Study on the Economic Value of Nursing

  • Author: Health Informer
  • Filed under: Health News
  • Date: Dec 27,2008

The American Nurses Association (ANA) is pleased to announce, on behalf of the larger nursing community, the release of a first of its kind study quantifying the economic value of nursing.

The study was conducted by the Lewin Group, supported by grants from Nursing’s Agenda for the Future, the ANA and a coalition of nursing associations dedicated to addressing nursing workforce issues. The research, first proposed in 2003 and published in the current issue of the journal Medical Care, is the result of years of analysis of data on the correlation between patient outcomes and nurse staffing levels. To read the complete article please visit www.lww-medicalcare.com.

“Nurses are a vital component to the health care system,” said ANA President Rebecca M. Patton, MSN, RN, CNOR. “This nursing funded study provides a model that shows how nurses affect the delivery of cost-effective, high quality care, and prevent adverse events.

This project was the culmination of years of research that could not have been possible without the tireless work and cooperation of The American Association of Critical Care Nurses, the American Association of Colleges of Nursing, the Oncology Nursing Society, the American Organization of Nurse Executives, and the 85 other nursing organizations who contributed to the project. I applaud their outstanding efforts, and commend them on this significant contribution to the nursing profession.”

The research culled findings from 28 different studies that analyzed the relationship between higher RN staffing and several patient outcomes: reduced hospital-based mortality, hospital-acquired pneumonia, unplanned extubation, failure to rescue, nosocomial bloodstream infections, and length of stay. The findings demonstrate that as nursing staffing levels increase, patient risk of complications and hospital length of stay decrease, resulting in medical costs savings, improved national productivity and lives saved.

“Estimates from this study suggest that adding 133,000 RNs to the acute care hospital workforce would save 5900 lives per year. The productivity value of total deaths averted is equivalent to more than $1.3 billion per year, or about $9900 per additional RN per year.” The additional nurse staffing would decrease hospital days by 3.6 million. More rapid recovery translates into increased national productivity, conservatively estimated at $231 million per year. “Medical savings is estimated at $6.1 billion, or $46,000 per additional RN per year. Combining medical savings with increased productivity, the partial estimates of economic value averages $57,700 for each of the additional 133,000 RNs.”

The research findings suggest significant policy related issues. First and foremost, healthcare facilities cannot realize the full economic value of professional nursing due to current reimbursement systems. Additionally, the economic value of nursing is “greater for payers than for individual healthcare facilities.”

The ANA is the only full-service professional organization representing the interests of the nation’s 2.9 million registered nurses through its 54 constituent member nurses associations, its 23 organizational affiliates serving 330,000 members of national nursing specialty organizations, and its workforce advocacy affiliate, the Center for American Nurses. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

Source: American Nurses Association


New Gonadotropin-Releasing Hormone (GnRH) Receptor Antagonist Demonstrates Rapid, Long-term Suppression of Testosterone – a hormone that stimulates prostate cancer growth.

Ferring Pharmaceuticals, USA today received approval from the U.S. Food and Drug Administration (FDA) for degarelix, a new injectable gonadotropin-releasing hormone (GnRH) receptor antagonist, indicated for patients with advanced prostate cancer. Potential trade names are still under review with the FDA. Following issuance of a trade name, Ferring Pharmaceuticals, USA will immediately begin commercialization in the U.S. On December 18, the Committee for Medicinal Products for Human Use (CHMP), part of the European Medicines Agency (EMEA), recommended granting a marketing authorization for degarelix in Europe. Degarelix is awaiting approval in other key global markets. It is a milestone for the company and represents Ferring’s first global product launch.

Phase III studies showed that degarelix is at least as effective as leuprolide (Lupron Depot(R)) in sustaining castrate levels or lower of testosterone, and had a statistically significant faster reduction of testosterone. At Day 3 of treatment, 96% of degarelix patients achieved castrate levels of testosterone, compared with zero percent receiving leuprolide. By Day 14, 99% of degarelix patients achieved castrate levels of testosterone, compared with 18% receiving leuprolide.

In the clinical trial, prostate specific antigen (PSA) levels were also monitored as a secondary endpoint. PSA levels were lowered by 64% two weeks after administration of degarelix, 85% after one month, 95% after three months, and remained suppressed throughout the one year of treatment. These PSA results should be interpreted with caution because of the heterogeneity of the patient population studied. No evidence has shown that the rapidity of PSA decline is related to a clinical benefit.

