Nursing shortage has been a growing problem in US hospitals. To determine
whether hospital nurse staffing levels affect patient outcomes and nurse retention,
Aiken and colleaguesArticle conducted a survey of registered nurses at adult general
hospitals in Pennsylvania and analyzed data on 30-day mortality and deaths
following complications (failure-to-rescue) among surgical patients and on
hospital characteristics obtained from hospital administrative databases.
In hospitals with high patient-to-nurse ratios, surgical patients experienced
higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses
were more likely to experience burnout and job dissatisfaction. In an editorial,
O'Neil and SeagoArticle discuss changes in nursing education, nursing practice, and
professional organization that are necessary to address the nursing shortage.
Studies indicate that risk of coronary heart disease (CHD) is inversely
related to physical activity. In this analysis of data from men enrolled in
the Health Professionals' Follow-up Study, a prospective cohort study of men
aged 40 through 75 years that began in 1986, Tanasescu and colleagues found
that increased total physical activity was associated with reduced risk of
CHD in a dose-dependent manner. Running, rowing, and weight training were
each associated with reduced CHD risk. Average exercise intensity was associated
with reduced CHD risk independent of the total volume of physical activity.
Traumatic or bloody lumbar puncture (LP) reduces the diagnostic value
of the procedure and may adversely affect outcomes of patients with acute
lymphoblastic leukemia (ALL) if leukemic cells or bacteria circulating in
the blood are introduced into the cerebrospinal fluid. Howard and colleagues
analyzed outcomes of lumbar punctures performed on children with newly diagnosed
ALL to determine risk factors for traumatic or bloody LP. Unmodifiable risk
factors included black race, age younger than 1 year, a traumatic or bloody
previous LP performed within the past 2 weeks, and a previous LP performed
when the platelet count was 50 × 103/µL or less. Modifiable
risk factors included procedural factors as reflected by treatment era, platelet
count of 100 × 103/µL or less, an interval of 15 days
or less between LPs, and a less experienced practitioner.
Evidence on the association between homocysteine levels and risk of
cardiovascular disease has been inconsistent. In a meta-analysis of observational
studies of associations between ischemic heart disease or stroke risk and
homocysteine concentrations, the Homocysteine Studies CollaborationArticle found
that lower homocysteine levels were modestly associated with reduced risk
of ischemic heart disease and stroke. Risks of these cardiovascular events
associated with homocysteine level were weaker in prospective studies than
in retrospective studies. In a meta-analysis of case-control studies, Klerk
and colleaguesArticle assessed the association between the MTHFR 677C→T polymorphism, a genetic alteration in an enzyme involved
in folate metabolism that causes elevated homocysteine levels, and risk of
coronary heart disease. Individuals with the MTHFR 677
TT genotype had a significantly higher risk of coronary heart disease than
individuals with the CC genotype. In an editorial, WilsonArticle suggests that measurement
of homocysteine levels and genetic testing for MTHFR variants
be reserved for selected high-risk individuals.
Mr J has obstructive sleep apnea but was unable to tolerate treatment
with nasal continuous positive airway pressure. Kuna discusses the definition
and diagnosis, epidemiology, pathophysiology, and clinical assessment and
management of obstructive sleep apnea.
Applications of clinical informatics.
Scientists have long sought the identity of a substance secreted by
certain white blood cells of individuals infected with HIV whose immune system
keeps the virus in check. Now researchers report that they have identified
components of this elusive anti-HIV factor.
A study of obese women suggests that android obesity may be associated
with a low-grade inflammatory state that triggers persistent platelet activation,
mediated perhaps by enhanced lipid peroxidation.
A discussion of career options and training pathways in academic general
For your patients: Information about lumbar puncture.
This Week in JAMA. JAMA. 2002;288(16):1943. doi:10.1001/jama.288.16.1943