Published in the October 2009 issue of Today’s Hospitalist
Look for swine flu vaccine this month
WITH THE CDC REPORTING a resurgence of swine flu during September, the FDA last month approved vaccines from several manufacturers for use against H1N1 influenza.
According to the FDA, the vaccines “induce a robust immune response” in healthy adults within eight to 10 days after a single dose. (At press time, the agency was still waiting on further evidence on the optimal dose for children.) Studies on the vaccine indicate that it offers similar protection to H1N1 as the seasonal flu shot does against other strains.
The vaccine may be available the beginning of October, when limited supplies may be targeted to health care workers and high-risk patients, including women who are pregnant. The HHS announced last month that supplies for the broader public should be available by mid-October.
In other H1N1 news, the Institute of Medicine (IOM) last month noted that health care workers in close contact with swine flu patients should be using the tightly fitted N95 respirators, not surgical masks. The IOM is also calling for more research into the effectiveness of protective gear.
And while the present resurgence of swine flu is hitting earlier than the seasonal flu, officials expect a third wave of swine flu to accompany seasonal flu this winter.
Assessment of VTE risk associated with PICC lines
A SINGLE-SITE STUDY of risk associated with peripherally inserted central catheters (PICCs) found that close to 5% of patients with PICCs developed one or more VTEs.
The retrospective study, which was conducted over several months in 2005 at a university hospital in Memphis, found that the strongest risk factor associated with VTEs was previous VTE history. Those patients, researchers said, were 10 times more likely to develop a VTE related to PICC use.
Researchers also found that tip location was “strongly associated” with risk. Patients whose PICC line was not confirmed to be in the superior vena cava or at the junction of the superior vena cava and the right atrium were “twice as likely to experience VTE,” authors wrote.
The study, which researchers said was the first to look at both upper extremity DVT and pulmonary embolism rates in hospitalized adults with PICC lines, was published in the September issue of the Journal of Hospital Medicine.
Researchers call for more evidence on e-ICUs
WHILE CLOSE TO 10% of the nation’s ICU beds are now being monitored in e-ICUs, researchers in a recent analysis point to the lack of objective evidence on how remote ICU coverage affects ICU costs and quality.
The study, which was published on the Health Affairs Web site in August, followed hospitals that both use telemonitoring coverage and those that do not in 12 communities around the country. The findings included the following:
Hospitals found that e-ICU use helped them leverage their own intensivist staffing and respond more quickly to emergencies. e-ICU users also said that the use of remote monitoring helped bedside staff spend additional time with families and perform other tasks.
Hospitals that had not adopted the technology pointed to telemonitoring costs, which researchers reported as ranging from $3 million to $5 million per 100 ICU beds to implement.
Only one in five e-ICU users did not report problems with interoperability between the hospital’s and the vendor’s IT systems. In some hospitals, that lack of reporting meant that alerts designed to signal drug interactions or ventilator problems were not functioning.
To gauge the impact of e-ICUs on costs and quality, researchers called for more health services research and for studies in comparative effectiveness.
Free video helps patients manage blood thinners
A NEW 10-MINUTE VIDEO available in both English and Spanish can help patients being discharged on anticoagulants learn how to better manage the therapy.
The DVD, produced by the Agency for Healthcare Research and Quality (AHRQ), helps patients understand blood thinners, the danger of developing blood clots and the need for regular testing. The video utilizes simplified medical terminology and animated graphics, and it allows patients to replay and review specific instructional segments.
According to an AHRQ press release, more than 7,300 Americans are treated in EDs every year for uncontrolled bleeding associated with using blood thinners, and about half of those patients need to be hospitalized. An unknown number of patients are treated as outpatients for less severe bleeding.
The video, which is designed to be used by clinicians during discharge planning, can be ordered by calling 800-358-9295 or e-mailing AHRQPubs@ahrq.hhs.gov. The DVD comes with a companion bilingual brochure, which is also free of charge.