Nurses Informations

The system is currently under clinical trial on patients with chronic leg ulcers with NHS Greater Glasgow and Clyde. It is anticipated it could be used for any kind of chronic or acute wound, including burns, chronic surgical wounds, and pressure ulcers.

Obesity Can Reduce Risk of Developing Pressure Ulcers

In a recent study published in the Journal of Gerontology: Medical Science, researchers suggest that obesity reduces the risk of developing pressure ulcers in hospitalized older adults. A total of 3214 patients admitted to 2 Philadelphia, PA, hospitals between 1998 and 2001 were assessed for risk factors for pressure ulcers. The goal of the investigation was to evaluate the chances of developing a pressure ulcer in both underweight and obese patients, relative to optimal weight patients. Patients enrolled in the study who were underweight demonstrated greater odds of developing a pressure ulcer (adjusted odds ratio [OR] = 1.8; 95% confidence interval [CI], 1.2-2.6). Study participants who were obese had reduced odds (adjusted OR = 0.7; 95% CI, 0.4-1.0), and those with severe obesity had the lowest odds of developing a pressure ulcer (adjusted OR = 0.1; 95% CI, 0.01-0.6). The investigators concluded that extra body fat lowers the risk of pressure ulcers in hospitalized older adults.

Source: Compher C, Kinosian BP, Ratcliffe SJ, Baumgarten M. Obesity Reduces the Risk of Pressure Ulcers in Elderly Hospitalized Patients. J Gerontol A Biol Sci Med Sci 2007;62(11):1310-2.

Monitor Helps Measure Bandage Pressure

Ulsys, Halifax, UK, launched the Vowden Trainer, a cutting-edge pressure monitor designed to increase the accuracy of leg ulcer treatment, at Medica 2007, which was held recently in Germany. The Vowden Trainer works by accurately measuring the application of pressure under a bandage applied over a leg ulcer, indicating exactly how much pressure the bandage is generating in order to help health care professionals apply the correct pressure without having to estimate. This eliminates inconsistent pressure application, allows for greater accuracy in treatment, and saves working time.

Medline Unveils New Packaging for Silvasorb

Medline Industries, Inc, Mundelein, IL, introduces innovative packaging for its line of SilvaSorb wound care dressings, designed to increase user safety. The new packaging, including an outer box and inner pouch, provides clear, concise instructions on the proper use of the product, along with a pamphlet that offers a 2-minute tutorial on important wound care guidelines. Packaging for each family of wound care products is color-coded and the inner pouch includes a crack-and-peel sticker for dressing change and charting.

American Red Cross and Pitney Bowes Partner to Deliver Holiday Cards to Wounded Service Members

WASHINGTON, Tuesday, December 18, 2007 — America’s wounded service members are always grateful for supportive cards and notes––especially during the holiday season.

This holiday season, communities across America are invited to mail cards along with personal messages of support to wounded service members at military hospitals around the country, through a unique partnership between the American Red Cross and Pitney Bowes Inc.

With the support of the U.S. Department of Defense and Walter Reed Army Medical Center, and with help from Pitney Bowes Government Solutions, the American Red Cross will collect, review and distribute holiday greeting cards to wounded military personnel. For security reasons, the Red Cross will be able to accept only holiday cards but not packages. Red Cross volunteers will receive and bundle the cards, which will be shipped by Pitney Bowes Government Solutions. Then, Red Cross volunteers at the medical facilities will distribute the cards throughout the holiday season.

“So many Americans want to show their support and gratitude by reaching out to wounded service members at Walter Reed and other military medical centers during the holiday season,” said Neal Denton, American Red Cross Senior Vice President for Service to the Armed Forces. “With the support of the Department of Defense, Walter Reed leadership and Pitney Bowes, we can bring a little cheer to these brave men and women,” added Denton.

“It is an honor to provide this small measure of comfort at holiday time to those who have sacrificed so much,” said Pitney Bowes President and CEO Murray Martin. “We want to make it as easy as possible for all Americans to show their appreciation to the men and women who serve this nation so proudly and selflessly.”

