Newsletter for Paradigm 97
September 15, 2010
PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.
Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.
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SNIPPET
The following is from the ISMP (Institute for Safe Medication practices....please read.
At the request of sanofi aventis, the manufacturer of LOVENOX (enoxaparin sodium) injection, and as a public service, the Institute for Safe Medication Practices (ISMP) has agreed to distribute the attached letter regarding recent reports of label adherence issues with Lovenox 30 mg and 40 mg prefilled unit dose syringes. The letter provides information about avoiding needle sticks when using the syringe, including the need to inspect syringes when removing them from the bubble pack, then assuring the label properly adheres to the syringe before use. The company is taking the required steps to address the issues that were identified regarding this matter as noted in the August 2010 issue of Nurse Advise-ERR®.
Thank you. ISMP Editorial Staff
Re: Lovenox® (Enoxaparin Sodium) Pre-filled Syringe Label Adherence Information.
Dear Healthcare Provider:
Sanofi-aventis U.S. is committed to the safety of patients and healthcare professionals who administer our medications.
Sanofi-aventis is aware that certain labels on Lovenox (enoxaparin sodium) 30 mg and
40 mg pre-filled syringes may not fully adhere to the syringe barrel. Additionally, we have received a limited number of reports of needle sticks to healthcare professionals administering the drug to patients reportedly as a result of the label adherence issue. We have determined that this label adherence issue does not affect the integrity or quality of Lovenox in its administration to patients.
We have conducted a preliminary investigation into the label adherence issue and are taking the required steps to address the issue(s) that were identified regarding this matter during the investigation. This label adherence issue is limited to the 30 mg and 40 mg pre-filled syringes.
Communication with healthcare professionals involved in the administration of Lovenox is key to reinforcing use of the safety device in all Lovenox pre-filled syringes to prevent unintended needle sticks. This safety device is activated by firmly pushing the plunger rod after the injection has been administered. A protective sleeve will automatically cover the needle and an audible “click” will be heard to confirm shield activation. Careful injection techniques and ensuring the activation of the safety device, consistent with nformation in the product labeling (Section 2.4), should reduce the risk of needle sticks. Aditionally, the syringe should be inspected before removing the needle shield. If the product label is not fully affixed to the syringe barrel, caution should be exercised by healthcare professionals before and after administering the injection. After administration, firmly push the plunger rod to deploy the protective sleeve before attempting any additional maneuver. Also, refer to section 2.4 Administration of the US Prescribing Information, specifically Subcutaneous Injection Technique, for proper injection technique.
Sanofi-aventis remains committed to providing you with product information to help ensure safe and effective use of Lovenox. If you have any questions or require additional medical information pertaining to Lovenox, please contact sanofi-aventis Medical Information Services at 1-800-633-1610 from 8am to 8pm (EST) Monday-Friday. Enclosures: Lovenox Full Prescribing Information
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FROM THE MEMBERS
The following is about Sandy Summer's website..........please read and donate....any amount will help her . August 4, 2010 -- Today The Truth About Nursing was notified that it qualifies as a charitable non-profit organization under section 501(c)(3) of the federal tax code. That means donations to the Truth made since its inception at the end of 2008 are tax-deductible as allowed by law. See our 501(c)(3) status letter here. Please make a tax-deductible donation to support our work to improve understanding of nursing today. Thank you!
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INTERESTING READING
Please remember that the REUTERS articles usually good for only 30 days
Women can be vulnerable to sudden, sometimes dangerous spikes in blood pressure during pregnancy, part of a condition called preeclampsia. And now scientists say they've developed a high-tech method to predict which women are most prone to preeclampsia in late pregnancy -- long before symptoms arise.
The approach relies on so-called "metabolic profiling" to track telltale metabolites found in blood plasma. The researchers say these changes could be key indicators for preeclampsia risk.... http://consumer.healthday.com/Article.asp?AID=643093
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Handy Hints: Fill a spray bottle up with white vinegar and spray all over the bathroom surfaces. The acetic acid stops mold from growing and kills lingering odors.
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If you want to banish belly fat, you've gotta do something fairly counterintuitive: eat. Yep, that's right. Don't starve yourself. Eat. Research shows that dieting too intensely or tracking every morsel too closely creates the perfect conditions for adding belly fat, not subtracting it.
