for Renowned Orthopedic Clinic on Florida's West Coast Orthopedic clinic is looking for NP with one or more years experience to work in their clinic. This clinic is renowned for its advanced outpatient spine surgeries and has patients come from all over the country for their expertise and successful procedures. This area has world famous beaches and great weather year round. You will feel like you are on vacation all year round. You will prepare patients for exams; document updates and write prescriptions. All procedures are done in the clinic which includes lumbar thoracic spines and neurology. Mon. to Fri. days - No nights or weekends. Competitive salary with great benefits and reloction assistance. For more information please call Martie Cunningham at 866-782-9029 x 5873. or email resume to martie.cunningham@comphealth.com
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Automated drug-dispensing improves care at nursing homes Dallas Morning News - Dallas,TX,USA "We hope the result will be a revolution in how nursing homes dispense drugs." OnSiteRx caught the attention of hundreds of nursing home administrators at ... http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-drugs_08bus.ART0.State.Edition1.4620e4c.html

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ATLANTA, Georgia --Quote: " Imagine my surprise when, in the course of doing research for this story, I stumbled upon my own personal health information online. There it was in black, white, and hypertext blue. My annual mammograms; the visits to the podiatrist for the splinter in my foot; the kind of birth control I use -- it was all on my health insurance company's Web site. And that's not all: The prescriptions drugs I use were listed on the Web site where I get my prescription drug insurance. I had no idea this was all on the World Wide Web. Welcome to the 21st century", says Dr. Steven Schwaitzberg, associate professor of surgery at Harvard Medical School and a medical informatics expert. "There's more information out there about people than could ever possibly be realized," he says.... http://www.cnn.com/2008/HEALTH/06/05/ep.online.records/index.html
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Check this out....really good suggestions. Rozalfaro@AOL.com (Roz) sent in the following: She wrote: "This person is my nursing school classmate--- and fellow basketball team member in 1969 --- Dr Marie Savard (they never say she was a nurse before (becoming) a doc). She's the new medical correspondent and did a great job on this topic today".

