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June 2003
Individuals with spinal cord injuries (SCI) are very susceptible to deep venous thrombosis (DVT). The literature in SCI shows that a 1.5 cm (not inch) difference in legs or difference between baseline measurements and subsequent measurements should be further investigated with Doppler studies. There may be not other reliable signs or symptoms.
Submitted by: Rhonda S. Olson, MS, RN, CRRN and
Kathleen Dunn, MS, RN, CRRN-A
Albumin is a blood product. This is especially important for Jehovah Witness patients who refuse blood and blood products. Many nurses do not realize that albumin is a blood product.
Submitted by: Linda Arfele, BSN, RN, CRRN
August 2003
New research in approaches to
treatment of Multiple Sclerosis (MS) includes the use of chemotherapy
agents in combination with approved MS drugs. Of particular
interest is the combination of interferons with azathioprine (AZA), a
drug generally used to prevent organ transplant rejection and for
cases of severe arthritis. Other chemotherapeutic agents being
studied in combination with existing therapies include
cyclophosphamide, methotrexate, and mycophenolate.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
September 2003
Using a clear film dressing like Tegaderm, Biofilm or Op-site over Stage I and Stage II pressure ulcers provides:
 |
added protection to that skin area |
|
allows visualization of the area |
|
aids in preventing friction and shear |
|
provides autolytic healing action to broken skin (Stage II) |
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provides a clean, warm, and moist optimal healing environment |
I always advise leaving the clear film dressing in place until it falls off or sufficient exudate collects requiring a dressing change. Thus, skin remains undisturbed for as long as possible and the film provides a slippery surface negating the effects of friction and shear. Of course, one still needs to address the causes of the pressure ulcer and take steps to prevent further breakdown.
Submitted by: Shirley Bristow, MSN, RN, CRRN
The iBOT Mobility System, a wheelchair that ascends and descends stairs, was approved by the Food and Drug Administration (FDA) August 13, 2003. The wheelchair uses sensors and gyroscopes to navigate stairs while balancing on two wheels. It can also shift into four-wheel drive for grassy hills and elevate its occupant to standing height.
The iBOT, made by Johnson & Johnson subsidiary Independence Technology, costs $29,000. Because the system is so complex, the FDA decided the wheelchair would require a doctor’s prescription and special training to operate. Sales are expected to begin in the United States by the end of the year.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
For the individual with an ostomy
who has limited dexterity (e.g., due to arthritis, or peripheral
neuropathy) or use of only one arm, a new ostomy pouch is available.
The Coloplast Assuraâ
Ostomy pouch with EasiCloseÔ
integrated outlet has a reliable Velcroâ
closure that allows easy emptying of the pouch.
The Velcro closure makes it possible to open, empty, &
re-close the pouch outlet with only one hand or with limited
dexterity.
Check with your client’s ostomy supply company, or contact the Coloplast Corporation at www.us.coloplast.com or 1-800-533-0464 for availability.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
Mayo Clinic researchers have found that those who have experienced a head injury are four times more likely to develop Parkinson’s disease than those who have never suffered a head injury. The risk of developing Parkinson’s increases eightfold for patients who have had head trauma requiring hospitalization, and it increases 11-fold for patients who have experienced severe head injury. Longer loss of consciousness and brain bruising visible on a CT scan are associated with elevated risk of Parkinson’s disease. The average head trauma was about 20 years before the start of the disease.
The study is published in the Tuesday, May 20, 2003 issue of Neurology, www.neurology.org.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
January 2004
An estimated 30% of individuals get less than sufficient sleep, however for most this does not trigger a visit to a health care practitioner. Therefore, a critical question to ask any client is, “ Do you have difficulty getting enough sleep and do you have problems staying awake during the day?”
One of the most common tools for sleep assessment, the Epworth Sleepiness Scale, is available on the Internet at http://www.sleepquest.com/s_sleepquestionnaire2.html
This is a subjective measure of sleepiness, and also screens for possible sleep apnea. Individuals completing the questionnaire by Internet send the results to the SleepQuest site, where the results are interpreted and correspondence is returned to the individual. The website is managed through Stanford University and is linked with Dr. William Dement, a founder of the study of sleep. Results of the scale indicating the possibility of a sleep disorder or sleep apnea should be discussed with one’s health care provider.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
February 2004
Advances in Medications for Osteoporosis
Some individuals with osteoporosis may be unable to tolerate currently recommended medications. A new drug, Teriparatide (Forteo) was approved by the FDA in 2003. Teriparatide is derived from human parathyroid hormone. It is the main regulator of calcium and phosphate metabolism. The medication is injected daily into the thigh or abdomen. Studies have found that women taking this medication plus calcium and vitamin D supplements showed significant increases in bone mineral density and a reduced risk of fractures. However, the long-term effects of taking teriparatide are currently unknown, so therapy for more than 2 years is not recommended. Teriparatide is also more expensive than other medications for treating osteoporosis.
Researchers are studying another medication, zoledronic acid (Zometa), as a once-a-year medication for treating osteoporosis. This medication is injected intravenously once-a-year and preliminary studies indicate it may be just as effective at increasing bone density as daily or weekly oral medications. Now, researchers must determine if this new method of administering an osteoporosis medication ultimately translates into fewer bone fractures.