Prostate cancer is known to grow in the presence of testosterone. Suppression of testosterone has been a treatment goal for advanced prostate cancer for many years. Surgical castration was the standard method of reducing testosterone from the 1940s until the mid-1980s when the earliest forms of medical castration, luteinizing hormone releasing hormone (LHRH) agonists, were introduced.

Degarelix is the only GnRH receptor antagonist approved by the FDA for the treatment of hormonally-sensitive advanced prostate cancer. Degarelix achieves medical castration differently than LHRH agonists, specifically by binding reversibly to GnRH receptors on cells in the pituitary gland, quickly reducing the release of gonadotropins and consequently testosterone.

“Degarelix was discovered in San Diego, developed by Ferring Pharmaceuticals in the U.S. and Europe, and in its pivotal Phase III study demonstrated both an immediate onset of action and a profound long-term suppression of testosterone and PSA,” commented Dr. Pascal Danglas, Executive Vice President Clinical & Product Development, at Ferring. “We are delighted to deliver a new treatment option for advanced prostate cancer to the medical community. Ferring has a considerable pipeline of urology products in development, and we expect to introduce additional treatment advances in the urology field in the near future.”

“Use of a GnRH receptor antagonist is a highly efficient way to stop the production of testosterone,” said Neal Shore, MD, FACS, Medical Director for Carolina Urologic Research Center, a clinical trial investigator and advisor to Ferring. “The approval of degarelix offers the medical community an effective alternative in the treatment of hormonally-sensitive prostate cancer. Now prostate cancer can be treated with immediate inhibition of the GnRH receptors, inducing rapid reduction of testosterone to castrate levels, and sustaining those levels over time, which are the goals of systemic therapy. When a patient has disease recurrence, it is always encouraging to clinicians and patients to see PSA levels fall so rapidly.”

Wayne Anderson, President and CEO Ferring Pharmaceuticals, USA added, “We are enthusiastically preparing to enter this therapeutic area of urology. We respect the challenges physicians and patients face in their fight against prostate cancer and hope that we can help them with this new treatment option. This is a big milestone for the U.S. operating unit, and we have been carefully preparing for over two years for this launch.”

Phase III Study Results

The 12-month, randomized, open-label, parallel-group Phase III study evaluated the efficacy and safety of degarelix compared with leuprolide administered monthly over one year of prostate cancer treatment. Patients with histologically confirmed prostate cancer were randomized to either degarelix or leuprolide: a degarelix subcutaneous (under the skin) injection of 240 mg for one month with monthly maintenance doses of 80 mg (n=207) or monthly intermuscular (into the muscle) injections of leuprolide depot 7.5 mg (n=201).

The primary endpoint was testosterone suppression to less than or equal to 50 ng/dL during monthly measurements from Day 28 to Day 364. Degarelix was at least as effective as leuprolide in achieving and maintaining castrate levels of testosterone.

Suppression of testosterone levels to less than or equal to 50 ng/dL occurred significantly faster in patients receiving degarelix than in those receiving leuprolide. At Day 3, 96% of patients demonstrated treatment response. In that same time period, none of the patients who received leuprolide demonstrated treatment response. Conversely, testosterone levels had increased by a median of 65% in 80% of those receiving leuprolide at Day 3.

Overall, the most commonly observed adverse reactions during degarelix therapy included injection site reactions (e.g. pain, erythema, swelling or induration), hot flushes, increased weight, fatigue, and increases in serum levels of transaminases and gamma-glutamyltransferase (GGT). 99% of these observed adverse reactions were Grade 1 or 2 (mild to moderate). Specifically relating to the injection site adverse reactions, most were transient, of mild to moderate intensity, occurred primarily with the starting dose and led to few discontinuations (<1%). Grade 3 (severe) injection site reactions occurred in 2% or less of patients receiving degarelix. Degarelix is contraindicated in patients with known hypersensitivity to degarelix or to any of the product components. Degarelix is not indicated in women or pediatric patients. Long-term androgen deprivation therapy prolongs the QT interval. Physicians should consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients with congenital long QT syndrome, electrolyte abnormalities, or congestive heart failure and in patients taking Class IA (e.g. quinidine, procainamide) or Class III (e.g. amiodarone, sotalol) antiarrhythmic medications.