Please address your holiday cards to:

We Support You During Your Recovery!
c/o American Red Cross
P.O. Box 419
Savage, MD20763-0419

Be sure to affix adequate postage when mailing to the Red Cross. Multiple cards without envelopes may be placed in one mailing envelope or a box that includes a return address. Please mail your holiday cards so that they are postmarked no later than December 24. Holiday cards must be received no later than December 27. Cards received after this date will be returned to the sender. Again, senders are reminded that "care packages" are not part of the program––send only cards and notes. Also, please refrain from using glitter or any other inserts that would not be appropriate in a hospital environment.

About the American Red Cross

The American Red Cross helps people prevent, prepare for and respond to emergencies. Last year, almost a million volunteers and 35,000 employees helped victims of almost 75,000 disasters; taught lifesaving skills to millions; and helped U.S. service members separated from their families stay connected. Almost 4 million people gave blood through the Red Cross, the largest supplier of blood and blood products in the United States. The American Red Cross is part of the International Red Cross and Red Crescent Movement. An average of 91 cents of every dollar the Red Cross spends is invested in humanitarian services and programs. The Red Cross is not a government agency; it relies on donations of time, money, and blood to do its work.

About Pitney Bowes

Pitney Bowes (NYSE:PBI) is a mailstream technology company that helps organizations manage the flow of information, mail, documents and packages. Our 35,000 employees deliver technology, service and innovation to more than two million customers worldwide. The company was founded in 1920 and annual revenues now total $6 billion. More information is available at www.pb.com.

Red Cross Blood Donor and Volunteer Featured on mtvU's "CAUSE EFFECT"

WASHINGTON, Tuesday, December 11, 2007 — Red Cross volunteer Krysta Leigh Meinzer is featured in "Cause Effect," a new multi-platform series from mtvU, MTV's 24-hour college network, profiling standout student activists on college campuses nationwide. Krysta details her passion for blood donations in an episode of the show, which is broadcast on mtvU and available on demand at mtvU.com and Think.MTV.com.

Meinzer is a 21-year-old college senior from North Carolina, majoring in communications at Lenoir-Rhyne College in Hickory, N.C. Krysta learned first hand about blood donation when she was a child. Her mother and father donated their own blood while her grandfather was undergoing chemotherapy as treatment for leukemia, and Krysta saw how beneficial it was in helping him have a greater chance at a longer, healthier life than he would have experienced otherwise. She currently holds the title of Miss Hendersonville, N.C. 2007, and has set the American Red Cross and blood donation as her platform.

"I am honored to be a part of the American Red Cross because it's an organization filled with friendly, dedicated people who are committed to making a difference in the world," said Meinzer. "When I became Miss Hendersonville, one of my goals was to recruit more blood donors, but I never imagined I would have the opportunity to reach a national audience through mtvU."

mtvU teamed up with Microsoft Corporation through the Windows Live Messenger i'm Initiative for "Cause Effect." Each episode spotlights two remarkable students, examining how they're using digital tools to effect positive, real world change, and inspiring others to take action and make a difference on pressing social issues.

When she was 17, Krysta began donating blood herself, and started volunteering with the local Red Cross Blood Services region a few years later. Beyond attending blood drives, Meinzer also travels to area schools, teaching students of all ages how blood works throughout the body, and the importance of regular blood donations for patients suffering from traumas and many diseases.

The new mtvU series is an extension of the Windows Live Messenger i'm Initiative, in which Microsoft donates a portion of the program's advertising revenue to one of several cause-related organizations each time a user has a conversation using the instant messaging software. The Red Cross is one of ten organizations receiving donations through this initiative, and is guaranteed by Microsoft to receive at least $100,000. Individuals can sign-up to support the American Red Cross through the i'm Initiative by visiting http://im.live.com.

Note: The names of actual companies and products mentioned herein may be the trademarks of their respective owners.

