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CMS Open-Door Newsletter

CMS has been holding "Open Door" forums to better communicate with providers related to home health issues. Information about accessing these forums and recent editions of the CMS Open Door Forum Newsletter can be obtained by visiting the CMS Web site at The online newsletter is in PDF format. To download, Acrobat Reader Software is required. To access a free download of Acrobat Reader, visit


Free Web Seminars: Supporting Family Caregivers

The American Society on Aging (ASA) is offering five Web- and audio-based seminars on "Supporting Family Caregivers: A Single Case Study Explored by Occupational Therapists, Social Workers, and Nurses." The free seminars are available on demand (24-hours-a-day) until December 31, 2003.


For registration and continuing education information visit


More Reasons to Check Medications

Adverse drug events are common in older patients living in the community; as many as 1.9 million events occur every year in adults 65 years or older. More than 25% of these events are considered preventable. Most common drugs involved in the incidents are: cardiovasculars, diuretics, nonopioid analgesics, hypoglycemic agents, and anticoagulants.


Of concern: 60.8% of these events were drug monitoring errors, such as failure to act on clinical assessments, laboratory findings, or inadequate laboratory monitoring. Only 21% were errors in patient adherence.


Source: Gurwitz, J. H., et al. (2003). Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA, 289, 1107-1116.


WOCN Releases New Clinical Guideline for the Treatment of Lower-Extremity Arterial Disease

WOCN has released "The Guideline for the Management of Patients With Lower-Extremity Arterial Disease." This clinical guideline is the first in a series of four documents relating to wound care to be released in a 2-year period. This clinical practice guideline can be used by physicians, nurses, therapists, and other professionals working with adults who have lower-extremity arterial disease (LEAD). The guideline supports clinical practice by providing consistent research-based clinical information with the goal of improved cost-effective patient outcomes.


Order by phone at (888) 224-WOCN or visit


Level of Visceral Obesity Defined for Elevated CHD Risk in Women

Middle-aged and elderly women with visceral adipose tissue (VAT) level of at least 106 cm in area on a CT scan are more likely to have metabolic risk factors for coronary heart disease (CHD). A single-slice CT scan taken midway between L4 and L5 was performed to measure abdominal VAT and subcutaneous adipose tissue areas. Low VAT correlated with higher HDL and HDL2 cholesterol concentrations and lower LDL/HDL ratios.


Now they're telling us even our insides are obese!


Source: Nicklas, B., Pennix, B., Ryan, A., et al. (2003). Diabetes Care, 26, 1413-1420.


Nonhealing Ulcers Respond Best to Maggot Therapy

When 18 veterans with diabetes who had a total of 20 nonhealing foot ulcers were treated either with conventional therapy or with maggot therapy, the maggots came out ahead.


In the study, conducted at the VA Medical Center in Long Beach, CA, six wounds were treated with conventional means, six with maggot therapy, and eight with conventional therapy followed by maggot therapy. After 5 weeks of therapy, the wounds treated by conventional means still had dead tissue over 33% of the surface. Maggot-treated wounds were completely cleaned after only 4 weeks. Maggot therapy was also associated with hastened growth of granulation tissue and greater wound healing rates. The author notes that "future studies also must address the cost-effectiveness of maggot debridement therapy and conditions in which it is likely to be futile."


Where do all these maggots come from?


The study's author, Dr. Ronald Sherman, is a leading authority on this ancient therapy. He sends vials, each containing 1,000 maggots, to physicians around the U.S. and Canada. Medically useful maggots are fly larvae that can be used to assist in wound healing by eating the dead skin from around wounds while leaving the healthy skin tissues intact-debridement.


Source: Sherman, R. A. (2003). Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy. Diabetes Care, 26 ( 2 ), 446-451.



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