Conventional wisdom assumed losing your mental edge was just part of aging, but that may be incorrect. Scientists believe working out your brain -- just like you would your body to keep in shape -- could ward off the dulling of mental faculties and strengthen connections between newly-generated brain cells, which people make throughout life.
Use it or lose it. Neurobics may help maintain your mental reserves and ensure you'll keep your mental edge clear into your elderly years. It's like cross training, and researchers have found it's never too late to start, even in people who have some degree of dementia.
"Good Morning America" medical contributor Dr. Marie Savard breaks down the things you can do to keep your mind in tip-top shape, and what bad habits may harm you.... http://abcnews.go.com/GMA/OnCall/story?id=5023860&page=1
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NEW YORK (Reuters 6/09) - Microsoft Corp and Kaiser Permanente, the biggest U.S. health maintenance organization (HMO), are working on a patient information exchange pilot program to help give patients more control over their health records, The Wall Street Journal said on Monday.
Similar efforts are underway at companies such as Revolution Health Group LLC and Google Inc, which launched its online healthcare service, Google Health, in February.
Data kept in Kaiser's personal health records, which includes patients' test results, prescriptions and immunizations, will be shifted to Microsoft's HealthVault, a Web-based service that allows patients to store and manage medical data from a variety of websites and selectively share information with them, the paper reported.... http://www.reuters.com/article/healthNews/idUSN0939925320080609?feedType=nl&feedName=ushealth1100
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Low vitamin D common with rheumatic diseases... PARIS (Reuters 6/12) - Nearly three quarters of patients seen at a rheumatology clinic, which focuses on diseases affecting the joints, muscles, bones, and tendons, have a vitamin D deficiency, researchers based in Ireland found.
Dr. Muhammad Haroon and associates at South Infirmary-Victoria University Hospital, Cork, assessed the occurrence of vitamin D deficiency in all new patients seen at their rheumatology clinic between January and June 2007. The research team's findings were reported at the European Union League Against Rheumatism 2008 meeting here in Paris.
Of 264 patients seen during this time period, 231 agreed to have their levels of vitamin D measured and other related tests performed. Overall, 162 patients (70 percent) had low vitamin D levels and 26 percent had a severe deficiency. Little difference was seen in the percentage of younger and older patients who were deficient....
http://news.yahoo.com/s/nm/20080612/hl_nm/low_vitamin_d_dc;
_ylt=AjbRql72CiHBZ9Kp5RgPQ6LVJRIF
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Scientist say garlic can beat "superbug" MRSA The killer superbug MRSA can be beaten with garlic, scientists have claimed.
Trials showed that allicin, a natural compound which gives garlic its distinctive smell, can cure patients suffering from the antibiotic-resistant infection.
In a trial, all 52 patients who took allicin capsules or sprayed a liquid on to their wounds recovered fully within four to 12 weeks. Leader Dr Ron Cutler, of the University of East London, said: "This is a breakthrough in the fight against MRSA."
The infection officially kills almost 2,000 hospital patients a year, although experts believe the true toll is closer to 5,000.... http://www.mirror.co.uk/news/topstories/2008/06/10/scientists-say-garlic-can-beat-superbug-mrsa-89520-20601849/
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Overactive bladder affects many aspects of life NEW YORK (Reuters 6/12) - An overactive bladder has a considerable effect on the quality of life, work productivity, sexuality and the emotional well-being of men and women, U.S. and European researchers report in the journal BJU International.
Dr. Karin S. Coyne of United BioSource Corporation, Bethesda, Maryland and colleagues conducted a secondary analysis of data from a telephone survey involving participants from five countries.
The researchers matched 1,434 subjects who had an overactive bladder, with or without other lower urinary tract symptoms, to another 1,434 participants without overactive bladder or stress urinary incontinence who acted as a comparison group, or the "controls. "
The overactive bladder patients subjects reported significantly greater rates of chronic constipation, asthma, diabetes, high blood pressure, bladder or prostate cancer, neurological conditions and depression. There were also significant differences between the patients and controls in all reported lower urinary tract symptoms.... http://www.reuters.com/article/healthNews/idUSTON27713720080612
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The next three articles were submitted by MJSolon@AOL.com (Melva) Thanks
Antibiotics Reduce Risk for Postpartum Perineal Wound Complications June 11, 2008 — Women who received antibiotic prophylaxis vs placebo had reduced rates of perineal wound complications by 2 weeks postpartum, according to the results of a prospective, randomized controlled trial reported in the June issue of Obstetrics & Gynecology.
"The anal sphincter is susceptible to trauma during a vaginal delivery," write Neena Duggal, MD, from Santa Clara Valley Medical Center in San Jose, California, and colleagues. "The use of operative vaginal delivery, especially in combination with midline episiotomy, has been associated with a significantly increased risk of anal sphincter trauma in both nulliparous and multiparous women."
The goal of this study was to determine whether prophylactic antibiotics at the time of repair of third-degree or fourth-degree perineal tears after vaginal delivery would reduce the risk for wound infection and breakdown.... http://www.medscape.com/viewarticle/575875
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Hospitals peer into patients' credit reports Financially squeezed by shrinking reimbursements and expanding uninsured patient rolls, some Atlanta hospitals are using tools to peek into patient credit reports to gauge their ability, and willingness, to pay medical bills.
Hospitals say the information helps quickly identify broke patients who qualify for charity, or free, care. Figuring out who they are early saves the hospital millions of dollars in collection costs -- processing billing statements and making follow-up calls, hospitals say. Armed with the additional information, hospitals also have better leverage in negotiating payment plans with those patients who do have the ability to pay.
But critics say access to patient financial information can lead to abuse. Hospitals might deny non-emergency care to patients with a poor credit history. Overzealous billing personnel might nudge patients to tap into available lines-of-credit to pay for care... http://www.msnbc.msn.com/id/25087914/
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WEDNESDAY, June 11 (HealthDay News) -- Children with bigger necks are more likely to develop a sleep-related breathing disorder, says a University of Virginia study.
