Chronic Pain by Genevieve M. Clavreul, RN, Ph.D.

Chronic Pain What nurses don't know about pain management By Genevieve M. Clavreul, RN, Ph.D. What is pain? There are many definitions. The most widely accepted is the one used by The International Association for the Study of Pain, which defines pain as “an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.” The American Academy of Pain defines it as “an unpleasant sensation and emotional response to that sensation.” Margo McCaffrey, MS, RN-BC, FAAN, a specialist in the nursing care of patients with pain, is credited with providing the definition most appropriate for use in clinical practice. She says pain is “whatever the experiencing person says it is, existing whenever and wherever the person says it does.” Isn’t Pain Subjective? Pain Assessment ScaleMost nurses feel that they have a good understanding of pain. We have, after all, nifty charts, diagrams and whatnots that we use to help our patients describe just how much discomfort they’re experiencing. On a scale from one to 10, with one being no pain, and so on; or my favorite, the happy/sad face pictorial chart where we ask the patient to choose the appropriate smiley/frownie face. Being able to accurately gauge the intensity and source of pain is a critical component to the nursing team’s ability to provide optimal patient care. However, there is a difference between treating the patient in pain and treating a patient living with chronic pain. My personal experience has lead me to question how well nurses are educated and trained to address the needs of patients living with chronic pain, and the regime of medication that is used to treat them. Many a competent and compassionate nurse has been thwarted and confounded when confronted by such a case. Regrettably, inappropriate care can set back a patient’s recovery, cause additional negative sequelae, and in some cases, threaten a patient’s well-being. Patricia’s Withdrawal Recently, my daughter Patricia underwent a long-awaited knee replacement surgery (for the record, she gave me permission to out her, so no HIPPA violation here). Patricia suffers from chronic pain and is on a long-term regimen of Kadian, a time-released morphine, and Narco for breakthrough pain. As the date for her surgery approached, she received the reminder call from the surgical nurse not to eat or drink after midnight. She took this to mean not taking her medication since it fell within that “no eat or drink” time. Which is why my daughter went into surgery that morning at 0700 without any pain meds on board. As my other daughter Chris and I waited patiently during the surgery and post-op recovery, I wondered how Patricia would react to being without her meds for so long. Chris and I entered her room later that morning just as a nurse was bringing in additional blankets to address Patricia’s uncontrollable shaking. My fears about withdrawal were realized. The nurse assured us that Patricia was simply suffering from a post-anesthesia “cold” and that he’d bring some more blankets in shortly and have her feeling all toasty and warm “real soon.” The Consult I took the opportunity to assess her myself — because as you know, you never stop being a nurse. Her color was extraordinarily pasty and pale, her lips appeared gray, you could see her muscles twitch with the naked eye and her extremities shook as if she had palsy. I shared my observations with the nurse and he assured me, once again, that it was simply a normal response to the anesthesia. At this time I reminded him that she was accustomed to taking both Kadian and Narco and had been doing so for many years, and because of the impending surgery had not taken her usual dose. To which he responded that she was ordered a PCA pump, but I could see that it was set to an amount that was nowhere near the level of her pre-surgical dose. Keep in mind that I had also talked at length on this very issue with the surgeon, the anesthesiologist, and every nurse (and there were many) I came in contact with prior to the surgery. So, I had to wonder, did the various physicians, nurses, technicians and others who are part of the pre-op and post–op process really read and integrate all the information that they demand from their patients? If they had, they would have taken steps to avoid putting my daughter into opioid withdrawal syndrome. Finally, the nurse informed me that he would ask for a pain consult and he stepped away to the nurses station to place the call. A short time later, a physician whose specialty was pain management arrived. After a brief series of questions, he ordered that Patricia return to her former pain management regime and the PCA dosage be increased as well. As he left, he commented to me that he found it frustrating that so many patients were placed in similar opioid withdrawal “crisis” after following the surgical nurse's instructions to “take nothing by mouth” after midnight. What they should do, he said, was take their scheduled pain medication, but do so with the most minimal amount of water needed to swallow. Needless to say, once Patricia was back on her pain treatment regime and the PCA dosage increased, the color returned to her cheeks, her lips lost their grey pallor and all signs of shivering ceased. Educating Ourselves Understanding chronic pain is an area where more education and instruction is needed. This is not to say that most nurses don’t do their utmost to alleviate their patient’s suffering, because they do. But treating chronic pain is not as simple as writing out a prescription and reminding the patient to take the medication as prescribed. Addiction is a very real possibility and the need to monitor for that outcome is critical. Nurses who want to learn more can contact a group such as the American Society for Pain Management Nursing (www.aspmn.org). They have chapters in many states, including one in Southern California. Their mission is to advance and promote optimal care for people affected by pain by promoting best nursing practices. Like many organizations, their meetings have a topic, a speaker and a Q&A. In addition to the meetings, the members themselves are an excellent resource to answer questions related to pain management, and I’ve found that many have extensive networks that include other experts. Action Plan There are many things that nurses can do to better understand this issue. We can ask that our hospital’s nursing education department provide continuing education in pain management, as well as provide opportunities for the nursing team to have “personal” time with physicians and nurses who specialize in pain management. Nurses can lead the charge in advocating for other interventions that may help reduce the need for opioids. Recently there has been a push to encourage the use of long-term physical therapy, aqua therapy, exercise, acupuncture and even yoga to address chronic pain. The results from these therapeutic interventions have been positive and can help reduce the patient’s dependence on medication. There’s a lot about pain management that even the experts don’t know, so the next time you have such a patient, don’t be shy about asking questions. Consult the experts on staff regarding care protocol. Booked Solid, Forever In closing, let me share with you a little story about unintended consequences. Not that long ago, the State of Washington legislature decided that it was in the best interest of their constituents who were being treated with opioids for chronic pain that they be required to see a physician specializing in pain management for assessment and to receive their prescriptions. On the surface, the legislation helped to ally the fears of the medical/nursing community that people living with chronic pain would have their needs met, and hopefully reduce illicit opioid distribution and minimize addiction, misuse and so forth. Unfortunately, what everyone failed to take note of was the shear paucity of pain management experts licensed in Washington — at that time there were two in the whole state. Needless to say, this placed an extraordinary burden on not only the patients, but the two sole practitioners as well. As they say, the road to you-know-where is paved with good intentions.