Halo Clothing
Patients wearing a halo brace may
wear an XL man’s button–up shirt.
You can leave the top two or three buttons open to accommodate
the halo brace. This works well for all but the largest patients.
An XXL T-shirt can be used if you clip the collar area at the
shoulder seams.
For women who need a bra, the best
solution is either a strapless bra or if they only need coverage or
light support, a tube top can be cut and the opening connected with Velcro.
Both can be “snaked” under the halo vest when dressing.
Also, some roomy items with Velcro closure can be found at:
www.dawnwells.com/Wishing_Wells/wishing_wells.html
All items in the collection may not
be suitable for patients with halos, but clothing is designed for ease
of use. The clothing is reasonably priced.
Submitted by: Kathleen L. Dunn, MS, RN, CRRN-A
Susan Wirt, RN, CRRN, CCM, CLCP, CRP
Rhonda S. Olson, MS, RN, CRRN
Foley Catheter Insertion
When inserting an indwelling Foley
catheter, insert up to the Y portion of the catheter prior to
inflating the balloon. This insures that the catheter is all the
way into the bladder, rather than just in the urethra. Once the
catheter is inflated, pull back gently until the balloon is covering
the urethral opening in the bladder. This tip is especially important
when inserting a Foley in individuals with spinal cord injury, who
lack sensation.
Submitted by: Ann Gutierrez, MSN, RN, CRRN-A
Bathing/Swimming
with Foley Catheter:
Submitted by: Ann Gutierrez, MSN, RN, CRRN-A
Kathleen Dunn, MS, RN, CRRN-A
Continuous
Passive Motion (CPM) Following Total Knee Arthroplasty
Post- surgery rehabilitation protocols for total knee arthroplasty often include CPM. However, CPM protocols vary considerably amongst institutions.
A recent Cochrane review reported results of a current meta-analysis to evaluate the effectiveness of CPM following total knee arthroplasty.
For the primary outcomes of interest, CPM combined with physiotherapy (PT) was found to statistically significantly increase active knee flexion and decrease length of stay. CPM was also found to decrease the need for post-operative manipulation. CPM did not significantly improve passive knee flexion and passive or active knee extension.
The reviewers concluded that CPM combined with PT may offer beneficial results compared to PT alone in the short term rehabilitation following total knee arthroplasy.
Source: Milne S, Brosseau L, Robinson V, Noel MJ, Davis J, Drouin H, Wells G, Tugwell P. (2003). Continuous passive motion following total knee arthroplasty. Cohrane Database System Review, 2: CD004260.
Submitted by: Kathleen A. Stevens, MS, RN, CRRN
Rhonda S. Olson, MS, RN, CRRN
New Medication for COPD Management
SPIRIVA® HandiHaler® (tiotropium bromide inhalation powder) is a new medication for COPD (chronic bronchitis & emphysema primarily). It is used just once a day.
SPIRIVA makes it easier to breathe by relaxing the muscles in the airways inside the lungs. SPRIVA opens narrow airways and helps keep them open for 24 hours. It is not a "rescue" medication – do not use it to quickly relieve shortness of breath. Keep an albuterol inhaler as a "rescue" medication. DO NOT use in conjunction with Combivent® (ipatropium bromide and albuterol sufate) or Atrovent® (ipatropium bromide) as the ipatropium bromide and tiotropium bromide act as antagonists.
SPIRIVA is for oral inhalation only. Capsules are inserted into HandiHaler, punctured by the press of a button, and inhaled slowly and deeply, but strongly enough to make the capsule inside the HandiHaler vibrate. Hold breath, then exhale and breath normally again. Repeat the inhalation. DO NOT swallow SPIRIVA capsules. DO NOT open capsules prior to use.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
New
Parkinson’s Drug FDA Approved
APOKYN™ (apomorphine hydrochloride injection) has been recently approved by the Food and Drug Administration (FDA) as the first and only therapy in the United States for the acute, intermittent treatment of hypomobility episodes associated with advanced Parkinson’s disease.
Hypomobility episodes are the “end-of-dose wearing of” and unpredictable “on/off” episodes in advanced Parkinson’s disease characterized by partial loss of movement or total immobility, including walking, talking, or other movement.
APOKYN is not used to prevent episodes and it does not replace other Parkinson’s disease medications, but rather treats an existing “off” episode when it occurs. As an acute, rescue treatment, APOKYN helps patients experiencing a debilitation “off” episode to walk, talk or move around easier. The medication is administered by the individual with Parkinson’s or their caregivers via injection under the skin.
APOKYN should not be used by patients who are being treated with certain drugs to treat nausea and vomiting or irritable bowel syndrome. (5HT3 antagonists or blockers). In addition, APOKYN should not be used by patients who have had and allergic reaction to sodium metabisulfite. An anti-emetic medicine may be required to preclude nausea.
New research on apormorphine has shown that it may also be effective in treatment of tremors.
APOKYN™ will be available in late August 2004.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
Sunlight & Pain:
It’s long been known that bright light can put many people in a good mood. That’s because natural sunlight (or special light bulbs that simulate it) triggers the release of "feel-good" brain chemicals like serotonin.
Now researchers say sunlight may be able to reduce pain as well. In a recent study, surgery patients in hospital rooms with lots of natural light took less pain medication than those in dimmer rooms.
