THIS JUST IN...

Nursing2007 introduces audio conferences
This Fall, Nursing2007 is hosting several audio conferences focused on the Institute for Healthcare Improvement's (IHI) 5 Million Lives Campaign initiatives. These online educational sessions aim to broaden your understanding of the IHI's newest recommendations. Brought to you by world-class faculty and health care experts, this series focuses on the expanded objectives that target the fundamental principle for health care providers—do no harm.

"Prevent Pressure Ulcers," will be held on Tuesday, October 30, at 1 p.m. and "Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infection," will be held on Wednesday, November 7, also at 1 p.m. For more information or to register, please visit www.nursingcenter.com/audioconference.

Generic a go for Coreg
The U.S. Food and Drug Administration (FDA) has approved the first generic versions of carvedilol (Coreg), a widely used drug used to treat high blood pressure, mild to severe chronic heart failure, and left ventricular dysfunction following heart attack. Carvedilol will be manufactured by multiple generic drug companies and will be available in four strengths: 3.125 mg, 6.25 mg, 12.5 mg, and 25 mg. Labeling on the generic products may differ from Coreg’s labeling because parts of the Coreg labeling are protected by patents or exclusivity.

ACC/AHA update unstable angina/non-ST-elevation MI guidelines
The American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly released revised guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (NSTEMI).

Major changes to the guidelines include:

• suggesting an initial noninvasive set of preliminary tests, such as a stress test, echocardiogram, or radionuclide angiogram
• recommending the use of antiplatelet therapy (clopidogrel) for at least 1 year after receiving a drug-eluting stent
• highlighting the importance of more intense lipid and blood pressure control
• advising cessation of nonsteroidal anti-inflammatory drugs for all unstable angina/NSTEMI patients during hospitalization.

The guidelines, which were last published in 2002, have been developed for cardiovascular specialists, emergency room physicians, and health care professionals who evaluate and treat patients with acute coronary syndrome. They focus on the diagnosis, treatment, and management of patients with unstable angina and the closely related condition of NSTEMI.

The 2002 guidelines recommended an early invasive strategy—diagnostic angiography and revascularization—as the way to treat unstable angina/NSTEMI patients. The revised guidelines differentiate more extensively between high- and low-risk unstable angina/NSTEMI groups, and recommend an early invasive strategy for unstable and high-risk patients, with an initial conservative (noninvasive) strategy—stress test, echocardiogram, or radionuclide study—as a possible treatment option in stabilized unstable angina/NSTEMI patients and low-risk patients. Risk status is determined by risk scores.

For clinical practitioners, the revised guidelines emphasize secondary prevention and recommendations that should be continued after the unstable angina/NSTEMI patient is discharged from the hospital to reduce risk of a recurrent heart attack.

Also new in the guidelines is the call for more intense lipid and blood pressure control. More stringent LDL cholesterol-lowering therapy and blood pressure management is recommended for unstable angina/NSTEMI patients. Low-density lipoprotein cholesterol (LDL) should be lower than 100 mg/dL and ideally reduced to 70 mg/dL. Blood pressure should be lower than 140/90 and for those with diabetes or chronic kidney disease, a reading lower than 130/80 is recommended. Because platelets are thought to play a key role in recurrent heart attack, the antiplatelet therapy clopidogrel is now recommended for at least 1 year after placement of a drug-eluting stent and shorter term for bare metal stent and with medical therapy.

Additional updates to the guidelines include recommendations to discontinue the use of hormone replacement therapy in postmenopausal women; add troponin biomarkers as markers of cardiac damage and B-type natriuretic peptide markers as potentially useful for cardiac risk assessment; and stop the usage of nonsteroidal anti-inflammatory drugs.

USPSTF releases new recommendations for chlamydial infection screening
The U.S. Preventive Services Task Force (USPSTF) has updated its guidelines for chlamydial infection screening, previously published in the American Journal of Preventive Medicine in 2001.

The USPSTF recommends screening for chlamydial infection for all sexually active nonpregnant young women age 24 and younger and for older nonpregnant women who are at increased risk. The optimal interval for screening for nonpregnant women is unknown.

It doesn’t recommend routine screening for chlamydial infection for women age 25 and older, whether or not they’re pregnant, if they aren’t at increased risk.

Screening for pregnant women who are at increased risk for chlamydial infection is recommended at the first prenatal visit. For pregnant women who remain at increased risk, and for those who acquire a new risk factor such as a new sexual partner, a screening should be conducted during the third trimester.

The USPSTF also states that evidence is insufficient to assess the balance of benefits and harms of screening for chlamydial infection in men.