Midwest Once Again Prepares for Winter Weather

Power has been restored to homes and businesses throughout most of the nation's midsection as winter weather is once again in the forecast for the weekend.

By Katie Lawson, Staff Writer, RedCross.org

Thursday, December 20, 2007 —

Red Cross volunteers delivered warm meals to Adna High School and allowed families to visit with friends, learn about services available in the community and take a break from cleaning up their homes and property. (Photo courtesy: Daphne Mathew/American Red Cross)

For a fourth consecutive weekend, a storm system threatens to bring a mixture of rain and snow to the region as early as Friday.

A cold front that began nearly two weeks ago swept through the Midwest, bringing sub-freezing temperatures and a combination of rain, freezing rain, sleet and snow. In Oklahoma, ice accumulation ranged between a glaze and one inch across most of the state, causing widespread power outages and treacherous travel conditions. The storms caused the biggest power outage in state history and utility workers continue their efforts to restore power to the region.

American Red Cross disaster workers were among the first on the ground in Kansas, Oklahoma and Missouri, delivering relief in the form of temporary shelters, warming centers, hot meals and snacks and other emergency assistance. Members of the Red Cross Annual Disaster Giving Program helped provide the funding to rush relief to the affected residents, but the need for additional donations is still great due to the vast devastation the storms caused throughout Kansas and Oklahoma.

The Red Cross opened more than 130 shelters in the region and worked with the Southern Baptist Convention to provide meals for the more than 18,000 people who needed safe shelter overnight. To date, the Red Cross has served more than 100,000 meals and snacks to those affected by the storms.

As custodians of nearly half of the nation’s blood supply, the Red Cross also took steps to prevent the ice storms from affecting blood collections. The Renaissance Hotel in Tulsa agreed to host a blood drive in the hotel to give stranded guests the opportunity to help out.

Elsewhere, schools in Iowa and Wisconsin were closed last week and Des Moines International Airport was also forced to close for a period of time due to ice. Media reports state that the storm predicted for the weekend will bring ice and snow along with wind gusts of between 25 and 35 mph.

Although the majority shelters have since closed their doors, the Red Cross remains on alert to provide shelter, food and comfort to residents in the nation’s midsection and elsewhere.

Fires and Floods Lead the List of Largest Red Cross Disaster Responses

WASHINGTON, Thursday, December 13, 2007 — In a year predicted to be heavy with hurricanes, home fires, wildfires and flooding kept the Red Cross busy helping people whose lives were changed by disasters. Excessive rain in some portions of the country, severe drought in other areas and a lack of major hurricanes changed the traditional disaster response landscape for the American Red Cross in a year that called for more than 230 large scale disaster responses.

While the California Wildfires and major flooding captured public attention, the majority of disaster relief operations were coordinated by Red Cross chapters responding locally to more than 70,000 community disasters, most of which were home fires. In fact, home fires account for approximately 93 percent of all Red Cross disaster responses in 2007, and that category leads the compilation of the five largest disasters.

The top five American Red Cross disaster responses for 2007 are:

• Home Fires – single family, multiple-family fires (continually)
• Southern California Wildfires (October 2007)
• North Texas and Midwest Floods (Texas, Kansas, Oklahoma, June 2007)
• New England Nor’easter (New Jersey, Connecticut, Massachusetts, New Hampshire, April 2007)
• Midwest floods (Ohio, Minnesota, Illinois, Wisconsin, Oklahoma, August 2007)

This ranking was calculated based on the number of families served by the Red Cross, the aggregate amount of services provided (including food and shelter) and the cost to the Red Cross.

“While the hurricane season proved to be less eventful than normal, this year showed that disasters can strike anywhere around the nation, not just coastal communities,” said Joe Becker, senior vice president, disaster response. “That’s why it’s important for families and individuals to have a disaster plan, no matter where you live and even if you think you are not vulnerable to a disaster.”