Source: Research presentation at the American Psychosomatic Society meeting (March 2004)
Submitted by: Mary Lynn Kennedy, MS, RN, CNS
Risk
Factors for Heart Attacks
A recent study found that nine risk factors --- ones that you can do something about -- account for 90% of hear t attacks.
Previously, researchers thought that only about half of heart attacks were explained by risk factors such as smoking or cholesterol. But now they say that the cause of almost all heart attacks can be pinpointed to one or more of the following:
· Smoking
· Abnormal cholesterol
· Diabetes
· High blood pressure
· Stress
· Abdominal obesity
· Sedentary lifestyle
· Eating too few fruits and vegetables
· Abstaining from alcohol
These risk factors are equal-opportunity killers – black or white, Asian or American, young or old, man or woman – all are susceptible to these same risks. Diet, exercise, and moderate consumption of alcohol can decrease risk of heart disease, but cannot reverse the potential danger posed by risks such as high cholesterol or smoking.
Salim Yusuf, MD was the principal investigator of this study which included nearly 30,000 subjects in 52 countries located on every populated continent.
Source: WebMD 9/5/200
European Society of Cardiology meeting, Munich, Germany, Aug 29 – Sept 1, 2004.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
Sleep
& Cancer:
How well you sleep can have an effect on the balance of certain hormones in your body. Moreover, if these hormones are chronically out of balance, it can decrease your body’s ability to fight off cancer. There are two possible ways this could happen, say researchers:
1) Melatonin – an antioxidant that mops up damaging free radicals is produced by the brain during sleep. If you aren’t getting enough sleep, you may not be producing enough melatonin. Result: a cell’s DNA may be more prone to cancer-causing mutations.
2) Cortisol – a hormone that regulates immune system activity, normally reaches peak levels at dawn & then declines throughout the day. If your sleep-wake cycle (circadian rhythm) is thrown off, your cortisol production may be out of kilter as well. This, in turn, can hinder your immune system’s ability to fight off “bad guys” like infection & cancer.
Source: Brain, Behavior & Immunity, Vol. 17, p. 321
Submitted by: Mary Lynn Kennedy, MS, RN, CNS
Antidepressant Approved for Diabetic Pain
The newly approved antidepressant medication, Cymbalta, has now received FDA’s approval to treat hand and leg pain caused by nerve damage in people with diabetes.
The
approval makes Cymbalta the first and only FDA-approved drug to treat
diabetic peripheral neuropathic pain.
The condition affects up to 5 million people in the U.S.
The
FDA based its approval on the results of two, 12-week clinical trails
in nearly 1,000 non-depressed adults who had diabetic neuropathy for
at least six months. Subjects
reported improvement in pain symptoms as early as in the first week of
treatment. Cymbalta also
reduced nighttime pain, which is common in people with diabetic
neuropathy and often causes sleeping problems.
The studies showed that the 60-milligram per day dose of the
drug was better tolerated and caused fewer side effects than a higher,
120 milligram per day dose of the drug, although both doses were safe
and effective.
The
most common side effects of Cymbalta were nausea, sleepiness,
dizziness, constipation, dry mouth, increased sweating, decreased
appetite and fatigue. Most
people were not bothered enough by side effects to stop taking the
medication.
Cymbalta
should not be taken by individuals on MAO inhibitors or thioridazine,
or those who have uncontrolled open angle glaucoma.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
Magnetic Stimulation for Stroke Recovery
A new therapy that uses magnetic pulses to stimulate the brain may help restore lost function after a stroke and speed recovery, a new study suggests.
Researchers found the therapy, known as repetitive trans-cranial magnetic stimulation, improved motor function and brain function in a small group of ten stroke patients.
In trans-cranial magnetic stimulation, an insulated wire coil is placed on the scalp. A brief electrical current is passed through the coil, creating a magnetic pulse that stimulates the cortex of the brain. This may cause muscle, hand or arm twitching if the coil is near the part of the brain that controls movement, or it may affect reflexes.
This repetitive magnetic stimulation of the brain is thought to help the brain recover more quickly after a stroke. Further research with a larger number of patients is needed.
Submitted by: Rhonda S. Olson, MS, RN, CRRN
February 2005
New Pain Reliever Approved
The FDA has approved a new pain reliever designed to ease a potentially debilitating type of pain caused by diabetes or shingles.
Lyrica is approved for the treatment of pain associated with:
|
Diabetic peripheral neuropathy |
|
Postherpetic neuralgia |
The FDA based its approval of Lyrica on six clinical trials, including three studies involving people with diabetic peripheral neuropathy and three involving people with postherpetic neuralgia.
The studies showed that Lyrica relieved pain symptoms in a significant proportion of patients and pain relief began as early as the first week of treatment in some patients. Lyrica is made by Pfizer, Inc.
Side effects associated with Lyrica were considered mild to moderate. The most common side effects were dizziness, sleepiness, dry mouth, swelling, blurred vision, weight gain, and difficulty with concentration or attention. The number of people who discontinued use of the drug due to these side effects was low.
Lyrica is expected to be classified as a controlled substance.
SOURCES: News release, Pfizer, Inc. and WebMD Medical Reference
SUBMITTED BY: Rhonda S. Olson, MS, RN, CRRN
Artificial Disc Approved for Severe Back Pain
The U.S. FDA has approved the first artificial disc for the treatment of severe low back pain: the CharitA© Artificail Disc, from Johnson & Johnson’s DePuy Spine, Inc.
