Home Community Newsletter Vol 4 Issue 152

Arthritis Insight Newsletter * Vol. 4 Issue 152 May 14, 2003

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Welcome to the 152nd issue of the Arthritis Insight Newsletter. All back issues will be posted at /community/newsletter
Feel free to pass this newsletter around to others who may be interested.

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The information in this newsletter should not take the place of advice and guidance from your own health-care providers. Material in this newsletter is provided for educational and informational purposes only. Be sure to check with your doctor before making any changes in your treatment plan. Information presented here is the opinion of the authors and has not necessarily been approved or endorsed by the medical advisors.

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Notes From Tina
(Tina@arthritisinsight.com)
Tina Underwood aka KrissyJo

We're down to the end of the Fundraiser :o) only one more day to get those donations in and/or mailed to be eligible for prizes. Paypal donations need to be dated and snail mail needs to be postmarked no later than May 15, 2003 to qualify. We'll give the snail mail entries a few days to get to the P.O. Box and then tally everything up and announce the winners. Keep an eye on the update page (/updates.html) for the final results.

~Kimmy

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Ron's Ramblin's
(Ron@arthritisinsight.com)
Ron Griffin aka IndyRon

Ron's Dad's taken a turn for the worse, which still has him running between two states trying to take care of things. Hopefully he'll be back with Ramblin's next week.

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Your Weekly Giggle
The Lemonade Stand
All you can drink for a quarter.

There was a business man driving down this country road when he spotted a little boy that had a lemonade stand - it being hot and him being thirsty - he decided to stop. once he got up to the little boy's stand, he noticed a sign that said "All you can drink 25 cents", well, he thought that it was an awful small glass, but since it was only 25 cents for all you can drink, he decided to get some anyway.

Well, he gave the boy a quarter, and shot down the whole glass in one swallow. Slapping the small glass back onto the table, he says, "fill 'er up." and the kid says, "sure thing, that'll be 25 cents."

To this the business man says, "but your sign says all you can drink for a quarter."

"It is," the little boy replies, "that's all you can drink for a quarter."

Check out all the jokes at:
/fun/jokes
Send yours in today!

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Tina's Tips
Tina@arthritisinsight.com

Arthritis can affect your ability to do even the simplest of tasks. I've heard some people say, "Accept your limitations." I'm not sure accepting them is the way to go. I prefer to challenge those limitations, work around them, finding alternate ways of achieving the same goal. Every week I'll share some tips I've found to work around those annoying limitations and I hope all of you will send in your tips too. We may not be the next Martha Stewart, but sometimes the simplest things can help so much.

Last week we were wondering...

I bought my mother a necklace for Christmas but she cannot open or close the clasp. Do you know of a site that has things such as a larger clasp?

We got a response! Many thanks to Bertie for taking the time to send it in!

This is in reply to the difficult necklace fastener, take necklace to
jewelry repair shop and ask to have magnetic clasp put on, so much
easier to put on the necklace.

Excellent suggestion!

Check out more tips at /living/tips.html and send in yours today to Tina@arthritisinsight.com Keep those tips coming!

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What’s New
Check out all the latest updates at /updates.html

Fundraiser 2003
We'd like to thank Jo Firey, Sarah Baumgartner, and Eileen Blackmore for their generous donations!
Only one day left if you're trying for those prizes! All snail mail donations must be postmarked by and paypal donations must be dated no later than May 15, 2003 to be considered in the running for prizes.
/help/fundraiser2003

Question of the Week
I know it's not Friday, but there was only one answer for the last question - let's see if we can get things moving again.
/community/question

Photo Album
Donna H. has a new grandbaby, go on over and see what a cutie Jake is.
/community/photo

Newsletter
Issue 151 is up and ready for your viewing pleasure. Go find a nice tall glass of something cold and take a look.
/community/newsletter

Photo Album
Wait'll you see how big Johnie's grandson Acacia has gotten.
/community/photo

News
You know it! TGIF and it's time to read all the latest news for your arthritis and general health.
/news

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Arthritis Insight Chat
/community/chat

Time to get the party started! Got some extra time? Can't sleep? Drop into the chatroom to talk to other members that know exactly what you're going through.

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Cooking with Char
Char LeFleur
Char@arthritisinsight.com

Hello friends! I am flaring quite a bit lately, mostly in my hands, wrists and elbows, and am looking for easy easy easy ways to make interesting and tasty meals. So if any of you have any ideas you would like to share, I would appreciate hearing from you. I know I am getting tired of sandwiches. So I know my poor husband must be too. But he isn't too picky about what I serve him, thank goodness. And will even bring home take out when I just cant work up the energy to make a meal. But your help on really quick and easy meals would be greatly appreciated. Even searching the Internet for quick easy recipes to adapt to gimp friendly, is a chore, lately.

A reminder that my husband and I are hosting Gimpfest 2003, here in Iowa in July. You can find details at www.fadedjeans.com/iowa . I hope you can come. It is going to be wonderful party!!

How about pizza?