PARADIGM BYTES Newsletter for Paradigm 97 July 12, 2012 PARADIGM DEFINED: 1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated. Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it. MISSION STATEMENT We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience. ***~~~***~~~***~~~*** SNIPPETS Female genital mutilation (FGM) (Circumcision) Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The procedure has no health benefits for girls and women. Procedures can cause severe bleeding and problems urinating, and later cysts, infections, infertility as well as complications in childbirth increased risk of newborn deaths. About 140 million girls and women worldwide are currently living with the consequences of FGM. FGM is mostly carried out on young girls sometime between infancy and age 15. In Africa an estimated 92 million girls 10 years old and above have undergone FGM. FGM is a violation of the human rights of girls and women. Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. However, more than 18% of all FGM is performed by health care providers, and this trend is increasing. FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death. Procedures Female genital mutilation is classified into four major types. Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. No health benefits, only harm FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls' and women's bodies. Immediate complications can include severe pain, shock, haemorrhage, tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue. Long-term consequences can include: recurrent bladder and urinary tract infections; cysts; infertility; an increased risk of childbirth complications and newborn deaths; the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing and repeated both immediate and long-term risks. Who is at risk? Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. In Africa, about three million girls are at risk for FGM annually. About 140 million girls and women worldwide are living with the consequences of FGM. In Africa, about 92 million girls age 10 years and above are estimated to have undergone FGM. The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in Asia and the Middle East, and among migrants from these areas. Cultural, religious and social causes The causes of female genital mutilation include a mix of cultural, religious and social factors within families and communities. Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice. FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage. FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist "illicit" sexual acts. When a vaginal opening is covered or narrowed (type 3 above), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage "illicit" sexual intercourse among women with this type of FGM. FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are “clean” and "beautiful" after removal of body parts that are considered "male" or "unclean". Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support. Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination. Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. In most societies, FGM is considered a cultural tradition, which is often used as an argument for its continuation. In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement. In some societies, FGM is practised by new groups when they move into areas where the local population practice FGM. International response In 1997, WHO issued a joint statement with the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) against the practice of FGM. A new statement, with wider United Nations support, was then issued in February 2008 to support increased advocacy for the abandonment of FGM. The 2008 statement documents evidence collected over the past decade about the practice. It highlights the increased recognition of the human rights and legal dimensions of the problem and provides data on the frequency and scope of FGM. It also summarizes research about why FGM continues, how to stop it, and its damaging effects on the health of women, girls and newborn babies. In 2010 WHO published a "Global strategy to stop health care providers from performing female genital mutilation" in collaboration with other key UN agencies and international organizations. Since 1997, great efforts have been made to counteract FGM, through research, work within communities, and changes in public policy. Progress at both international and local levels includes: wider international involvement to stop FGM; the development of international monitoring bodies and resolutions that condemn the practice; revised legal frameworks and growing political support to end FGM (this includes a law against FGM in 22 African countries, and in several states in two other countries, as well as 12 industrialized countries with migrant populations from FGM practicing countries); in most countries, the prevalence of FGM has decreased, and an increasing number of women and men in practising communities support ending its practice. Research shows that, if practising communities themselves decide to abandon FGM, the practice can be eliminated very rapidly. WHO response In 2008, the World Health Assembly passed a resolution (WHA61.16) on the elimination of FGM, emphasizing the need for concerted action in all sectors - health, education, finance, justice and women's affairs. WHO efforts to eliminate female genital mutilation focus on: advocacy: developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation; research: generating knowledge about the causes and consequences of the practice, how to eliminate it, and how to care for those who have experienced FGM; guidance for health systems: developing training materials and guidelines for health professionals to help them treat and counsel women who have undergone procedures. WHO is particularly concerned about the increasing trend for medically trained personnel to perform FGM. WHO strongly urges health professionals not to perform such procedures. http://www.who.int/mediacentre/factsheets/fs241/en/ ~~**~~**~~**~~**~~**~~ MEDICAL NEWS Nurse leaders happy with ruling on ACA The Supreme Court’s decision Thursday to uphold the Affordable Care Act means nurses can continue preparing for significant changes to the healthcare system. Those changes began soon after passage of the law in March 2010, and will become more substantial when the core measures go into effect by 2014. "This decision means millions of people will have access to the basic healthcare and preventive services that they’ve lacked," said Karen A. Daley, RN, PhD, MPH, FAAN, president of the American Nurses Association, which has been a staunch supporter of the ACA since its passage. http://news.nurse.com/article/20120628/NATIONAL01/107090007 *********************** U.S. FDA checks dictionary on corn syrup vs sugar WASHINGTON (Reuters) - U.S. food and beverage makers who add high-fructose corn syrup to soda, breakfast cereal, and other items will not be able to label it "corn sugar," under a decision by federal officials that frustrated corn processors but won praise from the sugar industry and some health advocates. Both sides say they have consumers' interests at heart and are trying to minimize confusion about the term "sugar." The U.S. Food and Drug Administration, which decides what goes on food labels, has ruled against the corn groups. The agency said calling high-fructose corn syrup "sugar" would mislead people - and could harm them. "FDA's approach is consistent with the common understanding of sugar and syrup as referenced in a dictionary," the agency said in a letter posted on its website late on Wednesday. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_125788.html ****************** Joint Commission Center for Transforming Healthcare Releases Tool to Tackle Miscommunication Among Caregivers (OAKBROOK TERRACE, Ill. – June 27, 2012) An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off. In addition to patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. Today, the Joint Commission Center for Transforming Healthcare is releasing a new Hand-off Communications Targeted Solutions Tool™ (TST) to assist health care organizations with the process of passing necessary and critical information about a patient from one caregiver to the next, or from one team of caregivers to another, to prevent miscommunication-related errors. Ineffective hand-off communication is recognized as a critical patient safety problem in health care. The “hand-off” process involves “senders,” the caregivers transmitting patient information and releasing the care of that patient to the next clinician, and “receivers,” the caregivers who accept the patient information and care of that patient. The Hand-off Communication TST was created to measure the effectiveness of hand-offs within an organization or to another facility, and provide proven solutions to improve performance. Using the tool and the solutions from the Center’s Hand-off Communications Project, health care organizations have reduced readmissions by 50 percent, and have reduced the time it takes to move a patient from the emergency department to an inpatient unit by 33 percent. Health care organizations also reported an increase in patient and family satisfaction; staff satisfaction; and successful transfers of patients. Health care organizations were able to complete their Hand-off Communications Project in approximately four months, using minimal resources. In fact, no staff was added and only minor changes were made to the roles and responsibilities of existing staff. ... http://www.jointcommission.org/center_transforming_healthcare_tst_hoc/ ; **~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days Don't Let Your Supermarket Make You Fat Where you shop for groceries influences what you buy. Use these budget-friendlystrategies to buy healthy food anywhere. That depends on where you shop for groceries, according to a new study. Shopping at deep-discount supermarkets, especially if they're far from home, is linked to higher body weight and more belly fat than buying groceries at neighborhood markets closer to home. The researchers say this is may be because people who trek to discount supermarkets tend to shop less frequently and buy more nonperishables