Critical Care Newsline — July 9, 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 our 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.


July 9, 2009

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1. EVIDENCE Immediate Intervention, Treatment of Obstructive Sleep Apnea Improves Systolic Function
2. EVIDENCE Oral Care Interventions Do Not Decrease Oropharyngeal Microorganisms in Pediatric Patients Receiving Mechanical Ventilation
3. EVIDENCE Antibiotic-Resistant Staph Infection Rates Increase Dramatically in NICUs
4. RESOURCE IOM Report: Top 100 Research Priorities
5. RESOURCE Preventing Hospital-Acquired Conditions; Avoiding Higher Medical Costs
6. NEWS Paper and Pencil Certification Exams Scheduled for Fall TRENDS Conference
7. REMINDER Nominate Colleagues for AACN Circle of Excellence Awards
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Immediate Intervention, Treatment of Obstructive Sleep Apnea Improves Systolic Function
Early identification and treatment of obstructive sleep apnea (OSA) improves systolic function in hospitalized patients with acutely decompensated heart failure (ADHF), according to a recent study. Researchers divided ADHF patients with OSA into two groups. One group received auto-adjusting positive airway intervention along with standard ADHF treatment; the second group received only standard ADHF treatment. In the intervention group, left ventricular ejection fraction (LVEF) improved 4.6%.

2. EVIDENCE Oral Care Interventions Do Not Decrease Oropharyngeal Microorganisms in Pediatric Patients Receiving Mechanical Ventilation
Chlorhexidine combined with nonpharmacological oral care did not reduce the number of microorganisms in the oropharynx, decrease the duration of mechanical ventilation or shorten hospital stay in critically ill children receiving mechanical ventilation, according to a recent study. Researchers evaluated two groups of pediatric patients; one group received chlorhexidine and one group did not. Both groups were similar in demographic characteristics, preexisting underlying diseases and pharmacological, nutritional and ventilatory support.

3. EVIDENCE Antibiotic-Resistant Staph Infection Rates Increase Dramatically in NICUs
The rate of methicillin-resistant Staphylococcus aureus (MRSA) infections in U.S. neonatal intensive care units (NICUs) has more than tripled in recent years, according to recently published research. The study—the largest to date of MRSA in NICUs—emphasizes reinforcing infection control measures that limit the spread of MRSA (hand washing, etc.). Researchers analyzed "late-onset" infections, developing more than three days after birth. In newborns, infections occurring during the first three days of life are generally transmitted during labor and delivery. In contrast, the late-onset infections like the ones evaluated in the new study are more likely transmitted by parents, healthcare personnel and other contacts. The characteristics of MRSA infections among infants in the NICU "may be more complex than in other types of populations," the authors concluded. "Further strategies to prevent MRSA transmission among NICU patients may need to be developed."

4. RESOURCE IOM Report: Top 100 Research Priorities
A new report from the Institute of Medicine lists 100 health topics that should receive priority attention and funding from a new comparative effectiveness research initiative. Comparative effectiveness research evaluates methods to prevent, diagnose, treat or monitor clinical conditions to determine which ones are most effective. Using these results, consumers, clinicians, policymakers and purchasers can make more informed decisions, ultimately improving care for individuals and groups. "Healthcare decisions too often area matter of guesswork because we lack good evidence to inform them,” the authors write. "This report lays the foundation for an ongoing enterprise to provide the evidence that health care providers need to make better decisions and achieve better results. Ultimately, comparative effectiveness research will fall short of its potential without vigorous efforts by Health and Human Services to promote adoption of the findings by healthcare providers and organizations,’ the authors conclude.

5. RESOURCE Preventing Hospital-Acquired Conditions; Avoiding Higher Medical Costs
Evidence-based guidelines that help prevent hospital-acquired conditions are available from The National Guideline Clearinghouse. Among the topics covered: pressure ulcer care; fall prevention; surgical site infections and deep vein thrombosis following knee or hip replacement. The guidelines were developed in response to Medicare’s decision in 2008 to stop paying hospitals at a higher rate for increased costs to provide care for certain hospital acquired conditions.

6. NEWS Paper and Pencil Certification Exams Scheduled for Fall TRENDS Conference
Planning to attend the fall 2009 TRENDS conference? Enhance your skills by taking a certification exam while you’re there. Paper and pencil versions of CCRN, PCCN, CCNS, ACNPC and CNML specialty exams, and the CMC (Cardiac Medicine) and CSC (Cardiac Surgery) subspecialty exams will be offered at the conference Oct. 30. Be sure to pre-register using the special TRENDS exam application available online. Applications and accompanying exam fees must be submitted to AACN postmarked no later than Sept. 18, 2009.

7. REMINDER Nominate Colleagues for AACN Circle of Excellence Awards
The nominations deadline for the 2010 Circle of Excellence Awards is Aug. 1, 2009. Up to 25 individuals who exemplify excellence in the care of acutely and critically ill patients and their families will be chosen to receive the 2010 awards; recipients will become part of the Circle of Excellence Society. Learn about the awards, review the criteria and fill out a nomination form at www.aacn.org/awards.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Development of New Cardiac Deformity Indexes for Pectus Excavatum on Computed Tomography: Feasibility for Pre- and Post-Operative Evaluation

Twenty-Five-Year Outcome of Pediatric Coronary Artery Bypass Surgery for Kawasaki Disease

Pleural Effusions Following Cardiac Surgery. Prevalence, Risk Factors and Clinical Features

PATIENT SAFETY
Smoking cessation aids Chantix, Zyban: Boxed warning and patient medication guides highlighting risk of serious neuropsychiatric symptoms

Patient Safety Links:

Joint Commission
Medline Plus
National Patient Safety Foundation
Institute for Safe Medication Practices Newsletter
AHRQ Patient Safety Network

9. AACN Resources
For information about AACN's many resources for acute and critical care nurses, click here.

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Reminders:

Visit AACN’s Online CE Center – AACN Members Get Unlimited Free CE Credits
Online Certification Exam Registration Available

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