The heparin recall of 2008

Heparin is one of the oldest drugs still in widespread clinical use. Its discovery in 1916 predates the establishment of the Food and Drug Administration. Since 1935, over 15,000 research papers have been published on the effects of heparin. Because the exact chemical formula of heparin is unknown, synthetic manufacturing has proven difficult. In 2008, a worldwide recall of heparin occurred. Scientists determined that a contaminant known as oversulfated chondroitin sulfate was responsible for the numerous deaths and adverse events. This contaminant was first traced to a chemical plant in Changzou, China. This article will review the discovery of heparin and the adulteration process that jeopardized the world's heparin supply.

Clinical experience with the Diametrics IRMA (Immediate Response Mobile Analysis) blood analysis system

The Immediate Response Mobile Analysis (IRMA) blood analysis system (Diametrics Medical Incorporated, St Paul, MN, USA) is a new point-of-care testing device that uses technology similar to the Gem Premier (Mallinckrodt Sensor Systems Incorporated, Ann-Arbor, MI, USA), which are ion-specific electrodes. We compared these two analysers using both patient blood samples (n = 50) and aqueous quality control solutions (n = 45). Linear regression (Pearson product-moment correlation coefficient) was performed to quantify the strength of the association between results. In addition, bias and precision were determined in accordance with the method described by Bland and Altman. The results demonstrated excellent correlation between the IRMA and the Gem Premier, and bias and precision were acceptable for both patient and quality control samples. Reproducibility of results was also assessed using one level of aqueous quality control solution (n = 50). The IRMA demonstrated very little variance in parameter readings over a five-day study period.

Self-induced ethmoidectomy from rhinotillexomania

A 53-year-old woman with a long history of compulsive nose picking (rhinotillexomania) presented with a large, self-inflicted nasal septal perforation and right-sided penetration of the ethmoidal sinus, or "ethmoidectomy."

Development of an innovative nursing care delivery system

In the reform of healthcare lies its renaissance, and in its challenges lie its opportunities. Faced with the changing needs of consumers, the evolving roles of care givers, technologic advances, and economic pressures, institutions are redesigning their physical facilities and systems of care delivery in preparation for a new era in healthcare. Innovative care delivery systems, developed to complement creative facility designs, will provide an approach to health-care that promotes administrative efficiency, patient/care giver satisfaction, and cost-effective use of resources. This article chronicles the development of a care delivery system for obstetric nursing, a blueprint for future healthcare at one institution.