Critical Care Newsline — July 10, 2008

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Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN. Every week, our advanced practice staff reviews hundreds of journals and Web sites, choosing only the most pertinent information for Critical Care Newsline. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites on a variety of topics to keep you informed on issues that affect nurses and the nursing profession.


July 10, 2008

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1. Research: Intermittent vs. Intensive Renal Support: Which is More Effective? (Abstract)
2. Resource: New Spanish-language Consumer Guide Compares Oral Diabetes Medications
3. Research: HORIZONS Trial Highlights Anti-thrombotic Treatment for Primary PCI With STEMI (Abstract)
4. News: Albuterol Inhalers Being Phased Out
5. Research: Silent Strokes in Middle Age (Abstract)
6. Reminder: Circle of Excellence Awards Deadline Extended to Aug. 1, 2008
7. Resource: AACN President’s Theme Web Page
8. Clinical Practice Resources
9. AACN Resources
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1. Research: Intermittent vs. Intensive Renal Support: Which is More Effective? (Abstract)
Intensive renal support in critically ill patients with acute kidney injury did not decrease mortality, improve recovery of kidney function, or reduce the rate of nonrenal organ failure as compared with less-intensive therapy involving a defined dose of intermittent hemodialysis three times per week and continuous renal-replacement therapy at 20 ml per kilogram per hour, according to results of a recent study.
http://content.nejm.org/cgi/content/short/359/1/7?query=TOC

2. Resource: New Spanish-language Consumer Guide Compares Oral Diabetes Medications
Pastillas para la diabetes tipo 2, a new consumer guide for Hispanic adults who have type 2 diabetes and need information to help them compare various oral medications for their illness, has been released by the Agency for Healthcare Research and Quality. Diabetes is one of the most serious health issues facing Hispanics in the United States. The guide compares 10 generic and 13 brand-name diabetes medications and explains how each works to lower blood sugar, which of them may increase body weight, which may cause side effects such as stomach problems or swelling and each pill's potential effect on "bad" and "good" cholesterol. To request a free copy, e-mail ahrqpubs@ahrq.hhs.gov or call 1-800-358-9295.

3. Research: HORIZONS Trial Highlights Anti-thrombotic Treatment for Primary PCI With STEMI (Abstract)
The current standard of care for anti-thrombotic therapy with primary PCI for acute ST elevation myocardial infarction (STEMI) is aspirin, clopidogrel, unfractionated heparin and platelet glycoprotein IIb/IIIa inhibitors. The HORIZONS trial evaluated bivalirudin compared with unfractionated heparin and IIb/IIIa inhibitors in patients with STEMI treated with primary PCI and found similar major adverse cardiac events with less bleeding and a lower incidence of net adverse clinical events after 30 days. Mortality at 30 days was also significantly less with bivalirudin. These results make a strong case for the use of bivalirudin with primary PCI in the majority of patients with STEMI.
http://www.ncbi.nlm.nih.gov/pubmed/18412079

4. News: Albuterol Inhalers Being Phased Out
Albuterol inhalers that contain chlorofluorocarbons (CFCs) will not be sold in the U.S. after Dec. 31, 2008. The phaseout of CFC-propelled inhalers is the result of the Clean Air Act and an international environmental treaty, the Montreal Protocol on Substances that Deplete the Ozone Layer. Under this treaty, the United States has agreed to phase out production and importation of ozone depleting substances including CFCs. Albuterol inhalers will be replaced by those that contain hydrofluoroalkanes (HFAs). If your patients are still using albuterol CFC inhalers, talk with them about switching now to an albuterol HFA inhaler. For more information, click on the following link.
http://www.fda.gov/cder/mdi/albuterol.htm

5. Research: Silent Strokes in Middle Age (Abstract)
About 10% of apparently healthy middle-aged adults have experienced silent cerebral infarcts, according to the latest results from the Framingham Offspring Study. The results emphasize the importance of following current guidelines on early detection and treatment of stroke risk factors.
http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.108.516575v1

6. Reminder: Circle of Excellence Awards Deadline Extended to Aug. 1, 2008
The nominations deadline for the 2009 Circle of Excellence Awards has been extended to Aug. 1, 2008. Historically, the awards program has focused on recognizing roles and practice situations. Beginning with the 2009 awards cycle, a single Circle of Excellence Award will replace the specific awards. Up to 25 individuals who exemplify excellence in the care of acutely and critically ill patients and their families will be chosen annually to receive the award. These recipients will become part of the new Circle of Excellence Society. You can learn more about the awards, review the criteria and fill out a nomination form by clicking on the following link.
http://www.aacn.org/awards

7. Resource: AACN President’s Theme Web Page
Find out more about AACN President Caryl Goodyear-Bruch’s theme, “With Confidence,” by clicking on the following link, where you’ll find all things related to her theme in one convenient location; you can download and print a theme art poster, watch a video of Goodyear-Bruch’s theme speech at NTI 2008 and check out other “With Confidence” resources.
http://www.aacn.org/confidence

8. Clinical Practice Resources

AACN HEALTHY WORK ENVIRONMENT STANDARDS
http://www.aacn.org/hwe

AHRQ WebM&M
http://webmm.ahrq.gov/

Quality Improvement Online
http://www.jcrinc.com/publications.asp?durki=9649

AACN PRACTICE ALERTS
http://www.aacn.org/WD/Practice/Content/practicealerts.pcms?menu=Practice

AACN’s LISTSERV FOR NURSE MANAGERS
http://health.groups.yahoo.com/group/NIHMBL/

PATIENT SAFETY ISSUES
Fluoroquinolones: Boxed Warning to be Added for Risk of Tendon Rupture and Tendonitis
http://www.fda.gov/medwatch/safety/2008/safety08.htm#Fluoroquinolone

Patient Safety Links:
Joint Commission
http://jcrinc.co.mansellgroup.net/UM/T.asp?A2557.25634.1623.1.63602
Medline Plus
http://jcrinc.co.mansellgroup.net/UM/T.asp?A2557.25634.1623.2.63602
National Patient Safety Foundation
http://jcrinc.co.mansellgroup.net/UM/T.asp?A2557.25634.1623.3.63602

Institute for Safe Medication Practices Newsletter
http://www.ismp.org/Newsletters/nursing/default.asp

AHRQ Patient Safety Network
http://psnet.ahrq.gov

GUIDELINES
Diagnosis and Treatment of Gastroesophageal Reflux Disease (GERD)
http://www.guideline.gov/Compare/comparison.aspx?file=GERD1.inc

EVIDENCE-BASED PRACTICE
Dyspnea on Exertion in Obese Women: Association with an Increased Oxygen
Cost of Breathing (Abstract)
http://ajrccm.atsjournals.org/cgi/content/abstract/178/2/116?etoc

Induced Hypothermia and Fever Control for Prevention and Treatment of Neurological Injuries (Abstract)
http://www.thelancet.com/journals/lancet/article/PIIS0140673608608375/abstract

Delirium and Use of Sedation Agents in Intensive Care (Abstract)
http://amedeo.com/p2.php?id=18577171&s=crc

Sedation Practice: Is It Time to Wake Up and Embrace Change? (Abstract)
http://amedeo.com/p2.php?id=18226186&s=crc

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