FLU

Updated and age-adjusted estimates of influenza vaccine effectiveness for the 2012-13 season show it was moderately effective overall, but much less so in seniors.

Overall, influenza vaccination reduced the risk for medical visits resulting from influenza A and B by 56% — including by 47% from influenza A (H3N2) and by 67% from influenza B, according to a report issued by the Centers for Disease Control and Prevention.

The preventive benefits against influenza B were consistent across age groups. The adjusted vaccine effectiveness estimates against influenza A (H3N2) viruses also were largely consistent (46%-58%) for people ages 6 months to 64 years, but the vaccine effectiveness estimate was only 9% among people ages 65 and older.

Confirmation of the protective benefits of the 2012-13 influenza vaccine among people 64 and younger, the report's authors wrote, "offers further support for the public health benefit of annual seasonal influenza vaccination and supports the expansion of vaccination, particularly among younger age groups."

Meanwhile, the low rate of effectiveness among seniors "reinforces the need for continued advances in influenza vaccines, especially to increase protective benefits for older adults."

"This finding should not discourage future vaccination by [people ages 65 and older], who are at greater risk for more severe cases and complications from influenza," the authors wrote. "Influenza vaccines remain the best preventive tool available, and [vaccine effectiveness] is known to vary by virus type/subtype, age group, season, host immunity and the outcome measured."

The authors noted the vaccine effectiveness estimates in the report are limited to the prevention of outpatient medical visits instead of more severe illness outcomes such as hospitalization or death.

To clinicians, the authors advise maintaining "a high index of suspicion for influenza infection among persons with acute respiratory illness while influenza activity is ongoing. Early antiviral treatment can reduce influenza-associated illness severity and complications."

The authors recommend "initiating antiviral medications for patients with suspected influenza, regardless of their influenza vaccination status," if they are 65 or older, hospitalized, have progressive or complicated illness or otherwise are at higher risk for complications from influenza.

"Antiviral treatment can be initiated empirically, preferably within 48 hours after illness onset, and should not be delayed pending confirmatory diagnostic testing nor be dependent upon tests with limited sensitivity (e.g. negative rapid tests). Among hospitalized patients, treatment should be initiated on admission."

The vaccine effectiveness estimates are not final, according to the report. An increased sample size and adjustment for additional potential confounders (such as chronic medical conditions and functional status) at the end of the season could change them.

The full report is available in the Feb. 22 edition of the Morbidity and Mortality Weekly Report at www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a2.htm?s_cid=mm6207a2_w.

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STAFFING RATIOS

D.C. Hospitals And Nurses Fight Over Staffing Ratios

Topics: Quality, States

By David Schultz

Feb 22, 2013

Hospital administrators in Washington, D.C., are furiously lobbying against a bill modeled on a California law that would require them to maintain a minimum nurse-to-patient ratio at all times.
Nursing unions say the proposed Patient Protection Act codifies into law minimum staffing levels that are needed to maintain patient safety, while hospitals say the cost of hiring new nurses to comply with the law would put them out of business.
The ratios called for in the bill vary depending on the hospital department. In a pediatrics unit, the bill would require no less than a 1-to-4 nurse-to-patient ratio. In the operating room, hospitals would have to maintain a 1-to-1 ratio -- one nurse for every patient at all times.
Deidre Beckford, a nurse at MedStar Washington Hospital Center who has worked there for more than 20 years, says understaffing has forced her to take care of five to six patients at a time.
"There are times when I have to do the dressing on patients and I can’t get to it," she said. "I have to put antibiotics on patients and they're late. You have to turn patients every two hours and you can’t get to it. It infringes on their care."
Washington Hospital Center didn’t respond to Beckford’s claims about infringed patient care, but its chief nursing executive, Sue Eckert, said in an email to KHN that the hospital manages its staffing levels collaboratively with nurses and that those levels can fluctuate depending on how many patients it has and how sick those patients are.
The nursing bill in D.C. would reduce some of this fluctuation. It’s modeled after a nearly identical law that took effect in 2004 in California, the only state to require minimum staffing ratios in its hospitals. So far, it’s unclear whether this requirement has had a positive or negative effect in California hospitals.
Studies have shown that the law has led to an increase in nurse hiring in California and a decrease in nurse turnover due to burnout. But researchers also found that the law put significant financial pressure on some hospitals.
When it comes to the ultimate question of whether this law reduced patient mortality, Teresa Serratt, a nursing professor at the University of Nevada, Reno, who has examined the effects of the California law, says the data are inconclusive.
"That's the big question everyone wants an answer to," she said.
Citing positive outcomes of the California law, the labor union National Nurses United is strongly pushing for the staffing ratio bill in D.C., which has been assigned to a committee but has no scheduled hearings as of yet. Nine of the Council’s 13 members signed on as co-introducers last week.
But the District of Columbia Hospital Association is waging an all-out campaign against it, supporting a competing bill that contains many of the same provisions as the Patient Protection Act but without the staffing ratio mandate. Robert Malson, the association’s president, says his organization is also scheduling individual meetings with every council member to try to persuade some of them to change their minds.
Malson said he's been informing them of "exactly which hospitals would go out of business, and in which sequence" if the Patient Protection Act passes, though he wouldn’t share that information with KHN.
He said the bill is an attempt to get legislators involved in D.C. hospitals' labor negotiations with its nurses, which have been far from harmonious in recent years. Almost two years ago, nurses at Washington Hospital Center staged a 24-hour strike a few months after voting overwhelmingly to join NNU, the largest nursing union in the country.
Serratt says the dueling bills are a sign that the relationship between hospitals and nurses in D.C. has grown dysfunctional.
"If you have really strong communication and good people on both sides of the table, we wouldn’t have the government getting in the middle of this kind of stuff," she said.


