and less fresh produce. Regardless of where you grocery shop, use these 5 budget-friendly strategies to buy healthy food every time: ... http://www.realage.com/food/how-to-eat-healthy-on-a-budget?eid=1010657443&memberid=4687812 ********************** FDA approves Belviq for treatment of obesity On June 27, the U.S. Food and Drug Administration approved Belviq (lorcaserin hydrochloride) for the treatment of obesity. It is to be used in combination with a reduced-calorie diet and exercise for chronic weight management. The drug is approved for use in adults with a body mass index (BMI) of 30 or greater (obese), or adults with a BMI of 27 or greater (overweight) and who have at least one weight-related condition such as hypertension, type 2 diabetes, or dyslipidemia. ... http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm?utm_source=BenchmarkEmail&utm_campaign=eNewsletter_July_2nd_2012&utm_medium=email ; ********************* Glaxo melanoma drugs beat chemo in pivotal trials (Reuters) - Late-stage trials of two experimental skin cancer drugs from GlaxoSmithKline, each designed to block different pathways used by tumor cells, have found the drugs helped patients with fewer side effects than current chemotherapy. Both drugs, trametinib and dabrafenib, were tested in patients with a mutation in a gene known as BRAF. About half of all melanomas, the deadliest form of skin cancer, have the genetic aberration. Cancer occurs through genetic changes in cells allowing tumor growth factor receptors which activate various pathways, including a protein known as MEK. It is believed that BRAF-mutated melanomas should be particularly dependent on MEK, which is needed to amplify the cancer's genetic signal. http://www.reuters.com/article/2012/06/04/us-cancer-melanoma-glaxosmithkline-idUSBRE85308S20120604?feedType=RSS&feedName=healthNews ********************** Entire Genome of Human Fetus Deciphered WEDNESDAY, June 6 (HealthDay News) -- Researchers report they have decoded the entire genome of a fetus using only a blood sample from the mother and a saliva sample from the father. The scientists said prenatal genome sequencing using the noninvasive method could one day be used to determine if a fetus has any of the thousands of genetic disorders that are caused by a single, often devastating, mutation on one gene. In pregnant women, bits of fetal DNA move through the mother's body in the plasma, a component of blood. Unlike a sample of DNA taken directly from fetal tissue or from amniotic fluid -- such as when expectant mothers undergo amniocentesis to look for chromosomal disorders such as Down syndrome -- the DNA in plasma is in fragments. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_125978.html ********************* RANDOM FACTS: The border between North and South Korea is one of the most militarized areas in the world, according to the State Department, with a combined total of almost two million military personnel under the control of Pyongyang (1.2 million), Seoul (680,000) and foreign powers including the United States (28,000). Bonus Fact: North Korean arms outnumber those in the South by about two to one, including offensive weapons such as tanks, long-range artillery, aircraft and armored personnel carriers. However, much of the military equipment in North Korea is obsolete. ********************** 3 New Weight Loss Myths, Busted Who isn't for looking for fresh ways to slim down? The trouble is that, in time, the latest weight loss or diet trick doesn't work anymore -- you get lazy or don't quite remember what the tip was so you follow it in a halfhearted, or even diet-busting, fashion. Here are three current weight loss beliefs that have morphed into myths. ... http://shine.yahoo.com/healthy-living/3-weight-loss-myths-busted-202700634.html ********************* Nurses Reducing Alarm Fatigue - Beep, bleep, bong, beep, bleep--monitors and medical devices create a cacophony of sounds aimed at alerting nurses to changes in their patients’ conditions, but with the so many bells going off, nurses can become overwhelmed and tune out or turn off the devices. Marjorie Funk, PhD, RN, FAHA, FAAN, said that alarm fatigue can lead to bad outcomes and suggested ways to minimize the risk. “Devices with alarms beep endlessly, demanding our attention, but once the staff become overwhelmed by the sheer number of alarms, it has led to sentinel events,” said 2011 American Association of Critical-Care Nurses (AACN) Distinguished Research Lecturer Marjorie Funk, Ph.D., RN, FAHA, FAAN, a professor at the Yale University School of Nursing in New Haven, Conn., at the association’s 2012 National Teaching Institute and Critical Care Exposition (NTI) in Orlando, Fla. ... http://www.nursezone.com/Nursing-News-Events/more-news/Nurses-Reducing-Alarm-Fatigue_40081.aspx ************************** Less folic acid in pregnancy tied to autism: study (Reuters Health) - In a new study of California moms, women whose children had autism recalled getting less folic acid through food and supplements early in their pregnancies than those whose kids didn't develop the disorder. Meeting recommendations for folic acid -- at least 600 micrograms per day -- in the first month of pregnancy was tied to a 38 percent lower chance of having a kid with autism or Asperger's, researchers reported last week in the American Journal of Clinical Nutrition. Folic acid -- the synthetic form of the B-vitamin folate -- has been added to breakfast cereals and other grains in the United States since 1998 because of evidence showing deficiencies in pregnant women made it more likely their babies would have brain and spine birth defects. Questions have remained about whether lack of the vitamin, or difficulty processing it, might increase the risk of mental retardation and certain developmental disorders as well. ... http://www.reuters.com/article/2012/06/06/us-less-folic-acid-idUSBRE85519G20120606?feedType=RSS&feedName=healthNews ********************** RANDOM TIDBITS: Advertisements for coffee in London in 1657 claimed that the beverage was a cure for scurvy, gout and other ills. Almonds are the oldest, most widely cultivated and extensively used nuts in the world. In 1932 James Markham obtained the 1st patent issued for a tree. The patent was for a peach tree. Rice paper isn't made from rice but from a small tree which grows in Taiwan. Willow bark, which provides the salicylic acid from which aspirin was originally synthesized, has been used as a pain remedy ever since the Greeks discovered its therapeutic power nearly 2,500 years ago. The first American advertisement for tobacco was published in 1789. It showed a picture of an Indian smoking a long clay pipe. ***************************** Infection Control Center: Nurses' first priority is excellent patient care; therefore, it's imperative to keep in mind your infection control nurse duties. The role of infection control nurses - and all nurses - is minimizing infections in the hospital, patient home, outpatient setting, or wherever patient care takes place. This Infection Control Center is dedicated to infection control best practices, real-life experiences and discussion among nurses dedicated to infection control and prevention. The center features blogs, videos, articles and more to help you understand the role of nurses in infection control, but you don't have to be an infection control nurse to benefit from the information below. http://nursing.advanceweb.com/resourcecenter/main.aspx?rpid=48 *************************** How Long Should You Take Osteoporosis Drugs? Researchers at the Food and Drug Administration (FDA) have taken a close look at the long-term benefit of bisphosphonates, a class of medications widely prescribed to treat osteoporosis. An FDA review of clinical studies measuring the effectiveness of long-term bisphosphonates use shows that some patients may be able to stop using bisphosphonates after three to five years and still continue to benefit from their use, says Marcea Whitaker, M.D., a medical officer at FDA’s Center for Drug Evaluation and Research. Whitaker is one of the co-authors of the FDA review, which was published in the May 31, 2012 issue of The New England Journal of Medicine. If you're one of the 44 million Americans at risk for osteoporosis—a disease in which bones become weak and are more likely to break—you may be taking bisphosphonates. This class of drugs has been successfully used since 1995 to slow or inhibit the loss of bone mass. Doctors commonly prescribe such brand-name drugs as Actonel, Atelvia, Boniva, and Fosamax (as well as a number of generic products) for osteoporosis. In fact, more than 150 million prescriptions were dispensed to patients between 2005 and 2009. According to the review, further investigation is needed on the long-term risks and benefits of these drugs. "These drugs clearly work," Whitaker says. "We just don't know yet the optimum period of time individual patients should be on the drug to both maximize its effectiveness and minimize potential risks." http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm309688.htm ************************* Work-related empowerment of nurse managers: A systematic review. Nursing and Health Sciences, 06/29/2012  Evidence Based Medicine Trus M et al. – The empowerment of nurse managers correlated positively with job satisfaction, perceived organizational support, role satisfaction, and managerial self–efficacy, and correlated negatively with emotional exhaustion and own health outcomes. Different theoretical approaches ensure a clear understanding of empowerment, but difficulties arise when the findings are synthesized across studies and settings because of the different theoretical frameworks used to conceptualize empowerment. ... http://www.ncbi.nlm.nih.gov/pubmed/22676260 *************************** RANDOM FACTS: Star Wars is the most successful movie-related toy line ever sold, with 250 million action figures sold between 1978 and 1986. Imagine those numbers since the digitally re-mastered re-release, new trilogy and Clone Wars cartoon series! Bonus Fact: Han Solo's ship in the Star Wars trilogy, The Millennium Falcon, was inspired by a hamburger with an olive on the side. ******************* FDA says Covidien device can get stuck