The CharitA© Artificial Disc replaces damaged or worn-out spinal discs. Currently, the most common surgical treatment for severe back pain caused by disc damage is spinal fusion. Every year, 200,000 Americans undergo this procedure.
Spinal fusion surgery removes the damaged disc. It uses bone grafts and metal screws and/or cages to immobilize that area of the spine; motion is limited. The CharitA© disc, however, actually replaces the disc with an artificial one. This lets the spine bend and twist, thus preserving motion.
The CharitA© device consists of two metallic endplates and a movable, high-density plastic center, which replaces the damaged disc. It’s designed both to align the spine and to allow the spine to move.
In the clinical trials, complication rates for the disc replacement surgery were similar to those seen in spinal fusion surgery. Complications of disc replacement include unresolved pain, allergic reactions, and bladder problems.
Patients who received the replacement disc maintained flexibility, left the hospital sooner, returned to work sooner (12 weeks or less vs. 6 months), and were more satisfied with their procedure than were spinal fusion patients.
SOURCES: News release, DePuy Spine Inc., Raynham, Mass. and WebMD Medical Reference
SUBMITTED BY: Rhonda S. Olson, MS, RN, CRRN
Lunesta – New Insomnia Treatment Option
Individuals experiencing difficulty falling asleep or sleeping through the night now have a new Food and Drug Administration – approved treatment option:
Lunesta™ (eszopiclone), from Sepracor.
Unlike other medications prescribed for insomnia, Lunesta is the first and only prescription sleep aid that is not limited to short-term use. It is a nonbenzodiazephine hypnotic medication with a unique chemical structure and mechanism of action. Even though Lunesta is not a narcotic, it has been classified as a schedule IV controlled substance, indicating a potential for abuse or misuse. Individuals with a history of substance abuse should not be prescribed Lunesta.
Potential side effects include an unpleasant taste, dry mouth, dizziness, headache, or cold-like symptoms. Individuals who take doses that are higher than recommended may also experience amnesia and hallucinations. Lunesta will be available in 1,2, and 3 mg. film-coated tablets, although it is not as yet commercially available.
Lunesta should be taken only when one is prepared for a full night of sleep. The peak concentration of the drug occurs quickly – one hour after dosing. Unlike other medications used for insomnia, with healthy non-elderly adults, Lunesta does not accumulate and produce “daytime grogginess’. Elderly patients should be cautiously observed – they should be prescribed the lowest starting dose and should not exceed 2 mg.
SOURCES: Lunesta™receives FDA Approval. Available at: www.lunesta.com. Accessed April 1, 2005.
LUNESTA™(eszopiclone) TABLETS 1mg, 2 mg, 3 mg. Food and Drug Administration website. Available at: www.fda.gov/cder/foi/label/2004/021476lbl.pdf. Accessed April 1, 2005.
Drug News. Nurseweek, March 14, 2005 SC.
SUBMITTED BY: Rhonda S. Olson, MS, RN, CRRN
May 2005 An innovative physical
therapy technique may relieve back pain associated with severe degenerative disc disease even
when all other treatment fail. The technique, called
Souchard’s global postural re-education (GPR) employs a series of gentle
movement to realign spinal column joints and strengthen and stretch
muscles that have become tight and weak from under-use. GPR corrects the
patient’s posture and decompresses the spinal
canal. In a study of 102
patients with chronic back pain associated with severe degenerative disc
disease of the spine (82 lower back pain, 20 neck pain), 92 subjects
reported pain relief and were able to return to their usual daily activities. For 85% of the
subjects, the improvement was noted after just three
weeks of treatment. Treatment lasted for an average of five months,
with breathing techniques and a home exercise program to
continue on. The pain has not recurred after an average of almost two
years.
GPR
was developed in France, and is only now being introduced in the United
States. SOURCES:
Web MD American Academy of
Neurology 57th Annual Meeting, April 9-16, 2005, Miami Beach, Fla. Conrado
Estol, MD, PhD, Neurologic Center for Treatment and Rehabilitation, Buenos
Aires, Argentina. SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
June 2005 Cholesterol-lowering drugs called statins
may reduce disability after a stroke. Researchers reporting at the American
Academy of Neurology 57th Annual meeting say individuals with strokes who
were taking cholesterol-lowering statin drugs before their stroke are 1.6
times more likely to recover and go home than those not on these
medications. For those individuals not taking a statin
drug before a stroke, starting them soon afterward also cuts the risk of
dying or being discharged to a nursing home, the study shows.
While most doctors may already prescribe statins to individuals
with strokes, researchers suggest starting to prescribe statins to
at-risk patients is important as well. Risk factors for stroke
include high blood pressure, tobacco use, family history,
diabetes, high cholesterol, obesity, and inactivity.
The researchers studied 1,618 people who had an ischemic stroke.
Outcomes were measured within 45 days of the stroke.