My husband came home with something that was labeled Pita bread, but wasn't really because it was pierced and you could not open the bread to make a pocket. But I discovered a wonderful use for it. Individual pizzas. Quick, easy, and fun for the kids.

Pita Pizza

Take a whole piece of pita bread.
Spread 2 tbs of a good pasta sauce or pizza sauce on the bread.
Add toppings of your choice ( I used ground beef that I had browned, onion, and green pepper, but absolutely anything would work.)
Cover with shredded Mozzarella cheese
Bake in 350 degree oven until cheese is melted and all ingredients are hot.
(the pita bread gets crunchy like thin crust pizza)

And here is an easy recipe for Chicken Risotto.

Chicken Risotto
1 (3 1/2 to 4 lb.) frying
chicken
salt and pepper to taste
1/4 c. margarine or butter
1c. rice
3/4 c. Romano cheese
3 tsp. chicken bouillon

Cut chicken into serving pieces and place in a large pot
with enough water to just cover chicken. Bring to a boil and
add 1/2 teaspoon salt and pepper to taste. Lower to a simmer
with lid partially on and simmer about 1 to 1 1/2 hours or
until chicken is tender. Remove chicken from broth and place
on a cookie sheet. Baste with melted butter or margarine and
sprinkle with desired spices (garlic, salt, parsley and paprika).
Place chicken in oven at 300 degrees while rice is cooking.
Place 2 1/2 cups of the chicken broth in a 2 to 3 quart casse-
role. Add chicken bouillon and heat to almost boiling. Add
rice and cook on low heat for 20 minutes. Add Romano cheese
and simmer chicken broth to desired consistency.

And how about one more chicken recipe. I have not tried this, but I intend to. It sounds delicious.

Chicken Casserole
6 boneless chicken breasts or
12 small turkey cutlets or a cut up chicken
Swiss cheese
1 can cream of chicken soup
1/2 can white wine
1 c. seasoned dressing bread
cubes
1/4 c. melted butter or
margarine

Spray a shallow casserole dish with cooking spray. Place
chicken or turkey in pan. Cover each piece of chicken with
sliced Swiss cheese. Mix the cream of chicken soup with the
white wine. Pour over the chicken. Crush the seasoned bread
cubes until fine. Mix with the melted butter or margarine and
sprinkle over the chicken. Bake at 400 degrees for 45 minutes. Check
for doneness. If not tender, bake for a few additional minutes.

If you have question, comments, or suggestions, or have recipes you would like to share, send them to Char@arthritisinsight.com.

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From: The FDA Consumer Magazine
May-June 2003
http://www.fda.gov/fdac/features/2003/303_meds.html
Strategies to Reduce Medication Errors
How the FDA is working to improve medication safety and what you can do to help
By Michelle Meadows

When Jacquelyn Ley shattered her elbow on the soccer field two years ago, her parents set out to find her the best care in Minneapolis. "We drove past five other hospitals to get to the one we wanted," says Carol Ley, M.D., an occupational health physician. Her husband, an orthopedic surgeon, made sure Jacquelyn got the right surgeon. After a successful three-hour surgery to repair the broken bones, Jacquelyn, who was 9 at the time, received the pain medicine morphine through a pump and was hooked up to a heart monitor, breathing monitor, and blood oxygen monitor. Her recovery was going so well that doctors decided to turn off the morphine pump and to forgo regular checks of her vital signs.

Carol Ley slept in her daughter's hospital room that night. When she woke up in the middle of the night and checked on her, Jacquelyn was barely breathing. "I called her name, but she wouldn't respond," she says. "I shook her and called for help." The morphine pump hadn't been shut down, but had accidentally been turned up high. The narcotic flooded Jacquelyn's body. She survived the overdose, but it was a close call. "If three more hours had gone by, I don't think Jacquelyn would have survived," Ley says. "Fortunately, I woke up."

Ley was pleased with the way the hospital handled the error. "They came right out and said the morphine pump was incorrectly programmed, they told me the steps they were going to take to make sure Jacquelyn was OK, and they also told me what they were going to do to make sure this kind of mistake won't happen again. And that's very important to me." The hospital began using pumps that are easier to use and revamped nurse's training. Ley believes there were many contributors to the error, including the fact that it was Labor Day weekend and there were staff shortages. "It goes to show that this can happen to anyone, anywhere," says Ley, who now chairs the board of the National Patient Safety Foundation.

Multiple Factors
Since 1992, the Food and Drug Administration has received about 20,000 reports of medication errors. These are voluntary reports, so the number of medication errors that actually occur is thought to be much higher. There is no "typical" medication error, and health professionals, patients, and their families are all involved. Some examples:

A physician ordered a 260-milligram preparation of Taxol for a patient, but the pharmacist prepared 260 milligrams of Taxotere instead. Both are chemotherapy drugs used for different types of cancer and with different recommended doses. The patient died several days later, though the death couldn't be linked to the error because the patient was already severely ill.

