1. Potera, Carol


Children fare better with more RNs on staff.


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Studies have shown clearly that adequate RN staffing improves the care of hospitalized adults (see In the News, April and August). Now a study examining RN staffing and outcomes in children shows the benefits to young patients, too. In the first large-scale study of its kind, researchers at the University of North Carolina School of Nursing found fewer complications in hospitalized children when RNs provided more hours of care and where nurse staffing levels were high.


They examined data on 3.65 million patients up to age 14 discharged from California hospitals between 1996 and 2001. Adverse events included septicemia, death, postoperative cardiac and pulmonary complications, pneumonia, and urinary tract infection. The researchers used a risk-reduction model to calculate how adding one hour of RN care per patient per day would affect the rates of these adverse outcomes.

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Their analysis showed that the largest reductions in complications would be seen at hospitals with the lowest levels of RN staffing. In the estimate, rates of cardiopulmonary complications declined by 4.4%; pneumonia, by 2.3%; and postoperative septicemia and other infections (except urinary tract infection), by 3.8%. Hospitals with the highest staffing levels benefited from additional RN care as well, but the reductions in complications were smaller. For instance, postoperative cardiopulmonary problems fell by 3.1%; pneumonia cases, by 1.7%; and cases of septicemia and other infections, by 3.4%. Moreover, the results suggest that postoperative cardiopulmonary complications could have been avoided in an estimated 425 to 596 children, pneumonia in 95 to 124 children, and septicemia in 719 to 787 others, had enough RNs been in place during the study period. The estimated rates of death and postoperative urinary tract infections were not decreased by increases in RN staffing.


"We still don't know what the 'correct' staffing ratios are," notes lead researcher Barbara Mark. She also points out that although California mandates minimum staffing ratios, their impact on care quality still must be evaluated. For states or hospitals considering such guidelines, says Mark, "it's important to have the broad participation of nurses in formulating them."


Carol Potera



Common food additives boost hyperactivity in children with no history of behavioral problems like attention deficit-hyperactivity disorder. A British study published online by the Lancet (September 6) examined the effects of common additives, such as "sunset yellow," "allura red," and tartrazine (a yellow coloring), along with sodium benzoate, on children's behavior. Two beverages and a placebo drink were tested in 153 three-year-olds and 144 eight- and nine-year-olds who were randomly assigned to drink one of the beverages. After a six-week period, teachers, parents, and trained observers evaluated the children, and children in the older group completed a test to assess attention and inhibition control. The additives raised the level of hyperactive behaviors, such as inattention, impulsiveness, and overactivity, in both age groups.


Calcium supplements in people age 50 and older: evidence supports their use in preventing bone loss and fractures, according to a metaanalysis published in the August 25 issue of the Lancet. The analysis of 29 studies involving 63,897 people showed that calcium supplements, with or without added vitamin D, reduced fractures and lowered the rate of bone loss at the hip and the spine. Calcium doses of 1,200 mg or higher were more effective than lower doses in decreasing fracture risk. Vitamin D in doses of 800 IU or higher also lowered fracture risk more effectively than lower doses did. The supplements particularly helped people who were elderly, were institutionalized, weighed less, or consumed little calcium.


Mark BA, et al. Policy Polit Nurs Pract 2007;8(2):83-92.