Don't Mess with Stress
A new study tracked the tension levels of 121 female dieters for 3 weeks and showed some concerning results. Those who followed a strict low-cal eating plan -- consisting of prepackaged meals totaling 1,200 calories a day -- experienced a significant rise in their levels of the stress hormone cortisol. And that can spell big trouble when it comes to belly management.
http://www.realage.com/tips/flatten-your-belly-with-this-eating-habit?eid=7199&memberid=4687812
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RANDOM FACT: Knots come out easier if you sprinkle talcum powder on them.
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Nursing Times publishes series of opinion pieces by Truth leaders August 29, 2010 -- Today the prominent U.K. nursing publication The Nursing Times began publishing a series of online opinion pieces by Truth executive director Sandy Summers and senior advisor Harry Jacobs Summers. The first article, "The image of nursing: A culture of respect,"' provides a general overview of the problems with the modern nursing image and what we can do about them. Future pieces will explain why the nursing image matters, explore specific stereotypes like the handmaiden and the naughty nurse, and discuss specific ways nurses and others can improve the image.... http://www.nursingtimes.net/forums-blogs-ideas-debate/nursing-blogs/the-image-of-nursing-a-culture-of-respect/5018600.article
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If you're trying to bring your blood pressure to healthy levels, a new study suggests that how much you weigh is more important than how fit you are. As expected, the study found that overweight or obese people were more likely to have a high systolic blood pressure - the top number in a blood pressure reading. But for those with a high body mass index (BMI) - a measure of weight versus height -- how in shape they were only had a small impact on their blood pressure.... http://www.reuters.com/article/idUSTRE66T54F20100730?feedType=nl&feedName=ushealth1100
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Gene variants in Japanese prostate cancer patients A large study in Japan into possible genetic causes for prostate cancer has uncovered five new gene variants which have never been seen in previous studies in Caucasians, researchers said on Monday. ...
http://www.reuters.com/article/idUSTRE6701F320100801?feedType=nl&feedName=ushealth1100
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Ever skip breakfast, secretly hoping you'll fit into your jeans better if you do? It's a natural thought. Less food in your belly means more room in your waistband, right? Think again. New research shows that skirting the ritual of a morning meal can totally sabotage your waistline by setting you up for minimal calorie burn and a bigger appetite throughout the day. ... http://www.realage.com/tips/follow-this-morning-ritual-to-get-slimmer?eid=8324&memberid=4687812
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Take your Vitamin D at this time of day: No doubt about it, vitamin D has risen to the ranks of nutritional superstardom. But you need to give this talent the red carpet treatment to really get a good show. One needs to get 400 international units of vitamin D and 1,200 milligrams of calcium per day
What does that mean? Research suggests this nutrient will perform best if you take it during your biggest meal of the day -- be it breakfast, lunch, or dinner .... Reference: Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D. Mulligan, G. B., Licata, A., Journal of Bone and Mineral Research 2010 Apr;25(4):928-930 http://www.realage.com/tips/take-your-vitamin-d-at-this-time?eid=7210&memberid=4687812
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RANDOM FACT: General Lew Wallace's best seller 'Ben-Hur', published in 1880, was the first work of fiction to be blessed by a pope.
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TODAY'S THRIFTY TIP: To determine your debt burden, add up all of your monthly consumer debt obligations and minimum required payments (not counting your mortgage). Include car loans, college
loans and credit cards. If the total consumes 15 to 20 percent or more of your paycheck, you need to take measures to reduce your debt, say financial planners.
BONUS TIP: Also, look for other signs of a high debt burden, such as borrowing to pay for necessities, missing payments or making late payments, being turned down for credit or neglecting to save for retirement or other financial goals.
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ANA and co-publisher National Nursing Staff Development Organization announced this month the release of Nursing Professional Development: Scope and Standards of Practice, the long-awaited update of a key resource for a dynamic and complex practice specialty. Previous editions have conceived nursing professional development primarily by its overlapping and equivalent practice domains: staff development, continuing education, and academia.
Major transformations in nursing professional development practice (NPD) have been underway since the previous edition published in 2000. Within the continuing education and academic domains, technology has changed the learning environment and the potential target audiences. Once locally or regionally defined, the target audience—the NPD specialist—is now global.
