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Are Hospice Services Right for Your Patient?

Before you can identify which of your patients might benefit from the cadre of services provided by hospice, you must first understand how hospice differs from traditional home care. Understanding the difference helps you discuss the option with a physician and with a patient or caregiver. The article "Hospice Referral and Care: Practical Guidelines for Clinicians" provides a description of patient and clinical indications for a hospice referral, services in the Medicare Hospice Benefit, and issues related to timing an end-of-life discussion. Practical tips are given to make the initiation of a hospice end-of-life discussion with the patient and family easier. Continuing education hours are also offered. To read the entire article, log onto:


Is Caffeine Sabotaging Your Patient's Plan of Care?

The increasing incidence of diabetes in America was one of the reasons researchers from Duke University examined the correlation between caffeine consumption and its effect on glucose control in type 2 diabetes. The study identified that persons with diabetes who ingest caffeine before a meal have a more difficult time regulating both their glucose and insulin levels than do those who avoided caffeine consumption. Caffeine seemed to affect digestion of the meal and the subsequent regulation of glucose and insulin levels. The researchers postulated that persons with diabetes who avoid caffeine may be able to improve the control of their disease.

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Lane, J. D., Barkauskas, C. E., Surwit, R. S., & Feinglos, M. N. (2004). Caffeine impairs glucose metabolism in type 2 diabetes. Diabetes Care, 27 (7), 2047-2048.


Is Patient Safety One of Your Organizational Goals?

Falls are one of the most common adverse events encountered by home care patients. We also know how difficult it is to get our patients to implement recommendations to prevent falls or protect themselves in case they do fall. The Veterans Administration's National Center for Patient Safety 2004 Falls Toolkit may provide your agency with some strategies to reduce the number of patient falls and improve performance in this area.

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The Web-based toolkit provides information on designing fall prevention programs, interventions for patients at risk for falls, and examples of equipment designed to protect the patient in case of a fall. In addition patient, family, and staff education information can be downloaded from the Web site and adapted for use. Although not specific to home healthcare, some of the strategies can be easily adapted, and its use is free. Check it out at


New Evidence Report on the Safety and Effectiveness of Melatonin Supplements Available

Agency for Healthcare Research and Quality (AHRQ) released a new evidence report that found that melatonin supplements, which people often take for sleep problems, appear to be safe when used for a period of days or weeks at relatively high doses and in various formulations. However, the safety of melatonin supplements used for months or even years is unclear. Although there is some evidence for benefits of melatonin supplements, for most sleep disorders the authors found evidence suggesting limited or no benefits. But the authors say that firm conclusions cannot be drawn until more research is conducted. The report was requested and funded by National Institutes of Health National Center for Complementary and Alternative Medicine and conducted by AHRQ's University of Alberta Evidence-based Practice Center in Edmonton. A print copy of the summary and the full report are available on the Web site or by sending an e-mail to


Is Not Sleeping Enough Making You Fat?

A recent study found that individuals who are overweight or obese report that they get less sleep per week than do their normal-weight counterparts. The researchers interviewed 924 participants, ages 18 to 91 years, who completed questionnaires asking about demographics, medical problems, sleep habits, and sleep disorders and found three factors that affected total sleep time: being a night-shift worker, male gender, and obesity. The results were similar when the investigators excluded subjects with specific sleep disorders, such as obstructive sleep apnea and insomnia.


One finding suggested that lost sleep may result in metabolic and hormonal consequences. For example, sleep restriction may reduce levels of leptin, a hormone involved in appetite regulation, thus mediating the sleep-obesity relationship. Or the imbalance may simply be related to an increase in eating during increased time awake. Although the researchers caution that their studies do not establish a cause-and-effect relationship between restricted sleep and obesity, they do suggest that an extra 20 minutes of sleep per night seems to be associated with a lower body mass index (BMI), the measure of body fat based on height and weight that applies to both adult men and women.


Vorona, R., Winn, M., Babineau, T., Eng, B., Feldman, H., et al. (2005). Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Archives of Internal Medicine, 165 (1), 25-30.


National Nursing Association Releases Cardiovascular Health for Women Resources

Cardiovascular disease is the leading cause of death in American women, killing six times as many women as breast cancer. Women's healthcare professionals are aware of these facts, but many of their female patients are not. To assist nurses and other healthcare providers in reducing their patients' risk for cardiovascular disease, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) has developed several professional education resources, including a new presentation package on CD-ROM, an evidence-based clinical practice guideline, a clinical practice monograph, and a workshop led by an AWHONN Consultant.

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