Majaz Moonis, MD, director of the Stroke Prevention Clinic at the
University of Massachusetts Memorial Medical Center in Worcester
explains that 45 days would be too soon to expect a
cholesterol-lowering effect in the patients who were started on
the statin drugs after a stroke. Moonis states that statin drugs
don’t just lower cholesterol: They also prevent cells from
clumping together, help repair the lining of blood vessels, and
reduce levels of C-reactive protein, which has been linked to
stroke and heart disease. Given these properties, Moonis concludes
that it seems reasonable to assume that statins facilitate brain
cell repair, thereby improving the outcome after stroke. SOURCES:
Web MD American Academy of Neurology 57th Annual
Meeting, April 9-16, 2005, Miami Beach, Fla. Majaz Moonis, MD, director
Stroke Prevention Clinic, University of Massachusetts Memorial Medical
Center, Worcester. Mark Alberts, MD, director, Stroke Program at
Northwestern University, Chicago. SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
July 2005 A newly approved blood test may help
identify people at increased risk for stroke who lack traditional risk
factors, such as high blood pressure or diabetes. SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
August 2005 When measuring urinary tract infection
(UTI) rates for persons with spinal cord injures (SCI), one must first
define UTI for this population. A positive culture, even over 100,000
organisms is NOT a UTI, but colonization and should not be treated or
counted. Only symptomatic UTIs (fever, chills, elevated serum WBC, AD,
malaise) should be counted as a UTI for patients with SCI. SUBMITTED BY:
Kathleen L. Dunn, MS, RN, CRRN-A
[Top]
September 2005 Hip fractures are an important cause of
morbidity and mortality in the elderly. Hip protectors are padded
undergarments designed to decrease the impact of a fall on the hip. As one reviewer notes, if we are to benefit
from the results of these studies, individuals at risk need to be better
educated about the value of hip protectors, and the devices themselves
must be optimized to provide maximum protection together with maximum
comfort and appearance. Moreover, other risk-reducing steps – diet,
exercise, etc. – must be continued, and even intensified; falls will still
occur, and other bones are easily broken SUBMITTED BY:
Rhonda S.
Olson, MS, RN, CRRN
[Top]
October 2005 Scientists have found that
cholesterol-lowering medications called statins reduce the incidence of
stroke and heart problems, irrespective of a person’s cholesterol level
before treatment. The U.S. Food and Drug Administration (FDA)
has approved statins as a treatment to reduce risk of stroke and heart
attack in patients with type II diabetes sho have no evidence of heart
disease but do have additional risk factors. These risk factors include
being over 55 years of age, obesity, a family history of heart disease,
high blood pressure, and smoking. SUBMITTED BY:
Rhonda S.
Olson, MS, RN, CRRN
[Top]
An advisory panel for the Food and Drug
Administration (FDA) approved the first-ever inhaled form of insulin in
September, 2005. The expert panel approved the new insulin device, known
as Exubera, for clients with type 1 or type 2 diabetes. The FDA must still
formally approve Exubera, but it usually follows the advice of its
committees. SUBMITTED BY:
Rhonda S.
Olson, MS, RN, CRRN
[Top]
December 2005
Mayo Clinic neurologists have created the
first new, reliable and easy-to-use clinical tool in 30 years for
measuring coma depth, a proposed replacement for the Glasgow Coma Scale.
The new scoring system, called the FOUR (Full Outline of UnResponsiveness)
Score, was described in the October issue of Annals of Neurology. SOURCES: AT&T Worldnet Healthology SUBMITTED BY:
Rhonda S.
Olson, MS, RN, CRRN
[Top]
January 2006
The most comprehensive genetic study to
date of multiple sclerosis (MS) has pinpointed a cluster of genes on
chromosome 6 as playing the major role in causing the disorder. SUBMITTED BY:
Rhonda S.
Olson, MS, RN, CRRN
[Top]
February 2006
The Food and Drug Administration has
approved insulin detemir (Levemir), a long-acting insulin available in 3
ml, prefilled cartridges for subcutaneous use. To achieve the best
glycemic control, insulin detemir should be administered once or twice
daily in combination with short-or rapid-acting insulin for mealtime blood
glucose coverage. SUBMITTED BY:
Rhonda S.
Olson, MS, RN, CRRN
[Top]
March 2006
The American Heart Association has updated
the guidelines for blood pressure management. The guidelines emphasize
increased intake of fruit and vegetables, and limiting alcohol intake to
moderate levels for patients who
SUBMITTED BY:
Ann Gutierrez, MSN, RN, CRRN-A
[Top]
SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
June 2006
The Food and Drug Administration has announced a safety
information alert for patients taking rosiglitazone (Avandia) and
rosiglitazone and metformin hydrochloride combined (Avandamet).
SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
July 2006
SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
August 2006
Catheter clamping is an outdated and dangerous practice in
patients with Spinal Cord Injury (SCI). There is absolutely no
evidence that it safely increases capacity. SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
September 2006
Recognizing symptoms of a stroke is an important area for patient,
family, and public education. If a stroke can be recognized,
diagnosed, and treated within 3 hours, the effects of a stroke may
be diminished. Unfortunately, lack of awareness of the symptoms of
a stroke often spells severe brain damage. SUBMITTED BY:
Rhonda S. Olson, MS, RN, CRRN
[Top]
October 2006
Results of a pilot study suggest that the antibiotic minocycline
and creatine, a substance produced in muscle tissue, may slow
Parkinson’s Disease.
Innovative Physical Therapy Relieves Back Pain
The test, called PLAC, is the first blood test approved by the FDA to
predict a person’s risk of ischemic stroke. Ischemic stroke affects about
700,00 people per year in the U.S.
