PERSONAL PROTECTIVE EQUIPMENT
FDA issues a ban on powdered gloves
Based on evidence of an "unreasonable and substantial risk of serious illness or injury," the FDA has issued a final rule banning powdered surgeon's gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon's gloves. The ban includes both natural rubber latex and synthetic latex gloves and applies to powdered gloves in commercial distribution and/or already in use at hospitals and other clinical settings.
In support of this action, the FDA cited serious risks to both patients and healthcare providers exposed to powder, including severe airway inflammation, hypersensitivity reactions, and allergic reactions, including asthma. During surgery, powder particles can trigger an immune response, leading to complications such as granulomas and adhesions.
The FDA decided to ban powdered gloves rather than merely requiring a strong warning label because of "the ability of powder to affect people who would not have an opportunity to read warning labels, and because potential warning labels would raise awareness of the risks, but would not eliminate the risks posed by glove powder." Nonpowdered surgical and patient examination gloves are available that provide the same level of personal protection, dexterity, and durability without the same health risks, according to the FDA.
The rule became effective in January.
Source: Banned devices; powdered surgeon's gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon's glove. Federal Register. December 19, 2016.
PALLIATIVE CARE
Improving quality, not length, of life
Patients who receive palliative care have fewer symptoms and experience a better quality of life than patients who do not, according to a review of available data. However, the evidence doesn't show that palliative care extends life. Although some individual studies have found that palliative care can extend life by a few months, survival benefits disappear when data from multiple studies are pooled together.
In this study, researchers analyzed data from 43 clinical trials involving 12,731 patients (mean age, 67) and 2,479 caregivers to assess the effect of palliative care on quality of life, symptom burden, survival, mood, advance care planning, site of death, healthcare satisfaction, resource utilization, and healthcare expenditures.
An analysis of data showed that palliative care offers a significant improvement in patient quality of life by reducing symptoms and stress. Palliative care was also associated with better advance planning, patient and family satisfaction with care, and lower use of healthcare resources. Findings for caregiver outcomes were "inconsistent."
Source: Kavalieratos D, Corbelli J, Zhang D, et al. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA. 2016;316(20):2104-2114.
LUNG TRANSPLANTS
New technique safely extends organ viability
An organ preservation technique called ex-vivo lung perfusion (EVLP) has been shown to preserve donor lungs for up to 20 hours. EVLP involves pumping a solution of oxygen, proteins, and nutrients into donor lungs, mimicking normal physiology. Under current protocols, donor lungs are kept on ice and bathed in an organ preservation solution. Donor lungs treated this way remain viable for a shorter period; 6 to 8 hours is the standard followed at most transplant centers.
To determine how EVLP outcomes compare with those of standard lung preservation protocols, researchers analyzed data on 906 adult patients who received lung transplants at a Canadian hospital between 2006 and 2015. Patients in one group received donor lungs with a total preservation time of less than 12 hours (n=809) and those in the other group received lungs with a total preservation time of more than 12 hours (n=97). Donor lungs managed with the EVLP technique were initially cooled to slow tissue deterioration, treated with EVLP for 4 to 6 hours, and again subjected to protective cooling until transplantation.
Analysis of patient outcomes showed that patients who'd received lungs that had been preserved for 12 or more hours using EVLP fared as well a year after transplantation as patients who'd received lungs preserved for less time. Researchers conclude that using EVLP to extend donor lung preservation time beyond 12 hours didn't adversely affect transplant outcomes and may increase the availability of donor lungs.
Sources: Yeung JC, Krueger T, Yasufuku K, et al. Outcomes after transplantation of lungs preserved for more than 12 h: a retrospective study. Lancet Respir Med. [e-pub November 17, 2016.] Preserving donor lungs longer makes transplant more elective than emergency surgery. University Health Network. News release. November 17, 2016.
NURSE STAFFING
Lower skill mix raises mortality risk
A large study was conducted to assess the association of nursing skill mix with mortality, patient reports of care quality, and quality of care indicators. The study involved 242 hospitals in six Western European hospitals, over 13,000 nurses, and nearly 18,900 patients. In findings that are consistent with similar studies in the United States and Canada, researchers found that a higher proportion of professional nurses at the bedside was associated with lower odds of mortality; lower odds of low hospital ratings from patients; and lower odds of poor quality, safety, and outcomes. For example, replacing one professional nurse with a nursing assistant was associated with a 21% increase in mortality and a 16% decrease in the odds of patients reporting satisfaction with their care. "The contention of some leaders in health care that fewer highly skilled professional nurses in hospitals supported by lower skilled, lower waged workers is safe and cost effective is not supported by this study," says lead author Linda Aiken, PhD RN.