An elderly patient with rheumatoid arthritis died after receiving an overdose of methotrexate--a 10-milligram daily dose of the drug rather than the intended 10-milligram weekly dose. Some dosing mix-ups have occurred because daily dosing of methotrexate is typically used to treat people with cancer, while low weekly doses of the drug have been prescribed for other conditions, such as arthritis, asthma, and inflammatory bowel disease.

One patient died because 20 units of insulin was abbreviated as "20 U," but the "U" was mistaken for a "zero." As a result, a dose of 200 units of insulin was accidentally injected.

A man died after his wife mistakenly applied six transdermal patches to his skin at one time. The multiple patches delivered an overdose of the narcotic pain medicine fentanyl through his skin.

A patient developed a fatal hemorrhage when given another patient's prescription for the blood thinner warfarin.

These and other medication errors reported to the FDA may stem from poor communication, misinterpreted handwriting, drug name confusion, lack of employee knowledge, and lack of patient understanding about a drug's directions. "But it's important to recognize that such errors are due to multiple factors in a complex medical system," says Paul Seligman, M.D., director of the FDA's Office of Pharmacoepidemiology and Statistical Science. "In most cases, medication errors can't be blamed on a single person."

A medication error is "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer," according to the National Coordinating Council for Medication Error Reporting and Prevention. The council, a group of more than 20 national organizations, including the FDA, examines and evaluates medication errors and recommends strategies for error prevention.

A Regulatory Approach
The public took notice in 1999 when the Institute of Medicine (IOM) released a report, "To Err is Human: Building a Safer Health System." According to the report, between 44,000 and 98,000 deaths may result each year from medical errors in hospitals alone. And more than 7,000 deaths each year are related to medications. In response to the IOM's report, all parts of the U.S. health system put error reduction strategies into high gear by re-evaluating and strengthening checks and balances to prevent errors.

In addition, the U.S. Department of Health and Human Services (HHS) and other federal agencies formed the Quality Interagency Coordination Task Force in 2000 and issued an action plan for reducing medical errors. In 2001, HHS Secretary Tommy G. Thompson announced a Patient Safety Task Force to coordinate a joint effort to improve data collection on patient safety. The lead agencies are the FDA, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality.

The FDA enhanced its efforts to reduce medication errors by dedicating more resources to drug safety, which included forming a new division on medication errors at the agency last year. "We work to prevent medication errors before a drug reaches the market and to also monitor any errors that may occur after that," says Jerry Phillips, R.Ph., director of the FDA's new Division of Medication Errors and Technical Support.

Here's a look at key areas in which the FDA is working to reduce medication errors.

Bar code label rule: After a public meeting in July 2002, the FDA decided to propose a new rule requiring bar codes on certain drug and biological product labels. Health care professionals would use bar code scanning equipment, similar to that used in supermarkets, to make sure that the right drug in the right dose and route of administration is given to the right patient at the right time.

"It's a promising way to automate aspects of medication administration," says Robert Krawisz, executive director of the National Patient Safety Foundation. "The technology's impact at VA hospitals so far has been amazing." The Department of Veterans Affairs (VA) already uses bar codes nationwide in its hospitals, and the result has been a drastic reduction in medication errors. For example, the VA medical center in Topeka, Kan., has reported that bar coding reduced its medication error rate by 86 percent over a nine-year period.

Here's how it works: When patients enter the hospital, they get a bar-coded identification wristband that can transmit information to the hospital's computer, says Lottie Lockett, R.N., a nursing administrator at the Houston VA Medical Center. Nurses have laptop computers and scanners on top of medication carts that they bring to patients' rooms. Nurses use the scanners to scan the patient's wristband and the medications to be given. The bar codes provide unique, identifying information about drugs given at the patient's bedside. "Before giving medications, nurses use the scanner to pull up a patient's full name and social security number on the laptops, along with the medications," Lockett says. "If there is not a match between the patient and the medication or some other problem, a warning box pops up on the screen."

The FDA's proposed rule on bar code labeling was published on March 14, 2003. The rule, which would take effect in 2006, applies to prescription drugs, biological products such as vaccines, blood and blood components, and over-the-counter (OTC) drugs that are commonly used in hospitals. Manufacturers, repackers, relabelers, and private label distributors of prescription and OTC drugs would be subject to the bar code requirements. The agency continues to study whether it also should develop a rule requiring bar code labeling on medical devices.

Drug name confusion: To minimize confusion between drug names that look or sound alike, the FDA reviews about 300 drug names a year before they are marketed. "We reject about one-third of the names that drug companies propose," says Phillips. The agency tests drug names with the help of about 120 FDA health professionals who volunteer to simulate real-life drug order situations. "We're also creating a computerized program that will assist in detecting similar names and that will help us take a more scientific approach to comparing names," Phillips says.