Prostate Cancer

Prostate cancer is the most common cancer, excluding skin cancers, and the second leading cause of cancer death in American men. About one man in six will be diagnosed with prostate cancer during his lifetime, and one in 35 will die of this disease.(1) Prostate cancer develops from cells in the prostate gland that begin to grow out of control. In most cases, prostate cancer grows slowly and can remain undetected throughout a man’s life, although it can grow and spread quickly.(2) The four types of standard treatment are: watchful waiting, surgery, radiation therapy, and hormone therapy, also called androgen deprivation therapy (ADT). Degarelix is a new form of hormone therapy that reversibly binds to the GnRH receptors, inhibiting the production of testosterone. By suppressing the production of testosterone, tumor growth is inhibited.(3)

References
1. American Cancer Society. What Are the Key Statistics About Prostate Cancer? http://www.cancer.org/; Last accessed 11/12/08.
2. American Cancer Society. Cancer Reference Information, Overview: Prostate Cancer. http://www.cancer.org/; Last accessed 11/12/08.
3. National Cancer Institute. Prostate Cancer (PDQ(R)): Treatment: Treatment Option Overview.
http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient/; Last accessed 11/12/08.

*Lupron Depot(R) (leuprolide acetate for depot suspension) is a registered trademark of TAP Pharmaceuticals Inc.

Source: Ferring Pharmaceuticals Inc.


United Healthcare Workers’ master agreement shows that workers’ unity–not top-down deals–is how working people win in today’s economy

More than 900 caregivers at ten nursing homes in Northern California will have a happy holiday after all, after staying united through nearly ten months of negotiations with Kindred Healthcare. On Friday, members of United Healthcare Workers (UHW) won a breakthrough three-year agreement that creates quality care committees to strengthen workers’ voice to advocate for their residents, provides substantial raises, and protects the right to organize for workers at ten non-union facilities.

“Quality care committees are unprecedented in the nursing home industry,” said Emma Penisini, a certified nursing assistant for eight years at Pacific Coast Care Center in Salinas. “Everyone’s so excited about this agreement. We all work hard to provide the best care we can, and now we have a stronger voice to make our nursing homes better for the people who need our care.”

The agreement includes:

  • Quality of Care committees to improve the quality of care for residents, with third-party mediation if necessary.
  • Substantial wage increases, with certified nursing assistants averaging more than $2.33 an hour more over the three year term.
  • Health insurance improvements that will bring all Kindred workers close to 95% employer contribution for premiums
  • Protection for workers at Kindred’s ten non-union nursing homes in California to have a free choice to form a union.
  • Successorship protection that guarantees recognition of caregivers’ union and their contract if facilities are sold
  • Subcontracting protection
  • Daily cancellation protection
  • Reopener in the second year to improve pension benefits

This victory shows that UHW’s strategy of member involvement and democracy is superior to the top-down “Alliance” strategy advocated by national SEIU President Andy Stern. Recent deals SEIU International has made with nursing homes in Southern California do not include many key standards won by UHW members, including wage scales, defined-benefit pension plans, successorship protections, a code of conduct for organizing non-union workers, and quality care committees to give workers a direct voice in resident care.

In the last five months, UHW members have won contracts with Mariner, Sava, Horizon West, and now Kindred Healthcare that protect workers’ right to form a union at 32 non-union nursing homes — far more than the number of homes UHW was allowed to organize under the national union’s failed Alliance strategy. Nursing home workers who join together in UHW will have full collective bargaining rights, unlike workers enrolled into “template agreements” under the Alliance model.

Despite caregivers’ unprecedented gains as members of UHW, national SEIU officials are preparing to force nursing home and homecare workers out of UHW against their will through a forced merger of local unions. The forced merger would move caregivers into a new union run by appointees accountable to Stern who would pursue the national union’s “Alliance” strategy that has resulted in inferior contracts. A recent SEIU “advisory vote” asked members to choose between two similar merger options with no way to reject the merger entirely. Caregivers boycotted the election and filed 125,000 protests, while only 28,000 votes were cast — less than ten percent of eligible voters.

