Critical Care Newsline — July 31, 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 expert clinical 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 31, 2008

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1. News: Influenza Guidelines Updated for 2008-2009 Season
2. Call to Action: Request for Public Comment on Blood Management Performance Measures
3. News: Essential U. S. Healthcare Workers to be Immunized First When Flu Pandemic Occurs
4. Research: Integrating Palliative and Critical Care in the ICU (Abstract)
5. News: Gardasil Is Safe, Says FDA, CDC
6. Research: Intensive Care Outcome Network (ICON) Protocol Plans Long-term Follow-up of ICU Patients (Free Full Text)
7. Reminder: Last Chance to Submit Circle of Excellence Award Nomination; Deadline is Tomorrow, Aug. 1
8. Clinical Practice Resources
9. AACN Resources
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1. News: Influenza Guidelines Updated for 2008-2009 Season
The CDC has updated guidelines for prevention and control of influenza, and now recommends that annual vaccination be given to all children aged 5 to 18 years in the 2008 to 2009 influenza season. To read the revised guidelines, click on the following link.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e717a1.htm

2. Call to Action: Request for Public Comment on Blood Management Performance Measures
The Blood Management Performance Measures Technical Advisory Panel (TAP) has identified 19 Blood Management Candidate Measures addressing key aspects of blood management. The Joint Commission is requesting stakeholder review and public comment on these measures. To participate, take the survey by clicking on the following link. Responses must be received by Aug. 19, 2008.
http://www.surveymonkey.com/s.aspx?sm=MZBRdqormuPzCsDFtfwzgw_3d_3d

3. News: Essential U. S. Healthcare Workers to be Immunized First When Flu Pandemic Occurs
The Department of Health and Human Services has just released long-awaited details on who would get vaccinated if and when an influenza pandemic strikes. Described as a “Tier One” priority, “those essential for maintaining emergency departments and intensive care units and providing medical and nursing care on inpatient wards” would be among the first group to receive the vaccine. These individuals play a "critical role in providing care for the sickest persons; highest risk of exposure and occupational infection," the plan states. Making enough vaccine to protect everyone would take months, so experts agree a plan is necessary to determine who receives the initial doses. Read or download the entire plan.
http://www.pandemicflu.gov/vaccine/allocationguidance.pdf

4. Research: Integrating Palliative and Critical Care in the ICU (Abstract)
One in five Americans die in the intensive care unit yet palliative care in this setting is often of poor quality. Therefore, this is an important focus for quality improvement. In a recent study, researchers evaluated palliative care in one hospital’s ICU using quality assessment intervention. They did not find significant improvement in family-assessed quality of dying or in family satisfaction with care; however, with an intervention to integrate palliative care in the ICU there was significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay. The researchers noted that improving family ratings may require interventions that have more direct contact with family members.
http://ajrccm.atsjournals.org/cgi/content/abstract/178/3/269?etoc

Improving palliative and end-of-life care is one of AACN’s major initiatives. To provide optimal, quality care, the science and skills for prolonging life, as well as palliative therapies must be embedded into the management of critically ill patients. For patients to receive quality care, palliation must be included throughout the trajectory of illness. Find more resources that will help you improve the palliative care for your patients at the following link.
http://www.aacn.org/WD/Palliative/Content/PalAndEOLInfo.pcms?menu=Practice

5. News: Gardasil Is Safe, Says FDA, CDC
Merck & Co's Gardasil vaccine remains safe and effective for protecting women and girls from a virus that causes cervical cancer, U.S. officials said last week after reviewing thousands of reports of health problems. Gardasil targets four strains of the human papillomavirus (HPV), a common sexually transmitted virus that causes genital warts and most cases of cervical cancer. It is approved for women and girls ages 9 to 26.
Consumers, doctors and others have raised questions about Gardasil's safety but the FDA and the CDC said the most serious adverse events did not appear linked to the vaccine and that Gardasil’s benefits continue to outweigh its risks. The agencies reviewed more than 9,700 reports of health problems following Gardasil injections. Six percent of the cases were deemed serious events. They included 20 deaths reported as of June 30. "There was not a common pattern to the deaths that would suggest they were caused by the vaccine," according to the FDA and CDC statement.
http://www.fda.gov/cber/safety/gardasil071408.htm

6. Research: Intensive Care Outcome Network (ICON) Protocol Plans Long-term Follow-up of ICU Patients (Free Full Text)
Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined. The ICON (Intensive Care Outcome Network) study is a multicenter, longitudinal study of survivors of critical illness in the United Kingdom. The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also help determine economic modeling of the long-term burden of critical illness.
http://www.biomedcentral.com/1472-6963/8/132

7. Reminder: Last Chance to Submit Circle of Excellence Award Nomination; Deadline is Tomorrow, Aug. 1
The nominations deadline for the 2009 Circle of Excellence Awards is only a day away. 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. Learn more about the awards, review the criteria and fill out a nomination form by clicking on the following link. Practice meaningful recognition by nominating a worthy colleague.
http://www.aacn.org/awards

8. Clinical Practice Resources

PATIENT SAFETY ISSUES
Electronic Medical Devices- Possible Malfunction Caused By Computed Tomography (CT) Scanning
http://www.fda.gov/medwatch/safety/2008/safety08.htm#ElectronicMedical

Micro-bubble Contrast Agents (Definity, Optison): Changes to Boxed Warnings, Warnings and Contraindications
http://www.fda.gov/medwatch/safety/2008/safety08.htm#Microbubble

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
The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America (Free Full Text)
http://www.journals.uchicago.edu/doi/full/10.1086/589747

NEW EVIDENCE-BASED PRACTICE
A Randomized Trial of Daily Awakening in Critically Ill Patients Managed With a Sedation Protocol: a Pilot Trial (Abstract)
http://www.ncbi.nlm.nih.gov/pubmed/18552687

Hospital Variability of Out-of-Hospital Cardiac Arrest Survival (Abstract)
http://www.informaworld.com/smpp/content~content=a794478091~db=all~order=page

Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema (Abstract)
http://content.nejm.org/cgi/content/abstract/359/2/142
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