After drugs are approved, the FDA tracks reports of errors due to drug name confusion and spreads the word to health professionals, along with recommendations for avoiding future problems. For example, the FDA has reported errors involving the inadvertent administration of methadone, a drug used to treat opiate dependence, rather than the intended Metadate ER (methylphenidate) for the treatment of attention-deficit/hyperactivity disorder (ADHD). One report involved the death of an 8-year-old boy after a possible medication error at the dispensing pharmacy. The child, who was being treated for ADHD, was found dead at home. Methadone substitution was the suspected cause of death. Some FDA recommendations regarding drug name confusion have encouraged pharmacists to separate similar drug products on pharmacy shelves and have encouraged physicians to indicate both brand and generic drug names on prescription orders, as well as what the drug is intended to treat.

The last time the FDA changed a drug name after it was approved was in 1994 when the thyroid medicine Levoxine was being confused with the heart medicine Lanoxin (digoxin), and some people were hospitalized as a result. Now the thyroid medicine is called Levoxyl, and the agency hasn't received reports of errors since the name change. Other examples of drug name confusion reported to the FDA include:

Serzone (nefazodone) for depression and Seroquel (quetiapine) for schizophrenia
Lamictal (lamotrigine) for epilepsy, Lamisil (terbinafine) for nail infections, Ludiomil (maprotiline) for depression, and Lomotil (diphenoxylate) for diarrhea
Taxotere (docetaxel) and Taxol (paclitaxel), both for chemotherapy
Zantac (ranitidine) for heartburn, Zyrtec (cetirizine) for allergies, and Zyprexa (olanzapine) for mental conditions --ll Celebrex (celecoxib) for arthritis and Celexa (citalopram) for depression.
Drug labeling: Consumers tend to overlook important label information on OTC drugs, according to a Harris Interactive Market Research Poll conducted for the National Council on Patient Information and Education and released in January 2002. In May 2002, an FDA regulation went into effect that aims to help consumers use OTC drugs more wisely.

The regulation requires a standardized "Drug Facts" label on more than 100,000 OTC drug products. Modeled after the Nutrition Facts label on foods, the label helps consumers compare and select OTC medicines and follow instructions. The label clearly lists active ingredients, uses, warnings, dosage, directions, other information, such as how to store the medicine, and inactive ingredients.

As for health professionals, the FDA proposed a new format in 2000 to improve prescription drug labeling for physicians, also known as the package insert. One FDA study showed that practitioners found the labeling to be lengthy, complex, and hard to use. The proposed redesign would feature a user-friendly format and would highlight critical information more clearly. The FDA is still reviewing public comments on this proposed rule. The agency has also been working on a project called DailyMed, a computer system that will be available without cost from the National Library of Medicine next year. DailyMed will have new information added daily, and will allow health professionals to pull up drug warnings and label changes electronically.

Error tracking and public education: On March 13, 2003, the FDA announced a proposed rule that would revamp safety reporting requirements. For example, the proposal would require that reports on actual and potential medication errors be submitted to the agency within 15 calendar days. FDA's Seligman says, "This rule is part of FDA's overall effort to understand the sources of medication errors and prevent them."

The FDA reviews medication error reports that come from drug manufacturers and through MedWatch, the agency's safety information and adverse event reporting program. The agency also receives reports from the Institute for Safe Medication Practices (ISMP) and the U.S. Pharmacopeia, or USP (see "Who Tracks Medication Errors?").

A recent ISMP survey on medication error reporting practices showed that health professionals submit reports more often to internal reporting programs such as hospitals than to external programs such as the FDA. According to ISMP, one reason may be health professionals' limited knowledge about external reporting programs.

The FDA receives and reviews about 250 medication error reports each month, and classifies them to determine the cause and type of error. Depending on the findings, the FDA can change the way it labels, names, or packages a drug product. In addition, once a problem is discovered, the FDA educates the public on an ongoing basis to prevent repeat errors.

In 2001, the agency released a public health advisory to hospitals, nursing homes, and other health care facilities about the hazards of mix-ups between medical gases, which are prescription drugs. In one case, a nursing home in Ohio reported four deaths after an employee mistakenly connected nitrogen to the oxygen system.

ISMP reports medication errors through various newsletters that target health professionals in acute care, nursing, and community/ambulatory care. Recently, ISMP launched a newsletter for consumers called Safe Medicine.

In December 2002, USP released an analysis of medication errors captured in 2001 by its anonymous national reporting database, MedMARX. Of 105,603 errors, 3,361 errors (3.2 percent) involved children. Most of the errors were corrected before causing harm, but 190 caused patient injury and of those, two resulted in death. As a result of this analysis, USP released recommendations for preventing drug errors in children in January 2003.

What Consumers Can Do
In one case reported to ISMP, a doctor called in a prescription for the antibiotic Noroxin (norfloxacin) for a patient with a bladder infection. But the pharmacist thought the order was for Neurontin (gabapentin), a medication used to treat seizures. The good news is that the patient read the medication leaflet stapled to his medication bag, noticed the drug he received is used to treat seizures, and then asked about it. ISMP president Michael Cohen, R.Ph., Sc.D., says, "You should expect to count on the health system to keep you safe, but there are also steps you can take to look out for yourself and your family."

