New guidelines for the control of asthma have been released. "Asthma control is achievable for nearly every patient," Dr. Elizabeth G. Nabel, director of the National Heart, Lung, and Blood Institute, said during a teleconference. She added that with proper medical care, patient teaching, and healthy environments, asthma can be managed and those suffering from it can lead, active, productive lives.

More than 22 million individuals in the United States have asthma, which includes 6.5 million children under age 18. Without control, this disorder can limit a person's activities and may lead to compromised respiratory effort and oxygenation, resulting in hospitalization and even death.

The new recommendations include:

• Using a step-like approach to prescribing medications, with a strong emphasis on the use of anti-inflammatory drugs.
• Identifying new classifications of asthma severity which are associated with specific treatment modalities, including those based on age.
• Looking at the risk factors associated with asthma and discussing options for its prevention such as reducing exposures to allergens and second-hand smoke.
• Identifying specific allergens through testing and expanding patient education to reduce exposure to culprits.
• Emphasizing asthma self-management and prevention.
• Creating tools for physicians to enhance detection and diagnosis as well as criteria for referral to specialists in the field.

Our series Respiratory Disorders (113) has programs on Asthma (113.1) and Allergies and Anaphylaxis (113.2) which explore the pathophysiology as well as signs and symptoms of these conditions. They can be used in schools of nursing as well as in hospitals for inservices, orientation, and even patient education.

According to a new study, a woman with untreated gestational diabetes may be two times more likely to bear overweight children as pregnant women whose blood sugar was within normal limits. Data on almost 9,500 mother-child pairs were analyzed. The pairs were pregnant women with hyperglycemia and their offspring, who were evaluated between the ages of 5 and 7 years, a time during which excessive weight gain can usually predict adult obesity.

Despite other variables such as race or ethnicity, the neonate’s birth weight, or maternal weight gain or age; the researchers noted that the risk of a child becoming overweight increased in proportion to the mother's blood-sugar level during pregnancy. Specifically, they found that mothers with gestational diabetes were 89 percent more likely than other women to have overweight children, and 82 percent more likely to have obese youngsters. In addition, data showed that mothers whose blood-sugar readings were high-normal (122 mg/dl to 140 mg/dl) were still 22 percent more likely to have overweight children than women with low-normal blood glucose levels (between 43 mg/dl and 94 mg/dl), and 28 percent more likely to bear children who become obese.

Gestational diabetes may increase children's obesity risk through metabolic imprinting, or simply put, pre-programmed for obesity by being overfed in utero because of the mother's high blood sugar. "As we have more people with diabetes and gestational diabetes during pregnancy I think the importance of additional risk factors for obesity increases," says Dr. Teresa Hillier from Kaiser Permanente's Center for Health Research (CHR). "And if there is an alteration going on to program the child for obesity I think that starts a vicious cycle for obesity in a way."

Pregnant women are typically screened for hyperglycemia between 24 and 28 weeks. According to the American Diabetes Association, between 1 and 14 percent of them will develop gestational diabetes. Risk factors for this condition, which are like those for diabetes outside of pregnancy, include family history for diabetes, being overweight and older age. It is also more common among most non-Caucasians. Treatment starts with diet and exercise and proceeds to insulin. Dr. Hillier added, "In sticking with treatment, women not only improve their outcome during pregnancy, but also in the long term for their child."

Our programs Pregnancy, Labor, and Delivery (687), and Human Development: Conception to Neonate (618) as well as our Freddie-Award winning Diabetes (685) discuss gestational diabetes and can be used by instructors for RN and LVN students or in hospitals for orientation or inservices.

According to a study in Australia, using saline rather than albumin fluid to normovolemia levels in individuals with traumatic brain injury (TBI) resulted in nearly double the survival rate at 24 months after the injury. "We determined that the 2-year mortality rate was significantly high in those patients who received albumin-based fluids compared to those who received saline, particularly those patients with severe brain injuries who presented with traumatic coma," said the study's lead author, Dr. John Myburgh. "Given the significant difference in mortality that we observed, we recommend that albumin-based fluids be avoided for the acute fluid resuscitation of patients with traumatic brain injury," he added.

TBI can be caused during falls, motor vehicle crashes, or physical assault resulting in blunt force trauma to the head. According to the Centers for Disease Control and Prevention, an estimated 1.4 million traumatic brain injuries occur each year in the United States with almost 50,000 deaths. Many of those who survive may have lifelong disabilities.

There was a previous a study in which saline and albumin were compared. The researchers found no statistically significant difference in the rates of death after 28 days. But, Myburgh and his team looked at the data differently; they assessed results at 24 months after injury. They noted that at that time that individuals with TBI who received albumin had a 63 percent higher risk of dying than those given saline. For those with severe brain injuries, the albumin group had an 88 percent increased risk of death compared to the saline group.

"These are people in very bad shape," said Dr. Keith Siller, medical director of the Comprehensive Stroke Care Center at New York University Medical Center in New York City. "If there's anything that can help them have better outcomes, we have to pay attention."

Our program, High-Tech Monitoring of Traumatic Brain Injury (501.1) is an excellent resource for advanced nursing students or nurses who currently work or want to work in critical care or emergency departments.

• September 13, 2007: New Data Analyses Techniques Show Long-Term Survival Better for Cancer Patients
• September 6, 2007: Cortical Stimulation Gives New Hope to Stroke Patients
• August 30, 2007: 50% of All Cancer Deaths can be Linked to Obesity and Smoking
• August 23, 2007: Physical Activity Found to Improve Cardiovascular Risk in Children with Type 1 Diabetes
• August 16, 2007: Hostility and Depression Harmful to Men's Immune System
• August 7, 2007: Decrease in Women's Use of Hormone Therapy Linked to Drop in Breast Cancer
• August 2, 2007: Use of SSRI's Down in Teens While Suicide Number Rises
• July 26, 2007: New Definitions from the International Diabetes Federation

Concept Media produces and distributes award winning education media for colleges, healthcare institutions, social service agencies and counseling centers throughout North America, Europe, and the South Pacific. Most programs come in VHS, DVD and CD formats. Site Licenses and Distance Learning packages are also available for our library of programs.

Concept Media is best known in the area of professional nursing education and represented in more than 95% of the nation's nursing school media libraries. We have developed partnerships with leading nursing education institutions including Brigham Young University, Drexel University, and ICN/ Washington State University College of Nursing. Concept Media is well-respected and has received numerous awards for programs on diabetes, human development, mental health, substance abuse, counseling, and addiction.

For your convenience, Concept Media also offers additional resources in the form of Instructor's Guides which are available online. And, in keeping with our mission to focus on the needs of educators in the healthcare field, we invite you to call with any suggestions, questions, program requests, or ways in which we can better serve you.

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