Red Cross disaster relief services are delivered through the efforts of more than 700 local Red Cross chapters and often include providing disaster survivors with food, shelter, emotional support, basic first aid, and clean up supplies. While the top five disasters were the largest and most costly for the Red Cross, disaster workers were also on scene at other notable events this year. Mental health workers provided comfort during the tragedy at Virginia Tech. Disaster workers were in place during tornadoes in Lady Lake, Florida, Enterprise, Alabama and Greensburg, Kansas. And, the American Red Cross provided aid during international disasters such as the Mexico floods, Peru earthquake and Hurricane Dean.

You can learn how to prepare yourself and your loved ones for a disaster by visiting www.redcross.org. Here you will find an interactive online presentation that will show how you can Be Red Cross Ready by getting a disaster supplies kit, making a plan should disaster strike, and remaining informed before and during a disaster.

Four U.S. Nurses Receive Red Cross Medal

A moving ceremony at American Red Cross national headquarters paid tribute to an elite group of nurses at the forefront of the profession

By Tom Goehner, Historical Outreach, National Headquarters

Friday, December 07, 2007 — Every two years since 1920, the International Committee of the Red Cross (ICRC) has honored nurses and volunteer health aids worldwide who have shown exceptional courage and devotion to the sick, wounded and disabled in times of war and peace.

From left to right: Lt. Col. Steven Drennan, Catherine Head, Marilyn Self, Brenna Aileo. (Photo by Bill Crandall)

The ICRC award is named in honor of British-born nursing pioneer Florence Nightingale, who is credited with founding the modern nursing profession. In the mid-19th century, Florence Nightingale was able to elevate nursing from an occupation akin to servant’s work to an internationally recognized healthcare profession with consistent training and standards.

Since Nightingale’s time, nursing has made enormous strides in education, skills and responsibilities. In addition to working in a wide variety of settings and continuing to manage traditional patient care, many nurses have become leaders in the development of complex systems of medical assessment and treatment. This year’s medal winners demonstrate that Nightingale’s pioneering spirit and creativity continue to live on today.

2007 Florence Nightingale Medal Recipients

Brenna Aileo is a retired Army nurse whose close friends encouraged her to volunteer with the American Red Cross in response to the events of September 11. She distinguished herself by deploying to multiple disasters and developing key disaster training programs. In 2004, Aileo stepped in as health consultant for the Red Cross Services to the Armed Forces. In this position Aileo assesses their health status and clears staff for overseas deployment. As she received her award, Aileo described the Red Cross as a series of individual threads that form a “blanket” of care that can cover us all.

Lt. Col. Steven Drennan is a nurse in the U.S. Army who has responded to conflicts and disasters and the ongoing health needs of communities worldwide. Drennan led a nursing team that developed a course for Iraqi ambulance teams and a burn management training program for Iraqi physicians and nurses. In addition, he successfully submitted grant proposals that provide burn treatment equipment and supplies for a Baghdad Hospital and created the Iraqi National Trauma Center, which offers clinical rotations within the Iraqi medical community. In his acknowledgements, Drennan praised the dedication and inspiration of Iraqi doctors and nurses in the face of so much adversity. He also thanked the Iraqi Red Crescent with whom he felt he shared the award.

Catherine Head has dedicated her career to improving health outcomes for vulnerable populations. Prior to serving as an American Red Cross volunteer, Head worked extensively as a nurse midwife in urban and rural settings. She then established one of the first full service birth centers in Pennsylvania. Along with Head’s many Red Cross duties, she established a process for deploying a healthy work force during disaster relief operations. As a result of Head’s new screening process, fewer relief workers need to be sent home in the middle of their assignments.

Marilyn Self has worked in paid and volunteer capacities with the American Red Cross for more than 25 years. Self has played a key role in recruiting, developing and effectively engaging nurses as health professional volunteers at the local, national and international levels. She improved the quality of health services available to victims of disasters through the development of a partnership to train public health nurses for work in shelters throughout Georgia. In addition, she coordinated Red Cross health activities in New York after September 11, in Georgia for Hurricane Katrina evacuees, and for many operations before and since. Self is a member of the Red Cross Critical Response Team and has led the health service response for multiple aviation disasters. As she thanked all those who helped her receive this honor, Self credited the American Red Cross for allowing her to grow professionally and face new challenges.