“This test provides a new tool to help us identify at-risk patients
earlier, so we can start therapies in time to prevent a stroke
altogether,” says research Christie Ballantyne, MD, director of the Center
for Cardiovascular Disease Prevention at the Methodist DeBakey Heart
Center in Houston, in a news release.
The PLAC test measures an enzyme known as Lp-PLAZ in the blood. It was
originally approved by the FDA in 2003 to help predict people’s risk of
heart disease. The FDA has now approved the test for predicting stroke
risk after a large study showed that people with higher than normal levels
of this enzyme are twice as likely to suffer an ischemic stroke associated
with hardening of the arteries.
SOURCES: FDA
News release, Methodist DeBakey Hear Center
Web MDUTI Rates In Persons with SCI
A good reference on this is:
Evidence Report/Technology Assessment No. 6, Prevention and Management of
Urinary Tract Infections in Paralyzed Persons (AHCPR Publication No
99-E008)
http://www.ahrq.gov/clinic/epcsums/utisumm.htm
UTIs in people with SCI are rarely related to catheterization technique,
but more often to 1) high pressure bladder, 2) over-distension, or 3) too
long a delay between catheterization. UTI rates may not be a good
nurse-sensitive indicator, as many factors are involved that are not under
the nurses’ control.
SOURCES: AHCPR Publication No 99-E008
Rehabilitation List-Serv
Clinical Nurse Specialist & Rehabilitation Case Manager
Rhonda S. Olson, MS, RN, CRRN
A systematic review of randomized controlled trials of hip protectors was
done to determine if they reduce hip fractures in the elderly (Sawka et
al, 2005). Analyses were pooled according to participant residence
(community or institutional). Eight trials of 12-28 month duration were
included. The Safehip brand of hip protector was used in most studies.
Compliance rates in the treatment groups were 31-70%. Four trials
including a total of 5,696 community-dwelling seniors showed insufficient
evidence to support the use of hip protectors in this group. In four
trials including 1,352 institutionalized elderly participants, hip
fracture rates in the control groups ranged from 8 to 19.4% and the pooled
risk difference for sustaining one or more hip fractures with hip
protector allocation was 4%. Thus, there is evidence that hip protectors
reduce hip fracture risk in institutionalized elderly.
Another study in Finland (Kannus, Parkkari, & Niemi, 2000) of 1,801 adults
over 70 who had at least one risk factor for hip fracture also supports
the use of hip protectors in community-based healthcare centers. Results
show that subjects at increased risk of hip fracture can reduce their
fracture risk by 60% by using hip-protector undergarments. “Users” may not
always wear the protector all the time. If the subject is wearing the
protector at the time of a fall, the risk is reduced by 80%. Willingness
to wear hip protectors appears to be an important factor.
SOURCES: Kannus, P., Parkkari, J., Niemi, S. (2000). Prevention of hip
fracture in elderly people with use of a hip
protector.
New England Journal of Medicine, 343, pp. 1506-1513
Griffith, R.W. (2001) Hip Protectors? [On-line]. (Retrieved August 4,
2005). Available:
http://www.healthandage.com/PHome/?gm=0&gc=24&1=2&gid2=1067&fa+a&path=null&x=35&y=4
Sawka, A.M., Boulos, P., Beattie, K., Thabane, L., Papaioannou, A., Gafni,
A., Cranney, A., Zytaruk,
J., Hanley D.A., & Adachi, J.D. (2005). Do hip protectors decrease the
risk of hip fracture in
institutional-and community-dwelling elderly? A systematic review and
meta-analysis of randomized
controlled trials. Osteoporos International, March 8. [On-line].
(Retrieved August 4, 2005). Available:
http://www.osteoporosis.ca/english/For%20health%20Professionals/Research/ORN/default.asp?S
=1Statins Help Diabetics
The findings, published in the September 27, 2005 online edition of the
medical journal The Lancet, suggest statins could help people at higher
risk of heart attack and stroke who have normal cholesterol levels, such
as diabetics. The researchers based their conclusions on statistics that
analyzed the results from 14 earlier clinical trials, involving 90,000
people.
Persons with diabetes mellitus have early and accelerated atherosclerosis.
The most serious complications of this are atherosclerotic heart disease,
cerebrovascular disease, and renal disease. The most common cause of death
with diabetes mellitus is myocardial infarction. Persons with diabetes
mellitus are 2-4 times more likely to have a coronary event than patients
without diabetes.
SOURCES: 1. Red Herring: The business of technology. Statins help
diabetics. [On-line] Retrieved 10/1/05
Available at: http:// www.redherring.com/PrintArticle.aspx?a-13740§or-Industries
10/1/05. Available at: http://www.thedoctorslounge.net/print.php
3. The Lancet.com. Efficacy and safety of cholesterol-lowering treatment:
Prospective meta-analysis
of data from 90,056 participants in 14
randomised trials of statins. [On-line] September 27, 2005.
Early online
publication. Retrieved 10/1/05. Available at http://www.thelancet.com/journals/eopInhaled Insulin Passes FDA Review
Unlike traditional insulin, Exubera is a dry powder that is breathed in
through an aerosol spray, similar to inhalers used by people with asthma.