The newly revised, Nursing Professional Development: Nursing Scope and Standards, reflects the complex and rapidly developing factors that influence its current and future practice: globalization, dynamic practice environments, evidence-based practice, and the technologies of nursing and health care. ...
http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2010-PR/Revised-Nursing-Professional-Development-Scope-Standards-of-Practice-.aspx
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Silence On Bad Doctors (Los Angeles Times) Researchers at Massachusetts General Hospital surveyed thousands of physicians in a variety of medical specialties; 17% said they'd had direct, personal knowledge of an impaired or incompetent colleague in their hospital, group or practice in the last three years. ... [D]octors are largely unmonitored. In large part, they are expected to police one
another. … In many ways, this approach makes sense. After all, who better to judge the work of one professional than someone with the same training and skills? But without other methods of monitoring in place, many incompetent and impaired physicians are allowed to continue treating patients (Valerie Ulene, 8/2). http://www.latimes.com/news/health/la-he-the-md-incompetence-20100802,0,26474.story
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RANDOM FACT: Dentists recommend that you keep your toothbrush at least 6 feet away from a toilet to avoid contamination.
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RANDOM FACT: A seventh grader in Florida recently won her school science fair by proving there are more bacteria in ice machines at fast-food restaurants than in toilet bowl water. (Keep in mind this was "clean" toilet bowl water--- flushing causes a huge amount of particulates to cling to stall walls, bathroom ceilings, etc. always put the lid down prior to flushing)
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The Society for Healthcare Epidemiology of America calls vancomycin-resistant enterococci (VRE) one of the "most out of control" resistant pathogens in U.S. hospitals.
Myriad aspects play into the development of this kind of epidemic - genetic and molecular features, environmental and host-microbe interactions, and epidemiological factors.
Continued attention on hospital-acquired infections has brought significant mainstream media attention to infections like those caused by VRE and MRSA.
Nosocomial VRE outbreaks in U.S. hospitals were first reported in the mid- and late 1980s1 Since then, infections have remained common in hospital environments largely because of the intrinsic resistance of enterococci to commonly used antibiotics and their ability to acquire resistance to new antibiotics. ... http://nursing.advanceweb.com/Features/Articles/VRE-Still-Resisting-Arrest.aspx
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RANDOM FACT: The most sensitive parts of the body are the mouth and the fingertips.
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Scientists create liver cells from patient's skin (Reuters) - Scientists have created liver cells in a lab for the first time using reprogrammed cells from human skin, paving the way for the potential development of new treatments for liver diseases that kill thousands each year. ... http://www.reuters.com/article/idUSTRE67O4RC20100825?feedType=nl&feedName=ushealth1100
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Forensic Nursing: The patients would come in and sit with the regular ED waiting room population, and we'd basically draw straws to care for these patients because no one was comfortable doing the exams," she said. "I'd see these patients without having had any training, and I'd read the kit while the patient was sitting there. It was not a good feeling for me, and I knew it was not good for the patient."
So, in 1998, when Frederick Memorial Hospital, Frederick, MD, wanted to bring a SAFE program to the hospital, Day, the ED charge nurse at that time, was happy, but not jumping at the opportunity to spearhead the program. Her plan to start the program and hand it off to someone else didn't pan out. She and two other nurses took the training to attain the SANE credential and started the program using the Sexual Assault Response Team model, which enlists support from various community agencies - rape crisis centers, child advocacy groups, police departments, crime labs and district attorney offices. ... http://nursing.advanceweb.com/florida-information/Regional-Articles/Features/Forensic-Nursing-in-Focus.aspx
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Preventing DVT and Pulmonary Emboli Preventing deep venous thromboses (DVTs) and pulmonary emboli (PEs) is one of the constant challenges facing nurses specializing in critical care. Lisa M. Soltis, MSN, APRN, CCRN-CSC, CCNS, cardiovascular/critical care clinical nurse specialist at Wake Med Health and Hospitals, Raleigh, NC, described the two-pronged approach her organization has taken to prevent DVTs and PEs over the past year. ...
http://nursing.advanceweb.com/south-eastern-tn-nc-sc-ms-al-ga-journal-articles/Regional-Articles/Features/Preventing-DVT-Pulmonary-Emboli.aspx
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Rapid Reporting: Minimizing Risk As healthcare professionals, we have long understood the need to report an "adverse incident" or "sentinel event" in the healthcare setting. A sentinel event, as defined by the Joint Commission is: "an unexpected occurrence, involving death or serious physical or psychological injury, or risk thereof (Joint Commission, 2010).