Slippery Roads and Icy Bridges? Stay on Track

The Red Cross reminds travelers to be prepared when driving this holiday season

By Shilpika Das, Staff Writer, RedCross.org

Thursday, December 06, 2007 — With millions of people hitting the road for holiday travel in the coming weeks, the American Red Cross urges families and individuals to take precautions against the deceptive dangers of wintry weather.

Driving in winter can be treacherous. Sleet and ice can lead to slower traffic, hazardous road conditions, and unforeseen dangers. Check your local weather station for storm updates before you plan your travel. Be Informed Use this guide to make an informed decision before you travel. Remember to listen to your local weather station for the latest winter storm information. Winter storm watch: A winter storm is possible in your area. Winter storm warning: A winter storm is headed for your area. A blizzard warning: Strong winds, blinding wind-driven snow, and dangerous wind chill are expected. Seek shelter immediately.

Winter storms can be ‘deceptive killers’ since the majority of winter-related deaths are caused by events related to the heavy snowfall, high winds, and freezing rain that often accompanies them. According to the U.S. Department of Commerce, almost 70 percent of winter deaths related to snow and ice take place in vehicles.

“The American Red Cross recommends that people prepare for disasters and other emergencies wherever they spend a lot of time, and for many of us that means our vehicles ,” says Darlene Sparks Washington, director for preparedness at the American Red Cross. “As cold winter weather approaches, it’s even more important that we all take simple steps to help keep ourselves and our loved ones safer while on the road,” says Washington.

The American Red Cross offers the following tips to help people prepare for the unexpected when traveling.

Winter-proof your vehicle

• Get your vehicle checked by a mechanic and pay attention to the battery, tire pressure, heater, defroster, wiper blades and washer fluid.
• Carry a disaster supplies kit in your vehicle at all times.
• Make sure you include winter items like shovel, windshield scraper, blankets and warm clothing, flares, jumper cables, and sand or cat litter for traction. (View complete list.)
• Ensure that you have a full tank of gas to avoid ice build-up in the fuel tank and fuel lines.

Before you hit the roads

• Let your family or friends know your destination, your primary and alternate routes, and when you expect to arrive. If your vehicle gets stuck along the way, help can be sent along your predetermined route.
• Pay attention to the weather forecast. Your local TV and radio stations can provide updated storm information that can help you avoid treacherous weather.
• Motorists should also be cautious about animals on the highway. Stay alert for deer-crossing signs.

If you are stranded

• Stranded drivers should stay with the vehicle and not try to walk to safety. You can quickly become disoriented in wind-driven snow and run the risk of developing hypothermia and frostbite.
• Exercise your arms and legs to maintain body heat.
• Change out of wet clothing, using dry replacements from your supplies kit to prevent hypothermia.
• Use the heater for 10 minutes every hour and leave the overhead light on when the engine is running so you can be seen.
• Keep the exhaust pipe clear so fumes won't back up in the vehicle
• Make it easier for rescuers to find you by tying a brightly colored cloth to the antenna
• After the snow has subsided, raise the hood to indicate you need help.

For additional winter safety tips and information on building disaster supplies kits, visit www.redcross.org.

Measles deaths drop by 91 percent in Africa and 68 percent globally

By Jennifer Lubrani, Staff Writer, RedCross.org

Thursday, November 29, 2007 — Measles is a leading killer of children in many developing countries where prevention, treatment and health care can be difficult to access. But with strong global support from governments, health workers and dedicated volunteers, significant progress is being made in the fight against measles.

A Malagasy Red Cross volunteer marks a child’s finger indicating she received a measles vaccine. (Photo: Gene Dailey/American Red Cross)

That’s the message from today’s announcement that the Measles Initiative has helped to reduce measles deaths in Africa by 91 percent—between 2000 and 2006— thereby reaching the goal to cut measles death by 90 percent four years ahead of the United Nations’ goal. Globally, measles deaths have dropped by 68 percent during this same time.

