FDA Approves
Avian Flu Vaccine |
April 17, 2007
FDA has approved the
first human vaccine
in the U.S. to be
used against the
H5N1 influenza
virus, commonly
referred to as avian
flu or bird flu. The
vaccine is made by
Sanofi Pasteur Inc.
If an avian flu
pandemic emerges,
the vaccine could
provide early,
limited protection
in the months before
a vaccine tailored
to the virus is
developed. Testing
has shown that about
45% of people who
received this
vaccine produced
levels of antibodies
expected to reduce
the risk of getting
the H5N1 flu.
The vaccine is
indicated for those
who could be at
increased risk of
exposure to the H5N1
influenza virus
contained in the
vaccine. However, it
will not be
available
commercially, but
will be placed in
the National
Stockpile for future
use if needed.
Source:
F.D.A.
http://www.fda.gov/bbs/topics/
NEWS/2007/NEW01611.html
|
Study Finds ICU Nurse
Working Conditions Linked to
Increase in Patient
Infections |
May 25,
2007
Last
Modified
Hospitals
that
have
better
working
conditions
for
nurses
are
safer
for
elderly
intensive
care
unit
(ICU)
patients,
according
to a
recent
report
led by
Columbia
University
School
of
Nursing
researchers
that
measured
rates of
hospital-associated
infections.
Hospital
associated
infections
are the
number
six
cause of
death in
the
United
States
(The
Centers
for
Disease
Control
and
Prevention,
March
2007).
Nurses,
as the
largest
workforce
in the
nation’s
hospitals,
are in a
unique
position
to
positively
impact
the
safety
of ICUs
if
systematic
improvements
to their
working
conditions
can be
made.
“Nurses
are the
hospitals’
safety
officers,”
said
Patricia
W. Stone,
Ph.D.,
M.P.H.,
R.N.,
assistant
professor
of
nursing
at
Columbia
University
Medical
Center
and the
study’s
first
author.
“However,
nursing
units
that are
understaffed
and that
have
overworked
nurses
are
shown to
have
poor
patient
outcomes.
Improvements
in nurse
working
conditions
are
necessary
for the
safety
of our
nation’s
sickest
patients.
With the
looming
nursing
shortage,
hospitals
direly
need to
address
working
conditions
in order
to help
retain
current
staff
now and
recruit
people
into
nursing
in the
future.”
Researchers
evaluated
several
measures
of
working
conditions
to
assess
their
effect
on
hospital-associated
infections.
They
analyzed
the
organizational
climate
as
measured
by nurse
surveys,
and
reviewed
objective
measures
of
staffing,
overtime
and
wages
with
payroll
data.
They
also
looked
at
hospital
profitability
and
magnet
accreditation
(a
national
recognition
program
for
nursing
excellence
in
hospitals).
Patient
outcome
data
came
from the
Centers
for
Disease
Control
and
Prevention
(CDC)
National
Nosocomial
Infection
Surveillance
system
and
Medicare
files.
|
After careful review, findings revealed that
ICUs with higher staffing had lower incidence of central line associated
bloodstream infections (CLSBI), a common cause of mortality in intensive care
settings. Other measures such as ventilator-associated pneumonia and skin
ulcers, which are common among hospitalized patients who cannot move regularly,
were also reduced in units with high staffing levels. Patients were also less
likely to die within 30 days in these higher-staffed units.
Increased overtime hours in ICUs
were associated with increased
rates of another common
hospital-associated infection,
catheter-associated urinary
tract infection, as well as
increased rates of skin ulcers
on patients.
“Our careful analysis found that
decisions related to staffing,
overtime, and overall work
environment directly affected
patient safety outcomes,” said
Andrew W. Dick, Ph.D., a senior
health economist at the RAND
Corporation and a co-author of
this study. “Involvement from
hospital administrators,
staffing professionals,
legislators and consumers is
needed in order to address
problems in the ICU work
environment. Our hope is that
with concentrated efforts, we
can prevent hospital infections
and improve patient safety in
ICUs.
One possible solution presented
in the study suggests increasing
the availability of
highly-qualified float nurses
through cross training. This
would allow hospitals to more
appropriately staff their ICUs
and further develop the skills
of nursing staff based on other
units.
Source: Columbia University
in
New York.
http://www.columbia.edu/cu/
news/07/05/icu.html
|
Tylenol (Acetaminophen)Toxicity |
5/30/2007 by
Maren Mayhew, MS, ANP, GNP
The FDA is concerned about the
incidence of acetaminophen
overdosage and has proposed a
regulation requiring drug
companies to place a prominent
label about the acetaminophen
content in all medications. The
FDA has attempted to reassure
the public that acetaminophen
remains extremely safe if used
with caution. However, a closer
look at the adverse effects of
this popular medication should
cause clinicians to reconsider
this drug and its usage in their
practices.
