Critical Care Newsline — April 23, 2009

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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’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 23, 2009

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1. EVIDENCE Severe Hypoglycemia Increases Risk of Dementia for Older Adults With Diabetes
2. EVIDENCE Obesity Links to Inflammation, High Blood Pressure and Heart Disease (Free Full Text)
3. EVIDENCE Acid Reflux Without Symptoms Does Not Worsen Asthma
4. EVIDENCE Use of Electronic Health Records Sketchy in U.S. Hospitals (Free Full Text)
5. NEWS AACN Launches NTI Group on Facebook
6. RESOURCE Hand Hygiene Monograph Helps Improve Compliance
7. CALL FOR NOMINATIONS AACN Leadership Positions
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Severe Hypoglycemia Increases Risk of Dementia for Older Adults With Diabetes
Older adults with type 2 diabetes who have hypoglycemic episodes severe enough to require hospitalization are more likely to develop dementia, according to a recent study. Although some studies have reported a link between history of hypoglycemia and impaired cognitive functioning in children and young adults with type 1 diabetes, no previous studies have evaluated hypoglycemic episodes as a risk factor for dementia in populations of older patients, who are more likely to have type 2 diabetes. Researchers found that, compared with patients who did not have hypoglycemia, patients with single or multiple episodes had a graded increased risk of dementia. Patients with 1 hypoglycemic episode had a 26 percent increased risk; 2 episodes, an 80 percent increased risk; and 3 or more hypoglycemic episodes were associated with nearly double the risk for dementia. The thinking has been that aggressive treatment to achieve tight glycemic control would lower this risk. But the study suggests such treatment may do more harm than good in older patients if blood sugar levels drop to very low levels.

2. EVIDENCE Obesity Links to Inflammation, High Blood Pressure and Heart Disease (Free Full Text)
Obesity-related disorders, such as diabetes and hypertension, lead to the development of cardiovascular disease, according to a recent study. The latest findings add to an increasing amount of evidence proving that body fat distribution may alter metabolic function and elevate heart disease risk. Accumulation of intra-abdominal fat also plays a role in insulin resistance. “Adipose tissue, once considered a simple energy warehouse, is now regarded as a complex organ not only contributing to the management of energy flux within the body but also interacting with the inflammatory system and the vascular wall. Furthermore, recent studies have underlined that there are intricate interplays among adipocytes, the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS), which participate in the obesity-associated dysmetabolic state,” the researchers reported, adding that fat deposits have distinct metabolic characteristics, leading to individual differences in the impact of obesity on cardiometabolic risk.

3. EVIDENCE Acid Reflux Without Symptoms Does Not Worsen Asthma
A commonly used treatment for acid reflux does not improve asthma symptoms or control in patients who do not have symptoms of gastroesophageal reflux (GER), according to a new study. The finding suggests that silent GER that causes only minimal or no reflux symptoms does not play a role in asthma, as has previously been thought. The multi-center, randomized clinical trial is the first to evaluate whether adding esomeprazole (Nexium), to asthma therapy might improve asthma control and quality of life in asthma patients who could have silent GER. Researchers found no differences between patients treated with the reflux medication and those who were not. "This study helps us rule out silent GER as one possible contributor to poorly controlled asthma, and is important news for many patients," researchers noted. “Asthma patients who take medication for acid reflux but who do not have reflux symptoms should talk with their doctors about whether they should continue the medication."

4. EVIDENCE Use of Electronic Health Records Sketchy in U.S. Hospitals (Free Full Text)
Despite a consensus that the use of health information technology should lead to more efficient, safer and higher-quality care, there are no reliable estimates indicating adoption of electronic health records in U.S. hospitals, according to a recent survey. Researchers found that based on responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (present in all clinical units) and an additional 7.6% have a basic system (in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas and teaching hospitals were more likely to have electronic records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation.

5. NEWS AACN Launches NTI Group on Facebook
Planning to attend NTI 2009 in New Orleans? Start networking early with our new NTI group on Facebook. If you have any questions about the conference, here’s the place to get answers. Join the lively discussions already under way.

6. RESOURCE Hand Hygiene Monograph Helps Improve Compliance
To help healthcare organizations target their efforts in measuring hygiene performance, The Joint Commission recently released “Measuring Hand Hygiene Adherence: Overcoming the Challenges.”
Measuring compliance with hand hygiene practices is complicated because of the need to monitor the practices of many care providers in numerous locations for sufficient periods of time. The monograph provides a framework to help healthcare workers make necessary decisions about when, why and how to measure compliance with hand hygiene, and includes systematic reviews of commonly used approaches.

7. CALL FOR NOMINATIONS AACN Leadership Positions
Do you know someone who you think would provide strong, effective leadership as a member of the AACN Board of Directors or the AACN Nominating Committee? Review the required competencies in the AACN Framework for Governance Leadership Positions and submit nominations by May 31, 2009.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Intensive Care Unit Occupancy and Patient Outcomes

Serum Lactate Is Associated With Mortality in Severe Sepsis Independent of Organ Failure and Shock

GUIDELINES
ISMP Guidelines for Use of Automated Dispensing Cabinets

Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information

PATIENT SAFETY ISSUES
Ceftriaxone: Update to Previous Alert on Interaction of Ceftriaxone With Calcium-containing Products

Arrow International Intra Aortic Balloon Pump Catheters: Class 1 Recall Due to Failure of Balloon to Increase Perfusion and Potential for Serious Injury or Death

Influend Cough and Cold Products: Recall Due to Possibility of Product Superpotency

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