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Take Note – March 2008


Updated guidelines on end-of-life care
To improve the quality of palliative end-of-life care, the American College of Physicians has revised its guidelines. According to the new recommendations, clinicians should regularly evaluate end-of-life patients for pain, dyspnea, and depression and ensure that patients complete advance care planning, including advance directives.

Registered nurses have a lower risk of death
A large Canadian study indicates that registered nurses (RNs) have a lower risk of dying from several conditions—including heart disease, stroke, and cancer—than the general population. However, the study of mortality data for 58,125 RNs also found that nurses working at least 15 years had a significantly increased risk of malignant melanoma and rectal cancer and that nurses in the profession for 25 years or more had an increased risk of breast and lung cancer compared with nurses working less than 5 years.

No payment for medical errors
Last year, Medicare announced that starting October 2008 it will no longer reimburse hospitals for treating certain preventable, hospital-acquired injuries and infections. Now, the private health insurance companies are adopting Medicare’s approach. According to the insurance companies, the change will force hospitals to improve safety.

Dengue threat moving north
A mosquito-borne illness of tropical and subtropical climates, dengue is becoming a serious problem along the United States–Mexico border and may continue spreading into temperate climates. Researchers at the National Institute of Allergy and Infectious Diseases say that dengue currently has a small impact in the United States, but the illness tends to occur in explosive epidemics, and there are no specific treatments or vaccines. Worldwide, dengue kills about 22,000 people a year. www3.niaid.nih.gov/news/newsreleases/2008/dengue.htm

Dangers of intensive insulin therapy and pentastarch resuscitation
A New England Journal of Medicine study found that intensive insulin therapy or pentastarch fluid resuscitation puts patients with severe sepsis at high risk for adverse events. The study was stopped early because of the number of hypoglycemic events in patients receiving intensive insulin therapy. Among those receiving pentastarch, the researchers noted a “significantly greater incidence of renal failure and a trend toward higher 90-day mortality.”

Real-time test for respiratory viruses
The Food and Drug Administration has cleared for marketing a molecular biology device that detects four common respiratory viruses in about 3 hours. The quick results are beneficial because antiviral drugs are most effective when therapy starts within the first 2 days of symptoms. The four viruses—influenza A virus, influenza B virus, and respiratory syncytial virus A and B—are among the leading causes of lower respiratory tract infections.

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