Researchers looked at 215 children, aged 18 months to 18 years, who were referred to a pediatric sleep center. Of these children, 37.3 percent were obese and had an increased frequency of snoring.
The children's neck size, in the sitting and neutral head position, was measured and apena-hypopnea index (AHI) and mean oxygen saturation values were used as indicators of the severity of the sleep-related breathing disorder.
Age-adjusted neck size correlated with body-mass index (BMI) and weight and showed a higher correlation with AHI than did BMI, weight or tonsil size. Neck size also showed a strong inverse correlation with mean oxygen saturation and was a better predictor of mean oxygen saturation than BMI, weight or tonsil size, the study found.
http://news.yahoo.com/s/hsn/20080612/hl_hsn/childrensnecksizeassociatedwithsleepdisorders;_
ylt=ApBTU11h15iRTbObJbaTVjHVJRIF
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Promising drug fights Alzheimer's in three ways WASHINGTON (Reuters 6/11) - A type of drug that may offer promise in treating Alzheimer's disease works in three ways to fight the formation of "plaques" in the brain that are a hallmark of the ailment, scientists said on Wednesday.
The researchers looked at a kind of drug called a gamma-secretase modulator, or GSM, now being tested to see if it slows Alzheimer's disease progression. One GSM drug now being tested in people with Alzheimer's is Myriad Genetics's Flurizan, also called tarenflurbil. A series of lab experiments showed these drugs inhibit production of long pieces of amyloid beta protein in the brain, block them from forming clumps, and boost production of shorter pieces that can make the longer ones less likely to stick together, the researchers said.... http://www.reuters.com/article/healthNews/idUSN1146894920080611?feedType=nl&feedName=ushealth1100
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Diet, exercise can delay diabetes for years: study LONDON (Reuters 5/22) - Drinking less alcohol, eating more vegetables and exercising can prevent or delay the onset of diabetes, researchers said on Friday in a study showing that lifestyle changes can make a big difference.
Diet and exercise reduced the incidence of diabetes by about 43 percent over 20 years among 577 high-risk Chinese adults, the researchers reported in the journal Lancet.
At the end of the 20 years, 80 percent of those who changed what they ate and exercised more had diabetes, compared with 93 percent who made no changes, said Guangwei Li of the China-Japan Friendship Hospital in Beijing and Ping Zhang at the U.S. Centers for Disease Control and Prevention.... http://www.reuters.com/article/healthNews/idUSL2293949320080522?feedType=nl&feedName=ushealth1100
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Wounds Prof. Michelle Pascone, MD; Giovanni Papa, MD; Alessandro Ranieri, MD Abstract: Debridement is a fundamental step in the management of all chronic and acute cutaneous wounds. Versajet™ Hydrosurgery System (Smith & Nephew, Hull, UK) is a novel waterjet dissection device designed to surgically debride difficult wounds. The authors used this new system on a variety of difficult chronic and acute lesions of different etiology (eg, necrotic infected traumatic and chronic wounds, burns, and post-surgical wounds), which were then managed with adequate dressings or different wound closure techniques such as skin grafting, use of dermal substitutes, negative pressure wound therapy (V.A.C.®, KCI, San Antonio, Tex), or treatment by secondary intention. Debridement can be safely accomplished in a brief operating time with sufficient tissue selectivity and eclecticism. Satisfactory results often were obtained with a single operating session. After debridement, the quality of the wound bed was ideal for accelerating endogenous wound healing or maximizing the effectiveness of other therapeutic measures. The authors believe this hydrosurgery device (Versajet) is a selective, safe, and innovative tool for debridement that allows for better control, can reduce collateral damage, and subsequently achieve overall better outcomes than conventional debridement techniques.... http://www.woundsresearch.com/article/8709
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From IV placement to blood draws to injection of medication, millions of needlesticks are performed on children each year - and for the child, parents and healthcare providers alike, the experience frequently is an unpleasant one.
Although techniques and interventions are available to make the process easier, they often are not employed because of barriers such as lack of awareness, time limitations or availability of supplies.
Recognizing the importance of improving needle pain management in pediatrics, RN VOICE (Registered Nurses for Venipuncture Optimization through Increased Comfort and Education) was established to facilitate solutions.
"There's plenty of information available about the impact of needle pain on children, but there's a huge gap between knowledge and practice," explained Sarah Leahy, BA, RN, RSCN, manager of the Center for Pain Relief at Children's Healthcare of Atlanta and member of the RN VOICE steering committee. "You can give people the knowledge but they still don't actually change their practice; the change has to become institutionalized to really be successful."
To bridge the gap from information to implementation, RN VOICE assembled a community of practitioners - nurses, child life specialists, pharmacists and physicians - from across the nation to promote improved needle pain management strategies. The result is a network of experts and a new resource - ManageIVpain.com - through which healthcare providers can access the tools they need to systemize needle pain management measures in their workplaces.... http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=114285
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WASHINGTON (Reuters 5/20) - The U.S. Medicare program may expand reimbursement for bariatric surgery for the obese, in light of a study that found the treatment can help reverse diabetes, the agency said on Monday. Recent research found the surgery can completely reverse type 2 diabetes, a metabolic condition spurred by weight gain and suffered by millions of Americans.
Medicare, the government health plan for the nation's 44 million elderly, "will assess the nature of the scientific evidence supporting surgery for the treatment of diabetes," the agency said on its Web site.... http://www.reuters.com/article/healthNews/idUSN1914912220080520?feedType=nl&feedName=ushealth1100
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You really can fight wrinkles from the inside out. And there's a fruit that can lead the charge. It's papaya. What makes papaya so perfect? Easy. Vitamin C. Papaya has loads of it, and getting lots of vitamin C may mean more youthful skin -- fewer wrinkles and less thinning and dryness. A recent study in women over 40 confirmed it. The Mysteries of C Vitamin C is a natural friend to skin. The nutrient is essential for making collagen, the protein fibers that give skin its strength and resiliency. And being a powerful antioxidant, C also disarms free radicals that would otherwise chip away and weaken collagen. (Did you know? Vitamin C helps protect skin from this sun scourge, too.)

