LAPAROSCOPY FOR REPAIRING HERNIAS
It's not necessarily best.
Researchers compared open mesh repair of inguinal hernia with laparoscopic mesh repair, assessing rates of hernia recurrence; complications; and "patient-centered outcomes" such as pain, activity level, and functional status. At just over 10%, the rate of recurrence within two years of laparoscopic repair was twice that of open repair when the hernia being repaired was itself not a recurrent one; the rates were comparable when the repairs were of recurrent hernias. Although after laparoscopy pain scores were somewhat lower and activities were resumed a day sooner, the rate of complications in that group was higher, and the study authors concluded that open repair of a primary hernia is superior to laparoscopic repair.
Neumayer L, et al. N Engl J Med 2004;350(18):1819-27
PREVENTING CONTRAST-INDUCED NEPHROPATHY
Sodium bicarbonate infusion found to be more effective.
Nephropathy caused by intravenous radiographic contrast agents may be better prevented with hydration with sodium bicarbonate than with hydration with sodium chloride, according to a recent study.
From 2002 to 2003 researchers at a single medical center randomly assigned 119 patients with stable renal insufficiency to receive hydration with either a sodium chloride infusion (154 mEq/L) (n = 59) or a sodium bicarbonate one (154 mEq/L) (n = 60) one hour before and for six hours after the administration of the radiographic contrast agent, iopamidol. Serum creatinine levels were obtained at baseline (one of at least 1.1 mg/dL was required for eligibilty) and for two days after the procedure. Patients whose serum creatinine levels were elevated by at least 25% within that period of time were considered to have developed contrast-induced nephropathy.
In the absence of significant differences either in demographics or mean baseline serum creatinine levels between the two groups, patients in the sodium bicarbonate group developed contrast-induced nephropathy much less frequently than did those in the sodium chloride group, 1.7% versus 13.6%, respectively, and all who did did so after undergoing cardiac catheterization. Because of those dramatic results, randomization was discontinued early and only sodium bicarbonate infusion was administered to the remaining and subsequently eligible patients (n = 191), of whom only 1.6% developed the disease. Additionally, sodium bicarbonate infusion was found to be safe.
Although further, multicenter studies are necessary to validate its findings, the results of this study suggest that sodium bicarbonate infusion may be quite effective in preventing contrast-induced nephropathy. Nurses should be aware of the possible side effects of the drug's administration, such as elevated systolic or diastolic blood pressures, or both, and monitor for them.
Merten GJ, et al. JAMA 2004;291(19):34.
JAPAN HALTS NATIONAL INFANT SCREENING PROGRAM
In 2002, two studies showed that screening infants for neuroblastomas not only fails to reduce the risk of death, but also causes substantial overdiagnosis and treatment of benign cases (see News, July 2002). As a result of those reports, Japanese officials began to reexamine that country's own policy of mass screening for neuroblastoma, which had been in place since 1984. According to a letter to the editor published in the May 6 issue of the New England Journal of Medicine, the ministry has recently ended the practice. "The Japanese experience with neuroblastoma screening underscores the importance of rigorous evaluation of potential benefit and harm before a screening program is adopted as public policy," write the letter's authors, Yoshitaka Tsubono and Shigeru Hisamichi.
STAFFING LEGISLATION AROUND THE COUNTRY
In California, the California Healthcare Association lost its case against the Department of Health Services to overturn the state's safe staffing law. Sacramento Superior Court Judge Gail Ohanesian upheld the law, writing that the hospital industry's proposal that the law "not apply at all times" would make "the nurse-to-patient ratios meaningless."
Connecticut became the 10th state to pass legislation limiting mandatory overtime for nurses. The law requires the state's commissioner of public health to establish minimum nurse-to-patient ratios.
Massachusetts.
The state senate passed an amendment to the state budget requiring all hospitals to establish minimum nurse-to-patient ratios (1:4 on medical-surgical units, 1:2 in ICUs, and 1:1 to 1:3 in EDs).-Doug Brandt