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Take Note – August 2008


Voluntary DNP certification test available in fall    
Doctor of nursing practice (DNP) graduates will be able to take a voluntary certification test beginning this fall. Created by the National Board of Medical Examiners and based on the medical licensing exam, the test could help establish a national standard for DNPs and enhance the profession’s credibility. (By 2015, roughly 200 nursing schools are expected to offer the DNP degree—a 2-year program open only to those with master’s degrees in advanced-practice nursing.) Test proponents say DNPs’ diagnostic and disease-management skills are comparable to those of primary care physicians. But some physicians are concerned that DNPs will use the test as leverage to seek scope-of-practice expansions that impinge on medical practice.

Study suggests genetic basis for metabolic syndrome                       
Five common variations on the CD36 gene increase the risk of developing metabolic syndrome (linked to cardiovascular disease and type 2 diabetes). A new study found that people with metabolic syndrome run four times the risk of heart disease and seven times the risk of diabetes as those without the condition. The researchers believe CD36 variants may influence the pathophysiology of metabolic syndrome and the metabolism of high-density lipoproteins. Greater understanding of the links among the CD36 gene, obesity, and disease risk may allow earlier identification and intervention for those susceptible to the syndrome.

C. difficile hospitalizations and deaths are on the rise    
Clostridium difficile infections are becoming more severe, more drug-resistant, and more deadly. A recent study found that hospitalizations for C. difficile–associated diseases (CDAD) increased 23% annually from 2000 to 2006, and the absolute number of CDAD hospitalizations more than doubled in all age-groups except the youngest, for whom they increased by 74%. In addition, C. difficile has grown resistant to some third-generation cephalo­sporins and fluoroquinolones. Alarmed with the rapid growth rate of the disease, the study authors are calling for research into the best preventive strategies, such as restricting the use of antimicrobial agents in human disease and the food supply.

Joint Commission announces 2009 National Patient Safety Goals       
The Joint Commission has released 2009 National Patient Safety Goals and related requirements for its accreditation programs and Disease-Specific Care Certification Program. The new goals give healthcare organizations proven solutions to persistent patient safety problems. Major changes include three new hospital and critical-access hospital requirements related to preventing deadly health care–associated infections caused by multiple drug-resistant organisms, central line–associated bloodstream infections, and surgical site infections.

Light exposure and melatonin improve cognitive and noncognitive functions in dementia patients               
Elderly dementia patients exposed to bright light during the day and given melatonin supplements showed a 5% decrease in mental decline, a 19% reduction in depression symptoms, and a 53% relative slowing of loss of ability to cope with daily living. Bright light and melatonin are the two major synchronizers of the circadian rhythm system (which regulates sleep schedules). In this recent Netherlands study, researchers who exposed patients to sunlight through large windows and added fluorescent fixtures found that light in conjunction with melatonin improved mental functioning about as well as drugs used to treat Alzheimer’s disease. However, they recommend giving melatonin only in combination with light therapy because it can adversely affect mood.

Aggressive blood glucose control may not decrease death in diabetics          
Two large studies found that drug therapy to achieve rigorous blood glucose regulation may not cut the risk of heart attack, stroke, or death in patients with type 2 diabetes mellitus. The U.S. trial was halted early when researchers found that 5% of patients receiving intensive drug therapy died before the end of the study, compared with 4% of patients under standard treatment. The Australian trial didn’t find a rise in deaths, but failed to find protection from cardiovascular disease. Both studies contradicted the long-held hypothesis that tight glycemic control protects diabetics against cardiovascular disease. Researchers recommend at least moderate blood glucose control to guard against renal, neurologic, and ophthalmologic diabetes complications. To avert cardiovascular complications, they stress that the only proven methods are statin therapy to control cholesterol, antihypertensives to control blood pressure, and aspirin to control blood clotting.

Silver-lined endotracheal tubes reduce risk of ventilator-associated pneumonia caused by resistant organisms         
A secondary analysis of a randomized, multinational trial has found that using endotracheal tubes lined with silver halves the risk of ventilator-associated pneumonia (VAP) caused by drug-resistant organisms. The silver-coated tubes were more effective than standard plastic tubes in preventing VAP caused by methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, or Acinetobacter baumannii. The silver has antibiotic properties but can’t leach off and isn’t absorbed by blood. Although silver-lined tubes cost about 10 times more than standard tubes, a single case of VAP can run about $40,000, with a mortality nearing 30%.

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