Make plans to attend our Spring Workshop.

“CURRENT INNOVATIONS”

Presented by Valleylab

MAY 6, 2000

(Saturday)

at

MERCY HEALTH CENTER CONFERENCE CENTER

Registration time: 0700

Conference time: 0745-1300

5.4 contact hours

Cost: $20.00 (brunch included)

The Internet is a nearly limitless source of research and resources for the healthcare professional. From research on the latest techniques and drugs to employment possibilities to organizational meeting dates, the Internet has it all. If you are a novice, this will provide you with the basics of Internet knowledge. If you are computer-savvy, but never use the Internet professionally, it will steer you in the right direction.

(Source - Point of View Magazine August 1999)

FOR THE APRIL MEETING

WILL BE PROVIDED BY

(PLEASE ALSO BRING SOMETHING TO DRINK)

You can also call National AORN at (1-800-755-2676 to renew your membership.)

MAY 16, 2000

There has been a great deal of activity in the legislative arena. The government affairs department would like to thank all of the volunteers who have worked so hard to ensure the reimbursement of the RNFAs and to all of those who have worked on the proper supervision and regulation of assistive personnel, including surgical technologists. We encourage you to continue your valiant efforts and hope that you will encourage others to do the same.

The following is the listing of updated information on the legislative efforts of AORN.

Thanks to the hard work of the Georgia AORN members, U. S. Representative Mac Collins (R-GA) is sponsoring the CRNFA Medicare reimbursement bill this session in Congress. The bill should be introduced in Congress the second week in March. We want to also thank all of the other AORN members who took time to write and or visit their Congressional delegates. At this time six U.S. Representatives have agreed to be original co-sponsors: Rep. Nathan Deal (R-9th-GA), Rep. Jim Greenwood (R-8th-PA), Rep. Phil English (R-21st-PA), Rep. Charlie Norwood (R-10th GA), Rep. John Lewis (D-5th-GA). and Rep. Peter Hoeskstra (R-2nd-MI). Please call 800-755-2676, ext. 233, for additional information, or contact our web site at http://www.aorn.org/Govt.

Kentucky members have worked very hard on the RNFA bill. Due to their dedication, Kentucky’s RNFA bill has passed both Chambers and is waiting the Governor’s signature. There will be a public signing of the legislation on March 8, 2000. Alabama and West Virginia have introduced RNFA bills.

Imagine for a moment that you suffer the agony of osteoarthritis, the inflammatory disease that causes sharp and unremitting pain in the knees, hips, and other joints. For years you have been taking the same pain medication once a day, every morning, with mixed success. And then you are offered another form of treatment, a pill you take at a different time of day. It turns out to be a miracle drug! It reduces the pain 50 to 60 percent more than your previous medication, with much less stomach irritation to boot. Now imagine your surprise when you learn that the new medication is the same pill that you’d been taking all along, at the same dosage, the only difference being the time of day you take it.

Participants in a 1982 French study didn’t imagine this difference; they provided crucial data for one of the landmark studies in the relatively young but increasingly promising field of chronotherapy. Chronotherapy, to put it simply, is medicine applied with an exquisite sense of timing.

We are all creatures of biological rhythms—not only obvious ones like the menstrual cycles of women but also subtler daily (or circadian) patterns—of rising and falling blood pressure, for instance, and waxing and waning levels of hormones. Because of these patterns, adherents of chronotherapy believe that people are more (or less) susceptible to disease symptoms at certain times of the day and more (or less) responsive to medication.

As a result, some simple tinkering—changing the time a medication is taken, adjusting a pill’s formulation to delay the release of the drug, or using an implanted pump that can deliver the medicine in pulses or waves—has been shown to maximize the effectiveness of many common drugs while minimizing side effects.

All the more reason, then, that you should ask your doctor whether timing might make a difference in treating a condition. If you have allergies, ulcers, or heart disease; if you suffer from asthma attacks in the middle of the night; if you wake in the morning with crippling pain from arthritis; or even if you struggle with the nauseating side effects of cancer treatment, chronotherapy may offer you relief.

Heart Disease for people with heart disease, morning is a danger zone. In a 1985 Harvard Medical School study, James E. Muller and his colleagues reported that 33 percent of all heart attacks occur during the morning hours after waking (risk peaks around 9 a.m.). Strokes and ventricular tachycardia, are also more likely to occur in the morning, Muller says.

