Showing posts with label Asthma. Show all posts
Showing posts with label Asthma. Show all posts

Thursday, May 5, 2011

Asthma Pill As Effective As Inhalers And Easier To Use

Leukotriene receptor antagonist (LTRA) pills are just as effective as inhalers in managing asthma symptoms, and are much easier to use, researchers from the University of East Anglia, England reported in NEJM (New England Journal of Medicine).

LTRAs are infrequently prescribed as an alternative to inhalers because some people believed them to be less effective. This latest study shows they are effective.

Examples of LTRAs include Singulair (montelukast) and Accolate (zafirlukast). In the United Kingdom guidelines recommend LTRAs as a third step in asthma management.

Prof David Price and team monitored 650 asthma patients for 24 months. There was clear evidence that LTRAs are not only just as effective as inhalers, they are also much more user-friendly.

Click on the "via" link for the rest of the article.

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Monday, April 18, 2011

FDA orders safety studies for some asthma drugs | Reuters

U.S. health regulators have ordered drugmakers to conduct clinical trials involving a total of 53,000 patients to test the safety of a controversial class of inhaled asthma drugs that are already on the market.

The trials are being required to demonstrate the safety of medicines known as long-acting beta-agonists (LABAs) when used in combination with inhaled steroids, another class of asthma drugs, the U.S. Food and Drug Administration said on Friday.

LABAs to be studied are AstraZeneca's Symbicort, GlaxoSmithKline's Advair Diskus, Merck & Co's Dulera, and Novartis AG's Foradil.

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Thursday, January 13, 2011

Asthma, Direct Patient Care (Bedside Nursing),

ShareThis Buzz up!3 votes
Tips to Remember: Asthma & Allergy Medications, American Academy of Allergy, Asthma & Immunology:"More than 50 million people in the United States suffer from asthma and allergies. Fortunately, today there are many effective medications available to treat these conditions. The following information is intended to help asthma and allergy sufferers better understand the most commonly used types of medications."
American Academy of Allergy, Asthma & Immunology
555 East Wells Street
Suite 1100
Milwaukee, WI 53202-3823
Phone: (414) 272-6071
Patient Information and Physician Referral Line: (800) 822-2762
For all general questions, e-mail info@aaaai.org
http://www.aaaai.org/patients/publicedmat/tips/asthmaallergymedications.stm

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Tips to Remember: Childhood Asthma, American Academy of Allergy, Asthma & Immunology:"Asthma is the most common serious chronic disease of childhood, affecting nearly five million children in the United States. Characterized by coughing, chest tightness, shortness of breath and wheezing, asthma is the cause of almost three million physician visits and 200,000 hospitalizations each year. In infants and children, asthma may appear as cough, rapid or noisy breathing in and out, or chest congestion, without the other symptoms seen in adults."
American Academy of Allergy, Asthma & Immunology
555 East Wells Street
Suite 1100
Milwaukee, WI 53202-3823
Phone: (414) 272-6071
Patient Information and Physician Referral Line: (800) 822-2762
For all general questions, e-mail info@aaaai.org
http://www.aaaai.org/patients/publicedmat/tips/childhoodasthma.stm

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Treating Asthma With Bronchodilators , Beta 2-agonists, Cleveland Clinic Department of Patient Education and Health Information:"Beta 2-agonists - Short-acting inhaled forms include: Albuterol (Proventil® HFA, Ventolin® HFA, Accuneb®, ProAir®) Metaproterenol (Alupent®) Levalbuterol (Xoponex® HFA, Xoponex® nebulizer solution) Pirbuterol (Maxair®) Albuterol and ipatropium bromide combination (Combivent® metered dose inhaler; DuoNeb®) Short-acting beta 2-agonists are also called "quick acting" or "rescue" medicines because they relieve asthma symptoms very quickly by opening the airways. These inhalers are the best for treating sudden and severe or new asthma symptoms. They work within 20 minutes and last four to six hours. They are also the medicines to use 15 to 20 minutes before exercise to prevent exercise-induced asthma symptoms."
The Cleveland Clinic Department of Patient Education and Health Information
9500 Euclid Ave. NA31 Cleveland, OH 44195
216/444-3771 or 800/223-2273 ext.43771
healthl@ccf.org
http://www.clevelandclinic.org/health/health-info/docs/3500/3528.asp?index=11789