Overdosage
is a big
problem.
More
than 200
million
persons
take
acetaminophen
each
year. Of
these,
about
200
persons
a year
die of
fulminant
hepatic
failure
from
acetaminophen
overdosage.
The
median
acute
dose
causing
liver
failure
is 24 g
(48
extra-strength
tablets).
Approximately
half of
the
overdoses
are
intentional.
The severity of the overdose problem stems from the fact that acetaminophen is an extremely common medication often used casually. It is found in many combination drugs for cough and cold remedies and also in opioid medications for severe pain. For adults, the maximum daily dose is 4 g. Acetaminophen comes in 325-mg tablets; however, the 500-mg tablets are more common. Simply taking 2 Extra Strength Tylenol tablets more than 4 times a day will produce an overdose. It only takes a few days of exceeding the maximum dose to cause liver damage. If the patient adds alcohol to his or her acetaminophen regimen, the risk of damage increases further. Smoking also increases the risk of liver damage.
|
The
easiest way to inadvertently
overdose on acetaminophen is to
combine various cough and cold
medications with Tylenol. Most
patients do not read labels
carefully and are unaware that
acetaminophen is present in many
medications. Some of the
pain medications that
contain acetaminophen include
hydrocodone with acetaminophen
(Lortab, Vicodin), tramadol with
acetaminophen (Ultracet),
propoxyphene (Darvocet), oxycodone
(Percocet, Tylox), pamabrom,
pyrilamine (Midol, Pamprin), and
Tylenol with codeine.
There
is a particularly significant risk
of acetaminophen overdose in infants
and children because of the varying
dosing schedules and the variety of
formulations with different
strengths of liquids. It is
unfortunate that some of the most
caring parents have overmedicated
their children, sometimes causing
death because they did not
understand or follow the dosage
recommendations.
Acetaminophen should
be respected as a drug with severe
toxicities. Liver failure from
acetaminophen overdose is the most
serious side effect and can vary
from mild to severe. The extreme
case is seen in acute liver failure,
which includes coagulopathy and
encephalopathy. In one study 27% of
these patients died without liver
transplantation. In
healthy adults, a dose of 4 g daily
can cause alanine aminotransferase
(ALT) elevations within 1 week. The
levels return to normal when the
drug is discontinued.
Acetaminophen was also shown to
increase the risk of major
cardiovascular events (nonfatal
myocardial infarction, fatal
congestive heart failure, nonfatal
and fatal stroke) with an increased
risk of 1.68. Therapeutic doses (2-4
g/day) of acetaminophen are
associated with increased risk of
serious upper gastrointestinal
events. Acetaminophen is also
associated with hypersensitivity
reactions, serious hematologic
disorders, and skin disorders
ranging from rashes to toxic
epidermal
necrolysis. These reactions are
rare, but the provider should be
alert to recognize reactions when
they occur. (See the full
article for more Tylenol reactions
and the full article).
Source: Medscape Nurses from
Web M.D.
http://www.medscape.com/
viewarticle/557074?src=mp
Posted
6/6/07
with
authors:
Jo Ann
Serota, MSN,
RN, CPNP;
Carol Rudy,
MPH, ARNP,
CPNP; Sally
Walsh, MSN,
RN, CPNP;
Jo Ann
Serota, MSN,
RN, CPNP
What is
Hookah
Smoking?
Hookah or
water-pipe
smoking,
also known
as narghile,
shisha, or
goza, has
been used in
the Middle
East and
Asia for
more than
400 years (Rosenow,
2006). The
hookah
apparatus
consists of
a base that
is filled
with water,
a bowl, a
heating
device that
contains the
tobacco and
other
products, a
pipe that
connects the
bowl to the
base, and a
hose that is
attached to
the base to
allow the
smoke to be
inhaled.
When the
smoker
inhales
through the
hose, the
smoke from
the tobacco
passes
through the
water into a
chamber and
then is
inhaled (Rosenow).
According to
the World
Health
Organization,
a 1-hour
session of
hookah
smoking
exposes the
individual
to high
levels of
toxic
compounds
including
carbon
monoxide,
heavy
metals, and
cancer-causing
chemicals as
well as
significant
levels of
nicotine (Rosenow).
One 30- to
60-minute
session is
equivalent
to smoking
an entire
pack of
cigarettes
at one
sitting (Loffredo,
2006).
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