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Free Diabetes-Cardiovascular Toolkit Now Available

Caring for patients with diabetes and cardiovascular disease is a problem faced by home healthcare professionals every day. In fact, due to prevalence of these diseases it's likely that home care professionals care for two, three, or four patients in a single day who are trying to manage these complicated issues. Teaching patients to manage one of these complex diseases can be challenging enough, but trying to get patients to master the skills to manage both can be daunting. However, help is on the way...


A collaborative effort between the American Diabetes Association, the American College of Cardiology, and the Preventative Cardiovascular Nurses Association has resulted in a free reproducible educational tool that may be just what you have been seeking. The information in this tool kit covers type 2 diabetes, nutrition and exercise, risk factor management, coronary heart disease, and vascular disease. The tool kit is available in both hard copy and CD-ROM formats. To request a complimentary copy call 1-800-DIABETES (342-2383) or e-mail


An Aspirin a Day to Keep the Doctor Away...Only if It's Taken

Although it is common knowledge that the daily ingestion of an aspirin can prevent myocardial infarction, stoke, or other cardiovascular events, only 35% of men and 26% of women identified to be at risk for cardiovascular complications take "an aspirin a day."

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The reason for this significant difference between genders is unclear; however, two possible explanations exist. First, women may be more sensitive to some to the gastrointestinal complications associated with aspirin therapy and, therefore, do not take the aspirin consistently. The second explanation may be related to physicians under prescribing aspirin therapy for female patients due to incorrect perception that women have a lower risk for cardiac diseases than their male contemporaries. For more information visit:


October 1 Brings More Challenges for ICD-9-CM Coding Staff

All Medicare claims are required to use updated ICD-9 codes. Historically, when the Center for Medicare and Medicaid Services (CMS) made a revision to the ICD-9-CM codes and rules, it gave providers a 90-day grace period. The October revision does not provide a customary grace period, and claims with incorrect codes will be rejected. The article published in September HHN is very helpful. HHN, CMS has posted a listing of the new, revised, and discontinued codes on its Web site:


Exercise Guide for Older People Free From National Institutes on Aging

An 86-page Exercise Guide for Older People is available in English or Spanish at no cost from the National Institutes on Aging. The document is available in PDF format for downloading at:


A video is available to accompany the Exercise Guide for $7.00. For more information visit


Have You Forgotten the Power of the Kegal?

For women who experience occasional stress incontinence due to sneezing, laughing, or coughing, Kegal exercises can improve their quality of life (as well as the agency's publicly reported outcomes). Many of us were taught this intervention as part of basic nursing or therapy education yet fail to teach our patients this simple, albeit effective, technique. Performing Kegal exercises as little as five times per day improves the strength of the pelvic muscles which, in turn, can improve bladder control.

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Proper performance of Kegals first requires identifying the pelvic muscles. By teaching patients to stop the flow of urine midstream they will become familiar with the activity required to exercise this muscle group. Once the patient can identify the muscles, she should perform ten 3-second repetitions of tightening five times daily to start and then gradually increase the tightening duration to up to 10 seconds.


Be sure to caution your patients that the tightening while in midstream is only to identify the muscles involved and should not be common practice due to the increase risk of urinary track infections. For more information log onto the North American Menopause Society's Web site:


FDA Warning About Web Site Bargains

The Food and Drug Administration published a public/consumer warning on its Web site regarding the purchase of prescription drugs from Web sites based outside of the United States. The FDA's warning points out that although some of the Web sites appear legitimate and provide lower-cost drugs, consumers may not be getting what they bargained for.


The FDA tested three commonly used drugs (Ambien, Lipitor, and Viagra) and found that the concentration of the active ingredients in the Lipitor and Viagra was only one-half of the concentration found in drugs purchased in American pharmacies; however, the concentration found in the Ambien was nearly twice of that was expected. Clearly, the potential risk to consumers related to incorrect dosing may make the "bargain" associated with purchasing lower-cost drugs less attractive.


The National Association of Boards of Pharmacy has established the VIPPS certification program for Web-based pharmacies to help consumers identify the legitimate pharmacy services. More information is available at the FDA Web site ( or the National Association of Boards of Pharmacy (