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Pennsylvania’s nursing shortage will get worse before it gets better, according to a report recently released by the Hospital and Healthsystem Association of Pennsylvania (HAP) in Harrisburg. Pennsylvania Nurses: Meeting the Demand for Nursing Care in the 21st Century summarizes data from a number of sources into a bleak, comprehensive look at the demand for, and supply of, registered nurses in that state over the next two decades.
"This report clearly delineates the dilemma facing not just health care providers, but all people who use the health care system," says Carolyn F. Scanlan, president and chief executive officer of HAP. "All of the demographic trends are going in the wrong direction, and these trends now appear to be long-term rather than cyclical."
She continues, "The nursing shortage is a result of many factors, including declining enrollments in and graduations from nursing schools and an older, sicker population. The shortage is complicated by a shaky financial condition in Pennsylvania’s hospitals and a broader range of job opportunities for all workers."
HAP has developed several resources to generate interest in nursing careers. The brochure, Nursing Opportunities Unlimited, promotes health care careers in nursing to a diverse population. The You Can Be a Nurse, too activity book, and the PaHealthCareers.org web site also were developed to encourage young people to consider careers in nursing. An Adobe PDF version of the report can be downloaded from www.haponline.org/hhap/. Click on workforce to access the report.
It’s no longer necessary to avoid using an oral prescription treatment to improve lipid profiles in patients with diabetes, according to researchers from the University of Texas Southwestern Medical Center in Dallas.
Researchers found that six weeks of treatment with extended-release niacin helped patients with type 2 diabetes improve readings on two primary cholesterol-related endpoints, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Researchers also found that lipid improvements were achieved without triggering major adverse effects in their blood sugar levels, as measured by changes in hemoglobin A1C levels, the study’s other primary endpoint.
Treatment with Niaspan, a once-daily formulation of niacin, resulted in an average increase of 24% in HDL-C for patients with diabetes receiving 1,500 mg, compared to a 20% increase in HDL-C in patients receiving 1,000 mg over the same time period. Patients receiving placebo increased HDL-C levels by 4% compared to baseline. In addition, patients receiving 1,000 mg reduced their TG by 15% compared to a 29% reduction in the 1,500 mg group. Patients in the placebo group reduced their TG by 5%.
A total of 148 patients with dyslipidemia or abnormal lipid levels primarily characterized by low HDL-C and elevated TG were enrolled in the double-blind study at 20 treatment sites and randomized to receive either 1,500 mg of Niaspan, 1,000 mg of Niaspan, or placebo. Enrollment was limited to patients with type 2 diabetes with HDL-C less than 40 mg/dL or, for patients already on a statin, LDL-C levels of less than or equal to 130 mg/dL.
"This study convincingly demonstrates that not only is extended-release niacin a relatively safe drug for use in patients with diabetes at these doses, but such patients who have lower than average HDL levels should be considered candidates for this treatment," notes study presenter, Gloria Vega, PhD, director of the Nutrition and Metabolism Laboratory at the Veteran’s Administration Medical Center and professor of clinical nutrition at the University of Texas Southwestern Medical Center.
Patient HgbA1c levels were largely unchanged, researchers noted. Hemoglobin levels for patients receiving 1,000 mg of niacin were measured at 7.21% at baseline and 7.33% after six weeks of therapy. Hemoglobin levels for patients receiving 1,500 mg were measured at 7.21% at baseline compared to 7.48% after six weeks of therapy. Further, only four patients were discontinued from the study because of inability to control glucose.
MEDecision in Wayne, PA, recently released CaseAlert, a software system that enables managed care organizations to analyze provider, facility, and pharmacy data to identify high-risk and high-cost patients.
The predictive software identifies both patients already at risk and those likely to be at risk. It also stratifies members for purposes of referring them to appropriate care management services. The software processes information from Oracle data repositories and is compatible with other MEDecision products including its claims and care management software solutions.
Patients with coronary artery disease (CAD) and type 2 diabetes who received metformin therapy at the time of hospital discharge had an improved long-term survival rate compared to patients taking other oral diabetes pills or insulin.
Researchers at the LDS Hospital in Salt Lake City followed 1,428 patients with type 2 diabetes and documented severe CAD prospectively for an average of 2.5 years. They found that patients with type 2 diabetes and CAD who were prescribed metformin at the time of hospital discharge had a 13.5% death rate compared to a 15.7% death rate in patients placed on other oral diabetes pills, and a 28.2% death rate for patients placed on insulin. Researchers found no significant differences in the rate of heart attacks experienced in all three patient groups.
Researchers from Brigham and Women’s Hospital in Cambridge, MA, found that the cholesterol-lowering drug pravastatin lowers levels of C-reactive protein (CRP) in people with heart disease and people at risk for heart disease.
The PRINCE (Pravastatin Inflammation CRP Evaluation) study included 2,400 participants with no prior history of heart disease. Researchers used a new high-sensitivity CRP test to measure CRP levels. CRP, a marker for arterial inflammation, recently has been shown to add significantly to cholesterol screening in determining a patient’s risk of developing heart disease.
Patients were selected randomly to receive either 40 mg of pravastatin or placebo. Patients were followed for 24 weeks. Researchers found that patients who took pravastatin reduced their median levels of CRP by more than 13%, while those who took placebo saw no reduction in their median CRP levels.
• Oct. 22 -24. The Sixth Annual Disease Management Congress and Exposition. Hynes Convention Center, Boston. Sponsored by the National Managed Health Care Congress. Topics include: policy implications of e-health and finding ways to pay for disease management. Continuing education approved for CRC, CCM, CPHQ, CDMSC, and others. Cost is $1,795. A discount is available for government employees and students. Contact: NMHCC, PO Box 414521, Boston, MA 02241-4521. Telephone: (888) 882-2500. Fax: (941) 365-0157. Web site: www.nmhcc.org.
• Nov. 3-7. HIAA 2001 Forum: Serving Customers/Creating Success. Renaissance Orlando (FL) Resort. Sponsored by the Health Insurance Association of America in Washington, DC. Tracts include: medical issues, government relations, and operations and finance. Cost is $595 for HIAA members and $745 for nonmembers. Contact: HIAA, 1202 F St. NW, Suite 500, Washington, DC 20004-1204. Telephone: (703) 968-8863. Fax: (202) 824-1720. Web site: www.hiaa.org.
If you have a new resource, conference, or seminar of interest to other case managers, send items for publication in the Resource Bank supplement to Russ Underwood, managing editor, Case Management Advisor, PO Box 740056, Atlanta, GA 30374. Phone: (404) 262-5521. Fax: (404) 262-5447. E-mail: firstname.lastname@example.org. Information on conferences and seminars should be received at least 12 weeks before the event to meet publication deadlines.