Healthcare providers in the temporary staffing industry, particularly the travel industry, are unique in that they need to double report: adverse events need to be reported to both the facility management team as well as to the staffing company that placed them in that particular job. However, during a crisis, we may not prioritize this reporting, and may forget the numerous benefits of reporting an incident in a timely manner. ... http://w3.rn.com/News/headlines_details.aspx?Id=34770
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RANDOM FACT: Despite his reputation for being rude and angry, Beethoven had many friends and was well liked. More than 20,000 people attended his funeral.
Mozart married Constanze Weber in 1782. He had first proposed to Constanze’s older sister, who had rejected his suit. In spite of this earlier proposal and financial difficulties, their marriage was a happy one until Mozart’s death in 1791 at the age of 35.
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Fertility treatments eventually show "diminishing returns" (Reuters Health) - Couples' chances of becoming pregnant with various forms of fertility treatment may start to fall after two or three tries with the same tactic, a new study suggests.
The findings, reported in the journal Fertility and Sterility, may offer some guidance on a question under debate in the infertility treatment field: How many treatment cycles should a couple undergo before proceeding to another -- often more intensive and expensive -- form of treatment? There are a number of options for treating fertility problems, depending on what the cause is, if that can be determined at all. http://www.reuters.com/article/idUSTRE6734LY20100804?feedType=nl&feedName=ushealth1100
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(Reuters) - A scan of all the human DNA has turned up 95 genes that affect blood cholesterol, including a few affected by drugs on the market and others that might be the basis of new drugs, researchers said on Wednesday.Their findings demonstrate that regulating cholesterol levels is even more complex than many people knew but also point to some short-cuts to prevent heart disease.
The variations they found account for between a quarter and a third of the inherited variation in cholesterol levels and triglycerides, the researchers report in the journal Nature. Diet and exercise can also greatly affect cholesterol levels. ... http://www.reuters.com/article/idUSTRE6735NZ20100804?feedType=nl&feedName=ushealth1100
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RANDOM FACT: Every time you sneeze some of your brain cells die.
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IUD works for emergency birth control: study (Reuters Health) - A copper intrauterine device was 100 percent effective at emergency contraception in a study of almost 2000 Chinese women who had the device implanted up to 5 days after unprotected sex.
The device - called Copper T380A, or Copper T - continued to be effective at preventing pregnancy a year after it was inserted.
Copper T, marketed as ParaGard in the United States, is a T-shaped piece of flexible plastic wrapped in a layer of copper that is inserted into the uterus. It works by stopping sperm from reaching the egg and by preventing an embryo from implanting in the wall of the uterus. ... http://www.reuters.com/article/idUSTRE67558I20100806?feedType=nl&feedName=ushealth1100
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Sneaking a snack now and then is a recipe for waistline disaster, right? Maybe not. A new study suggests a snack strategy that might help you avoid ending up five sizes bigger.
In the study -- involving healthy, normal-weight people -- the participants ate three snacks a day for 8 weeks and didn't pack on any extra pounds. The magic secret? Eat what you know. ...
Reference: Effects of snack consumption for 8 weeks on energy intake and body weight. Viskaal-van Dongen, M. et al., International Journal of Obesity 2010 Feb;34(2):319-326.
http://www.realage.com/tips/how-to-snack-without-getting-huge?eid=7207&memberid=4687812
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Uncover Hidden Calories This quiz can reveal excess calories you might not be counting
If you find weight creeping on, take our quiz and see if you can uncover the hidden calories. You'll see that they can add up in the most surprising places! http://www.ivillage.com/are-you-eating-too-many-calories/4-q-129942?nlcid=wh|08-10-2010|
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Promoting Mental Health and Preventing Suicide: A Toolkit for Senior Living Communities
The Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services has completed a toolkit for Promoting Mental Health and Preventing Suicide: A Toolkit for Senior Living Communities. The toolkit contains resources to help staff in senior living communities promote mental health and prevent suicide among their residents. This toolkit is a FREE resource and is available for order or download on SAMHSA's Health Information Network. http://mentalhealth.samhsa.gov/publications/allpubs/SMA10-4515/
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Blacks more prone to blood clots after stents (Reuters) - Blacks treated with a drug-coated stent to open clogged heart arteries are nearly three times more likely to develop a life-threatening blood clot than whites, U.S. researchers said on Monday. ... http://www.reuters.com/article/idUSTRE67T59E20100830?feedType=nl&feedName=ushealth1100
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RANDOM FACT: Queen Berengaria of England, who married Richard I (the Lion-Hearted) in 1191, never lived in or even visited England.
