GERIATRIC PATIENTS
Bringing hospital care to the home
Because many acutely ill older adults experience adverse events while hospitalized, researchers set out to explore the feasibility of caring for them at home. The results were encouraging.
Researchers from Johns Hopkins University School of Medicine studied 455 people age 65 and older with four conditions: community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, and cellulitis. Patients could choose to enter the hospital or to stay at home and receive a "hospital-at-home" model of care, which included full-time nursing care if indicated and visits from a physician at least daily. If indicated, at-home patients could also receive intensive levels of medical services, including oxygen therapy and intravenous drugs.
Two-thirds of patients in the study chose to remain at home. Researchers reported these findings:
* At-home patients experienced fewer complications, such as delirium.
* At-home care cut costs by one-third.
* At-home patients needed an average of 3.2 days of hospital care, compared with 4.9 days for those admitted to the hospital.
* At-home patients received more personal nursing attention than hospitalized patients typically get.
* At-home patients and their families reported high levels of satisfaction with the care they received.
Researchers concluded that the hospital-at-home care model is "feasible, safe, and efficacious" for certain older adults who need acute care.
Source: Hospital at home: Feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients, Annals of Internal Medicine, B Leff, et al., December 6, 2005.
NURSING SHORTAGE
How to lure retired nurses back to work
Under pressure from the nursing shortage, many hospital administrators are looking for ways to retain nurses who are nearing retirement and recruit nurses who are already retired. Nurses age 50 and older are the fastest growing segment of the nursing population. By 2010, 50 will be the average age for nurses. Statistically, most nurses retire between ages 55 and 58.
Organizations such as the Center for American Nurses and the American Nurses Association have identified working conditions and policies that appeal to older nurses. These include no-lifting policies, phased retirement, health benefits for part-time work, more paid time off, flex time, self-scheduling, and job sharing. Some hospitals are printing text in larger fonts to accommodate aging eyes.
For more information, visit the Web site of the Center for American Nurses at http://www.centerforamericannurses.org and search for "mature nursing workforce."
POSTOP BOWEL FUNCTION
Chewing gum may speed recovery
Chewing gum after elective open sigmoid colon resection appears to reduce the average hospital stay by about 2 days, according to a small study. Chewing gum may stimulate bowel motility and speed the return of normal bowel function.
The study involved 34 patients who'd undergone elective open sigmoid resections. Half of them chewed one stick of sugarless gum three times a day for 1 hour each time, starting the morning after surgery and continuing until discharge. All patients tolerated the gum. The other 17 patients received standard care without chewing gum. Researchers found that:
* the first passage of flatus occurred at 65.4 hours after surgery in the gum-chewing group, compared with 80.2 hours in the control group
* first bowel movements occurred at 63.2 hours in the gum-chewing group, compared with 89.4 hours in the control group
* feelings of hunger returned at 63.5 hours in the gum-chewing group and 72.8 hours in the control group
* the average hospital stay for the gum-chewing group was 4.3 days, compared with 6.8 days for the control group.
Previous studies have shown that early feeding after colon resection can speed the return of normal bowel function and shorten hospital stays. But many patients can't tolerate early feedings.
Researchers speculate that gum chewing may stimulate bowel motility by directly activating the cephalic-vagal reflex and increasing production of gastrointestinal hormones associated with bowel motility. They call for further study to confirm their conclusions. More research could also determine whether gum containing sugar or gum with differing flavors or textures would be more effective.
Source: Gum chewing reduces ileus after elective open sigmoid colectomy, Archives of Surgery, R Schuster, et al., February 2006.
ANALGESIA
Do obese people feel more pain?
Obese people may be more sensitive to pain than people of normal weight. New research suggests that obese people have a lower threshold for pain than people of normal weight.
Researchers evaluated pain reactions in 62 older adults with osteoarthritis of the knee. One-third of them were obese (body mass index greater than 30 but less than 35). Researchers then gave each study subject a mild electrical shock to the sural nerve, which extends along the ankle into the calf. This caused tingling and mild pain in the lower leg. Subjects received shocks once before and once after a 45-minute training session that included muscle relaxation techniques and other ways to cope with pain.
Researchers measured the reflex of lower leg muscles surrounding the sural nerve to help gauge pain reaction. They also questioned patients about their perception of pain.
Although obese people didn't report feeling any more pain than people of normal weight, they had a stronger physiologic response to the pain stimulus, based on objective measurements. Researchers say this indicates a lower tolerance for pain.