More Food for Your Face A little extra vitamin C isn't all it takes to plump your complexion. Here are a few more food tips that can help keep your face fresh:
Munch on walnuts. In the vitamin C study, researchers also noted that diets rich in linoleic acid -- an essential fatty acid in walnuts -- meant moister, plumper skin. (Bonus: Walnuts will make this happy, too.)
Ease up on fats and refined carbs. Scientists found both were linked to aging skin. Discover the dark side of processed foods with this article.
Think whole grains. The magnesium and B vitamins you get from them help with the regeneration of skin cells. Find out what foods are mostly whole grains.
Keep the fruits and veggies coming. To stay smooth and healthy, your skin needs a whole slew of antioxidant-rich produce. Like this root vegetable.
Read this article for a complete chart of healthy food choices for your skin. Yes! Eat some papaya today! Beyond its lode of vitamin C, papaya has enzymes that help with digestion and immune function. For recipes and more, pore through Papaya.

Reference: Dietary nutrient intakes and skin-aging appearance among middle-aged American women. Cosgrove, M. C., Franco, O. H., Granger, S. P., Murray, P. G., Mayes, A. E., American Journal of Clinical Nutrition 2007 Oct;86(4):1225-1231.
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Whatever their color, bell peppers are brimming with age-fighting antioxidants. But which bell has the most -- red, orange, yellow, or green? If you're going to pick just one, you might be better off red. A study recently showed that reds were the bell of the ball when it came to disease-fighting phenol content. Phenol Defenders, and MorePhenols aren't the only feather in a red bell pepper's cap. According to another study, red bells are also highest in vitamin C -- that mighty antioxidant that helps keep your skin and blood vessels young. (Discover how the vitamin C in red and yellow peppers may help save lives.) Color Me HealthyBut don't chuck your green, yellow, or orange bell peppers. For maximum RealAge benefits, you want a colorful and diverse diet -- so you get the broadest antioxidant protection. To keep yourself colorful, follow the simple rules of this diversity diet. Go green . . . grow red . . . in your own organic garden. Whether it takes up an acre or sits in a window box, a garden can provide super nutritious foods fairly cheaply. Add these heirloom red pepper plants, a little sun, a little water, and -- presto! You’ve got big beautiful bells. Roast, grill, skewer, slice, and chop . . . Perfecto.Reference: Characterization and quantitation of antioxidant constituents of sweet pepper (Capsicum annuum L.). Marin, A., Ferreres, F., Tomas-Barberan, F. A., Gil, M. I., Journal of Agricultural and Food Chemistry 2004 Jun 16;52(12):3861-3869.
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"We have a 'perfect storm' of a healthcare crisis in this country, and we all have to get ready and act now," warned Terry Fulmer, PhD, RN, FAAN, the Erline Perkins McGriff Professor and Dean of the College of Nursing at New York University, New York City.
"What I mean by the 'perfect storm' is we have the first baby boomers turning 65 in 2011, and that situation will create not only a larger number of older people experiencing chronic disease, but a significant exodus from the workforce at the time of our greatest need. That creates a gap behind those retirements in terms of people prepared to care for the projected 78 million people over the age of 65."
As one of 14 committee members who wrote the Institute of Medicine (IOM) report, Retooling for an Aging America: Building the Health Care Workforce, Fulmer described one of the most pressing questions in healthcare today: "What can we do to adequately care for those older adults?"... http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?cc=117141
(this is my opinion....as I have expressed many times before.... nurses are leaving even those who are in their 60's (who could work longer) ...because of the patient to nurse ratios, the total lack of support, and the indifference paid to the nurses' working situation).
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Electronic health record standards agreed WASHINGTON (Reuters 6/26) - A major consumer group, insurers together with Google Inc and Microsoft Corp said on Wednesday they have agreed to standards intended to speed adoption of personal electronic health records.
The electronic medical record field remains in its infancy. While U.S. privacy laws govern actions by medical providers such as doctors, there is little in the way of other established privacy, security and data usage standards despite decades of industry efforts.
Backers, which also include some doctors and employer groups, said they hope to break a stalemate in moving medical records online, sparked by consumer fears that their personal information will be abused, or held against them.... http://www.reuters.com/article/healthNews/idUSN2520650720080626?feedType=nl&feedName=ushealth1100
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NEW YORK (Reuters 6/26) - A sudden loss of hearing can be an early warning of impending stroke, according to results of a study released Thursday.
Dr. Herng-Ching Lin and colleagues at Taipei Medical University identified 1423 adult patients hospitalized in 1998 with a first episode of sudden hearing loss and matched each "case" patient to four "control" patients.
Patients in the hearing loss group were significantly more likely to have hypertension (high blood pressure), diabetes, and elevated cholesterol levels, the investigators note.
Over the next 5 years, 180 hearing-loss patients (13 percent) and 441 control patients (8 percent) suffered a stroke. After adjusting for gender, income, level of urbanization, and comorbid illnesses, the risk of stroke was 1.64 times greater in the hearing-loss patients.... http://www.reuters.com/article/healthNews/idUSTON67358320080626?feedType=nl&feedName=ushealth1100
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This is for patient teaching : CDC Recommends Shingles Vaccine for MillionsShot Usually Prevents Condition That Can Be Unbearable Important health news for you or a loved one: The U.S. Centers for Disease Control and Prevention is now recommending that people age 60 or older get vaccinated against shingles. The shot is effective about two-thirds of the time. A common skin disease caused by the chickenpox virus, shingles ranges from mild to severe and debilitating. It sometimes damages vision and hearing and can lead to an excruciatingly painful chronic nerve condition called post-herpetic neuralgia. More:
Is the shingles virus related to genital herpes? How shingles affects other infections
Why did a healthy woman get shingles? How your family affects your risk
Surprising number of shingles patients report severe pain
Three medications that may ease the pain This enjoyable exercise could help prevent shingles
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A best place to walk A walk on a treadmill or a walk in the park? Either one will get you fit, but the walk in the park may make you feel a whole lot better! Research confirms it: Exercising in a green environment puts you in a better frame of mind than working out in a sterile gym. Go figure! The Green SceneIn a study, people walked on a treadmill and viewed pictures of urban areas or images of rural scenes with lots of green spaces. The result? Besides bringing down blood pressure, viewing the green scenery improved energy and activity levels, raised self-esteem, and boosted mood. Double the pleasure of walking outside: Catch up on a good book, too. Playaway Digital's tiny audiobooks (they're smaller than an Altoids tin) come complete with headphones, battery, and book pod. Listen to the #1 best-seller, and then return for a new title. The miles will fly by.
Reference: The mental and physical health outcomes of green exercise. Pretty, J., Peacock, J., Sellens, M., Griffin, M., International Journal of Environmental Health Research 2005 Oct;15(5):319-337.
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Looks like there may be yet another reason to kick sugar and white flour out of your diet: eye health. Cutting back on processed carbs could lower your risk of advanced age-related macular degeneration (AMD), a leading cause of blindness in people 60 and older. The Carb ConnectionWhat makes refined carbs so bad for your peepers? Seems their high glycemic index may be partly to blame. High-glycemic-index foods boost a whole bunch of bad things linked to AMD -- like increases in oxidative stress, inflammation, and blood-fat levels. See the FutureAlong with replacing the "bad" carbs in your diet with high-fiber whole grains, try these other sight-saving steps:
Make sure your diet includes
these four super eye nutrients.
Figure out if changes in your vision are normal. (
This article can tell you what's normal when your eyes age -- and what's not.)
See if it's time for a checkup.
Answer the questions in this Disease Prevention Checklist.
Reference:
Association between dietary glycemic index and age-related macular degeneration in nondiabetic participants in the Age-Related Eye Disease Study. Chiu, C. J., Milton, R. C., Gensler, G., Taylor, A., American Journal of Clinical Nutrition 2007 Jul;86(1):180-188.
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Scientists test brain pacemakers for depression
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Experiments with so-called deep brain stimulation are in their infancy WASHINGTON - It's a new frontier for psychiatric illness: Brain pacemakers that promise to act as antidepressants by changing how patients' nerve circuitry fires. Scientists already know the power of these devices to block the tremors of Parkinson's disease and related illnesses; more than 40,000 such patients worldwide have the implants.... http://www.msnbc.msn.com/id/24829527/
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Whole Milk is Effective, Cost-Effective as an Oral Contrast Agent An item commonly found in many homes - whole milk - is just as effective, costs less and is easier on the patient than a diluted (0.1 percent) barium suspension that is also commonly used as an oral contrast agent in conjunction with CT to examine the gastrointestinal tract, a new study finds.
The study included 215 patients undergoing abdominal and pelvic CT, said Chi Wan Koo, MD, lead author of the study. All patients were given an IV contrast media; 115 were also given whole milk as an oral contrast agent; 100 received a 0.1 percent barium suspension. Two radiologists reviewed all the images and scored them based on degree of bowel distension and bowel wall visibility. Adequate bowel distension is necessary to optimize resolution of the bowel wall and contents, said Dr. Koo.
The study found that the images taken of patients who were given whole milk were just as useful as the images that were taken of patients given the diluted barium, she said. ...
http://nursing.advanceweb.com/editorial/content/editorial.aspx?cc=117266
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TODAY'S RANDOM FACT... Broccoli is the only vegetable that is also a flower.

