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Didn't Heal

In an article written by Richard M. Stillman, MD, FACS, Chief of Staff, Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center, it is suggested the factors that adversely affect wound healing can be remembered by using the mnemonic device DIDN'T HEAL.


D = Diabetes: Long-term effects diminish sensation and arterial flow


I = Infection: Foreign bodies, including sutures, potentate wound infection


D = Drugs: Use of steroids and antimetabolites impedes wound healing


N = Nutritional problems: Lack of adequate protein, vitamins A and C, and zinc impairs normal wound healing


T = Tissue necrosis: Resulting from local or systemic ischemia


H = Hypoxia: Inadequate tissue oxygenation from vasoconstriction


E = Excessive tension on wound edges


A = Another wound: Competition for substrates necessary for wound healing


L = Low temperature: Reduced tissue temperature in distal aspects of upper and lower extremities


Dr. Stillman's article can be found at http://www.emedicine.com/med/topic2754.htm. The article covers wound care to include a description of the phases of normal wound healing, useful laboratory studies used to determine underlying factors that may slow wound healing, treatment of specific types of wounds, and various types of wound care dressings.


Medication Fact Sheet for Seniors

The National Institute on Aging (NIA) has helpful information available on how to safely take medications. The fact sheets are free and available in Spanish. Those 65 years and older take more medications and can fall victim to healthcare fraud. These sheets provide hints to help avoid risks and get the best results from medications. Also included is how to spot false claims about unreliable remedies. Call 1-800-222-2225 for free copies of Medicamentos U'selos con Cuidado and Curanderos. This information and other Spanish publications also are available at the NIA Web site at http://www.niapublications.org

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Wound Care Video Series

Geriatric Video Productions has available a series of three wound care videos on the care and prevention of pressure ulcers and surgical wounds. The first video is Assessment of Complex Wounds and guides the viewer through a complete wound assessment, describing the types of wounds and healing phases. Management of Complex Wounds is the second in the series and focuses on aggressive wound management and appropriate documentation. Complications of wound healing and choosing the right product also are covered in great detail. The final video is Prevention and Treatment of Pressure Ulcers and includes a demonstration in assessing, staging, and defining wound depth, dimensions, and tunneling. The emphasis is on the identification of risk factors. Each video is 28 minutes in length, and the cost for each of the videos is affordable to most home care staff education budgets. Check it out at http://www.geriatricvideo.com/training/wc.html.

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MRSA Community-Acquired Infections

Scientists at the National Institute of Allergy and Infectious Disease (NIAID), part of the National Institutes of Health, recently released a paper stating infections from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) have become increasingly difficult to treat. Experts also report the number of this type of infection is on the rise. Community-acquired strains differ from hospital strains and cause healthy people to become seriously ill, keeping scientists puzzled. Work at the Rocky Mountain Laboratories (RML) in Hamilton, Montana, is attempting to identify genes that may be helping to promote the disease.


S. aureus strains that are community-acquired are much more difficult to treat because their origin is unknown, and they are virtually resistant to antibiotic treatment. Mild forms of the disease, such as impetigo or cellulitis, are easily treated. MRSA is much more severe and can affect vital organs and lead to toxic poisoning of the blood. A severe form of this type of infection is necrotizing pneumonia, in which bacteria destroy the tissues of the lungs.


Neutrophils are the first line of defense against bacteria. They comprise approximately 60% of all white blood cells found in the body. Scientists at NIAID's RML have found MRSA strains have the ability to avoid destruction by the neutrophils, causing healthy people to become infected by the strain of community-acquired MRSA.



National Institute of Allergy and Infectious Diseases (NIAID) Web site, available at http://www.niaid.nih.gov.


Voyich, J. (2005). Insights into mechanisms used by Staphylococcus aureus to avoid destruction by human neutrophils. The Journal of Immunology, 175 (6), 3907-3919.


The Med Form

Arizona Hospital and Healthcare Association is supporting a tool to assist patients in keeping track of their medications. Forty-six percent of all medication errors occur at transition points, according to the Institute for Healthcare Improvement. These points include admission and discharge to and from healthcare facilities. The Med Form is a listing of all current prescribed medications, over-the-counter medications, and vitamins/herbs to include dosage, prescribing physician, and reason for taking the medication. Patients are instructed to keep the Med Form with them at all times and update it as needed. The form can be found at http://www.themed-form.com/ and comes in two versions, an 8.5 x 11 and one that folds to fit into a wallet. A Spanish version also is available.

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Additional Resources: Agency for Healthcare Research and Quality Patient Safety Network, http://psnet.ahrq.gov/.