Category: Bronchodilators, Respiratory Drugs, Medications

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Allergy and Asthma FAQ:"The Allergy and Asthma FAQ is an informal gathering of the "net wisdom" on allergies and asthma. It includes links to various (Web and non-Web) sources of information. This started as the misc.kids Allergy and Asthma FAQ, so a certain amount of this information is geared towards parents, but there is plenty of information for adults, too. "
http://www.cs.unc.edu/~kupstas/FAQ.html

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alt.support.asthma FAQ:"Welcome to alt.support.asthma! This newsgroup provides a forum for the discussion of asthma, its symptoms, causes, and forms of treatment. Please note that postings to alt.support.asthma are intended to be for discussion purposes only and are in no way to be construed as medical advice. Asthma is a serious medical condition requiring direct supervision by a physician."
http://www.radix.net/~mwg/asthma-gen.html

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Andrew Lopez, RN
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Tuesday, December 14, 2010

Organ Donation Informed Consent, Is A Single Parent's Sufficient?

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

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Summary:  Organ donors are in high demand.  Frequently intended recipients can wait a lifetime for the critical matching organ.  In this case, two nurses obtained a consent from a child's mother.  When the father later expressed his disagreement, the child's corneas had been harvested and it was too late.

The patient was an 11-year-old child that had died soon after an Asthma attack.

"By condition (excluding pregnancy), the five leading causes of hospitalization among children are: bronchitis/asthma, digestive disease, pneumonia and respiratory infection, otitis media and mental disorders."1

The parents were approached for the purpose of donating the child's corneas under the Uniform Anatomical Gift Act.

"What is a Corneal Transplant?

The cornea is a dime-sized clear tissue covering the front of the eye. Light rays pass through the cornea and then through the lens. The lens forms an image on the retina in the back of the eye where the optic nerve is located. Sight is controlled by the optic nerve, the only nerve of vision. This nerve activates the retina to pick up the image in view."2

The mother alone was present at this time when it was first discussed.

"The child's mother maintains that she told the nurse it "did not matter" to her."3

"The Uniform Anatomical Gift Act (UAGA) of 1968 provided for the first time that an individual could donate his or her organs at death to another for medical purposes. It was adopted in all 50 states and the District of Columbia, and was a major step toward solving the organ donation problem. But new medical technologies have now made many transplant operations commonplace, and a shortage of donor organs remains."4

With this, the harvesting center was contacted and the patient's information left.  A consent form was faxed over to the hospital.  Two nurses then spoke to the mother by telephone and signed off on the form that consent had been obtained.

Individual state laws may vary in procedure for who can consent to an anatomical gift.  In Alaska for instance:

"(a) A competent person who is 18 or more years of age may make a gift to take effect upon death of all or a part of the person's body for a purpose specified in AS 13.50.020.

(b) When persons in prior classes are not available at the time of death, and in the absence of actual notice of contrary indications by the decedent or actual notice of opposition by a member of the same or a prior class, any of the following persons, in order of priority listed, may give all or a part of the decedent's body for a purpose specified in AS 13.50.020:

(1) the spouse;
(2) an adult son or daughter;
(3) either parent;
(4) an adult brother or sister;
(5) a guardian of the decedent at the time of death;
(6) any other person authorized or under obligation to dispose of the body.
(c) The persons authorized by (b) of this section may make the gift after or immediately before death."5

The agent for the organ center came and harvested the child's corneas and returned to the center.  He had looked over the consent form obtained, initialed it to verify it had been obtained by phone and was satisfied.

"When the cornea, a thin tissue that covers the front of the eye, becomes cloudy or damaged due to disease, injury or hereditary conditions, the result is vision loss or even blindness.