Know what kind of errors occur. The FDA evaluated reports of fatal medication errors that it received from 1993 to 1998 and found that the most common types of errors involved administering an improper dose (41 percent), giving the wrong drug (16 percent), and using the wrong route of administration (16 percent). The most common causes of the medication errors were performance and knowledge deficits (44 percent) and communication errors (16 percent). Almost half of the fatal medication errors occurred in people over 60. Older people are especially at risk for errors because they often take multiple medications. Children are also a vulnerable population because drugs are often dosed based on their weight, and accurate calculations are critical.
Find out what drug you're taking and what it's for. Rather than simply letting the doctor write you a prescription and send you on your way, be sure to ask the name of the drug. Cohen says, "I would also ask the doctor to put the purpose of the prescription on the order." This serves as a check in case there is some confusion about the drug name. If you're in the hospital, ask (or have a friend or family member ask) what drugs you are being given and why.

Find out how to take the drug and make sure you understand the directions. If you are told to take a medicine three times a day, does that mean eight hours apart exactly or at mealtimes? Should the medicine be stored at room temperature or in the refrigerator? Are there any medications, beverages, or foods you should avoid? Also, ask about what medication side effects you might expect and what you should do about them. And read the bottle's label every time you take a drug to avoid mistakes. In the middle of the night, you could mistake ear drops for eye drops, or accidentally give your older child's medication to the baby if you're not careful. Use the measuring device that comes with the medicine, not spoons from the kitchen drawer. If you take multiple medications and have trouble keeping them straight, ask your doctor or pharmacist about compliance aids, such as containers with sections for daily doses. Family members can help by reminding you to take your medicine.

Keep a list of all medications, including OTC drugs, as well as dietary supplements, medicinal herbs, and other substances you take for health reasons, and report it to your health care providers. The often-forgotten things that you should tell your doctor about include vitamins, laxatives, sleeping aids, and birth control pills. One National Institutes of Health study showed a significant drug interaction between the herbal product St. John's wort and indinavir, a protease inhibitor used to treat HIV infection. Some antibiotics can lower the effectiveness of birth control pills. If you see different doctors, it's important that they all know what you are taking. If possible, get all your prescriptions filled at the same pharmacy so that all of your records are in one place. Also, make sure your doctors and pharmacy know about your medication allergies or other unpleasant drug reactions you may have experienced.

If in doubt, ask, ask, ask. Be on the lookout for clues of a problem, such as if your pills look different than normal or if you notice a different drug name or different directions than what you thought. Robert Krawisz of the National Patient Safety Foundation says it's best to be cautious and ask questions if you're unsure about anything. "If you forget, don't hesitate to call your doctor or pharmacist when you get home," he says. "It can't hurt to ask."

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Who Tracks Medication Errors?
The Food and Drug Administration
Accepts reports from consumers and health professionals about products regulated by the FDA, including drugs and medical devices, through MedWatch, the FDA's safety information and adverse event reporting program.
1-800-332-1088
www.fda.gov/medwatch/how.htm

Institute for Safe Medication Practices
Accepts reports from consumers and health professionals related to medication. Publishes Safe Medicine, a consumer newsletter on medication errors.
1800 Byberry Rd., Suite 810 Huntingdon Valley, PA 19006-3520
215-947-7797
www.ismp.org/Pages/Consumer.html

U.S. Pharmacopeia
MedMARX is an anonymous medication error reporting program used by hospitals.
www.medmarx.com
12601 Twinbrook Parkway Rockville, MD 20852
1-800-822-8772
www.usp.org


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Patient Safety Proposals
In March 2003, Health and Human Services Secretary Tommy G. Thompson announced two proposed rules from the FDA that will use state-of-the-art technology to improve patient safety. Here is a snapshot of each rule:

Bar codes: Just as the technology is used in retail and other industries, required bar codes would contain unique identifying information about drugs. When used with bar code scanners and computerized patient information systems, bar code technology can prevent many medication errors, including administering the wrong drug or dose, or administering a drug to a patient with a known allergy.
Safety Reporting: The proposed revamping of safety reporting requirements aims to enhance the FDA's ability to monitor and improve the safe use of drugs and biologics. The rule would improve the quality and consistency of safety reports, require the submission of all suspected serious reactions for blood and blood products, and require reports on important potential medication errors.

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Hospital Strategies
Hospitals and other health care organizations work to reduce medication errors by using technology, improving processes, zeroing in on errors that cause harm, and building a culture of safety. Here are a couple of examples.

Pharmacy intervention: It was a challenge for health care providers, especially surgeons, at Fairview Southdale Hospital in Edina, Minn., to ensure that patients continued taking their regularly prescribed medicines when they entered the hospital, says Steven Meisel, Pharm.D., director of medication safety at Fairview Health Services. "Surgeons are not typically the original prescribers," he says. The solution was to have pharmacy technicians record complete medication histories on a form. In a pilot program, the technicians called most patients on the phone a couple of days before surgery. A pharmacist reviewed the information and then the surgeon decided which medications should be continued. After three months, the number of order errors per patient dropped by 84 percent, and the pilot program became permanent.

