Critical Care Newsline — April 9, 2009

Critical Care Newline Home
 


Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN’s clinical practice experts. 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 that will keep you informed on issues affecting nurses and the nursing profession.

April 9, 2009

********************************************
1. EVIDENCE Effect of Clopidogrel Plus Aspirin Cuts Stroke Risk for Patients with Atrial Fibrillation
2. EVIDENCE Americans Lack Timely Access to Optimal Care in Medical Emergencies
3. EVIDENCE Aspirin Use to Prevent Cardiovascular Disease (Free Full Text)
4. NEWS Specialty Nursing Associations Endorse Global Vision Statement on Care of Older Adults
5. ADVISORY Companies Must Halt Production of Unapproved Narcotics, FDA Warns
6. REMINDER National Healthcare Decisions Day Is Next Thursday, April 16
7. REMINDER FOR CHAPTER LEADERS ATTENDING LDW Have You Received Your Confirmation?
8. Clinical Practice Resources
9. AACN Resources
*********************************************

VOTE Online in AACN’s Annual Election; Voting Closes April 25

1. EVIDENCE Effect of Clopidogrel Plus Aspirin Cuts Stroke Risk for Patients with Atrial Fibrillation
Patients with atrial fibrillation who cannot take vitamin K–antagonist therapy may benefit from a combination of clopidogrel and aspirin, which reduced their risk of major vascular events, especially stroke, according to a recent study. On the downside, the combined medications increased the risk of major hemorrhage. The study’s researchers followed progress of more than 1,700 patients and reported “At a median of 3.6 years of follow-up, major vascular events had occurred in 832 patients receiving clopidogrel (6.8% per year) and in 924 patients receiving placebo (7.6% per year). The difference was primarily due to a reduction in the rate of stroke with clopidogrel. Stroke occurred in 296 patients receiving clopidogrel (2.4% per year) and 408 patients receiving placebo (3.3% per year). Major bleeding occurred in 251 patients receiving clopidogrel (2.0% per year) and in 162 patients receiving placebo (1.3% per year).”

For more on this topic, see the Evidence-Based Practice section below for free full text of the warfarin, aspirin, clopidogrel (WATCH) trial.

2. EVIDENCE Americans Lack Timely Access to Optimal Care in Medical Emergencies
As many as one in four Americans are more than an hour away from the type of hospital that's most prepared to save their life during a time-sensitive medical emergency, according to a new study. Since little is known about which U.S. hospitals are best equipped and staffed to tackle emergent illnesses like stroke, cardiac arrest, heart attack and the severe bloodstream infection sepsis, many more Americans may be in peril because no system exists to transport them to the right hospital at the right time. The new study shows that 71 percent of Americans have access to an emergency department of some kind within 30 minutes, and 98 percent can reach one within an hour. But on a state-by-state basis, the findings suggest that many of those nearby facilities may not be able to provide care for the most emergent conditions. The development of a regionalized emergency care delivery system should be explored,” the authors concluded, adding that a truly comprehensive emergency care system needs to be built from a population health perspective, with groups of EMS providers and hospitals thinking collaboratively about how to provide the best emergency care to their region.

3. EVIDENCE Aspirin Use to Prevent Cardiovascular Disease (Free Full Text)
A recent literature review on the use of aspirin to prevent cardiovascular disease focuses on new evidence outlining the pros and cons of using the drug for the primary prevention of cardiovascular disease. Based on these findings, the U.S. Preventive Services Task Force Recommendation Statement on this topic was updated. New gender-based guidelines suggest that men age 45 to 79 and women age 55 to 79 should take aspirin to prevent heart disease; younger men and women should not.

For a quick look, read a summary of the recommendations. http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm

4. NEWS Specialty Nursing Associations Endorse Global Vision Statement on Care of Older Adults
Twenty-seven national nursing organizations, including AACN, have endorsed the Specialty Nursing Association Global Vision Statement on Care of Older Adults. The statement emphasizes that, with the rapid increase in the population of U.S. older adults, the nurse workforce must become equipped to meet the group’s changing and specific health care needs. Nurses must be competent to deliver care to older adults, being sensitive to the physiological, functional, and psychological needs that set them apart from younger adults.

5. ADVISORY Companies Must Halt Production of Unapproved Narcotics, FDA Warns
The U.S. Food and Drug Administration recently warned nine companies to stop manufacturing 14 unapproved narcotic drugs widely used to treat pain. The FDA’s warning letters notified the companies they may be subject to enforcement action if they do not stop manufacturing and distributing prescription unapproved products that include high concentrate morphine sulfate oral solutions and immediate release tablets containing morphine sulfate, hydromorphone or oxycodone. This action does not include oxycodone capsules. Consumers who rely on narcotics for pain relief continue to have access to narcotic products that the agency has evaluated and determined to be safe and effective.

6. REMINDER National Healthcare Decisions Day Is Next Thursday, April 16
April 16 is National Healthcare Decisions Day (NHDD). The NHDD Initiative, now in its second year, is a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and opportunity to communicate and document their healthcare decisions Last year, 76 national organizations, including AACN, and approximately 400 state and local organizations participated in the first annual NHDD. As a result, hundreds of thousands of people learned more about—and took action on—advance directives.

7. REMINDER FOR CHAPTER LEADERS ATTENDING LDW Have You Received Your Confirmation?
If you registered for the Leadership Development Workshop (LDW) at NTI 2009 and have not yet received your confirmation, please contact the Chapters Department, 800-394-5995 ext. 365. The confirmation includes the date, time, location and agenda of the event.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Randomized Trial of Warfarin, Aspirin, and Clopidogrel in Patients With Chronic Heart Failure: The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) Trial (Free Full Text)

Stressful Intensive Care Unit Medical Crises: How Individual Responses Impact on Team Performance

A Prospective Study of Ventilator-Associated Pneumonia in Children

GUIDELINES
American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease

PATIENT SAFETY ISSUES
Digoxin (Caraco Brand) - Recall of Tablets Because They May Differ in Size

*****************************************************************************************
If you do not wish to receive e-mail updates from AACN, please reply to
unsubscribe@aacn.org

Do you have a comment, question or story idea for the Critical Care Newsline? Send your email to enewsletter@aacn.org

UPDATE YOUR OWN INFORMATION ONLINE

Did you know you can update your demographic profile, including your e-mail address, online? Simply log in using your membership or customer identification number. Your default password is the first 15 letters of your last name. Go to: http://www.aacn.org/DM/CustomerProfile/UpdateCustomerProfile.aspx

*****************************************************************************************