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Clinical Guideline Clearinghouse

Access to clinical guidelines and the strength of the evidence on which they are based for many conditions affecting patients can be found at the National Guideline Clearinghouse (http://www.guideline.gov/). A simple search tool at the top of the site enables you to find what organizations are recommending as best practice for multiple conditions. New guidelines are submitted and posted every week. Following is a small sample of organizations posting clinical guidelines in 2005 and the topics they have posted:

 

* American Academy of Family Physicians. Summary of policy recommendations for periodic health examinations.

 

* American Heart Association. Physical activity and exercise recommendations for stroke survivors.

 

* National Institutes of Health Consensus Development Panel. Symptom management in cancer: pain, depression and fatigue.

 

* University of Iowa Gerontological Nursing Interventions Research Center. Bathing persons with dementia and Improving medication management for older adult clients.

 

* Wound, Ostomy, and Continence Nurses Society. Management of wounds in patients with lower-extremity neuropathic disease.

 

 

What Will You Do If the Unthinkable Occurs?

If a bioterrorism emergency occurred in your area, how would you and your agency respond? The AHRQ's Web site (Bioterrorism and Health System Emergency Preparedness at http://www.ahrq.gov/news/ulp/btbriefs/) contains information to help healthcare organizations meet bioterrorism attacks in their communities.

  
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Help in Assessing Medications Prone to "The Grapefruit Effect"

Scientists discovered "the grapefruit effect," one of the most commonly known sources of food-drug interaction, when they learned that grapefruit inhibits the CYP3A4 enzyme needed to metabolize certain drugs. Drug level elevations occur when grapefruit interferes in CYP3A4 metabolism, which leads to the drug's side and toxic effects.

  
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You can find a comprehensive database of grapefruit-drug interactions, along with supporting scientific literature, at http://ww.DrugInteractionCenter.org.

 

Is This Wound Infected?

Chronic wounds, especially in immunosuppressed patients, may not show the classic signs of infection (erythema, heat, edema, and purulent drainage). Consider the possibility of infection if the patient has chronic wound infection signs:

  
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* Delayed healing

 

* Pocketing at the base of the wound

 

* Foul odor

 

 

Source: Gardner, S. E., Franz, R. A. (2004).Wound bioburden. In: S. Baranoski, E. A. Ayello, editors. Wound care essentials. Philadelphia, PA: Lippincott, Williams & Wilkins.

 

VNAA Clearinghouse for National Chronic Care Management Programs

The Visiting Nurse Association of America (VNAA) will collect information and research regarding chronic care management models for Congestive Heart Failure, diabetes, asthma, chronic obstructive pulmonary disease, and other chronic conditions and disabilities from VNAs around the country. VNAA's goal is to establish a VNAA Clearinghouse for National Chronic Care Management Programs to identify models that are most appropriate for specific patient populations or individuals depending on demographic, social, and clinical criteria. For more information, contact Shelley Ludwick at 888-866-8773 or at sludwick@vnaa.org. This project is possible through a $200,000 US Congress grant secured by Senator Ted Kennedy.

 

Teaching Tools for You and Your Patients

Stop re-creating the wheel when your tax dollars have already created it!! Multiple government agencies have created multiple teaching tools and clinician pocket resources that are posted at the Agency for Health-care Research and Quality (AHRQ) Quality Tools Web site. Examples of recently included tools are a wallet card for tracking blood pressure (http://www.nhlbi.nih.gov/health/public/heart/hbp/hbpwallet.pdf) and a booklet for teaching blood pressure management (http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_low/hbp_low.pdf). See the complete index of resources at:http://www.qualitytools.ahrq.gov/whatsnew/whatsnew_docin-dex.aspx. Many teaching tools are already translated into Spanish and other languages.

 

New for Patients With Diabetes[horizontal ellipsis]

New Drug

You will be seeing a brand-new class of drugs-in-cretin mimetics-to treat type 2 diabetes. Byetta (exenatide) is the first incretin mimetic, which regulates glucose in the same way as the naturally occurring hormone, incretin. Exenatide seems to stimulate insulin secretion only when blood sugar is high and to restore the insulin response that is lost in patients who have type 2 diabetes.

 

The Food and Drug Administration has currently approved exenatide as adjunctive therapy for type 2 diabetes, for patients in whom glycemic control is inadequate despite therapy with metformin and/or sulfonylurea. Monotherapy with exenatide may also be approved within the year, however.

 

Byetta (exenatide) is administered by subcutaneous injection before the morning and evening meals, using a 5-[mu]g or 10-[mu]g prefilled pen-injector device. The most frequent side effect was nausea, which decreased over time. Other side effects include delayed gastric emptying, anorexia, and weight loss. When used in conjunction with a sulfonylurea, hypoglycemia can occur but is easily reversed by ingesting an oral carbohydrate. Patients with severe renal or gastrointestinal disease should not take exenatide.

 

New FREE Pamphlets

Foot and leg amputations remain a major diabetes complication. With proper self-care, at least half of these amputations could be prevented. To help your patients prevent amputations, the National Diabetes Education Program has created copyright-"free" resources at http://www.ndep.nih.gov/diabetes/control/control.htm.

 

* Take Care of Your Feet for a Lifetime. A 16-page, easy-to-read brochure available in English and Spanish, which can be ordered, downloaded from the Internet, or viewed online.

 

* Foot Care Tips. A one-page, patient-friendly fact sheet, available in English and Spanish, and available online.

 

* Take Care of Your Feet-To Do List. A planning and reminder list, which stimulates patient compliance. Also available in English and Spanish.