in brain (Reuters) - A Covidien Plc device for rare malformed blood vessels can get stuck in the brain and has been linked to nine patient deaths, U.S. regulators warned. The device, made by Covidien unit ev3, uses a spongy material to block off blood flow to abnormal tangles of blood vessels before they are removed by surgery. The material is delivered to the brain through a tube inserted into a groin artery, known as a catheter. But the catheter can get stuck in the spongy material while inside the brain, causing serious complications including hemorrhage and death, the U.S. Food and Drug Administration said in a notice posted to its website on Thursday. ... http://www.reuters.com/article/2012/06/29/us-fda-covidien-idUSBRE85S0YL20120629?feedType=RSS&feedName=healthNews ********************** Male Nurses Helping Change the Face of Nursing With healthcare emerging as one of the nation’s fastest growing industries and the demand for nurses continuing to rise, more men are showing heightened interest in the nursing profession. The growing number of men in nursing is promising for several reasons – one being that more men entering the field could help address the nursing shortage. Yet despite the narrowing of the gender gap, men can still face major hurdles as a minority in nursing. While men were critical in creating the world’s first nursing school in India more than two thousand years ago, nursing has primarily been a career associated with women. This association is frequently reinforced in pop culture and the media, and as a result men are often asked why they became nurses instead of physicians.... http://jjnursingnotes.com/JUNE12/index.html#careers ************************* Magnet Status Magnet designated hospitals are considered the best of the best with an environment where staff are engaged and patients are satisfied. Hospitals across the country are prompted to pursue Magnet status for a variety of reasons, but the common thread throughout is a desire to build an environment that promotes high staff engagement and quality patient care. The vision of Magnet, which was developed by the American Nurses Credentialing Center, is that these organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. Magnet designation represents a facility's continued commitment to quality outcomes and in order to be successful the hospital as a whole has to be dedicated to excellence. Bedside First Every level of staff must be devoted to achieving this goal, from the staff nurses to the managers to the CEO. ... http://nursing.advanceweb.com/Archives/Article-Archives/Reaching-Magnet.aspx ************** Magnet Research: Raising the Bar Almost 30 years of evidence documents the program's mission. To view the Course Outline and take the test online, click here (https://nursing.advanceweb.com/CE/TestCenter/Course.aspx?CourseID=956&CreditID=1) Learning Scope #383 1 contact hour Expires April 23, 2014 You can earn 1 contact hour of continuing education credit in three ways: 1) Grade and certificate are available immediately after taking the online test. 2) Send the answer sheet (or a photocopy) toADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better. *********************** (The following article is free...) Evidence-Based Guidelines for Blood Transfusion The AABB has initiated a process to develop evidence-based guidelines for blood transfusion to assist clinicians, other health professionals, and patients in their transfusion decisions. In this article, the author discusses the process of developing the recently published guidelines for plasma transfusion using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. Blood transfusion is one of the most common of all clinical interventions. In many instances, physicians order blood transfusions after conducting a detailed analysis of the patient's clinical presentation, laboratory values, and consultations with transfusion and hematology professionals to make certain that this therapy is indicated. However, in other instances, physicians have been known anecdotally to order transfusions for more subjective and questionable reasons, including desires to "increase patient's sense of well-being" and to reach unnecessarily high posttransfusion laboratory values. ... http://www.nursingcenter.com/evidencebasedpracticenetwork/JournalArticle.aspx?Article_ID=1330461 *************** Quiz Time (answer at end of newsletter) Registered nursing is the top occupation in terms of job growth through 2020: True False ***************** (This is an excellent article for all of us) Watch your language: Culture change for the medical record Clinicians should adopt the selective use of “skin failure” to communicate that the skin is an organ, and like other organs, it is prone to failure. Interestingly, our society accepts that as adults age, they may succumb to heart, kidney and other organ failures. When a 90-year-old patient at the end of life dies of heart failure, oversight agencies do not tag the cardiologist with multiple deficiencies. Should that same resident develop a “pressure ulcer,” however, surveyors will cite and raging relatives will sue. ... http://www.ltlmagazine.com/article/watch-your-language-culture-change-medical-record ****************************** Study unpicks gene changes behind breast cancer (Reuters) - Scientists have mapped the complete genetic codes of 21 breast cancers and created a catalogue of the mutations that accumulate in breast cells, raising hopes that the disease may be able to be spotted earlier and treated more effectively in future. The research, the first of its kind, untangles the genetic history of how cancer evolves, allowing scientists to identify mutational patterns that fuel the growth of breast tumors, and start to work out the processes behind them. "These findings have implications for our understanding of how breast cancers develop over the decades before diagnosis in adults and might help to find possible targets for improved diagnosis or therapeutic intervention in the future," said Mike Stratton, who led the research team. Breast cancer kills more than 450,000 women a year worldwide and is the most common cancer among women, accounting for 16 percent of all cases, according to the World Health Organization (WHO). ... http://www.reuters.com/article/2012/05/17/us-cancer-breast-genetics-idUSBRE84G0XT20120517?feedType=RSS&feedName=healthNews ********************** FDA approves Perjeta for type of late-stage breast cancer On June 8, 2012, the U.S. Food and Drug Administration approved Perjeta (pertuzumab), a new anti-HER2 therapy, to treat patients with HER2-positive late-stage (metastatic) breast cancer. Intended for patients who have not received prior treatment for metastatic breast cancer with an anti-HER2 therapy or chemotherapy, Perjeta is combined with trastuzumab, another anti-HER2 therapy, and docetaxel, a type of chemotherapy. HER2 is a protein involved in normal cell growth. It is found in increased amounts on some types of cancer cells (HER2-positive), including some breast cancers. In these HER2-positive breast cancers, the increased amount of the HER2 protein contributes to cancer cell growth and survival. Perjeta is a humanized monoclonal antibody, manufactured through biotechnology methods. It is administered intravenously and is believed to work by targeting a different part of the HER-protein than trastuzumab, resulting in further reduction in growth and survival of HER2-positive breast cancer cells. ... www.fda.gov/womens fda@service.govdelivery.com *********************** Roche's breast cancer drug gets FDA nod (Reuters) - U.S. health regulators have approved a new breast cancer drug from Roche Holding AG that the company hopes will become the standard treatment for women with an aggressive, incurable form of cancer. Roche unit Genentech announced Friday that the Food and Drug Administration approved the injectable drug Perjeta for women with a type of breast cancer known as HER-2 positive, which makes up about a quarter of all breast cancers and has no cure. Analysts predict the medicine could be another blockbuster cancer drug for the Swiss company. The FDA accepted the application for the drug under priority review, meaning the agency believes the drug may represent a potentially significant advancement over existing treatments. In clinical trials, the drug kept the cancer from worsening for 6 extra months, compared to the current standard of care. ... http://www.reuters.com/article/2012/06/09/us-roche-fda-idUSBRE85801L20120609?feedType=RSS&feedName=healthNews ************************** RANDOM FACT: Though it may seem that termites enjoy all wood, they will bypass ebony, a dense black wood from various tropical trees in Southeast Asia. ADDITIONAL FACT: The wood of ebony sinks in water because it is so dense. It is the wood of choice for the black keys on pianos. ************* New Monograph Aims to Decrease Central Line-Associated Bloodstream Infections (CLABSIs) (OAKBROOK TERRACE, Ill. – May 16, 2012) Central line-associated bloodstream infections (CLABSIs) are a serious form of health care-associated infections (HAIs), with a mortality rate of 12 to 25 percent in the United States alone. Reliable access to the bloodstream is one of the most essential components of modern medical care, but bloodstream access devices introduce a risk of bloodstream infection (BSI). The device that poses the greatest risk for BSI is the central venous catheter (CVC), also known as a central line. It is estimated that more than 5 million CVCs are inserted each year; any patient with a central line is at risk of developing a CLABSI, which is associated with increased morbidity, mortality and cost. The U.S. Centers for Disease Control and Prevention recently estimated the annual cost of CLABSI is more than $1 billion, and the estimated cost per patient is more than $16,000. The risk associated with CLABSI is even greater in developing countries, where the rates of HAIs related to devices are, in most cases, three to five times greater. ... http://www.jointcommission.org/new_monograph_central_line_associated_bloodstream_infections_clabsi/ ********************** Drop 50% More Body Fat with Whole Grains If you could make a simple diet change to drop more pounds and