In 2001, a global health initiative—led by the American Red Cross, UNICEF, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, and the World Health Organization— was launched to reduce measles deaths in Africa. Since 2005, the Initiative has expanded to Asia and other parts of the world where children are at risk.

Since 2001, the Measles Initiative has supported the vaccination of more than 400 million children in over 50 countries. The vaccination campaign includes additional life-saving health interventions, including Vitamin A, de-worming medicine and insecticide-treated bed nets for malaria prevention.

A key to this success are volunteers at Red Cross and Red Crescent societies around the world. The American Red Cross provided financial and technical support to national societies, where volunteers work in advance to spread the word about upcoming campaigns.

“We literally go door-to-door informing, educating and motivating mothers and caregivers about the critical need to vaccinate their children,” said Bonnie McElveen-Hunter, chairman of the American Red Cross. “These mobilization efforts are essential for our success, helping us consistently reach more than 95 percent of the vulnerable population and saving countless lives.”

Still measles continues to take the lives of nearly 600 children under 5 years each day – approximately 242,000 children each year.

Although the fight against this deadly disease is not over, measles deaths are being dramatically reduced, ensuring that children around the world have a safer and healthier future.

Assessments and Best Practices in Care of Older Adults

Caring for older adults is far more complex than the majority of today's nurses and other healthcare providers ever learned in school, and than the majority of faculty in any schools of nursing are prepared to teach their students. In fact, lack of knowledge about care of older adults among the teachers, students and working graduates of nursing programs results in inadequate assessment skills-skills that are the foundation of good geriatric care---and ultimately in missed or erroneous diagnoses, treatments that can harm rather than heal, and a reduced quality of life among those 65 years of age and older.

In order to provide resources that will help to fill the gap between knowledge and practice in the care of older adults, the John A. Hartford Foundation has funded the Hartford Institute for Geriatric Nursing (HIGN) at New York University's College of Nursing, and the American Journal of Nursing, for a project called How to Try This. How to Try This is an initiative that will translate the evidence-based geriatric assessment tools in the HIGN Try This assessment series into cost-free, web-based resources including demonstration videos and a corresponding print series featured in the AJN.

Why is assessment of older adults so important? Illnesses in older people often look different than in younger ones. For instance, younger adults with a urinary tract infection will have many or all of these symptoms: frequent urination, pain from bladder spasms, blood in the urine, and fever. Changes that occur with aging often mask these symptoms that provide early clues to a urinary tract infection. The first sign of a urinary tract infection in an older adult might be confusion or a fall. If the nurse does not have the knowledge and skills to further evaluate the older adult who might fall or become confused, the infection can go untreated and result in overwhelming infection, and possibly death.

Age-appropriate assessments: the foundation for good care of older adults

Assessment has long been recognized as the most important step in determining appropriate care. The Scope and Standards of Gerontological Nursing Practice establishes the professional standards, required nursing knowledge, and the specific nursing skills and abilities against which gerontological nurses are held professionally and legally responsible. These standards define assessment as the first step in managing patients and the basis for developing a comprehensive plan of care.

Good assessment leads to all subsequent care and requires that nurses know:

• on whom assessments should be conducted
• when to conduct the assessment
• how to conduct the assessment
• how to interpret the assessment
• how to communicate the findings to the patient, family, and other members of the healthcare team
• how to use the findings to shape the plan of care.

Eszopiclone (Lunesta), manufactured by Sepracor Inc., is a new nonbenzodiazepine hypnotic developed for the treatment of insomnia. Insomnia is characterized as either short-term or transient (lasting a few days to 2 weeks) or chronic (lasting more than 3 weeks). It is estimated that 20% to 40% of adults complain of short-term insomnia and 10% to 15% of chronic insomnia. 1

Insomnia can affect daytime function and represents a significant economic burden to society. Patients experiencing either transient or chronic insomnia often complain of daytime fatigue, impaired mood, general malaise, and impaired mental, physical, social, and occupational functioning. 1 Finding the cause of insomnia is important before prescribing pharmacologic treatments (see Tables : “Management of Persistent or Chronic Insomnia” and “Principles of Sleep Hygiene”).