Long-Term Care Costs Increase from 2004

According to a survey conducted by MetLife Mature Market Institute, the cost for long-term care has increased more than 5% from 2004. The survey was conducted in July and August 2005 and included all 50 states. A minimum of 10 nursing homes or 15%, whichever was greater, and minimum of 15% of home care agencies or 5, whichever was greater, were surveyed in each area. The survey revealed the average daily cost for a private room in a nursing home facility is $203 per day or $74,095 annually. Last year's cost was $192 per day. Average cost for a home healthcare aide was found to be $19 per hour, an increase of $1 over last year's figures. This year's survey included costs for homemaker/companion care, with an average hourly rate of $17. The area with the lowest cost for both home healthcare aides and homemaker companions was Shreveport, Louisiana, with an average cost of $17 and $12, respectfully. Vermont logged in with the highest cost for a home healthcare aide at $31 per hour and Rochester, Minnesota, had the highest rate for homemaker/companion at $23 per hour.

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The MetLife Mature Market Institute is MetLife's information and policy resource center on issues relating to aging, retirement, and long-term care. Staffed with gerontologists, it provides research, training, and education to support MetLife. To read the 16-page report, log onto Met Life's Mature Market Institute under What's New and look for "The Met Life Market Survey of Nursing Home and Home Care Costs" at http://www.metlife.com (home page).


Recognizing a Stroke

According to a study by University of North Carolina researchers, three simple commands can be extremely useful in assessing whether a person may be experiencing a stroke. Doctors say that bystanders can recognize a stroke by asking these three simple questions:


1. Ask the individual to smile


2. Ask him/her to raise both arms


3. Ask the person to speak a simple sentence (i.e., It is sunny out today.)



If the person has trouble with any one of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.


These three commands are known as the Cincinnati Prehospital Stroke Scale and are used by health professionals in the first step of assessing for signs of a stroke. The three tasks listed require different parts of the brain and can indicate a left- or right-side brain stroke.


For more about strokes, log on to http://www.medi-cinenet.com/stroke/article.htm.


FDA Approves New Treatment for Myelodysplastic Syndrome

The Food and Drug Administration (FDA) has approved the drug Revlimid (lenalidomide) for the treatment of patients with a subtype of myelodysplastic syndrome (MDS). The subtype is MDS patients with deletion 5q cytogenetic abnormality.


MDS is a collection of disorders in which the bone marrow does not function normally and the body does not make enough normal blood cells. Patients with MDS may need blood and platelet transfusions and antibiotic therapy for infections. In clinical trials, patients treated with Revlimid no longer needed transfusions, with most patients becoming independent of transfusion by 3 months. The transfusion-free period lasted for an average of 44 weeks.


MDS can develop following treatment with drugs or radiation therapy for other diseases, or it can develop without any known cause. Some forms of MDS can progress to acute myeloid leukemia, a type of cancer in which too many white blood cells are made.


Revlimid is structurally similar to thalidomide, a drug known to cause severe birth defects. Additional studies are ongoing in animals to address whether there is a risk that Revlimid will also cause birth defects when taken during pregnancy. While these studies are under way, the company is marketing Revlimid under a risk management plan called RevAssist, designed to prevent fetal exposure.


Under RevAssist, only pharmacists and prescribers registered with the program will prescribe and dispense Revlimid. The program requires patients, including female patients undergoing mandatory pregnancy testing, to give informed consent before starting Revlimid. Physicians are to check pregnancy tests, limit prescriptions to a one-month mail supply, and report any pregnancies to the FDA. FDA and the manufacturer will reevaluate the risk management plan when results of further animal testing for birth defects are completed. The labeling for Revlimid will include a Black Box Warning and a Medication Guide regarding the prevention of fetal exposure.


For consumer inquiries, call 888-INFO-FDA.


FDA News

Individualized drug treatment has been cleared for marketing via a new blood test. The Invader UGT1A1 Molecular Assay test can detect variations in a person's gene that affects how certain drugs are metabolized by the body. The Invader assay detects variations in the gene UGT1A1. The gene produces the enzyme UDP-glucuronosyltransferase. This enzyme is active in metabolizing certain drugs, such as irinotecan, a drug used to treat colorectal cancer. Using the results of this test, physicians will be able to determine the right drug dosage for each individual and thus reduce potential harmful drug reactions. Another genetic test currently being used to personalize treatment is the Roche AmpliChip, used when prescribing antidepressants, antipsychotics, beta-blockers, and some chemotherapy drugs. These tests are intended to assist the physician in individualizing treatment decisions. Other considerations affecting dosage amounts should also be considered, such as the patient's liver function, age, kidney function, and additional drugs being taken. The Invader UGT1A1 Molecular Assay is manufactured by Third Wave Technologies, Inc., in Madison, Wisconsin.


Source:http://www.fda.gov/bbs/topics/NEWS/2005/NEW01220.html. Retrieved August 22, 2005.