body fat, would you? Switching from refined-wheat foods, such as white bread or pasta, to whole-grain versions can boost your weight loss by 35% and help you melt nearly 50% more body fat. In a new study, 79 overweight or obese postmenopausal women were randomly assigned to eat a diet containing refined or whole-grain wheat products. After 12 weeks, both groups lost weight (7.9 pounds for the whole-wheat group and 5.9 pounds for the refined-wheat group). The whole-wheat group also shed 3% body fat, whereas the refined-wheat eaters shed 2.1%. ... Try these 9 quick- cooking whole-grains recipes for busy nights. http://www.realage.com/food/lose-body-fat-with-whole-grains?src=nl&dom=realage&list=tod&link=text&ad=food-nutrition&eid=1010657379&memberid=4687812 ********************** High-Fiber Foods for Better Weight Loss Make your weight-loss regimen a whole lot easier. Just munch on these high-fiber foods. We're talking about fresh fruits and veggies, whole grains, nuts and seeds, and hearty beans. They're not only low in fat and calories, they also cause a drop in appetite that'll keep you from grabbing that between-meal Twinkie. Fiber: A Dieter's Best Friend These high-fiber foods keep your mouth busy (very satisfying) longer than mushy, highly processed foods do. And because fiber resists digestion, you feel full longer. Translation: Sticking to your weight-loss nutrition plan requires little to no willpower. ... http://www.realage.com/food/fiber-rich-foods-boost-weight-loss?src=edit&chan=tip&con=tip&click=p1 ******************** Suzanne Somers' Top 10 Summer Slim-Down Tips Health-care advocate, entrepreneur, and New York Times bestselling author Suzanne Somers shares with you her top-ten favorite tips for keeping a slim, svelte, sexy body this summer. ... http://www.everydayhealth.com/suzanne-somers/top-10-summer-slim-down-tips.aspx?xid=aol_eh-diet_3_20120709_&aolcat=EFG&ncid=webmail17#/slide-1 ~~**~~**~~**~~ HUMOR SECTION While carpenters were working outside the old house I had just bought, I busied myself with indoor cleaning. I had just finished washing the floor when one of the workmen asked to use the bathroom. With dismay I looked from his muddy boots to my newly scrubbed floors. "Just a minute," I said, thinking of a quick solution. "I'll put down newspapers." "It's all right, lady," he responded. "I'm already trained." ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Back issues of the ISMP newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp. Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org http://www.nationalnurse3.blogspot.com/ RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 http://www.washingtonwatch.com/bills/show/110_HR_2123.html Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263 The Nursing Site http://thenursingsite.com . http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.snopes.com http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 National Do Not Call Registry If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** MOOG Medical Devices Group, Curlin Infusion Administration Sets: Class I Recall - Potential for Reverse Flow of Fluid There is a potential for a reverse pump segment in the administration set. This malfunction could reverse the flow of fluid or medicines backwards from what was intended. This may cause blood loss, an under-delivery of prescribed medicines or fluids, or a potential delay in therapy. Use of the affected administration sets may cause serious adverse health consequences, including death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm306327.htm ************************* Introvale (levonorgestrel and ethinyl estradiol) Tablets: Recall - Packaging Flaw Sandoz notified the public that it issued a voluntary recall of 10 lots of its generic oral contraceptive Introvale in the US, following a recent report of a packaging flaw. A consumer reported that the white placebo tablets were mistakenly in the ninth row (labeled “Week 9”) of the 13-row blister card, rather than in the correct position in the 13th and final row (labeled “Week 13”). Each three-month blister card contains 84 peach-colored active tablets and seven white placebo tablets in 13 rows, each representing one week. While the white placebo tablets can be clearly distinguished from the peach-colored active tablets, the risk of an unintended pregnancy for a patient taking the wrong tablet over several days cannot be excluded. The lot numbers involved in the recall are as follows: LF00478C, LF00479C, LF00551C, LF00552C, LF00687C, LF00688C, LF00763C, LF00764C, LF00765C and LF01261C. These lots were distributed only in the US between January 2011 and May 2012. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm307103.htm ********************* (Sorry, I missed this one) Bedford Lboratories™ announces a nationwide voluntary recall for the following three lots of Cytarabine for Injection, USP: Cytarabine for injection, USP 1 gram per viral - NDC #55390-133-01 Lot 2066986 - Exp. Date March 31, 2014 Lot 2111675 - Exp. Date April, 30, 2014 Lot 2131148 - Exp. Date May, 31, 2014 This voluntary market recall is being conducted due to a post-release investigation of the manufacturing area which determined a potential elevated risk of a lack of sterility assurance for these specific lots. To date, there have been no reports of any adverse events for the lots being recalled. Cytarabine in combination with other approved anticancer drugs is indicated for remission induction in acute non-lymphocytic luekemia of adults and children. it has also been found useful in the treatment acute lymphocytic luekemia and the blast phase of chronic myelocytic luekemia. Intrathecal administration of cytarabine is indicated in the prophylaxis and treatment of meningeal luekemia. ... http://www.fda.gov/Safety/Recalls/ucm293076.htm?source=govdelivery ************* Advanced Sterilization Products (ASP) Sterrad Cyclesure 24 Biological Indicator: Safety Communication – Potential Risk of Infection [UPDATED 07/06/2012] The FDA issued a clarification for personnel at facilities that utilize Sterrad sterilizers: The voluntary recall is for only certain lots of Sterrad Cyclesure 24 Biological Indicators. FDA review of ASP data showed that certain lots of Sterrad Cyclesure 24 Biological Indicators cannot effectively monitor the sterilization process throughout a 15-month shelf life. ASP made a change in December 2011 to the materials used to manufacture the product. Product lots manufactured prior to this material change are not subject to the recall. Refer to the list of affected lots found in ASP’s Recall Alert to determine if the product in inventory is subject to this recall. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm310624.htm ~~**~~**~~**~~**~~**~~ ADVERTISEMENTS from the members This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: JMVick1@att.net (Maria) June 24, 2012 jselph1@windstream.net (P. J.) June 25, 2012 ~~**~~**~~**~~**~~**~~ 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.... please send me your new name/address, okay? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: lglnrse@gmail.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY There are a thousand hacking at the branches of evil to one who is striking at the root. --Henry David Thoreau Send me an e-mail--- would love to hear from you.... Frankie RNFrankie@AOL.com Correct answer: True. According to Bureau of Labor Statistics’ Employment Projections 2010-2020, the RN workforce is the number 1 occupation in terms of job growth through 2020. ^^^^^^^^^^^^^^^^^^ Nursing education by the numbers Data from the American Association of Colleges of Nursing show nursing is a growing, vibrant profession attracting men and women. 259,100: Total enrollment in all nursing programs leading to a baccalaureate degree in 2011—up from 238,799 in 2010 11.4%: Percent of male students in baccalaureate program—compared to 6.6% of men in the U.S. nursing workforce 15.8%: Percentage growth in enrollment in RN-to-baccalaureate programs from 2010 to 2011. 184: Number of doctor of nursing practice programs in the U.S. in 2011 Source: http://www.aacn.nche.edu

June Newsletter

PARADIGM BYTES Newsletter for Paradigm 97 June 12, 2012 PARADIGM DEFINED: 1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated. Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it. MISSION STATEMENT We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience. ***~~~***~~~***~~~*** SNIPPETS Compassion and fatigue January 3, 2012 -- Recent press items have highlighted the devastating effects of nurse under-staffing on patients and nurses alike. Today, Laura Landro's "Informed Patient" column in The Wall Street Journal discussed compassion fatigue among nurses, especially those who regularly care for terminally ill patients. Landro's Health Blog provided additional information about the problem, which may contribute to burnout and high turnover, which in turn add to compassion fatigue. That cycle can lead to worse patient care. The Wall Street Journal pieces include expert comment from several nurses, and the items convey that nurses play an important role in care, though they might have focused more on the danger that impaired nurses pose to patients because of the critical nature of nursing. And on December 31, 2011, the Daily Mail (UK) ran a piece by Sam Greenhill about a woman who, though not a nurse, had "nursed" her 89-year-old grandmother back to health at a hospital, after the physicians and other health professionals had apparently written the patient off. The woman reportedly fed, washed, and advocated for her grandmother while the hospital's actual nurses were too overworked to do so. We're generally critical of media accounts that suggest lay people have acted as "nurses" by providing unskilled care, since that suggests nursing requires no special education or skills. But here it sounds like the lay person did a better job than the real nurses. Of course, despite the happy ending, the piece also presents a distressing picture of what happens when nurses are so overworked that they cannot do the most basic part of their jobs--saving lives. We thank those responsible for these pieces. ... (Try to read all of this...very good) http://www.truthaboutnursing.org/news/2012/jan/wsj.html#ixzz1x9WYff8x ~~**~~**~~**~~**~~**~~ FROM THE MEMBERS (This was sent in by Kurt Ullman, a member of Paradigm97) Thirty-six percent of physicians are not accepting new Medicaid patients, and 26% see no Medicaid patients at all, according to a new survey from a staffing company called Jackson Healthcare. The firm's online survey of 2232 physicians in April found that dermatologists are the least likely (34%) among all specialists to accept new Medicaid patients, followed by endocrinologists and plastic surgeons (36% each), general internists (42%), and physical medicine and rehabilitation specialists (43%). The specialists most willing to make an appointment for a new Medicaid patient are pediatric subspecialists (95%), pathologists (90%), radiologists (86%), anesthesiologists (83%), and general surgeons (81%). The numbers also reveal a lesser degree of physician disenchantment regarding Medicare. Seventeen percent of physicians said they are not accepting new Medicare patients, and 10% said they have closed their practice to Medicare entirely. The specialists least inclined to see new Medicare patients are adult psychiatrists (57%), plastic surgeons (68%), general internists (73%), family physicians (75%), and obstetricians-gynecologists (76%). In contrast, rates of accepting new Medicare patients top 90% among cardiologists, hematologists/oncologists, general surgeons, anesthesiologists, and neurologists. **************** ( I wrote to Kurt): If Medicare paid much more promptly, perhaps those facts would improve. Baby Boomers are going to have to lobby for this to happen . Frankie (This is Kurt's answer): This is only going to get worse. Under the healthcare reform act, much of the money savings come from providers, allegedly (that's another thread altogether), but even if it gets chucked by the Supremes, the 1997 Medicare Sustainability Act calls for something like 30% cuts (allegedly). Kurt ************ NON-MEDICAL NEWS: We have all heard of phishing (if not sure, go to: http://us.norton.com/transactsafely/phishingfaq.jsp for more info) Now, I just learned about Pharming ! How to Protect Against Pharming Pharming is an attempt to defraud Internet surfers by hijacking a Web site’s domain name, or URL, and redirecting users to an imposter Web site where fraudulent requests for information are made. To protect yourself against pharming, follow these basic guidelines: Check the URL of any site that asks you to provide personal information. Make sure your session begins at the known authentic address of the site, with no additional characters appended to it. Maintain effective, up-to-date virus protection. Symantec recommends Norton AntiVirus. Use a trusted, legitimate Internet Service Provider. Rigorous security at the ISP level is your first line of defense against pharming. Check the certificate. It takes just a few seconds to tell if a site you land on is legitimate. On the latest version of Internet Explorer and on many other commonly available Web browsers, go to "File"" in the main menu and select "Properties",or right click your mouse anywhere on the browser screen and, from the menu that pops up, click on"Properties. When the "Properties" box pops up, click on "Certificates" and check if the site carries a secure certificate from its legitimate owner. Block suspicious Web sites automatically. Norton Internet Security detects and blocks fake Web sites, making it easier for you to be confident most of the sites you are using are legitimate. http://us.norton.com/transactsafely/prevention.jsp?om_em_cid=hho_email_clubnorton_apr12_nam_us_A ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days As America's waistline expands, costs soar (Reuters) - U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960. The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows. Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops. ... http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430?feedType=RSS&feedName=healthNews *********************** RANDOM FACT: A report by the American Journal of Epidemiology states that long term job stress is worse for your heart than gaining 40 pounds or aging 30 years. ********************** How to Control 4 Common Body Odors The Skunk Ape of the Everglades announces its arrival with an aroma that’s part chicken coop, part outhouse, and the creature certainly grabs our imagination. But there’s nothing captivating about our own body odor. Luckily, we have a fix for the fumes! Here are 4 common body odors and tips to control them: Smelly feet: If the 250,000 sweat glands in your feet cause excessive sweating or if you wear damp socks or shoes for too long, your feet can stink. The solution? Zap the overgrowth of stinky bacteria: After washing and drying your feet, apply a diluted solution of lemongrass oil or verbena oil. Underarm odor: Anxiety, hormones, and armpit hair can turn your sweat sour. Wildly overactive sweat glands (i.e., hyperhidrosis) can also cause underarm odor. Most folks need deodorants, not antiperspirants, but if you really suffer from armpit odor, try a boric acid or tannic acid solution. Still dripping? Put on 20% aluminum at night and wash it off in the morning, or try antibiotic creams to kill multiplying bacteria. If you have hyperhidrosis, Botox turns off the faucet. Beta-blockers (high blood pressure medication) can help relieve chronic, stress-related sweating. Bad breath and flatulence: What you eat fuels bad breath and flatulence. Food odors -- onions, garlic, and curry, for example -- pass into your bloodstream and the aromas are exhaled from your lungs. The intestines pump out methane when you can’t cope with carbs or don’t have good bacteria in your guts. Remedy bad breath by flossing, brushing teeth and tongue, and drinking plenty of water. For flatulence, try Beano and probiotics (spore forms). http://www.realage.com/beauty-skin-care/how-to-control-4-body-odors?eid=1010657395&memberid=4687812 ************************** RANDOM FACT: On Oct. 22, 1987 a Japanese buyer, Eiichi Kobayashi, purchased the Old Testament portion of a Gutenberg Bible for $5.4 million dollars at a Christie's Auction. The last sale of a complete version took place nine years before, again at a Christie's, for $2.2 million. Today, single pages from the first-edition Bibles fetch $25,000 each. In addition to providing their well-known Bibles in hotel rooms, the Gideons also distribute Bibles to militaries of various countries, to hospitals, nursing homes, and prisons. ******************* AORN study highlights benefits of double-gloving Double-gloving with inner indicator gloves may protect nurses’ skin from needle sticks, according to results of a 24-month study published by the Association of periOperative Registered Nurses. The study in the March issue of AORN Journal examined the effect of double-gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. Denise Korniewicz, RN, PhD, FAAN, senior associate dean of research at the University of Miami School of Nursing & Health Studies, and Maher El-Masri, RN, PhD, associate professor and research leadership chairman at the University of Windsor in Canada, found that healthcare providers observed blood on their hands after surgery less frequently when they wore two pairs of gloves than when they wore a single pair. The researchers also found the frequency of changing gloves during surgery was significantly higher among healthcare providers who wore dark-colored gloves under light-colored gloves than among those wearing two pairs of gloves of the same color. The majority of healthcare providers in the study expressed favorable views about double-gloving, according to an AORN news release. The study is available via subscription or purchase at http://bit.ly/GYuDxj. http://news.nurse.com/article/20120409/NATIONAL01/304090021 ********************* RANDOM FACT: In its 2008 Death on the Job Report, the AFL-CIO ranked commercial fishing as the occupation with the highest fatality rate, with 150 deaths per 100,000 workers. ***************** U.S. gives nod to Eli Lilly's brain plaque test Reuters - U.S. regulators gave the nod to an imaging test from Eli Lilly and Co. that can for the first time help doctors detect brain plaque tied to Alzheimer's disease, the company said. The U.S. Food and Drug Administration approved the radioactive dye, called Amyvid, to help doctors rule out whether patients have Alzheimer's, the most common form of dementia, Lilly announced late on Friday. The dye binds to clumps of a toxic protein called beta amyloid that accumulates in the brains of patients with Alzheimer's. Doctors can then see the plaque light up on a positron emission tomography, or PET, scan. Patients with Alzheimer's always have some brain plaque, so its absence in the test would tell doctors to look for other causes of mental decline, such as depression or medications, Lilly has said. ... http://www.reuters.com/article/2012/04/07/us-fda-lilly-amyvid-idUSBRE8360C220120407?feedType=RSS&feedName=healthNews *********************** Nurses’ assessments of individualised care in long-term care institutions Journal of Clinical Nursing (full text available) Aims.  The aims of this study were to explore nurses’ assessments of individualised care in long-term care wards and to examine how their sociodemographic variables were associated with their views of such care. Background.  Although the importance of individualised care is highlighted both by nurses and by older people, there is a limited amount of research about individualised care, especially in the long-term care of older people. Design.  An exploratory design was employed. Methods.  Data were collected using questionnaires [Individualised Care Scale (ICS)-Nurse] from nurses (n = 283, n = 215, response rate 76%) working in the long-term care wards (n = 19) of four institutions in 2009. Data were analysed statistically. Results.  Overall, nurses perceived that they supported patient individuality during nursing activities but the care they provided was not so individualised. Nurses perceived that they supported older peoples’ individuality in the clinical situation and in decisional control over care well but supported older peoples’ individual life situation to a lesser extent. The higher the nurses’ age, the longer the working experience in health care or experience in the current ward, the more positive views they had about the support of individuality. Conclusions.  