“In hard economic times, working people get the short end of the stick if we don’t stick together,” said Maria Samuel, an elected member of UHW’s executive board, a shop steward, and a certified nursing assistant for 27 years at Golden Gate Healthcare Center in San Francisco. “The last thing we need is more top-down deals that shut us out of important decisions. We’re winning great contracts in UHW because healthcare workers are involved in every decision our union makes.”

Workers at nine of the ten Kindred Healthcare facilities will vote on the agreement Monday and Tuesday. Workers at Pacific Coast Care Center in Salinas ratified an identical agreement last Friday. The contract takes effect upon ratification and will cover the following facilities:

  • Pacific Coast Care Center, Salinas
  • Bay View Nursing and Rehabilitation Center, Alameda
  • Hacienda Care Center, Livermore
  • Fifth Avenue Healthcare Center, San Rafael
  • Santa Cruz Health Center, Santa Cruz
  • Tunnell Center, San Francisco
  • Golden Gate Healthcare Center, San Francisco
  • Lawton Healthcare Center, San Francisco
  • Nineteenth Avenue Healthcare, San Francisco
  • Victorian Healthcare Center, San Francisco

With more than 150,000 members, SEIU United Healthcare Workers-West is the fastest-growing healthcare union in the United States. We represent healthcare workers in all job classifications and all healthcare settings, including hospitals, homecare, nursing homes and clinics. Our mission is to achieve high-quality healthcare for all. www.seiu-uhw.org

Source: SEIU United Healthcare Workers-West


Stress-related Weight Gain Spikes With Financial Crisis

  • Author: Health Informer
  • Filed under: Health News
  • Date: Dec 24,2008

Naturopathic No Crave Diet author warns many turn to food for comfort during economy crisis

The global financial crisis of the past year has hurt Americans and Canadians in more than just their wallets. Trends show that as a result of increased stress, many are eating more than usual and losing their battle against the bulge even as they try harder to diet.

“I’ve been seeing nearly three new patients a day for months, and 90 percent of them have stress-related eating issues,” said Dr. Penny Kendall-Reed, a world-famous naturopathic physician and author who treats patients on how to utilize the brain and holistic measures for controlling food cravings without the unpleasant side-effects normally associated with dieting.

According to Dr. Kendall-Reed, as many people become more stressed about work stability and the economic downturn, they compulsively turn to food.

“Stress stimulates the hunger center in the brain, destabilizes our blood sugar, makes us resistant to our anti-hunger messengers, and reduces our levels of ‘happy hormone’ serotonin, all of which trigger cravings that inevitably lead to weight gain,” said Dr. Kendall-Reed.

Dr. Kendall-Reed should know; her revolutionary, research-based No-Crave Diet concept, co-authored with her husband Dr. Stephen Reed, helps people take back control of their weight by teaching them how to counter the biological process that makes us crave the wrong foods, effectively silencing the craving urge fueled by stress.

“A standard complaint I get from patients at a time like this is that their diets are not working,” said Dr. Kendall-Reed. “That’s simply because stress promotes storage of calories, particularly around the midsection, which is the most dangerous place to gain weight and the hardest to remove.”

Monitoring about 90 percent of her patients on the No-Crave Diet for six to eight weeks prior to when the financial crisis worsened in mid-October, Dr. Kendall-Reed noticed that they have continued to lose weight and report no recurrence of cravings.

Dr. Kendall-Reed frequently lectures in the U.S., Canada, and the Caribbean and come January 9, 2009 will be in Santa Monica, Calif. teaching how to beat the food cravings that lead to weight gain.

Dr. Penny Kendall-Reed

Dr. Penny is a specialist in weight loss and preventative health, and co-author, with husband Dr. Stephen Reed, of The No Crave Diet book and the national best seller, The Naturopathic Diet (and the more comprehensive book The New Naturopathic Diet). She travels extensively throughout Canada and the United States lecturing on weight loss and related diseases.

The Kendall-Reeds also co-authored: Healing Arthritis, The Complete Doctor’s Stress Solution, and The Complete Doctor’s Healthy Back Bible (voted a Chapters/Indigo recommended book in their “Trusted Advisor” series). Visit www.nocrave.com and www.pkrhealth.ca, for more information.


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