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Take Note – April 2009


President Obama picks ANA’s Mary Wakefield as next HRSA administrator

Longstanding ANA member Mary Wakefield, PhD, RN, FAAN, has been named administrator of the Health Resources and Services Administration (HRSA, part of the U.S. Department of Health and Human Services).

An expert on rural health and nursing workforce issues, Dr. Wakefield has extensive knowledge of the healthcare system and policy-making process. As HRSA Administrator, she’ll lead the agency in improving access to health care for people who are uninsured, isolated, or medically vulnerable. Most recently, Dr. Wakefield was the Associate Dean for Rural Health at the University of North Dakota School of Medicine and Health Sciences, where she was a tenured professor and Director for the Center for Rural Health.

Read more about Mary Wakefield’s appointment to HRSA Administrator.


Predischarge patient education cuts readmissions and ED visits

About one in five patients has a complication or an adverse event such as a drug interaction after hospital discharge. These episodes can impair recovery and necessitate readmission or an emergency department (ED) visit, both of which are costly. A new study found that patients who understood their discharge instructions were 30% less likely to be readmitted or visit the ED than other patients. As a result, their total costs (actual hospital costs combined with estimated outpatient costs) were an average of $412 lower. In a randomized controlled trial, the research team used the Re-Engineered Hospital Discharge Program (RED) to teach patients about their post-hospital care plans. Specially trained nurses helped one group of patients arrange follow-up appointments, confirm drug routines, and understand their diagnoses. Thirty days after discharge, patients in the RED program had 30% fewer subsequent ED visits and readmissions than the other group.

Read more about the benefits of educating patients before they leave the hospital.


When it comes to exercise, think 50 minutes—not 30

To maintain weight loss and lose extra pounds, the American College of Sports Medicine now recommends 50 minutes or more of moderate to intense physical activity five times per week. This upward revision of the group’s 2001 guidelines (which recommended about 30 minutes daily five times per week) is based on recent evidence showing overweight people need more exercise to achieve significant weight loss and prevent weight gain.

Read more about adult weight loss and weight regain.


Stem-cell transplantation reverses neurologic deficits in early MS

Transplanting stem cells can reverse symptoms of early-stage multiple sclerosis (MS). In a new study, 21 patients with relapsing-remitting MS who hadn’t responded to interferon beta therapy underwent autologous nonmyeloablative hematopoietic stem-cell transplantation. After 3 years, all patients were free of disease progression, about 75% hadn’t relapsed, and 81% showed neurologic improvement.

Read more about adult weight loss and weight regain.


Occupational exposure to organic solvents raises females’ lymphoma risk

Females exposed to chlorinated solvents on the job have a 40% higher risk of non-Hodgkin’s lymphoma (NHL). Carbon tetrachloride exposure more than doubles the risk, while formaldehyde exposure increases the risk by 30%. The case-control study, conducted in 1996 to 2000 among Connecticut women, involved 601 cases of NHL and 717 controls. Researchers used a job-exposure matrix to evaluate occupational exposure. Subjects who’d ever been exposed to any organic solvent in a work setting had a borderline increased risk of NHL; subjects with an average probability of exposure to any organic solvent at a medium-high level had a significantly higher risk.

Maternal obesity linked to increased risk of birth defects

Offspring of obese (but not overweight) mothers may be at increased risk for certain congenital abnormalities. Researchers who analyzed 18 observational studies of pregnant women with children born with such abnormalities found that those who were obese before pregnancy or during early pregnancy were more likely than other women to have offspring with neural tube defects, cardiovascular anomalies, cleft lip and/or palate, and other congenital abnormalities. Undiagnosed diabetes or hyperglycemia and maternal nutritional deficiencies may partially explain the congenital abnormalities.

CDC confirms first U.S. case of Marburg fever

An American who’d traveled to Uganda in January 2008 has been confirmed as the first U.S. case of Marburg hemorrhagic fever. The patient, now recovered, developed the illness 4 days after returning to the United States; the case was diagnosed retrospectively in January 2009. Initial testing of samples collected during the patient’s acute illness failed to show evidence of Marburg infection. However, analysis of a convalescent sample found a possible previous infection, and more detailed testing at the Centers for Disease Control and Prevention (CDC) confirmed Marburg. The patient probably acquired the illness from contact with bats while visiting Uganda’s “python cave,” a popular tourist destination inhabited by thousands of bats.

For minor stroke and TIA, urgent treatment cuts recurrences and costs

Immediate referral and treatment of patients experiencing minor strokes or transient ischemic attacks (TIAs) lower the recurrence rate and reduce overall costs. In phase 1 of a two-phase trial, roughly 300 patients with TIA or minor stroke were referred to a specialty care clinic through their primary physicians and received care several days later. In phase 2, a similar number of patients went to the specialty care clinic immediately and started treatment that day. Previously, the researchers reported that in phase 2 (immediate referral), stroke recurrences after 90 days fell by 80% compared to phase 1. On further analysis, they found that phase-2 treatment also lowered fatal or disabling strokes, the overall number of hospital bed-days, hospital costs, and 6-month disability.

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