Computerized Physician Order Entry (CPOE): Studies have shown that CPOE is effective in reducing medication errors. It involves entering medication orders directly into a computer system rather than on paper or verbally. The Institute for Safe Medication Practices conducted a survey of 1,500 hospitals in 2001 and found that about 3 percent of hospitals were using CPOE, and the number is rising. Eugene Wiener, M.D., medical director at the Children's Hospital of Pittsburgh, says, "There is no misinterpretation of handwriting, decimal points, or abbreviations. This puts everything in a digital world."

The Pittsburgh hospital unveiled its CPOE system in October 2002. Developed by the hospital and the Cerner Corporation in Kansas City, Mo., Children'sNet has replaced most paper forms and prescription pads. Wiener says that, unlike with adults, most drug orders for children are generally based on weight. "The computer won't let you put an order in if the child's weight isn't in the system," he says, "and if the weight changes, the computer notices." The system also provides all kinds of information about potential drug complications that the doctor might not have thought about. "Doctors always have a choice in dealing with the alerts," Wiener says. "They can choose to move past an alert, but the alert makes them stop and think based on the specific patient indications."

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Member Stories
Witchy Woman's Story

Well, first off, I just want to say that I have read some of the other stories here and my OA really doesn't seem that bad, in comparison to what others have, but, I just wanted to bitch and moan to someone that would understand.

I am a 37-year old mother of 3 boys - 12, 7 and 4. I have a full-time job (7:00 - 3:30) and also help run my husband's small construction business. I take care of the book work, payables etc.

A little over 4 years ago, after the birth of my 3rd son, I had the great pleasure of tripping and falling. Oh, what a happy day. I can honestly say that that day changed my whole life. What I thought was just simple knee pain from falling, actually turned out to be OA.

I saw a few doctors who ran tests and of course, recommended that I do physical therapy. Ok, fine. I walked on the treadmill, did some exercises with these stupid rubber bands, but no relief from the pain. So it was back to the doctors. He recommended a cortisone injection. Well, I don't really care for doctors (it seems that they just want to rush you off to be under the knife) and I wasn't thrilled about getting a needle in my knee. God, I sound like a big baby!

I procrastinated for a while before caving to get the cortisone injection. Which, of course, was supposed to last for any where from 6 months to 12 months. RIGHT!! Try about 1 week.

About 2 years after the fall, I couldn't stand it any more. I actually went under the knife. I will never, ever, ever do that again! I just hope I don't have to have knee replacement. I'm still recovering from that surgery.

Well, at least with the surgery, I don't have pain with each step. What I do have now is pain when I go up and down the steps. Oh, did I mention that I work on the second floor of an office building with no elevator, but 16 steps. I also have a cape cod home that has my washer and dryer in the basement (15 steps) and 13 steps to the second floor. Right, like you guys don't count the steps too!

I read article after article about exercise for people with OA. Cripe, with all the "running around" that I do every day, that should count as exercise.

I am now looking into alternative medicine. I think I'm going to do some research into how yoga or tai chi effects may or may not benefit people with OA. As far as anti-inflammatories go, I eat Motrin like tic tacs and my knee is still swollen. Hey, if you have a headache and you take Motrin, how does it know it's supposed to go to your head and not or knee or whatever.

Well, I guess I've gotten that off my chest.

Thanks for listening!

To see the rest of stories go on over to:
/community/stories

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Notes and Insights:

Birthday Board!
Happy Birthday Joan Westgate, Amanda Grubbs aka Daisy, Diane H, Michele Deptula, Deborah and Heather!!!
Check out all the birthdays at
/community/birthday
and make sure to send them an arthritis-friendly e-card:
/cgi-bin/postcards/postcard.pl

Fundraiser 2003
We don't like to beg, but we're having a hard time staying online. The cost of keeping Arthritis Insight running is large (to us anyway), and while there are still no salaries being paid, there are monthly bills that need to be covered if we want to stay online.
Our solution? We're having a Fundraiser.
It's been two years since we've had one - and we know we're not the only ones out there asking you to part with your money, but if you can help, please check out the Fundraiser information at:
/help/fundraiser2003

Gimpfest 2003 Iowa, Here We Come!
Come be part of the fun when dozens of gimps head to Stuart, Iowa on July 24-27.
Get all the details here:
http://www.fadedjeans.com/iowa/

AJAO Regional Conference
"Taming Juvenile Arthritis"
June 2003 - Phoenix, Arizona
The Arthritis Foundation is proud to host the 2003 American Juvenile Arthritis Organization (AJAO) Regional Conference, "Taming Juvenile Arthritis." The American Juvenile Arthritis Organization leads the effort to improve the quality of life for those affected by childhood arthritis and related diseases. This 3-day conference is geared towards children, teens, young adults and family members who are affected by juvenile rheumatoid arthritis and other childhood rheumatic diseases
http://jraworld.arthritisinsight.com/community/involved.html