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Bone marrow cells can help in heart failure: study STOCKHOLM (Reuters) - Patients with chronic heart failure given injections of their own bone marrow stem cells have better heart function and live longer, German researchers said Sunday.
The beneficial effects of the cell therapy were seen within three months and continued for five years, according to findings from one of the biggest studies to date on using stem cell therapy to treat heart conditions. ... http://www.reuters.com/article/idUSTRE67S0X420100829?feedType=nl&feedName=ushealth1100
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New therapy for metastatic melanoma Approximately 60,000 new cases of melanoma, will be diagnosed in the U.S. in 2010. The disease, which is the most serious type of skin cancer, accounts for about 10,000 deaths each year. That's according to the American Cancer Society. And although melanoma is treatable when caught early, after it spreads to other parts of the body, a patient is usually given a grim diagnosis of less than a year to live. Now a study in the New England Journal of Medicine reports a new drug treatment may help some of these patients live longer.
While looking at genes in cancer patients back in 2002 , scientists found that in 40 to 60 percent of melanoma cases and 7 to 8 percent of all cancers, a protein mutation known as BRAF was present. With this mutation, the protein becomes overreactive, causing cancer cells to grow. When researchers targeted this BRAF mutation with a drug known as PLX4032, it inhibited the mutation, shrinking tumors and slowing the progression of the disease in 81 percent of those treated. ... http://pagingdrgupta.blogs.cnn.com/2010/08/26/new-therapy-promising-against-metastatic-melanoma/
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U.S. dietary supplements often contaminated: report The consumer magazine published a report on Tuesday highlighting the U.S. Food and Drug Administration's lack of power to regulate such supplements, and said the agency rarely uses what little power it does have.
The report from the influential group urged Congress to speed up small moves toward giving the agency more clout, especially in regulating supplements.
Despite the "natural" labels carried by many of the supplements, many are contaminated.... http://www.reuters.com/article/idUSTRE6721F520100803?feedType=nl&feedName=ushealth1100
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Guiding Principles for Diabetes Care (NDEP)This evidence-based booklet outlines important patient-centered principles of diabetes care, helping health care professionals identify people with pre-diabetes and undiagnosed diabetes for treatment aimed at preventing long-term complications.... http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=108
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Make it Happen: Changing institutional culture is a difficult task. In the U.S., with only 13.6 percent of infants exclusively receiving human milk for the first 6 months of life, breastfeeding is not the cultural norm.1 Many women begin breastfeeding, but the drop-off rate is alarmingly high. ... http://nursing.advanceweb.com/Features/Articles/Making-it-Happen.aspx
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The Effect of a Dysphagia Educational Program on Registered Nurses' Intentions to Perform Dysphagia Assessment Journal of Neuroscience Nursing, 08/02/2010 Werner H – There has been an increase in demand on healthcare providers to demonstrate evidence of their effectiveness on patient outcomes. A dysphagia assessment can be performed by an RN in the emergency room and in other patient care areas to prevent serious complications of aspiration. This study was the first to examine the RN's intention and ability to perform dysphagia assessments. (required to subscribe for full article) http://journals.lww.com/jnnonline/Abstract/2010/08000/The_Effect_of_a_Dysphagia_ Educational_Program_on.12.aspx
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When Unemployed Means Unhealthy Too
The proposed reasons included loss of insurance, lack of income to attend to medical issues, and increased stress which could lead to poorer eating and exercise habits as well as increased stress hormones that could worsen blood pressure, diabetes and arthritis.
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Calcium supplements increase the risk of heart disease in the elderly, study say Millions of post-menopausal women take calcium supplements in an effort to stave off osteoporosis, but recent studies have shown that the pills provide little benefit: Even though they may increase bone density, they do not reduce the risk of fractures or of death. Now, some researchers are becoming convinced that the supplements not only provide no benefit, but that they can even be harmful, increasing the risk of heart attacks by nearly a third. ... http://www.latimes.com/news/health/boostershots/la-heb-calcium-supplements-20100729,0,3937993.story?track=rss
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RANDOM FACT: The first lighthouse to use electricity was the Statue of Liberty in 1886. I never thought of the Statue as a lighthouse, did you?