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Studies link lead to adult crime, brain damage WASHINGTON (Reuters 5/27) - Exposure to lead in early childhood or in the womb can cause permanent brain damage that may even cause criminal behavior, researchers reported on Tuesday.
Two studies showed that people with high levels of lead in childhood grew up with blocks of missing brain cells -- and they also were far more likely to be arrested for crimes, especially violent crimes.
The effect is so strong that it may account for a large percentage of crimes in inner-city areas, where old houses are far more likely to have lead paint, said Kim Dietrich of the University of Cincinnati in Ohio, who led one of the studies in the Public Library of Science journal PLoS Medicine.... http://www.reuters.com/article/healthNews/idUSN2740549020080528?feedType=nl&feedName=ushealth1100
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LONDON (Reuters 5/27) - People given cholesterol-fighting statin drugs before heart surgery are far less likely to die or suffer complications afterwards, German researchers said on Wednesday.
The analysis of more than 31,000 patients provides some of the strongest evidence yet of the benefits of statins before heart surgery but it also found that too few doctors are prescribing them, they said in the European Heart Journal.
"This is the first big summary of all the existing studies about people undergoing cardiac surgery," said Oliver Liakopoulos, a researcher at the University of Cologne, who led the study.... http://www.reuters.com/article/healthNews/idUSL2753138520080528?feedType=nl&feedName=ushealth1100
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HUMOR SECTION