To clear this window, the damaged cornea is removed surgically and replaced with healthy, transplanted eye tissue-a donated cornea. This transplant operation is successful in more than 90 percent of cases in the US. After a successful transplant, patients have renewed vision or see for the first time."6

Each individual facility must generate protocols on organ procurement and obtaining informed consent:

"Each hospital in the state shall develop procedures for identifying potential donors of gifts, requesting gifts, notifying and coordinating with eye banks, tissue banks, and organ procurement agencies, and assisting in the procurement, removal, storage, and transportation of gifts."7
 

The child's father would arrive on the scene soon after.  When approached and informed of the harvesting, he was perturbed.  He would not sign the consent after the fact and chose to take legal action against the hospital and the donor center.

In court, summary judgement was entered for the defense:

The parent's appealed.

Questions to be answered:

1. Under the Uniform Anatomical Gift Act (UAGA), is the consent of a parent sufficient to proceed with harvesting of a child's organs.

2. Were the nurses negligent in their explanation of the procedure or in not waiting till the father was available?

The applicable laws stated that as long as a consent from a legally "responsible" and informed party is obtained, no liability or negligence can be assigned.  It was clear from the testimony of the nurses that they spoke to the mother and informed her of what was to happen.

In obtaining organs, time is typically of the essence.  The longer an organ or tissues remains in a body, the less likely it will be useful for the purposes of transplantation.

There was no evidence that the mother was either "coerced" or "rushed" into making a decision.  There was no documentation that she "wished to speak to her husband" before making the decision.  If more time had been needed or another family member needed to be consulted, the mother could have clearly stated this.

On the part of the nurses, a single adult guardian consent only was needed and obtained.

When the agent of the eye bank looked over the informed consent, he as satisfied that it was legitimate.  In harvesting the child's corneas, he acted in good faith and had no reason to believe a proper consent had not been obtained.

The court dismissed the plaintiff's argument that the "good faith" actions of the hospital or eyebank were "subject to interpretation."  The court was satisfied that under the conditions, the actions of the employees were reasonable and within the boundaries of existing law.

This case does point out the need for judgement and clear documentation when a consent for organ donation is obtained.  The nurses were wise to obtain not one but two witness signatures on the consent form.  The agent of the eye bank was wise to make sure the notation was made of a "telephone" consent.

Regardless of these precautions, the nurses, hospital and eyebank were still sued.  Had this lawsuit been initiated after either of the employees involved had left, the hospital may or may not have covered or defended them.

Related Link Sections:

Clinical Charting and Documentation, Nurses Notes
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Informed Consent
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm

Organ Donation:
http://www.nursefriendly.com/nursing/directpatientcare/organ.tissue.donation.htm
 

Sources:

1. National Association of Children's Hospitals and Related Institutions.  No date given. About Childrens Hospitals - Facts on Children's Health - Illness and Injury.  Retrieved June 20, 1999 from the World Wide Web: http://www.nachri.org/abouth/facts/hlth_illness.html

2. Old Dominion Eyebank.  No date given.  Corneal Transplant. Retrieved June 20, 1999 from the World Wide Web: http://www.odeb.org/html/cornealtransplant.htm

3. RRNL 39 May 12 (1999)

4. National Conference of Commissioners on Uniform State Laws.  No date given.  Why All States Should Adopt The Revised Uniform Anatomical Gift Act (1987). Retrieved June 20, 1999 from the World Wide Web: http://www.nccusl.org/whystate/uagawhy.html

5. The Alaska Legal Resource Center. No date given.  Persons Who May Execute An Anatomical Gift.  Retrieved June 20, 1999 from the World Wide Web:  http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section010...

6. Medical Eye Bank of Florida.  No date given.  Anatomy of the Eye. Retrieved June 20, 1999 from the World Wide Web: http://www.castlegate.net/mebfl/anatomy.htm

7. The Alaska Legal Resource Center. No date given. Requests By Hospitals For Anatomical Gifts. Retrieved June 20, 1999 from the World Wide Web: http://www.touchngo.com/lglcntr/akstats/Statutes/Title13/Chapter50/Section014...
 

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Send comments and mail to Andrew Lopez, RN

Created on Saturday May 23, 1999

Last updated by Andrew Lopez, RN on Monday, January 25, 2010

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Andrew Lopez, RN
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