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This was submitted by KurtUllman@sprintmail.com If this is a repeat...excuse please.
Why Females Live Longer Than Males: Is It Due to the Father's Sperm?
ScienceDaily (Dec. 2, 2009) — Researchers in Japan have found that female mice produced by using genetic material from two mothers but no father live significantly longer than mice with the normal mix of maternal and paternal genes. Their findings provide the first evidence that sperm genes may have a detrimental effect on lifespan in mammals.
http://www.sciencedaily.com/releases/2009/12/091201192105.htm
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HUMOR SECTION
Some of the following we have seen before.......but many are new (at least to me).
These are sentences actually typed by Medical secretaries in NHS Greater Glasgow.
1. The patient has no previous history of suicides.
2. Patient has left her white blood cells at another hospital.
3. Patient's medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is tearful and crying constantly. She also appears to be depressed.
8. The patient has been depressed since she began seeing me in 1993.
9. Discharge status:- Alive, but without my permission.
10. Healthy appearing decrepit 69-year old male, mentally alert, but forgetful.
11. Patient had waffles for breakfast and anorexia for lunch.
12. She is numb from her toes down.
13. While in ER, she was examined, x-rated and sent home.
14. The skin was moist and dry.
15. Occasional, constant infrequent headaches.
16. Patient was alert and unresponsive.
17. Rectal examination revealed a normal size thyroid.
18. She stated that she had been constipated for most of her life until she got a divorce.
19. I saw your patient today, who is still under our care for physical therapy.
20. Both breasts are equal and reactive to light and accommodation.
21 Examination of genitalia reveals that he is circus sized.
22. The lab test indicated abnormal lover function.
23. Skin: somewhat pale, but present.
24. The pelvic exam will be done later on the floor.
25. Large brown stool ambulating in the hall.
26. Patient has two teenage children, but no other abnormalities
27. When she fainted, her eyes rolled around the room.
28. The patient was in his usual state of good health until his airplane ran out of fuel and crashed.
29. Between you and me, we ought to be able to get this lady pregnant.
30. She slipped on the ice and apparently her legs went in separate directions in early December.
31. Patient was seen in consultation by Dr. Smith, who felt we should sit on the abdomen and I agree.
32. The patient was to have a bowel resection. However, he took a job as a stock broker instead.
33. By the time he was admitted, his rapid heart had stopped, and he was feeling better.
Stay away from hospitals !
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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........
Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /
Free CEs http://www.myfreece.com/welcome.asp
https://nursing.advanceweb.com/CE/TestCenter/Main.aspx
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Providing On-Line Continuing Education Since 1997
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to: RNFrankie@AOL.com.
Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)
Founder, Forum for Shared Governance info@sharedgovernance.org
http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.nationalnurse3.blogspot.com/
Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263
The Nursing Site http://thenursingsite.com .
To double check for "Urban Legends" http://www.snopes.com
http://www.solutionsoutsidethebox.net/ Raconte's website
http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3
National Do Not Call Registry
If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood
This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/
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MEDICAL RECALLS
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This one dates from April....sorry, that I missed it.
Promacta (eltrombopag): Portal Venous System Thromboses in Study of Patients With Chronic Liver disease
GlaxoSmithKline and FDA notified healthcare professionals of a new safety finding in patients with thrombocytopenia due to chronic liver disease treated with eltrombopag, a thrombopoietin receptor agonist approved for the treatment of thrombocytopenia in adult patients with chronic immune (idiopathic) thrombocytopenic purpura. The ELEVATE study, a randomized, double-blind, placebo-controlled, multinational study was terminated following the identification of an imbalance of thrombosis of the portal venous system in the patients treated with eltrombopag versus matching placebo.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm211796.htm
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Tygacil (tigecycline): Label Change - Increased Mortality Risk FDA reminded healthcare professionals of an increased mortality risk associated with the use of the intravenous antibacterial Tygacil (tigecycline) compared to that of other drugs used to treat a variety of serious infections. The increased risk was seen most clearly in patients treated for hospital-acquired pneumonia, especially ventilator-associated pneumonia, but was also seen in patients with complicated skin and skin structure infections, complicated intra-abdominal infections and diabetic foot infections ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm224626.htm
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Inferior Vena Cava (IVC) Filters: Initial Communication: Risk of Adverse Events with Long Term Use Since 2005, the FDA has received 921 device adverse event reports involving IVC filters, of which 328 involved device migration, 146 involved embolizations (detachment of device components), 70 involved perforation of the IVC, and 56 involved filter fracture. Some of these events led to adverse clinical outcomes in patients. These types of events may be related to a retrievable filter remaining in the body for long periods of time, beyond the time when the risk of pulmonary embolism (PE) has subsided.