Sources: Aiken L, Sloane D, Griffiths P, et al. for the RN4CAST Consortium. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Qual Saf. [e-pub November 15, 2016.] Study finds employment of more nurse assistants in hospitals is associated with more deaths and lower quality care. University of Pennsylvania School of Nursing. News release. November 16, 2016.
OBSTETRICS
Labor in water, but give birth on land
Spending the early stages of labor in a birthing pool may offer some advantages to pregnant women. However, in-water delivery has no proven benefit to women or newborns and is risky for the infant. These updated recommendations on laboring and delivering in water were recently released by the American College of Obstetricians and Gynecologists (ACOG).
Potential risks of in-water delivery include a higher risk of maternal and neonatal infection, problems with neonatal temperature regulation, umbilical cord damage, aspiration and respiratory distress in the infant, and asphyxia and seizures.
ACOG provides guidelines for hospitals and birthing centers that offer water immersion for women in the first stage of labor. These guidelines include:
* developing a rigorous patient selection process
* maintaining and cleaning tubs and immersion pools
* following infection control procedures
* monitoring pregnant women at appropriate intervals while immersed
* moving women out of the tubs if concerns about maternal or fetal well-being develop.
The full guideline, Committee Opinion Number 679, is available at http://www.acog.org.
Sources: The American College of Obstetricians and Gynecologists. Committee Opinion. Immersion in water during labor and delivery. Number 679, November 2016. Ob-gyns weigh in: laboring in water is OK, but deliver baby on land. The American College of Obstetricians and Gynecologists. News release. October 24, 2016.
In February, celebrate
* Age-related Macular Degeneration/Low Vision Awareness Month http://www.geteyesmart.org
* National Children's Dental Health Month http://www.ada.org
* Perianesthesia Nurse Awareness Week (February 6-12) http://www.aspan.org/
* Burn Awareness Week (February 5-11) http://www.burnawareness.org
* Wear Red Day (February 3) http://www.goredforwomen.org
PATIENTS WITH MENTAL HEALTH DISORDERS
Pets a primary source of support for many
Results of a new study reinforce the importance of dogs, cats, and other pets to patients with long-term mental health disorders. For the study, 54 patients with a long-term mental health diagnosis were recruited. Twenty-five of these identified having a pet in their social network; 60% identified dogs or cats. A few other animals, including birds, a hamster, and a guinea pig, were also represented.
Data were collected from face-to-face interviews with study participants and a simple mapping technique involving three concentric circles. Patients were asked, "Who or what do you think is most important to you in managing your mental health." They then placed sources of support, such as family members, friends, pets, healthcare professionals, and hobbies, in the appropriate circle, with the central circle considered "most important."
Most (60%) of participants with pets placed the pet in the central circle, 20% placed the pet in the second circle, and 12% in the third. Only 8% (3 participants) didn't place a pet anywhere on the map.
The authors believe that "this is the first qualitative study empirically exploring the role of pets in the social networks of people managing a long-term mental health problem." They conclude that "pets should be considered a main rather than a marginal source of support in the management of long-term mental health problems, and this has implications for the planning and delivery of mental health services."
Source: Brooks H, Rushton K, Walker S, Lovell K, Rogers A. Ontological security and connectivity provided by pets: a study in the self-management of the everyday lives of people diagnosed with a long-term mental health condition. BMC Psychiatry. [e-pub December 9, 2016.]
OUTPATIENT CARE
After 10 years of effort, uneven results
Despite more than a decade of regional and national efforts, clinical quality of outpatient care for American adults hasn't consistently improved, researchers report. Using data from the Medical Expenditure Panel Survey, a nationally representative annual survey of American adults, researchers evaluated 46 quality indicators of outpatient care between 2002 and 2013. They found declines or stagnation in many measures of outpatient care. Two measures of clinical quality worsened during the study period: avoidance of inappropriate medical treatments and avoidance of inappropriate antibiotic use. Three clinical quality measures were unchanged: recommended diagnostic and preventive testing, recommended diabetes care, and avoidance of inappropriate imaging.
However, four measures of clinical quality improved: recommended medical treatment, recommended counseling, recommended cancer screening, and avoidance of inappropriate cancer screening. In addition, the evidence shows that patient experience has improved. The proportion of participants highly rating their care experience improved for overall care, caregiver communication, and access to care.
Although acknowledging that patient experience has improved over the last decade, the researchers concluded that "deficits in care continue to pose serious hazards to the health of the American public."
Source: Levine DM, Linder JA, Landon BE. The quality of outpatient care delivered to adults in the United States, 2002 to 2013. JAMA Intern Med. [e-pub Oct. 17, 2016.]