This study identified some shortcomings in the realisation of individuality in the care of older people. Nurses seem to think they generally provide individualised care but this was not necessarily realised in the current evaluations of the care they delivered. Relevance to clinical practice.  There is need to identify issues that may help in developing individualised care in clinical practice. Nurses’ attitude to older people in the geriatric care settings needs exploration. Nurses may focus on physiological needs that may hinder the recognition of older patient’s individuality. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2011.03855.x/abstract;jsessionid=287B14BCA8D9C27F28454B634EA07DA9.d01t02 ************************* Childbirth takes longer now than 50 years ago: study Many tasks can be tackled more quickly now than 50 years ago, but delivering a baby naturally it seems is not one of them, according to a U.S. government study. Compared with the 1960s, U.S. women have in recent years spent two to three hours longer in labor, according to researchers at the U.S. National Institutes of Health, who said the findings suggest doctors may need to rethink the definition of "normal" labor. The extra time is spent in the first stage of labor - the longest part of the process, before the "pushing" stage, according to findings published in the American Journal of Obstetrics & Gynecology. Mothers are different as well. On average, they're older and weigh more, and their newborns are bigger too. ... http://www.reuters.com/article/2012/04/02/us-childbirth-idUSBRE82T16M20120402?feedType=RSS&feedName=healthNews ***************************** RANDOM FACT: A solar flare is an enormous explosion in the solar atmosphere, involving sudden bursts of particle acceleration, plasma heating, and bulk mass motion. It is believed to result from the sudden release of energy stored in the magnetic fields that thread the solar corona in active regions around sunspots. The largest of solar flares can be equal to billions of one-megaton nuclear bombs! ********************* Thanks to the ACA, insurers cannot drop or deny coverage because of pre-existing conditions, children up to the age of 26 are now allowed to stay on their parent’s insurance plans, and Seniors are protected from the Medicare “Donut Hole” that threatened so many of our most vulnerable citizens. These are just some of the initial life-changing benefits that are cause for celebration today. •Take a look at our quick Summary of Benefits and Protections -- Do your Patients know what the ACA is already doing for them? http://www.nursingworld.org/HCR-Brief.aspx •Visit http://www.healthcareandyou.org/-- ANA partnered with organizations that represent consumers, physicians, hospitals and pharmacists to create this website, which provides easy-to-understand information about the health care law. Find out what’s happening in your state and what Health Care Reform means for you! ************************* Diagnosis and treatment of osteopenia Gulay Karaguzel and Michael F. Holick Osteopenia is a term to define bone density that is not normal but also not as low as osteoporosis. By definition from the World Health Organization osteopenia is defined by bone densitometry as a T score −1 to −2.5. There are many causes for osteopenia including calcium and vitamin D deficiency and inactivity. Genetics plays an important role in a person’s bone mineral density and often Caucasian women with a thin body habitus who are premenopausal are found to have osteopenia. Correction of calcium and vitamin D deficiency and walking 3 to 5 miles a week can often improve bone density in the hip and spine. There are a variety of pharmaceutical agents that have been recommended for the treatment of osteopenia and osteoporosis including hormone replacement therapy, selective estrogen receptor modulator therapy, anti-resorptive therapy. In addition patients with osteoporosis who have failed anti-resorptive therapy can have a significant improvement in their bone density with anabolic therapy. (The full article is in PDF form. You can get it at following link: http://www.springerlink.com/content/t68034062172t010/ ************************ RANDOM FACT: By 2010, no state had a prevalence of obesity less than 20%. 36 states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more. Historically, obesity primarily afflicted adults, but this has changed in the last 2 decades. 15-25% of American children and adolescents are now obese. Children and adolescents who are obese are likely to be obese in adulthood and to develop obesity-related health problems. *********************** Half of Stroke Victims Don't Call 911, Research Shows Public needs more education about telling symptoms, experts say FRIDAY, March 16 (HealthDay News) -- Slightly more than half of Americans with stroke symptoms call 911, a rate that hasn't changed since the mid-1990s, a new study finds. The study highlights the need for more public education about stroke symptoms and the importance of early treatment, said the researchers from New York-Presbyterian Hospital/Weill Cornell Medical Center. "People do not always recognize the seriousness of stroke symptoms, or instead of calling 911 they may call their primary-care physician for an appointment and lose valuable time as the damage becomes irreversible," study leader Dr. Hooman Kamel, a neurologist at New York-Presbyterian Hospital/Weill Cornell, said in a medical center news release. The researchers examined data from more than 1,600 stroke cases collected by the National Hospital Ambulatory Medical Care Survey between 1997 and 2008. ... http://www.nlm.nih.gov/medlineplus/news/fullstory_123037.html ************************** RANDOM FACT : U.S. citizens are not legally permitted to come in contact with extraterrestrials or their vehicles, according to the Code of Federal Regulations, implemented in 1969. RANDOM FACT #2: In July of 1947, the U.S. Army Air Force announced that they had recovered a flying saucer that crashed near Roswell Air Field in New Mexico. Within hours, however, the Army dismissed the statement, claiming the saucer was a misidentified weather balloon. ***************** Reducing Bloodstream Infections in an Outpatient Hemodialysis Center - New Jersey, 2008 - 2011 The Centers for Disease Control and Prevention's March 16, 2012 Morbidity and Mortality Weekly Report featured a New Jersey hemodialysis clinic's use of recommended interventions and dialysis event surveillance data to reduce the number of bloodstream infections in the facility. http://www.cdc.gov/mmwr/pdf/wk/mm6110.pdf ************* (Thank you, Barbara ) : DENTAL X-RAYS LINKED TO COMMON BRAIN TUMOR (Reuters Health) - A new study suggests people who had certain kinds of dental X-rays in the past may be at an increased risk for meningioma, the most commonly diagnosed brain tumor in the U.S. http://www.reuters.com/article/2012/04/10/us-dental-x-rays-idUSBRE8390GM20120410?DCMP=NWL-pro_healthlawpulse ***************** U.S. News - Nurse sentenced to life for killing patients by injecting ... Apr 2, 2012 – A Texas jury on Monday sentenced a former nurse to life in prison after ... patients by injecting bleach into their kidney dialysis lines, the Lufkin ... http://tinyurl.com/6tcvfjq http://www.usatoday.com/news/nation/story/2012-04-02/nurse-bleach-injection-dialysis/53952548/1 ******************** GENE STUDIES BEGIN TO UNRAVEL AUTISM PUZZLE (Reuters) - A sweeping study of hundreds of families with autism has found that spontaneous mutations can occur in a parent's sperm or egg cells that increase a child's risk for autism, and fathers are four times more likely than mothers to pass these mutations on to their children. http://www.reuters.com/article/2012/04/04/us-autism-usa-genes-idUSBRE83312820120404?DCMP=NWL-pro_healthlawpulse&&& Related Resources Autism research may be about to bear fruit http://news.lp.findlaw.com/ap_stories/other/1500/04-09-2012/20120409145000_14.html?DCMP=NWL-pro_healthlawpulse *********************** Health care groups respond to proposed ICD-10 extension The CMS plan to delay the ICD-10 compliance date for a year has received mixed reaction from industry stakeholders. The Medical Group Management Association applauded the move but expressed concerns that the ICD-10 implementation process remains flawed. Meanwhile, the American Health Information Management Association reiterated its stance against ICD-10 delay and advised health groups to stay focused on their implementation efforts. http://r.smartbrief.com/resp/dBsjCPaXbgeududlImko ************** HHS panel updates HIV treatment guidelines The HHS Panel on Antiretroviral Guidelines for Adults and Adolescents has released new guidelines for the treatment of patients with HIV. The new guidance includes revisions in the recommendations on starting antiretroviral therapy, drug interactions tables, co-infection and prevention of secondary transmission. Medscape (free registration) (4/10)      Study examines end-of-life cancer care http://r.smartbrief.com/resp/dBsjCPaXbgeuduaJJGGW ************ A study in Health Affairs said no particular type of hospital provided better cancer care for patients when considering National Quality Forum measures such as ICU admissions, chemotherapy usage or hospice care at the end of life. Researchers from the Dartmouth Institute for Health Policy & Clinical Practice found a large number of inpatient services were provided to terminally ill patients and said hospitals need to examine such care and "question its alignment with patient preferences -- whether they be for early supportive care or aggressive treatment in the last days of life." Modern Healthcare (free subscription required) (4/9)      http://r.smartbrief.com/resp/dBsjCPaXbgeuduaVNfNJ *************** Study looks at maternal-fetal Staphylococcus aureus transmission Maternal methicillin-resistant Staphylococcus aureus colonization at 34 to 37 weeks of gestation or at delivery increased the risk of babies carrying the bacteria, according to a study in the journal Pediatrics. Researchers also found that