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CNA Class

 Fun and games at virtual day.

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I wouldn't have bothered to get out of bed

I just had an Alzheimer resident tell me "the program was stupid and now they won't let me leave. What kind of program is this? If I had known it was going to be like this I wouldn't have bothered to get out of bed!"
I had to agree!

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Smoking Deaths Now Equal in Women and Men

By Nancy Walsh, Staff Writer, MedPage Today

Published: January 23, 2013

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

 

Action Points

• The risk of death from cigarette smoking continues to increase among women, and the increased risks are now nearly identical for men and women as compared with persons who have never smoked, a study has found.
• Note that individuals who quit between ages 25 and 34 had a 10-year increase in life expectancy.

Smoking continues to kill Americans at a staggering rate, with women now as likely to die from tobacco-related disease as men, two large surveys found.
In one national survey, the rate of all-cause mortality was three times higher for smokers than for nonsmokers, with a hazard ratio of 2.8 (95% CI 2.4 to 3.1) for men and 3 (95% CI 2.7 to 3.3) for women, according to Prabhat Jha, MD, of the Center for Global Health Research in Toronto, and colleagues.
In a second study, the relative risk of death from any cause among a contemporary cohort of smokers was 2.80 (95% CI 2.72 to 2.88) for men and 2.76 (95% CI 2.69 to 2.84) for women, reported Michael J. Thun, MD, of the American Cancer Society in Atlanta, and colleagues.
"Most people in the U.S. assume that smoking is on its way out. But the grim reality is that smoking still exerts an enormous toll on the health of Americans," Steven A. Schroeder, MD, of the University of California San Francisco, wrote in an editorial accompanying the studies in the Jan. 24 New England Journal of Medicine.
The study by Jha and colleagues included 216,917 adults who participated in the U.S. National Health Interview Survey during the years 1997 to 2004.
Those who reported current smoking had less education, were less likely to be overweight or obese, and drank more alcohol.
Women in this cohort were less likely than men to quit smoking.
During about 7 years of follow-up, 7,479 men and 8,236 women in the cohort died.
Analysis of the mortality data revealed that people who had never smoked were twice as likely to live to age 80 compared with current smokers.
Among men, the likelihood of living to 80 was 61% (95% CI 55 to 67) for nonsmokers, falling to 26% (95% CI 18 to 33) for those who continued to smoke.
For women, the corresponding numbers were 70% (95% CI 64 to 76) and 38% (95% CI 30 to 45), according to Jha and colleagues.
Hazard ratios for death from lung cancer were "notably high" for both women (HR 17.8, 95% CI 11.4 to 27.8) and men (HR 14.6, 95% CI 9.1 to 23.4), the researchers found.
In addition, hazard ratios for death from ischemic heart disease among current smokers were 3.5 (95% CI 2.7 to 4.6) for women and 3.2 (95% CI 2.5 to 4.1) for men.
Jha and colleagues also examined the effects of smoking cessation and found that individuals who quit between ages 25 and 34 had a 10-year increase in life expectancy, while those who quit at ages 35 to 44 had a 9-year increase.
Even those who quit at ages 45 to 54 had a gain of 6 years, and those who stopped between ages 55 and 64 could expect an additional 4 years.
Overall, smoking cessation by about age 40 reduced the risk of death by 90%, the researchers found.
Between 1965 and 2010 the prevalence of smoking among American adults fell from 42% to 19%, but 30 million people worldwide begin smoking each year.
"On the basis of current rates of smoking initiation and cessation, smoking, which killed about 100 million people in the 20th century, will kill about 1 billion in the 21st century," Jha and colleagues predicted.
Limitations of the study included the possibility of confounding variables and cause of death misclassification.
The study by Thun and colleagues compared mortality rates in several historical and contemporary cohorts over three time periods, 1959 to 1965, 1982 to 1988, and 2000 to 2010.
In the earliest time period, the relative risk for lung cancer-related mortality among smokers was 12.22 for men but only 2.73 for women, yet by the latest period the risk for men was 24.97 and had risen to 25.66 for women.
Between the 1980s and the later periods there also was a doubling of mortality risk associated with chronic obstructive pulmonary disease in men, from a relative risk of 9.98 to 25.61, and in women, from 10.35 to 22.35.
This increase may relate to the different design of cigarettes today, which allow deeper inhalation into the lung parenchyma, the investigators wrote.
In the latest cohort, risks of death from ischemic heart disease also rose among smokers, to 2.86 for women and 2.50 for men.
The researchers noted that the finding of "nearly identical" risks for women and men in the latest time period was "new and confirms the prediction that, in relative terms, 'women who smoke like men die like men,'" meaning that they begin earlier and smoke more heavily than in the past.
Limitations of this study included its population of predominantly white adults who were mostly 50 and older.
In his editorial, Schroeder emphasized the increased importance of smoking as a health hazard for women.
"More women die of lung cancer than of breast cancer. But there is no 'race for the cure' for lung cancer, no brown ribbon, and no group analogous to the Susan G. Komen Breast Cancer Foundation," he pointed out.
In addition, the growing stigma associated with smoking has resulted in the habit being concentrated among the less privileged, and "it risks becoming invisible to those who set health policies and research priorities," he wrote.
Further efforts toward smoking prevention and cessation remain an urgent need, he concluded.


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