JRA JAMFEST: General Information:
Dates: Saturday May 17, 2003 - Sunday May 18, 2003
Target Audience: Kid Friendly,General Audience
Time: 11:00 a.m.- 5:00 p.m.
Phone: 502-589-6620, ext 106
Location:
Derby Flea Market & Traders Circle:
2900 South 7th Street Road,
Louisville, KY 40216
Ticket Information: free admission, fee for games, raffles, etc..
Event Details/Other Comments:
JRA JamFEST is a two day event to benefit FACES. FACES is Facing Arthritis with Compassion, Encouragement and Support, a group for children, teens and young adults living with juvenile rheumatoid arthritis (JRA). All proceeds will go directly to FACES and will help us sponsor children and their families to JRA conferences, JRA camps, and other juvenile arthritis related events! Join us for a day of live music on May 17th featuring Doubleback and headlining, Wayne Young and the Youngsters!!! May 18th enter our Karaoke Contest! Come out for the fun, entertainment, games, prizes, food, drink, information and lots more!!!!

Join the Arthritis Dieters!
This is a group of people with arthritis who want to lose weight with others who know of the challenges of living with is arthritis. All those medications that make living with arthritis tolerable, but pile on the pounds. This group has been set up to give us a protected group where we can talk to others who know what it is like.
http://groups.yahoo.com/group/arthritis-dieters/

Wanna help?
Having surgery? Starting a new drug or treatment? Filing for disability? Keep an Arthritis Insight journal so all of our members can share and learn from your experience. If you want to keep a journal just let us know.

Write an article!
We always need articles on all subjects relating to arthritis. C'mon folks, we can't do this without you.

Ken Akers Cheer Fund
Donations to the Ken Akers Cheer Fund will be used to send flowers and gifts to those community members who are hospitalized, flaring or just in need of some good cheer.
/community/kenscheerfund

Thank You!
A great big thank you to NeedaBasket.com (http://needabasket.com). NeedaBasket is now Arthritis Insight's official gift basket company. They are giving us a great discount and are donating baskets for our Arthritis Warriors.

Special Offers for Arthritis Insight Members
Whenever possible we will try get to our sponsors to agree to discounts and the like for our members. Here are our current special offers:

Sore No More (http://sorenomore.com) gel will send a free sample of the pain relieving gel to any Arthritis Insight Community Member who emails them at dma@glogerm.com.

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AI Help Desk
Linda Peck

Linda's taking the week off, hopefully she'll be back next week.

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Weekly News Summary
Karen Sears
kaekae@arthritisinsight.com

More health news can be found on our site:
/news/

ELECTRICAL ACUPUNCTURE BENEFICIAL IN OLDER PATIENTS WITH CHRONIC LOW BACK PAIN
Percutaneous nerve stimulation (PENS) via acupuncture needles reduces pain and disability in older patients with chronic low back pain, based on results of a study published in the May issue of the Journal of the American Geriatrics Society.
Medscape, May 13 (free registration required)

ONE THIRD OF RHEUMATOID ARTHRITIS PATIENTS SHOW RADIOLOGICAL PROGRESSION AFTER ONE YEAR OF TREATMENT
Radiological progression was seen in 36.6% of patients with early rheumatoid arthritis after one year of treatment with disease-modifying anti-rheumatic drugs, even though they had a decrease in symptoms of the disease.
Doctor’s Guide, May 13 (free registration required)

CHRONIC FATIGUE ESTIMATED TO COST BRITAIN 3.5 BILLION A YEAR
Chronic fatigue syndrome, or myalgic encephalomyelitis (ME.) as it is sometimes known, costs the UK economy 3.5 billion a year, according to a report by Sheffield University researchers.
Medscape, May 12 (free registration required)

GENENTECH, XOMA HALT TESTING OF RAPTIVA FOR ARTHRITIS
Genentech Inc. and Xoma Ltd. said on Monday they had stopped testing psoriasis drug Raptiva (efalizumab) as a treatment for rheumatoid arthritis, a use that could have doubled its sales.
Medscape, May 12 (free registration required)

FOLATE SUPPLEMENT IMPROVES RESPONSE TO METHOTREXATE IN RHEUMATOID ARHTRITIS
A variety of factors, including folate supplementation, influence toxicity, efficacy and other aspects of methotrexate therapy in patients with rheumatoid arthritis, Dutch researchers report in the May issue of the Annals of the Rheumatic Diseases.
Medscape, May 12 (free registration required)

SEPARATE TREATMENTS STRATEGIES NEEDED FOR DISEASE MODIFYING ANTIRHEUMATIC
DRUGS IN RHEUMATOID AND PSORIATIC ARTHRITIS
Patients with psoriatic arthritis (PsA) appear to have more side effects when treated with disease modifying antirheumatic agents (DMARDs) than do patients with rheumatoid arthritis (RA).
Doctor’s Guide, May 12 (free registration required)