infant Staphylococcal colonization peaked at 2 months of age, with a rate of 20.9%. PediatricSuperSite.com (4/11) http://r.smartbrief.com/resp/dBsjCPaXbgeudubhRZwk ************** An Evidence-Based Approach to COPD: Part 1 Corbridge, Susan PhD, APN, ACNP, AE-C; Wilken, Lori PharmD, TT-S, AE-C, BCACP; Kapella, Mary C. PhD, RN; Gronkiewicz, Cindy MS, RN, ACNS-BC, AE-C OVERVIEW: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States, affecting as many as 24 million Americans and resulting in 1.5 million ED visits, 700,000 hospital admissions, and 124,000 deaths annually. This article, the first in a two-part series on COPD, outlines current guidelines and other evidence-based recommendations on diagnosing and managing stable COPD in the outpatient setting. Part 2 will appear in a future issue of AJN and will focus on managing acute exacerbations of COPD. AJN, American Journal of Nursing: March 2012 - Volume 112 - Issue 3 - p 46–57 doi: 10.1097/01.NAJ.0000412639.08764.21 Feature Articles http://journals.lww.com/ajnonline/Fulltext/2012/03000/An_Evidence_Based_Approach_to_COPD___Part_1.22.aspx?WT.mc_id=EMxj08x20120416xL14 ~~**~~**~~**~~**~~**~~ HUMOR SECTION "The Supreme Court has ruled that anybody can be strip-searched for any kind of arrest. That's something to think about the next time you bring 12 items into a 10-item-or-less lane." -Jay Leno A couple in their nineties are both having problems remembering things. During a checkup, the doctor tells them that they're physically okay, but they might want to start writing things down to help them remember Later that night, while watching TV, the old man gets up from his chair. 'Want anything while I'm in the kitchen?' he asks. 'Will you get me a bowl of ice cream?' 'Sure..' 'Don't you think you should write it down so you can remember it?' she asks. 'No, I can remember it..' 'Well, I'd like some strawberries on top, too. Maybe you should write it down, so as not to forget it?' He says, 'I can remember that. You want a bowl of ice cream with strawberries.' 'I'd also like whipped cream. I'm certain you'll forget that, write it down?' she asks. Irritated, he says, 'I don't need to write it down, I can remember it! Ice cream with strawberries and whipped cream - I got it, for goodness sake!' Then he toddles into the kitchen. After about 20 minutes, the old man returns from the kitchen and hands his wife a plate of bacon and eggs.. She stares at the plate for a moment. 'Where's my toast ?' ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as DrRobertHess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. Complete Your CE Now-Less than $6 per hour ANCC & State Board approved ; Instant certificates - no waiting No tests required (excluding Florida) ; High-quality, evidence-based course material http://advprjo61.securesites.net/CMEResource20111012Nurse.php Free CEs http://www.myfreece.com/welcome.asp https://nursing.advanceweb.com/CE/TestCenter/Main.aspx This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. Sentinel Events.........Joint commission. http://www.jointcommission.org/sentinel_event.aspx This is an excellent nursing site, check it out: http://nursingpub.com/ Back issues of the ISMP newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp. Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 http://www.washingtonwatch.com/bills/show/110_HR_2123.html Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263 The Nursing Site http://thenursingsite.com . http://www.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/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** Roche Diagnostics Operations Elecsys Troponin I and Elecsys Troponin I STAT Immunoassays: Recall – With certain types of plasma samples, doctors may receive a falsely low result (up to a maximum of 50% lower than the actual concentration of Troponin I). These incorrect results may cause serious adverse health consequences, including death. The affected lot numbers are 163176 and 163177. Elecsys Troponin I and Elecsys Troponin I STAT Immunoassays are used to determine heart damage as an aid in the diagnosis of a heart attack. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm301483.htm ************************ Morphine Sulfate Injection USP, 4 mg/mL (C-II), 1 mL fill in 2.5 mL Carpuject by Hospira, Inc: Recall - May Contain More Than Intended Fill Volume The affected product is a prefilled glass cartridge for use with the Carpuject Syringe system. The affected lot number is 10830LL, with an expiration date of April 1, 2013. Morphine Sulfate Carpujects 4 mg/mL are packaged in Slim-Pak tamper detection packages with each box containing 10 Carpujects (NDC 0409-1258-30). The affected lot was distributed in January 2012. It was initially distributed to wholesalers and a limited number of hospitals in Arizona, Colorado, Hawaii, Illinois, Indiana, Michigan, Minnesota, Ohio, Texas and Virginia. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm300852.htm *********************** Thoratec Corporation, HeartMate II Left Ventricular Assist System (LVAS): Class 1 Recall- Outflow Graft May Kink or Deform FDA is notifying health care professionals of a Class 1 Recall due to detachment of the bend relief from its intended position around the proximal outflow graft may allow the graft to kink or deform, resulting in reduction of blood flow from the HeartMate II LVAS pump, pump/graft thrombosis, or perforation of the outflow graft. Additionally, the metal end of the bend relief may be sharp and cause erosion and cutting of the outflow graft. This product may cause serious adverse health consequences, including death. Model numbers affected: 103393, 103695, 104692, 104911, 104912. The HeartMate II LVAS is indicated for use as a bridge to transplantation in heart transplant candidates at risk of imminent death from non-reversible left ventricular failure. It is also indicated for use in patients with New York Heart Association (NYHA) Class IIB of IV end-stage left-ventricular failure who have received optimal medical therapy for at least 45 of the last 60 days and who are not candidates for heart transplantation. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm298710.htm *********************** Thoratec Corporation Issues Update on Worldwide Medical Device Correction Notification Relating to Sealed Outflow Graft Used With HeartMate II® Left Ventricular Assist System Thoratec Corporation initiated a voluntary worldwide medical device correction notification of all serial numbers of the HeartMate II® Left Ventricular Assist Systems (HM II LVAS) having Catalog No. 104692, 103393, 104911, or 104912. Thoratec took this action based upon reports of the sealed outflow graft bend relief not being properly connected to the HeartMate II LVAS. The reported incidence of the defect, disconnected outflow graft bend relief, is 0.91% (29/3,200). Of these 29 incidents, 24 were observed in x-ray images or during surgical procedures, and were thus unlikely to be related to patient symptoms. However, in at least one reported case, it is noted that the disconnected bend relief may have contributed to the need for reoperation. The bend relief is designed to prevent kinking of the outflow conduit that connects the HeartMate II pump to the ascending aorta. ... http://www.fda.gov/Safety/Recalls/ucm296981.htm?source=govdelivery ********************** Dialysate Concentrates Used in Hemodialysis: Safety Communication - Alkali Dosing Errors FDA is notifying health care providers to consider the presence and quantity of acetate, citrate, and/or acetic acid in dialysate concentrates when determining the patients’ dialysate prescription. The FDA received a complaint describing alkali dosing errors that occurred during hemodialysis using dialysate concentrates containing acetic acid and acetate. When metabolized, these potential sources of alkali can contribute to elevated bicarbonate levels in patients undergoing hemodialysis. This can contribute to metabolic alkalosis, which is a significant risk factor associated with cardiopulmonary arrest, low blood pressure, hypokalemia, hypoxemia, hypercapnia, and cardiac arrhythmia. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm305630.htm ************************ Baxa Corporation Abacus Total Parenteral Nutrition (TPN) Calculation Software: Class I Recall - Potential Dosing Errors A number of errors have been reported by Abacus software users as a result of ordering salt based parenteral nutrition ingredients on an ion based ordering template. Abacus TPN Calculation Software is designed and intended to allow the ordering of electrolytes in only one of two ways: as a salt (such as calcium gluconate 10%) or as an elemental ion (such as calcium). However, if a dosage is entered into the system based on one method, when the template is configured for the other method, a dosing error can occur. The problem associated with mix-ups related to salt-based or ion-based ordering of electrolytes is not exclusive to calcium gluconate. Affected catalogue numbers include: 8300-0045: Abacus Calculator Only (Abacus CE) 8300-0046: Abacus Single Work Station (Abacus SE) 8300-0047: Abacus Multi-Work Station (Abacus ME) : http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm305762.htm ~~**~~**~~**~~**~~**~~ ADVERTISEMENTS from the members This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: hollie_lynne@yahoo.com (Hollie) April 27, 2012 tami.berube@yahoo.com (Tami) June 5, 2012 cathie.grant@sgmc.org (Cathie) June 7, 2012 dbusseyRN@gmail.com (Darcy) June 7, 2012 ~~**~~**~~**~~**~~**~~ 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 ~~**~~**~~**~~**~~**~~ EDITORIAL STAFF: GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views. ~~**~~**~~**~~**~~**~~ THOUGHT FOR THE DAY I am a most unhappy man. I have unwittingly ruined my country. A great industrial nation is now controlled by its system of credit. We have come to be one of the worst ruled, one of the most completely controlled and dominated Governments in the world -- no longer a government by free opinion, no longer a government by conviction and the vote of the majority, but a government by the opinion and duress of a small group of dominant men. -- Woodrow Wilson 1919 Hope to see you online/ or better yet....write me..... Frankie RNFrankie@AOL.com