The FDA is concerned that these retrievable IVC filters, intended for short-term placement, are not always removed once a patient’s risk for PE subsides. Known long term risks associated with IVC filters include but are not limited to lower limb deep vein thrombosis (DVT), filter fracture, filter migration, filter embolization and IVC perforation. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts
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Lamictal (lamotrigine): Label Change - Risk of Aseptic Meningitis FDA notified healthcare professionals and patients that Lamictal (lamotrigine), a medication commonly used for seizures in children two years and older, and bipolar disorder in adults, can cause aseptic meningitis. Symptoms of meningitis may include headache, fever, stiff neck, nausea, vomiting, rash, and sensitivity to light. In cases of meningitis, it is important to rapidly diagnose the underlying cause so that treatment can be promptly initiated. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts
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6 French Engage Introducer Devices by St. Jude Medical: Recall - Potential for Separation of Shaft From Hub Some devices in the affected batches have the potential for separation of the shaft (sheath) from the hub or for a break in the hub assembly. If either of these were to occur during use, a potentially life threatening episode of bleeding could occur. The Engage Introducer is used to implant catheters and electrodes into blood vessels during surgery and helps to prevent blood loss. Affected batches of the Engage Introducer were produced between April 27 and June 03, 2010. The recall affects approximately 5,120 devices. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm222397.htm
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FDA proposed to withdraw approval of the drug midodrine hydrochloride, used to treat the low blood pressure condition, orthostatic hypotension, because required post-approval studies that verify the clinical benefit of the drug have not been done. To date, neither the original manufacturer nor any generic manufacturer has demonstrated the drug’s clinical benefit, for example, by showing that use of the drug improved a patient’s ability to perform life activities.
BACKGROUND: The drug, marketed as ProAmatine by Shire Development Inc. and as a generic by others, was approved in 1996 under the FDA’s accelerated approval regulations for drugs that treat serious or life-threatening diseases. That approval required that the manufacturer verify clinical benefit to patients through post-approval studies. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm222640.htm
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NeoProfen (ibuprofen lysine) Injection: Recall and Shortage - Risk of Particulate Matter FDA notified healthcare professionals of a recall of two lots of NeoProfen (ibuprofen lysine) Injection because the product failed to meet a visible particulate quality requirement. NeoProfen is a non-steroidal anti-inflammatory therapy indicated to close a clinically significant patent ductus arteriosus in premature infants weighing between 500 and 1500 g, who are no more than 32 weeks gestational age when usual medical management (e.g., fluid restriction, diuretics, respiratory support, etc.) is ineffective. The recall includes product lots 1734991 (expiration date: April, 2011) and 1922319 (expiration date: March, 2012). RECOMMENDATION: These two lots are the only lots currently available to prescribers. As NeoProfen stock is being replenished by the manufacturer, there will be a product shortage that is expected to be temporary. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts
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Nimodipine Oral Capsules: Medication Errors - IV Administration May Result in Death, serious Harms FDA reminded healthcare professionals that oral nimodipine capsules should be given only by mouth or through a feeding or nasogastric tube and should never be given by intravenous administration. Nimodipine is a medication intended to be given in a critical care setting to treat neurologic complications from subarachnoid hemorrhage (ruptured blood vessels in the brain) and is only available as a capsule. Intravenous injection of nimodipine can result in death, cardiac arrest, severe falls in blood pressure, and other heart-related complications. The prescribing information also provides clear instructions on how to remove the liquid contents from the capsules for nasogastric tube administration in patients who are unable to swallow. The instructions recommend that the syringe used for withdrawal of capsule contents be labeled with "Not for IV Use." FDA continues to receive reports of intravenous nimodipine use, with serious, sometimes fatal, consequences. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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Solo Slim, Solo Slim Extra Strength: Recall - Undeclared Drug Ingredient FDA lab analysis of Solo Slim was found to contain the undeclared drug ingredient Didesmethyl Sibutramine. Sibutramine is an FDA-approved drug used as an appetite suppressant for weight loss. Solo Slim is packaged in white plastic bottles with blue screw-on cap containing 30 capsules per bottle and bears UPC 8 35470 00206 9. Solo Slim Extra Strength is packaged in white plastic bottles with blue screw-on cap containing 30 capsules per bottle and bears UPC 8 35470 00220 5. All lots of these products with expiration dates including and prior to August 2013 currently available on the market are being recalled. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts
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Huber Needles: Recall - Risk of Coring
Multi-Med, Inc., 22 Gauge x 1 inch Straight and Right Angle Huber Needles
Navilyst Medical Inc., Vaxcel Implantable Vascular Access Systems Containing Huber Needles Infusion Set Needles [Manufactured by Nipro for Exelint]
ISSUE: FDA notified healthcare professionals of the Class I Recall of certain Huber needles that were determined by FDA testing to produce cores when inserted into ports. Coring may lead to infection, damage or death of tissue, swelling, or other serious adverse health consequences, occurring as a result of the core travelling through blood vessels into the patient’s lungs. These issues may potentially cause death.