Eszopiclone is indicated for the treatment of insomnia and has been studied in clinical trials with patients experiencing both chronic and transient insomnia. When administered at bedtime, eszopiclone is effective in decreasing sleep latency (trouble falling asleep) and improving the patient’s ability to stay asleep.

The precise mechanism of action of eszopiclone as a hypnotic is unknown, but its effect is believed to result from its interaction with GABA-receptor complexes. 2 Eszopiclone is rapidly absorbed after oral administration, and peak concentration is achieved within 1 hour. The drug is minimally bound to plasma proteins and therefore absorption and distribution is minimally affected by other drugs competing for protein binding sites.

In clinical studies, the effect of food on the absorption of eszopiclone was most noticeable when taken concomitantly with a high-fat meal; maximum absorption was delayed by approximately 1 hour, 2 although the half-life remained unchanged. Patients should be advised that a delay of sleep onset may occur if eszopiclone is taken with or soon after a high-fat meal.

Eszopiclone is metabolized by oxidation and demethylation, primarily by plasma metabolites, although some metabolism occurs in the liver via CYP 3A4 and CYP 2E1 enzymes. Drug metabolism in patients with severe hepatic impairment was decreased and resulted in an increased drug exposure in patients with this condition. The half-life of eszopiclone is approximately 6 hours and the metabolites are primarily eliminated though urinary excretion. Less than 10% of the orally administered drug is excreted unchanged. 2

There are no specific contraindications to the use of eszopiclone at this time. Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of the patient. 2 Insomnia may be a primary condition or comorbid with a psychiatric, medical, or other sleep disorder. Assessment of insomnia should include a thorough history obtained from both the patient and bed partner, and followed by a physical examination. The primary focus should be on the functional impact, severity, and chronicity of the complaints, with rapid identification of target symptoms to formulate a management strategy. 3

General precautions that should be considered include the timing of drug administration, use in elderly or debilitated patients, use in patients with current illnesses, and use in patients with depression. Specific information related to these special patient populations is presented in the dosage and administration section.

Eszopiclone was studied in six placebo-controlled clinical trials with 2,100 subjects experiencing both chronic and transient insomnia. Adverse events reported during the clinical trials in at least 2% of the study population were generally mild and resulted in minimal study subjects who discontinued treatment. The most commonly reported adverse reaction with eszopiclone use was unpleasant taste. Other reported adverse events with a dose-related response included viral infection, dry mouth, dizziness, hallucinations, infection, and rash. 2

Tolerance, dependence, and abuse with the use of benzodiazepines have led to concerns in using these types of hypnotics in the treatment of chronic insomnia. However, no tolerance or serious withdrawal syndrome to eszopiclone was observed during the 6-month clinical trials. The risk of patient abuse or dependence while using hypnotics increases with higher doses and duration of use, the concomitant use of other psychoactive drugs, and in patients with a history of drug or alcohol abuse and psychiatric disorders. Unlike most other medications for insomnia, eszopiclone is not just for short-term use only. However, because eszopiclone was used in clinical trials for a maximum of 6 months, practitioners are advised to carefully monitor for tolerance or dependence in patients on long-term drug therapy.

The recommended starting dose of eszopiclone is 2 mg for most nonelderly adult patients with insomnia characterized by sleep latency. For those who also have difficulty with sleep maintenance or do not achieve adequate results with the lower dose, 3 mg has been shown to be more effective. For elderly patients, the recommended starting dose is 1 mg for those with difficulty falling asleep and 2 mg in those with complaints of difficulty staying asleep. In all patients, the drug should be administered immediately before bedtime. As mentioned previously, concomitant intake of a high-fat meal and eszopiclone may prolong the time before the drug becomes effective in inducing sleep.