This type of therapy is short acting and most diabetic clients will need
to continue nightly injections to provide long-term control. Concerns
about potential lung damage have been raised, as well as incorrect
administration of the inhaled insulin, leading to under-dosing. The main
side effect is coughing.
SOURCES: AT&T Worldnet HealthologyMayo Clinic Develops New Coma Measurement
System
When using the FOUR Score, evaluators assign a score of zero to four in
each of four categories, including eye, motor, brain stem and respiratory
function. A score of four represents normal functioning in each category,
while a score of zero indicates nonfunctioning.
Eelco Wijdicks, M.D. Mayo Clinic neurologist and inventor of the Four
Score, tested the system in 120 intensive care unit patients at Mayo
Clinic and compared it to scores by specialists using the Glasgow Coma
Score. He cites advantages of the FOUR Score found in this study as
follows:
• Comatose patients remain fully
testable even if intubated, which applies to almost half of all comatose
patients.
• Brain stem reflexes, indicators of
the entire brain’s health, are tested, providing information for immediate
intervention and prognosis.
• More precise measurements and
higher agreement between evaluators than the Glascow coma Scale.
• Recognition of a
locked-in-syndrome.
• Attention to stages of brain
herniation and breathing as indicators of coma depth
• Scores have better correlation with
outcomes.
Further evaluation of the FOUR Score is needed, but the hope is that this
tool will allow physicians an improved tool for assessment, intervention,
prognosis, and better explanations to families of the patient’s condition.Multiple Sclerosis Gene Cluster Pinpointed
The findings will ultimately help doctors to develop better treatments for
MS.
Previous studies had already pointed to this area on chromosome 6 as
playing a role in MS. Researcher Margaret Pericak-Vance, MD reports that
the difference with this study is that we now know that it is the major
effect – that is, no other genes have an effect as large on causing MS.
A person who harbors the genetic defect will not definitely develop MS. It
does, however make them more susceptible. While the exact causes of MS are
unknown at present, it is thought to be a complex interaction of genetic
and environmental factors.
SOURCES: New Basal Insulin: Insulin detemir (Levemir)
Unlike other long-acting insulins, insulin detemir is clear. Patients
accustomed to the cloudy appearance of long-acting insulins may find this
confusing.
Unopened Levemir should be refrigerated; once opened, prefilled insulin
detemir syringes can remain at room temperature for 42 days. Syringes
unused after 42 days at room temperature must be discarded.
Remind patients taking insulin detemir not to mix it in the same syringe
with any other type of insulin. They should also prime the prefilled
syringe when it’s first opened to remove air and thus ensure appropriate
dose delivery.
For more information, go to
www.fda.gov/cder/foi/label/2005/021536lbl.pdf
SOURCES: Guideline Updates for Blood Pressure
Management
drink alcohol. Clinicians should offer
individualized lifestyle advice and refer patients diagnosed as having
hypertension to dietitians, health educators, or behavioral modification
programs. Other specific recommendations include:
• Reducing sodium intake to about 1.5
g/day.
• Eating 8 to 10 servings of fruits
and vegetables daily to increase potassium intake.
• Moderating alcohol intake, because
there is a dose-response relationship between alcohol and BP, especially
in people drinking more than
2 drinks daily.
• Following the DASH diet and
emphasizing fruits, vegetables, and low-fat dairy products. The diet also
includes
whole grains,
poultry, fish and nuts, and it restricts fats, red meat, sweets, and
sugar-containing beverages.
SOURCES: Electrical Stimulation Boosts Brain Injury
Recovery
But coupling the technique known as cortical stimulation with aggressive
rehabilitation is key to reversing the impairment, doctors say.
In a small study (N=8) examining the safety of cortical stimulation
therapy, Helmi Lutsep, M.D. and co-investigators found that stroke
patients who received stimulation with rehabilitation improved
significantly better in hand mobility and strength test than people
undergoing rehabilitation alone.
The study was published in the March issue of the journal Neurosurgery, by
H. Lutsep, J.A. Brown, M. Weinand, and S.C. Cramer.
In cortical stimulation, a pacemaker-like device called an external pulse
generator sends a low current through a wire to an electrode placed
surgically atop the dura. The electrode rests above the motor cortex, the
area in the brain corresponding to hand function. Surgeons pinpoint the
site using “neuronavigation” techniques, including functional magnetic
resonance imaging, or fMRI, then remove a circular, 4-centimeter flap of
the skull to access the dura.
Similar to deep brain stimulation (DBS) used to treat Parkinson’s disease,
cortical stimulation is considered generally safer and less invasive than
DBS, because surgeons don’t go deep into the brain. On the other hand,
entry into the skull is still required.
A larger scale (N=174) follow-up study called EVEREST is underway at 16
sites around the country, to confirm the safety and effectiveness of
cortical stimulation therapy. Like the trial, the EVEREST trial will focus
on people age 21 years and older who have had an ischemic stoke at least
four months prior to screening and suffered weakness in one hand or arm.
Stroke patients who would like more information or to enroll in the
EVEREST trial should contact the study call center at 888-546-9779.