According to the researchers, these findings demonstrate the importance of looking at both subjective and objective pain indicators because subjective indicators don't always accurately reflect underlying physiologic processes. They reported their findings at the annual meeting of the American Psychosomatic Society in Denver, Colo.
CHRONIC ILLNESSES
Mediocre care for all?
Regardless of age, race, sex, or insurance status, hospitalized patients in the United States receive only about 55% of recommended care for common chronic illnesses. In a national survey involving nearly 7,000 adult patients, researchers conducted telephone interviews and reviewed medical records to determine how patients were treated for 30 chronic illnesses, including hypertension, diabetes, and heart disease. They found that it was almost a "coin flip" whether physicians and nurses provided correct care according to well-known, standardized treatment guidelines. They blame the poor result on the "fragmented and chaotic" health care system in the United States.
In a previous study, Veterans Affairs (VA) facilities had scored better than average, providing correct care 67% of the time. Researchers attribute this to the VA system's greater use of electronic technologies to standardize and track patient care.
The survey was conducted in 12 metropolitan areas by RAND Health, a large independent health-policy research organization, and funded by a grant from the Robert Wood Johnson Foundation.
Source: Who is at greatest risk for receiving poor-quality health care?, The New England Journal of Medicine, S Asch, et al., March 16, 2006.
ANTIBIOTIC RESISTANCE
"Bad bugs, no drugs"
Six drug-resistant microbes have been placed on a "hit list" by the Infectious Diseases Society of America (IDSA). The IDSA wants to spur development of treatments for certain bacterial and fungal infections that resist currently available antibiotics.
"These are life-threatening drug-resistant infections, and we're seeing them every day," says IDSA president Martin J. Blaser, MD. Currently, few if any drugs are in development to treat them.
Officials at IDSA are urging Congress to pass legislation encouraging drug makers to research new treatments through tax credits, market exclusivity guarantees, and other incentives. They believe that market forces aren't strong enough to compel drug makers to look for treatments without incentives.
These are the microbes on the hit list:
* methicillin-resistant Staphylococcus aureus (MRSA)
* Escherichia coli and Klebsiella species
* Acinetobacter baumannii
* Aspergillus
* vancomycin-resistant Enterococcus faecium (VRE)
* Pseudomonas aeruginosa.
The IDSA examined this issue in its 2004 policy report, Bad bugs, no drugs: As antibiotic R&D stagnates, a public health crisis brews. For more information, visit the IDSA Web site at http://www.idsociety.org.
Source: Bad bugs need drugs: An update on the development pipeline from the Antimicrobial Availability Task Force of the Infectious Diseases Society of America, Clinical Infectious Diseases, GH Talbot, et al., March 1, 2006.
National Nurses Week: May 6-12
National Nurses Week will run from May 6 to May 12, the birthday of Florence Nightingale. This year's theme, chosen by the American Nurses Association (ANA), is "Nurses: Strength, commitment, compassion." For more information about National Nurses Week, visit the ANA's Web site at http://www.nursingworld.org/pressrel/nnw.
SURVEY RESPONSES
Are you seeing "horizontal violence"?
Nurses who recently visited our Web site answered this question: In the last 6 months, have you witnessed any nurse treating another nurse inappropriately (horizontal violence)?
For more information about this issue, see "Nurse against Nurse: How to Stop Horizontal Violence" in the March issue of Nursing2005. Visit http://www.nursingcenter.com to answer our monthly survey question and view results from other surveys.
HOSPITAL FOOD
Hold the fries
French fries in hospital cafeterias contain artery-clogging trans fats in all 20 of the top-rated hospitals surveyed by the Center for Science in the Public Interest (CSPI). Partially hydrogenated oil used to cook french fries and other foods is the primary source of trans fats in the American diet.
"Partially hydrogenated oil has as much place in hospital cafeterias as ashtrays have in operating rooms," says Michael F. Jacobson, CSPI executive director. Alternatives for frying food are available; for example, soy, canola, and other more heart-friendly oils.
French fries served at the Hospital of the University of Pennsylvania in Philadelphia had the most trans fat (5.3 grams per 6-ounce serving). Those served at Children's Hospital of Philadelphia had the lowest (1.2 grams per 6-ounce serving).
For more information on survey results, visit CSPI's Web site at http://www.cspinet.org.