Patients with severe hepatic impairment should use eszopiclone with caution, and practitioners should start with a 1 mg dose and monitor these patients carefully. In patients also taking potent inhibitors of CYP 3A4 (e.g., ketoconazole, clarithromycin, nefazodone), the dose of eszopiclone should be reduced. Practitioners should prescribe eszopiclone with caution to patients with depression because of a potential for intentional overdose. Because only a minimal amount of the drug is excreted unchanged in the urine, no dose adjustments are considered necessary for patients with renal impairment. 2

Eszopiclone has not been studied in pregnant women and the drug is classified as a Pregnancy Category C. It is also unknown whether the drug is excreted in human milk. Eszopiclone in pregnant or lactating women should be used with caution. Clinical studies completed thus far have studied eszopiclone only in the adult and geriatric population. The safe and effective use of the drug in the pediatric population has not been established.

Sepracor offers information handouts for patients available through pharmacists during drug dispensing or from the Lunesta Web site ( http://www.lunesta.com ). Most importantly, the patient must be informed to take eszopiclone just before their anticipated bedtime. After first taking eszopiclone and until the full effects of the drug are known, patients are also advised to avoid conducting potentially dangerous activities (driving or operating machinery) the next day. Alcohol and other sleep medications should not be taken along with eszopiclone. In addition, prescribing practitioners should carefully review all prescription and over-the-counter medications currently used by the patient. If a patient has been using eszopiclone for more than a few weeks, he should be instructed not to suddenly stop using the medication to avoid potential withdrawal effects.

Gary Laustsen PhD, APRN, BC

• Unsafe medication-use practice habits place patients in danger of an infection. To protect patients, remember the following:
  • Place a sterile cap on the end of a reusable I.V. administration set that has been removed from a primary administration set, saline lock, or I.V. catheter hub that will be used again.
  • Properly disinfect the port when accessing needle-free valves on I.V. sets.
  • Always follow aseptic technique.
  • Avoid “looping” - attaching the exposed end of the I.V. tubing to a port on the same tubing.
  • Prohibit unlicensed staff from connecting/disconnecting any medical tubing.
  • Establish policies and assess compliance.
• It was recently reported that an order for PRANDIN (repaglinide) was misread as AVANDIA (rosiglitazone). Both are used to treat diabetes, but the drugs act in different ways. As a precaution, encourage prescribers to include generic names with handwritten orders to help staff differentiate these look-alike brand names.

(from Drug News Weekly)

• The FDA has approved the following new indication:
  • Diovan (valsartan) - for the treatment of high blood pressure in children and adolescents 6 to 16 years of age.
• The FDA has approved Triesence (triamcinolone acetonide) 40 mg/mL injectable suspension, a synthetic corticosteroid for visualization during vitrectomy and treatment of sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids.
• Roche Pharmaceuticals has discontinued the production of Roferon-A (interferon alfa-2a, recombinant). This action is related to the product's life cycle, not to any safety or efficacy concerns.
• Manufacturers have updated the prescribing information for desmopressin acetate (DDAVP, DDAVP Nasal Spray, DDAVP Rhinal Tube, DDVP, Minirin, and Stimate Nasal Spray). Patients taking desmopressin and children treated with intranasal formulations for primary nocturnal enuresis (PNE) are at risk for developing severe hyponatremia, resulting in seizures and death. Thus, desmopressin intranasal formulations are no longer indicated for PNE treatment and should not be used in hyponatremic patients or patients with a history of hyponatremia. All formulations should be used with caution in patients at risk for water intoxication with hyponatremia.

• Jaw-trust manuever

• Major Problems:

1. Increase ICP
2. Encephalophathy

• CHON not present
• related to history of viral infections
• Symptoms > HYPOglycemia

• Complication > pleural effusion
• Respiratory status monitoring

• develops cycles of binge eating, followed by purging.