SOURCES: Monochromatic Infrared Photo Energy (MIRE™)
in the Treatment of Pain and Medical Conditions
More than 3,300 subjects in five clinical studies have demonstrated
significant pain improvement (p<0.0001) after treatment with Anodyne
Therapy. The largest such study (N=2239) demonstrated a mean 67% pain
reduction in an 11-point numeric VAS scale after a clinical treatment
program involving Anodyne Therapy. These clinical outcomes have been
documented in more than 15 studies (published or in press) in medical
journals, including the 2006 March/April Vol 20, No. 2 issue of the
Journal of Diabetes and Its Complications.
MIRE increases nitric oxide locally in the area in which it is applied.
The nitric oxide has many desirable effects. Circulation is enhanced up
to 3,200% within 20 minutes. Anodyne Therapy consists of the application
of 2 sets of MIRE pads to the area to be treated; three 30 minute
sessions per week are recommended, combined with therapeutic exercise,
neuromuscular reeducation, and/or gait training. Treatment is generally
provided in an outpatient rehabilitation center, however, chronic
conditions may require a home system for ongoing treatment.
Clinical programs using Anodyne Therapy are usually covered by Medicare
and private insurance providers as long as physical therapy is covered.
For in home use, Medicare recognizes Anodyne Therapy for the treatment
of peripheral neuropathy in diabetics. Private insurance may cover
Anodyne Therapy when medically necessary.
SOURCE: Dr. Thomas Burke, “Nitric Oxide and Pain Relief. Monochromatic
Infrared Photo Energy in the Treatment of Pain & Medical Conditions”.
American Society for Pain Management Nursing, Monday, April 17, 2006.
Methodist Hospital, Houston, Texas.
SOURCES: Avandia and Avandamet: New Warnings
Rosiglitazone, present in both drugs, is a thiazolidinedione
medication indicated for treatment of insulin resistance that
complicates the management of diabetes mellitus.
Adverse reactions: The new warnings were prompted by reports of
serious adverse reactions, including new onset of diabetic macular
edema or worsening of macular edema in patients with diabetes who
already had the disorder. Patiens with diabetes who experience new
onset or worsened diabetic macular edema quite often experience
peripheral edema and have hypertension and poor glycemic control.
In some patiens, discontinuing the medication will improve or
completely resolve the macular edema. Symptoms may also be
alleviated in some patients receiving the higher doses of these
drugs when doses are reduced.
Patient monitoring: Assess for symptoms that suggest macular edema
including blurred or distorted vision, decreased color
sensitivity, and decreased ability to adapt to the dark. In
addition, watch for signs of peripheral edema or sudden weight
gain suggestive of fluid retention.
For additional information, go to
www.fda.gov/medwatch/SAFETY/2006/Avandia_DHCPletter.pdf
SOURCES: Pavlovich-Danis, S.J. (2006). Drug News. www.nurseweek.com,
February 27, 2006SC.
www.fda.gov/medwatch/SAFETY/2006/Avandia_DHCPletter.pdfContinuous Passive Motion Following Total
Knee Arthroplasty
Fourteen trials met the criteria for the meta-analysis, ranging
from 1966 to 2002. Results favoring CPM were found for the main
comparison of CPM combined with physical therapy (PT) versus PT
alone at end of treatment. For the primary outcomes of interest,
CPM combined with PT was found to statistically significantly
increase active knee flexion (4.30 degrees) and decrease length of
stay (-0.69 days). CPM was also found to decrease the need for
post-operative manipulation. CPM did not significantly improve
passive knee flexion and passive or active knee extension.
The reviewers concluded the CPM combined with PT may offer
beneficial results compared to PT alone in the short term
rehabilitation following TKA.
SOURCE: Milne, S., Brosseau, L., Robinson, V. Noel, M.J., Davis,
J., Drouin, H., Wells, G., & Tugwell, P. (2003). Continuous
passive motion following total knee arthroplasty. Cochrane
Database Systematic Review, (2), CD004260.Evidence –Based Practice: Abolishing
Catheter Clamping
Catheter clamping has been shown to cause reflux of colonized
bacteria from the bladder to the kidneys, risking pyelonephritis
or other kidney complications, and can also cause hematuria,
increasing the patient's risk for a systemic infection. It can
cause significant autonomic dysreflexia. It is also easy to forget
to unclamp the patient, and the whole procedure is a waste of
nursing time.
Therefore, there is no justification for catheter clamping in
evidence-based practice. While most facilities have done away with
this practice years ago, some physicians persist with writing
orders for the clamping of catheters.
Kathleen L.
Dunn, MS, RN, CRRN-A
An easy way to remember three steps to recognizing a stroke is:
STR.
Ask these three simple questions:
S * Ask the individual to SMILE
T *Ask the person to TALK – to speak a simple
sentence (Coherently) (i.e., It is sunny out today).
R *Ask the person to RAISE BOTH ARMS.
If he or she has trouble with ANY ONE of these tasks, call 911
immediately and describe the symptoms to the dispatcher.
Rehabilitation nurses can use this as a teaching tool to help
increase public awareness and early recognition of a stroke. It is
easy to remember because it is the first 3 letters of stroke. Advances in Parkinson’s Disease Research:
In a study of 200 patients in the earliest stages of the disease –
they didn’t yet require medication for its symptoms – those who
took either of the two pills did not seem to decline as rapidly as
those given a placebo.
The compounds are thought to lessen a type of cellular stress or
fight inflammation that may damage cells.
It is far too early for patients to seek the pills; further
research is nee