HOW TO CALL THE POLICE WHEN YOU'RE OLD AND DON'T MOVE FAST ANYMORE.
George Phillips of Meridian, Mississippi was going up to bed when his wife told him that he'd left the light on in the garden shed, which she could see from the bedroom window.George opened the back door to go turn off the light but saw that there were people in the shed stealingthings. He phoned the police, who asked 'Is someone in your house?' and he said 'no'. Then they said that all patrols were busy, and that he should simply lock his door and an officer would be along when available.George said, 'Okay,' hung up, counted to 30, and phoned the police again. 'Hello, I just called you a few seconds ago because there were people stealing things from my shed. Well, you don't have to worry about them now because I just shot them.' Then he hung up.Within five minutes six police cars, a SWAT Team, a helicopter, two fire trucks, a paramedic and an ambulance showed up at the Phillips' residence and caught the burglars red handed !!!One of the Policemen said to George: 'I thought you said that you'd shot them!' George said, 'I thought you said there was nobody available !!!!
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

www.nurse.com Pay Only $34.99 for a full year of CONTACT HOURS

MyFreeCE offers a membership-based web site where you can earn CE contact hours for your license or credential renewal. By purchasing a MyFreeCE membership for $29.95 you can take over 150 courses and earn hundreds of CE contact hours during your 12-month membership period. Your $29.95 membership fee includes your testing, re-testing (if necessary), completion certificates, and all course materials. There are no hidden costs or fees. http://www.myfreece.com/welcome.asp