ROUTINE LYME SEROLOGY APPEARS UNNECESSARY IN PATIENTS FROM NON-ENDEMIC AREAS
Routine Lyme serology in patients with early inflammatory arthritis appears to have little diagnostic use in non-endemic areas.
Doctor’s Guide, May 12 (free registration required)

RISK OF HIP/KNEE OSTEOARTHRITIS NOT INCREASED BY PHYSICAL ACTIVITY IN ADULTS
Adults who take part in physical activity do not increase risk of hip/knee osteoarthritis (OA), according to United States researchers.
Doctor’s Guide, May 12 (free registration required)

GREATER QUADRICEPS STRENGTH LINKED TO TIBIOFEMORAL OSTEOARTHRITIS PROGRESSION
Patients with knee osteoarthritis whose knees are misaligned or lax run the risk of tibiofemoral progress if they do muscle strengthening exercises, according to a prospective, longitudinal cohort study.
Doctor’s Guide, May 12 (free registration required)

INFLIXIMAB MAY INDUCE ANTINUCLEAR ANTIBODIES
The monoclonal antibody infliximab may induce antinuclear antibodies -- especially IgM and IgA anti-double stranded DNA antibodies -- in patients with rheumatoid arthritis and spondyloarthropathy, according to research conducted at Ghent University Hospital, Belgium.
Doctor’s Guide, May 12 (free registration required)

TREATMENT MAY HELP JOINT PAIN
Italian researchers report encouraging results from a new study aimed at finding a better treatment for people suffering from a type of persistent joint pain that does not respond well to standard treatment with steroids.
Ivanhoe Newswire, May 12

MUSCLES TO BLAME FOR WOMEN'S KNEE INJURIES: STUDY
Women who participate in jumping and pivoting sports, such as basketball, volleyball and soccer are eight times more likely to rupture a knee-stabilizing ligament than are men.
Yahoo News, May 9

BMD DECLINES AFTER ALENDRONATE THERAPY IS STOPPED IN PATIENTS ON STEROIDS
Patients who stop taking alendronate but continue to take more than 6 mg/day glucocorticoids have substantial loss of bone mineral density (BMD) in the lumbar spine and hip, according to a report in the April issue of Arthritis and Rheumatism. Conversely, BMD is maintained in those who continue to take both glucocorticoids and alendronate.
Medscape, May 9 (free registration required)

U.S. ADULTS DON'T SEEK CARE FOR JOINT PAIN: CDC
About one in five American adults with chronic joint symptoms have never seen a health care provider for the problem, according to a report released Thursday by the U.S. Centers for Disease Control and Prevention (news - web sites) (CDC).
Yahoo News, May 8

NARCOTICS, ANTIDEPRESSANTS UP WOMEN'S FRACTURE RISK
Older women who take narcotic or antidepressant medications may be at increased risk of bone fractures, a new study has found.
Yahoo News, May 8

AUTOANTIBODIES ARE PROGNOSTIC OF EROSIVE DISEASE IN EARLY RHEUMATOID ARTHRITIS
Measurement of autoantibodies helps predict structural damage early in the course of rheumatoid arthritis (RA), according to a report in the May issue of the Annals of the Rheumatic Diseases.
Medscape, May 8 (free registration required)

RHEUMATOID ARTHRITIS ASSOCIATED WITH ARTERIAL STIFFNESS
In rheumatoid arthritis patients, increased arterial stiffness may contribute to the increased cardiovascular mortality seen in this population, according to a report in the May Annals of the Rheumatic Diseases.
Medscape, May 7 (free registration required)

DIET MAY AFFECT LUPUS
Diet -- and especially, vitamin C -- may play a role in minimizing the effects of lupus.
Ivanhoe Newswire, May 7

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Contribute

Have you written something you think our subscribers would like to read? Send it to Tina@arthritisinsight.com and maybe we'll use it in our newsletter.

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A Closing Thought
Play More Golf

The year is 1923. In 1923, do you know who was:

President of the largest steel company?
President of the largest gas company?
President of the New York Stock Exchange?
Greatest wheat speculator?
President of the Bank for International Settlements?
Great Bear of Wall Street?
Now, these men should have been considered some of the world's most successful men. At least, they found the secret to making bundles of money. Now, almost 80 years later, the history book asks us, do we know what actually became of these men?

ANSWERS:

The president of the largest steel company, Charles Schwab, died a pauper.
The president of the largest gas company, Edward Hopson, went insane.
The president of the NYSE, Richard Whitney, was released from prison to die at home.
The greatest wheat speculator, Arthur Cooger, died abroad, penniless.
The president of the Bank for International Settlements, shot himself.
The Great Bear of Wall Street, Cosabee Livermore, committed suicide.
However, in that same year, 1923, the PGA Champion and the winner of the most important golf tournament, the US Open, was Gene Sarazan. What became of him, you ask? Well, he played golf until he was 92, died in 1999 at the age of 95, and was extremely financially secure at the time of his death.

What can we learn from this quiz? Stop worrying about business and start playing more golf.

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Arthritis Insight Newsletter Copyright 2003

AI Staff
Page last updated on May 15, 2003