SOCIAL NETWORKING
How to "tweet" discreetly
Nurses who inappropriately use social media face risks, including disciplinary action by the state board of nursing, loss of employment, and legal consequences. To help nurses and nursing students maintain professional standards while using social media, the American Nurses Association (ANA) has released its Principles for Social Networking and the Nurse: Guidance for the Registered Nurse.
The guide offers advice about using social media in a way that protects patients' privacy and confidentiality. The guide also tells how to maintain the provisions in the Code of Ethics for Nurses and standards of practice. Members of the ANA may download the guide for free at the members-only section of their website, http://www.nursingworld.org.Non-membersmayorderthepublicationatthesamewebsite.
CPR RECOMMENDATIONS
Current protocols stand up to testing
Two trials evaluating new strategies for CPR were stopped early because neither strategy produced better outcomes than existing CPR protocols.
* One study evaluated outcomes when emergency medical service (EMS) personnel responding to an out-of-hospital cardiac arrest performed 2 minutes (180 seconds) of CPR before checking cardiac rhythm and performing defibrillation, if indicated. Researchers compared outcomes in a similar group of patients assigned to receive only a brief period (30 to 60 seconds) of EMS-administered CPR before rhythm analysis, in keeping with current recommendations. They found "no difference in the outcomes with a brief period, as compared with a longer period, of EMS-administered CPR before the first analysis of cardiac rhythm."
* The second study evaluated the so-called impedance threshold device (ITD), which is a valve that attaches to an oxygen bag used in rescue breathing. The valve allows the patient to exhale air during the chest compression phase of CPR. Prior research has suggested that by increasing the degree of negative intrathoracic pressure, the device may enhance venous return and cardiac output, improving survival rates. But in a study of 8,718 patients at 10 sites in the United States and Canada, researchers found that the ITD "did not significantly improve survival with satisfactory function among patients with out-of-hospital cardiac arrest receiving standard CPR."
Both large-scale studies were conducted by members of the Resuscitation Outcomes Consortium, which consists of 11 research centers in the United States and Canada.
Sources: Stiell IG, Nichol G, Leroux BG, et al. Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest. N Engl J Med. 2011;365(9):787-797. Aufderheide TP, Nichol G, Rea TD, et al. A trial of an impedance threshold device in out-of-hospital cardiac arrest. N Engl J Med. 2011;365(9):798-806.
RECURRENT STROKE
No benefit found for stenting
Patients with intracranial arterial stenosis, a common cause of stroke, are at high risk for a second stroke. To reduce the risk of recurrent stroke, these patients may be treated with percutaneous transluminal angioplasty and stenting (PTAS). But results of a recent study indicate that these patients may do better with aggressive medical management alone.
The study involved 451 patients who'd had a recent transient ischemic attack or stroke attributed to stenosis of 70% to 99% of the diameter of a major intracranial artery and who were at highest risk for recurrent stroke. Patients were randomly assigned to receive either aggressive medical management alone or aggressive medical management plus PTAS with a device system approved by the FDA for certain high-risk stroke patients. They found that the 30-day rate of stroke or death was 14.7% in the PTAS group and 5.8% in the medical management group. Because of these startling findings, enrollment was stopped after 451 patients underwent randomization.
Beyond 30 days, stroke in the same area of the brain occurred in 13 patients in each group. During a follow-up period of just under 1 year, 20.0% of patients in the PTAS group and 12.2% of patients in the medical management group had a stroke or death, a significant difference. A possible explanation is that a stent could dislodge unstable arterial plaque, researchers suggest.
Sources: Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):993-1003. National Institutes of Health. NIH stroke prevention trial has immediate implications for clinical practice. NIH press release, September 7, 2011.
OLDER WOMEN
Value of supplemental vitamins questioned
Although many people take dietary supplements, the long-term effects of many vitamin and mineral supplements are unknown. To explore the issue, researchers studied 38,772 postmenopausal women (mean age, 61.6) at baseline in 1986. The subjects' use of supplements was self-reported in 1986, 1997, and 2004. Analyzing the data, researchers found an increased risk of total mortality associated with these supplements: multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper. The association was strongest with supplemental iron. However, in contrast to some prior studies, calcium supplementation was associated with a lower mortality risk.
Source: Mursu J, Robien K, Harnack LJ, Park K, Jacobs DR. Less is more: dietary supplements and mortality rate in older women. Arch Intern Med. 2011;171(18):1625-1633.
POSTOPERATIVE MORTALITY
Even mild anemia is risky
After major noncardiac surgery, even mild anemia is associated with increased morbidity and mortality according to a new study. Researchers analyzed data from 227,425 patients, of whom 30% had preoperative anemia. Mortality in the 30 days after surgery was 42% higher in patients with all degrees of anemia than in patients without anemia. Similarly, rates of postoperative morbidity from conditions such as sepsis and venous thromboembolism were 35% greater among patients with anemia.
Source: Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011 Oct 6. [Epub ahead of print]
SURVEY RESPONSES
Ever had a sharps injury?
Nurses who recently visited our website answered this question:
Have you ever suffered a needlestick injury?
Answer monthly survey questions and see results from past surveys by visiting http://www.nursingcenter.com/ poll, or check out the Quick Poll at http://www.nursing2011.com.
MELANOMA
New treatment practices under the sun
Updated guidelines for patients with primary cutaneous melanoma focus on biopsy techniques, pathology, surgical treatment, and long-term follow-up care. Although the deadliest form of skin cancer, melanoma is nearly always curable when detected early.
For patients with invasive melanoma, clinicians should take a detailed history and perform a thorough exam of the skin and lymph nodes (including sentinel lymph node biopsy) to determine extent of disease spread. For patients with melanomas of any thickness, the guidelines recommend not performing baseline blood tests or imaging studies because research doesn't support their use in the absence of suspicious signs and symptoms.
The guidelines also call for, at a minimum, an annual follow-up exam with a dermatologist, as often as every 3 months in some cases. The guidelines are issued by the American Academy of Dermatology.
Source: Bichakjian CK, Halpern AC, Johnson TM, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2011 Aug 24. [Epub ahead of print]
MAGNETIC RESONANCE IMAGING
Inner ear effects may explain vertigo
Magnetic resonance imaging (MRI) machines are known to cause vertigo in some patients. To explore why, researchers designed an experiment involving 10 volunteers with healthy labyrinths (inner ear structures that control balance) and two volunteers who lacked labyrinthine function. The volunteers underwent MRI of different strengths and durations. Researchers asked them about feeling dizzy and observed them for nystagmus, a rapid, involuntary eye movement that occurs when the brain detects motion.
While in the MRI machine, all of the volunteers with healthy labyrinthine function had nystagmus, and higher MRI strengths caused faster nystagmus, regardless of the scan's duration. Neither of the patients without healthy labyrinthine function experienced nystagmus.
Researchers believe that the MRI's strong magnetic force acts on fluid circulation in the inner ear, leading to vertigo. They suggest that their findings may lead to more comfortable and noninvasive ways to diagnose and treat inner-ear disorders.
Sources: Roberts DC, Marcelli V, Gillen JS, Carey JP, Della Santina CC, Zee DS. MRI magnetic field stimulates rotational sensors of the brain. Curr Biol. 2011 Sep 22. [Epub ahead of print] Magnetic field may cause MRI-induced vertigo. Johns Hopkins Medicine press release, September 22, 2011.
In December, celebrate
* World AIDS Day (December 1) http://www.worldaidscampaign.org
* National Handwashing Awareness Week (December 4 to 10) http://www.henrythehand.com