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I ran across this while bumming around the internet: The Meniscus Educational Institute is accredited as a provider of continuing education for nurses by the American Nurses Credentialing Center’s Commission on Accreditation. The Meniscus Educational Institute is approved by the California Board of Registered Nursing (California BRN Provider No. 13164).
Colorectal Cancer: Pathway to Survival A CE activity for generalist nurses and pharmacists, oncology nurse specialists including advanced practice nurses, physician assistants, and oncology pharmacists who provide care to patients with colorectal cancer (CRC) across a variety of practice settings.
Critical Decision Making in Health Care-Associated Infections: Managing Serious Pediatric Infections A CE activity for physicians, nurses, and pharmacists in which Web-based patient cases evolve based on the therapeutic options you choose. Throughout the cases, refer to the patient’s medical chart, applicable literature, and clinical guidelines to help with your decision making. Compare your peers’ selections with your own, and your rationale with that of our expert faculty.
Critical Decision Making in Health Care–Associated Infections: Managing Serious Skin and Soft Tissue Infections A CE activity for physicians, nurses, and pharmacists in which Web-based patient cases evolve based on the therapeutic options you choose. Throughout the cases, refer to the patient’s medical chart, applicable literature, and clinical guidelines to help with your decision making. Compare your peers’ selections with your own, and your rationale with that of our expert faculty.
Critical Decision Making in Health Care–Associated Infections: Serious Cases in the Intensive Care Unit A CE activity for physicians, nurses, and pharmacists in which Web-based patient cases evolve based on the therapeutic options you choose. Throughout the cases, refer to the patient’s medical chart, applicable literature, and clinical guidelines to help with your decision making. Compare your peers’ selections with your own, and your rationale with that of our expert faculty.
Hot Topics in Colorectal Cancer for the Oncology APN A CE activity for advanced practice oncology nurses who care for patients with colorectal cancer (CRC) as well as their families or nurses who are interested in the topic and may care for this population in the future. http://www.meniscus.com/web/frames/fsnurses.htm
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The Power of Clinical Nursing Research: Engage Clinicians, Improve Patients' Lives, and Forge a Professional Legacy http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2313935/?user_id=157159&email=rnfrankie@aol.com&news_id=399&subspec_id=44American Journal of Critical Care CME
Intensive Care Nurses' Knowledge of Pressure Ulcers: Development of an Assessment Tool and Effect of an Educational Program http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2313937/?user_id=157159&email=rnfrankie@aol.com&news_id=399&subspec_id=44American Journal of Critical Care CME
Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2313940/?user_id=157159&email=rnfrankie@aol.com&news_id=399&subspec_id=44
American Journal of Critical Care CME
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Order today and receive 15% off any of the titles in the CE program! This offer is good through July 31 so order your books today and start earning your Free CE credits.