BACKGROUND: Following hospital reports to the FDA of leakage after accessing the port with a Huber needle (labeled to be non-coring), FDA conducted its own laboratory testing of Huber needles from multiple manufacturers. Huber needles are safety needles used on vascular access ports implanted in patients in need of repeated intravenous therapy. A "coring" Huber needle could damage the implanted port by removing silicone slivers from the access membrane. The defect in the port as a result of coring can cause the ports to leak. The core can also potentially enter a patient’s body when the port is initially accessed if it is not flushed correctly.
RECOMMENDATION: Clinicians should immediately discontinue use of the recalled products. If you must use the kit, consider using an alternative, unaffected non-coring needle if possible. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm224163.htm
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Fingerstick Devices to Obtain Blood Specimens: Initial Communication - Risk of Transmitting Bloodborne Pathogens (When do we ever use lancets, etc on multiple patients?)Reusable fingerstick (blood lancing) devices and point of care (POC) blood testing devices (e.g., blood glucose meters, PT/INR anticoagulation meters, cholesterol testing devices) FDA and CDC have noted a progressive increase in the reports of bloodborne infection transmission over the past 10 to 15 years (primarily hepatitis B virus), resulting from the shared use of fingerstick and point-of-care [POC] blood testing devices.
Fingerstick and POC blood testing devices used on more than one patient may not be safe for several reasons. Improper use or device malfunction can lead to the use of the contaminated lancet blade on more than one patient. It is difficult for healthcare staff to ensure that all blood has been removed from POC blood testing devices and the reusable portions of the fingerstick device. If POC blood testing devices are used on multiple patients and are not cleaned and disinfected correctly and thoroughly between each patient, contaminated blood left on them could result in bloodborne pathogen transmission among patients.
Fingerstick devices should never be used for more than one person. If dedicating POC blood testing devices to a single patient is not possible, the devices should be properly cleaned and disinfected after every use as described in the device labeling. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm224135.htm
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NURSING HINTS CORNER
This first appeared on 2/17/04 and then again in 2006. I think it is worth another repeat appearance.
Recent surveys have provided a scientific rationale for IM site selection. The Ventro-gluteal is the only site that has not been associated with any adverse effects whatsoever. The ventrogluteal site lacks major nerves and blood vessels, has well developed muscle mass, and is easy to locate.
Directions for this placement are as follows: place heel of NON-dominant hand over the patient's greater trochanter. Position the index finger on or toward the anterior superior iliac spine, then stretch the middle finger away from the index finger. The center of this V formed by the fingers and the iliac crest is the injection site. I strongly suggest that just before injection, a small tap by the nurse's finger, will be a distraction (momentarily) and will help alleviate the pain of injection.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com
WELCOME TO:
trh5501@hotmail.com Terese September 1, 2010
Bednibroc@yahoo.com Debbie September 1, 2010
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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com
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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
Labor is prior to, and independent of, capital.
Capital is only the fruit of labor,
and could never have existed
if Labor had not first existed.
Labor is superior to
capital,
and deserves much the higher consideration.
--Abraham Lincoln
Hope to see you online..... Frankie
RNFrankie@AOL.com