Researchers suspect part of the explanation is that blood pressure surges in the morning,. In most healthy people blood pressure hits a low of about 100/60 during sleep; it climbs sharply to a high of 120/80 shortly after awakening and stays at that level through much of the waking day. Most people with high blood pressure exhibit the same pattern but at elevated levels, so their sharp morning rise concern doctors , “Over an hour or two there can be an increase in blood pressure of 30 points, easily,” says William B. White of the University of Connecticut School of Medicine in Farmington.

The Food and Drug Administration has just approved a new medication that aims to smooth out this blood pressure spike. Covera-HS, developed by Searle, is actually a new formulation of a standard blood pressure drug called verapamil. But while the familiar formulation is meant to be taken in the morning—which can leave the patient relatively unprotected for a crucial hour or more—Covera is designed to be taken at bedtime and is released into the bloodstream just before dawn. “It’s got a special coating that keeps the drug from being released, in any great quantity, until about five or six o’clock in the morning,” says White, who headed a recent study of Covera.

Arthritis Arthritis pains are not all the same. In rheumatoid arthritis, the most sever form of the disease, pain and stiffness peak early in the morning; in osteoarthritis, the most common form, pain in the knees and joints typically worsens toward the end of the day. This is one area where chronotherapy has already been widely adopted, as doctors have learned to time anti-inflammatory drugs to deliver maximum relief.

In the case of rheumatoid arthritis, say Gaston Labrecque, a pharmacologist at Laval University in Quebec, most doctors now advise their patients to take nonsteroidal anti-inflammatory drugs (NSAIDS)—such as ibuprofen, ketoprofen, or indomethacin—after the evening meal if their pain is most severe in the morning. These drugs can be twice as effective if taken at least two hours before pain peaks. And when NSAIDS are taken at night, side effects—especially gastric upset, but also vertigo, headache, and anxiety—are greatly reduced.

In the case of osteoarthritis, the same type of pain medication is usually more effective when used around noon or mid-afternoon, a couple of hours before aches and pains become most intense. Still, say Labrecque, patterns of pain vary even among people with the same type of arthritis, so individuals should discuss the timing of their symptoms with their doctors to determine the best course of action.

Asthma Emergency room physicians have long known that they see more patients with asthma at night, and studies support that idea that the disease is a nocturnal one: Episodes of difficult breathing peak around four in the morning, and nearly 70 percent of all deaths from asthma occur between midnight and 8 a.m.

The lungs are especially vulnerable to inflammation at night because the confluence of several circadian rhythms. The body’s own blood-borne anti-inflammatory “drug,” cortisol, drops to its lowest level around midnight; levels of adrenaline, a hormone that helps keep airways relaxed and open, also fall during the night; and sensitivity to irritants and allergens is at its height.

Martin estimates that about two-thirds of all asthmatics—roughly 6.5 million Americans—suffer nighttime breathing difficulty sever enough to wake them at least three nights a week. “Are 6.5 million asthmatics being treated with chronotheray?” he says. “The answer is no. My guess is that a minority of physicians are doing this, because education is slow. But it is progressing.”

Allergies Like asthma, allergic rhinitis—more commonly known as hay fever—tends to be most bothersome in the early morning, when the upper airway and nasal cavities are most inflamed. Physiologist Smolensky suggests that a chronotherapeutic approach, such as taking long-acting antihistamine pills at bedtime, might provide relief for the estimated 70 percent of sufferers whose symptoms peal in the morning.

Unfortunately, says Smolensky, U.S. researchers have lagged behind foreign ones in testing the effectiveness of such a dosing strategy. He cites the work of French drug company, Pharmuka, which recently compared morning, midday, and evening use of mequitazine, a once-a-day antihistimine that is not available in this country. The drug doesn’t induce drowsiness, says Smolensky, so it can be taken at any time of the day. But the study showed 40 percent less sneezing when it was taken in the evening.

Should Americans who suffer from hay fever take their antihistimines at bedtime? Smolensky says it would make sense to do so if the pill is supposed to last eight hours or longer.

Ulcers Stomachs churn out 20 to 30 percent more acid after dinner and during the night, according to Labrecque. So the timing of ulcer drugs such as cimetidine (Tagamet) and famotidine (Pepcid) must take this pattern into account. Studies have shown stomach acidity can be reduced more effectively by a single evening dose of these drugs than by three staggered doses during the day.

Cancer In 1976 Georges E. Rivard of Sainte-Justine Hospital in Montreal began treating about 120 children with leukemia with a combination of several anticancer drugs, including one known as 6-MP (for 6-mercaptopurine) that was to be taken at home once a day. He asked parents to give the drug to their children in either the morning or the evening, whichever was more convenient, but to stick to the same time throughout the treatment.