SAGE has partnered with PsychoEducational Resources (PER) to provide Free CE credits to mental health professionals. Mental health professionals can now choose from a wide range of SAGE books, and receive CE credits free of charge after completing a CE Quiz online (80% correct for a pass). Thirty-One (31) new titles have just been added to the program to allow even more opportunity for CE credits. The SAGE CE program now has a total of 63 titles for you to chose from which can be viewed at www.sagepub.com/ceprogram.
CE certification can be achieved in three easy steps:
Step 1: Purchase and read a SAGE Book in the Program
Step 2: Go to the CE Quiz site, enter the pass code (included on the insert of the book) and take the interactive quiz
Step 3: Obtain 80% correct and print or download certification
CE credits can be used:
For license renewal
To meet managed care mandates
To obtain discounts on professional liability premiums (check with your insurance carrier)
To demonstrate commitment to ongoing professional development
For a complete list of SAGE titles in the CE Program, please visit www.sagepub.com/ceprogram. To view the complete CE statement for details of CE coverage, please call PER at 1-800-892-9249 or visit their website at http://per-ce.net/ce.php.
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links.
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MEDICAL RECALLS
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FDA informed healthcare professionals of reports of life-threatening complications associated with recombinant human Bone Morphogenetic Protein (rhBMP) when used in the cervical spine. The safety and effectiveness of rhBMP in the cervical spine have not been demonstrated and these products are not approved by FDA for this use. There have been at least 38 reports of complications during the last 4 years with the use of rhBMP in cervical spine fusion. These complications were associated with swelling of neck and throat tissue, which resulted in compression of the airway and/or neurological structures in the neck. Some reports describe difficulty swallowing, breathing or speaking. FDA recommends that practitioners either use approved alternative treatments or consider enrolling as investigators in approved clinical studies. FDA requires hospitals and other user facilities to report deaths and serious injuries associated with the use of medical devices. If you suspect that a reportable adverse event was related to the use of rhBMP, you should follow the reporting procedure established by your facility. Reporting adverse events is everyone’s responsibility, even if the event involves off-label use of medical devices. ... http://www.fda.gov/medwatch/safety/2008/safety08.htm#Protein
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Jack Distribution, LLC issued a voluntary nationwide recall of selected lots of Rize 2 The Occasion Capsules and Rose 4 Her Capsules, marketed as dietary supplements. The products were recalled because certain lots contained thiomethisosildenafil, an undeclared ingredient that is an analog of sildenafil, a FDA-approved drug used for Erectile Dysfunction. This undeclared chemical poses a potential threat to consumers because it may interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. Consumers who have one of the above products should stop using them immediately and contact their physician if they have experienced any problems that may be related to taking the products. See the manufacturer's press release for the specific lot numbers of the recalled products. Read the entire 2008 MedWatch Safety Summary, including a link to the manufacturer's press release regarding this recall at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Rize
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Sage Products informed healthcare professionals of the voluntary recall of limited lots of 2% Chlorhexidine Gluconate Cloth Patient Preoperative Skin Preparation product. The product was recalled because certain lots were found positive for Burkholderia cepacia (B. cepacia). B. cepacia poses little medical risk to healthy people. However, people who have certain health problems such as a weakened immune system or chronic lung diseases, particularly cystic fibrosis (CF) may be more susceptible to infections with B. cepacia. This organism is a known cause of infections in hospitalized patients and its effects range from no symptoms to serious respiratory infections, especially in patients with CF. The product was distributed to U.S. hospitals and medical centers nationwide and was shipped between 4/28/08 and 6/19/08. Healthcare professionals should stop using the product and coordinate the return of the product with the manufacturer.
Read the complete MedWatch 2008 Safety Summary, including a link to the firm press release, at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Chlorhexidine
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UPDATE 6/26/08] Roche Laboratories informed healthcare professionals of changes to the WARNINGS and ADVERSE REACTIONS sections of the CellCept prescribing information. The changes are based on postmarketing data regarding cases of Progressive Multifocal Leukoencephalopathy (PML) in patients treated with CellCept.
[Posted 04/10/2008] FDA informed healthcare professionals that the Agency is investigating a potential association between the use of CellCept and Myfortic, medicines used to prevent organ rejection, and the development of progressive multifocal leukoencephalopathy (PML), a life-threatening disease. PML is a rare disorder that affects the central nervous system usually occurring in patients with immune systems suppressed by disease or medicines. FDA is reviewing data submitted by Roche, including postmarketing reports it has received of PML in patients who took CellCept or Myfortic, and the proposed revisions to the CellCept prescribing information. FDA has asked Novartis, the maker of Myfortic, for data on PML cases and to revise the Myfortic prescribing information to include the same information about PML included in the CellCept prescribing information. FDA anticipates it may take about 2 months to complete its review of the postmarketing reports and the proposed revisions to the prescribing information. As soon as the review is completed, FDA will communicate the conclusions and recommendations to the public. Until further information is available, patients and healthcare professionals should be aware of the possibility of PML, such as localized neurologic signs and symptoms in the setting of a suppressed immune system, including during therapy with CellCept and Myfortic. http://www.fda.gov/medwatch/safety/2008/safety08.htm#mycophenolate
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NURSING HINTS CORNER
Apron Catchall A full-length vinyl chef's apron works well for a stroke patient who is learning to feed him/her self again. It catches spills, and it is more dignified than a geriatric bib. These inexpensive aprons come in a variety of colors and styles. Terrilynn M. Quillen, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 41 Springhouse Corporation/www.springnetcom.
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.
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This ad is from: GShort @AOL.com (Gwen) These are great little cakes ! http://www.delightfulgreetingcakes.com/worldsgreatest.php
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This ad is from Wendie (The Inservice guru)
The eLifeCard can save your life when seconds count! Carry this life-saving card in your wallet in case of emergency at home, at work, at school, traveling, or on vacation! NEW online estate planning system membership makes it possible for you to buy, upload, change and securely store your health care directive, allergies and medication lists, emergency contacts, and more. Exceptional package of other benefits. Give yourself and your family the gift of peace of mind. For FREE information, email name & phone number. All responses kept confidential and answered promptly.
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508-564-9556 (office) 915-990-1367 (fax)
whowland1@mac.com www.thefoundationnetwork.com
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NEW MEMBERS

Welcome To:

gadsdengirlie14@AOL.com (Annie) 6/2/08

cks081@yahoo.com (Kay) 6/2/08

Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
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NOTICE:
I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.......lol
So please send me your new name/address, ok? RNFrankie@AOL.com

OLD ADDRESS: mharris555@cs.com

NEW ADDRESS: mharris555@comcast.net .

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EDITORIAL STAFF:
GALLO RN @AOL.com (Sue), GingerMyst @AOL.com (Anne), 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.~~**~~**~~**~~**~~**~~
THOUGHT FOR THE DAY

The high office of the President has been used to foment a plot to destroy the American's freedom and before I leave office, I must inform the citizen of this plight. --President John Fitzgerald Kennedy -

In a speech made to Columbia University on Nov. 12, 1963, ten days before his assassination.


Hope to see you online..... Frankie
(RNFrankie@AOL.com)