When Rivard analyzed survival data five years late, he realized that the children who had taken 6-MP at night were three times more likely to have had their cancer go into remission. The effect has been lasting: Rivard published a follow-up study in 1993 showing that the children who had received chemotherapy at night were more than twice as likely to still be cancer-free. “Almost everyone gives 6-MP at night because of this study,” says Rivard.

The theory behind this strategy is that most healthy cells divide once a day, while cancer cells divide two or three times more frequently. Chemotherapy targets cells in the process of dividing, so the drugs can wipe out normal cells as well as cancerous ones. Destruction of healthy cells in the stomach lining, for example, can cause nausea; in the bone marrow, anemia. Knowing when the body’s healthy cells are at rest provides a window when cancer cells will be relatively vulnerable to the drug and healthy cells protected.

The combination of drugs in the Rivard trial is no longer used. But the implication—that the timing of chemotherapy can increase its success—has been confirmed in both animal and human studies, according to William Hrushesky, a longtime advocate of chronotherapy for cancer, at Albany Medical College in New York. In one study of women suffering from ovarian cancer, for example, the women were all given two drugs, doxorubicin and cisplatin. Those who got the doxorubicin in the morning and the cisplatin in the evening were four times more likely to survive than those for whom the timing was reversed.

For an approach that depends on timeliness, chronotherapy has been a long time coming. “We’ve been working in this field for 25 years,” says Labrecque. “So we’ve know for about 25 years that the effectiveness and toxicity of drugs are not constant over a 24 hour period. But it takes about 20 years before it gets to be known by everybody doing research and another five to ten years before it’s known to physicians in practice.” If the current excitement is a reliable barometer, chronotherapys' time has come.

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Call to order The regular meeting of AORN of Central Oklahoma, held at Integris Baptist Medical Center on February 15, 2000, was called to order by President Mary Hurt at 7:00pm.

Announcements The following announcements were made by President Mary Hurt.

Legislative Report Dorothy Paulk. Congressmen are home week of February 14, a good time to contact them. A topic close to home - RNFA initiative; points to make include:

1 Develop your personal self.

Technology has transformed how we do the simplest tasks. But technologic savvy is not limited to operating the newest equipment or software. Through educational programs, publications and technology experts, learn what tomorrow’s technology will be able to do. This way you will help to lead the way in making technology an asset to your career.

Develop your spoken and written communication skills so you can speak and write about what you know and value. Hone your skills in a second or third language, then use them to communicate with colleagues and consumers from other countries.

Become active in professional, political and community organizations, first as a volunteer and eventually as a leader. Your new skills will serve you best if the right people know about you when someone with your talents is needed.

The most fulfilled nurses remain active throughout their lives, volunteering their leadership skills for local, national and international activities. They continue to enhance science through mentoring, leadership, philanthropy, writing, teaching, and travel.

School of Nursing and Business

July 16-21, 2000

Washington, D.C.

Strategic Management Skills

Financial Challenges in Modern Healthcare Organizations

Managerial Communication in the Age of Technology

Ethical and Legal Issues in an Economically Constrained Environment

Labor and Employment Issues in the 21st Century Workforce

An Election Year Preview of Key Health Policy Initiatives

Kimberly-Clark Corporation through the AORN Foundation is awarding one scholarship. One grant will be given to a team of an OR Director and a Surgical Services Manager from the same institution. Call the foundation if interested.

It happens in every workplace.

Employees who were once enthusiastic, confident workers start to come in late and call in sick more often. Their productivity drops and their attitudes turn sour. They complain about their health and may even show signs of abusing alcohol or drugs. These workers may be showing signs of employee burnout.

As an employee or manager, it’s important to recognize the symptoms of burnout, understand its causes and take action to help an employee recover, if possible.

SYMPTOMS OF EMPLOYEE BURNOUT

#    change in work habits and attitude

#    loss of motivation

#    absenteeism/tardiness

#    negativity and emotional outbursts

#    health problems

          #    increased use of drugs or alcohol

Readjust workloads creatively when your department loses employees due to down-sizing.

Whenever possible, give advance notice about changes in positions and assignments.

Firm up schedules to provide a sense of continuity during uncertain times.

Redistribute workloads or bread larger projects into smaller ones to help overworked employees.

Be a good listener. Give employees a chance to vent their frustrations.

Schedule a team event outside the company to promote loyalty.

        Refer employees to resources available in your community or through your           
        Employee Assistance Program (EAP).

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