From the abstract:
Shift durations of 12 hours or more are now ubiquitous in hospitals, with currently working staff nurses reporting satisfaction with this shift length, although others who prefer shorter work hours have generally left hospital nursing. Nurse administrators are beginning to question the wisdom of having nurses work extended hours. In part 1 of this 2-part series, the authors provide an update on recent findings that challenge the current scheduling paradigm that supports unsafe long work hours. Part 2 discusses obstacles that nurse administrators face when they "buck the 12-hour trend" and offers guidance for introducing work schedule changes
From the abstract:
Introduction: The epidemiology of multidrug-resistant organisms is changing as evidenced by a shift to the community. Hospitalized patients are admitted to home health care with multidrug-resistant organisms. Numerous states have reported an increased incidence of community-acquired infections caused by multidrug-resistant organisms where reportedly no exposure to antibiotics or health care in the 3 months before symptom onset occurred. Method: A cohort research design with four separate home care agencies and a total of 127 nurses' bags were cultured. Conclusions: The present study hypothesizes that the implementation of infection prevention and control strategies including education and training on proper hand hygiene and appropriate decontamination of high-touch surfaces (nurses' bags) will interrupt the chain of transmission. Hand hygiene practices and environmental disinfection methods differ for Clostridium difficile than for other multidrug-resistant organisms, underscoring the need for addressing environmental factors. If present, implications for routine care and cleaning of nurses' bags and specific changes in hand hygiene practices before and after home care visits are necessary.
A new study (subscription required) found that patients admitted to full or near-full hospitals increased their risk of dying by 5.6%.
University of Michigan Health System researchers evaluated four factors that can affect hospital deaths: occupancy, nurse staffing levels, weekend admissions, and seasonal flu.
]]>From the abstract:
In mid-November 2009, the Government Accountability Office (GAO) released a report documenting the failure of current surveillance systems to capture the extent of work-related injury and illness in the United States. Independent assessments of the national surveillance system demonstrate that up to 80% of worker illness and injury are missed. The GAO documented that more than two-thirds of occupational health physicians report that workers fear disciplinary action for disclosing an injury or illness. More than a third of these physicians reportedly had been asked by company officials or workers to provide care that would not trigger an incident report even when it was "not sufficient to properly treat" the condition.
The GAO analysis focuses on the flaws in the contemporary occupational disease surveillance system, but the nation's reporting mechanism has been hobbled for more than a century. Numerous technical challenges confront any . .
]]>From the abstract:
This report shows that the prevalence of CNA training programs within the nursing home setting dropped from 1997 to 2007. Consequently, aspiring CNAs are increasingly forced to seek outside training. The report describes two main problems with this scenario. First, it creates a disincentive to join the direct-care field, since CNAs must pay a larger share of their own training costs. Second, outside training programs are harder to monitor than training provided within nursing homes.
Apple's iPad is dominating the gadget buzz this winter, but a few years ago, we and others made a big deal about the "polyglot" iPod, turning it into a talisman of the globalized supply-chain. The point was to accent the global context in which U.S. prosperity must be maintained. Then we managed to find a mildly affirmative story of Apple's superior ability to capture value by creatively managing seven suppliers located in four different nations with manufacturing dispersed across five different countries.
That was then, though. More salient today as an insight into America's standing in a globalized production system may be the backstory of another consumer electronics sensation--Amazon's Kindle e-reader--yet here the story has a darker hue.
See also:
The U.S. Can't Manufacture the Kindle and That's a Problem
Source: Willy Shih, Harvard Business Review, October 13, 2009
From the abstract:
Health care is one of the largest contributors to waste production in the United States. Given increased awareness of the environmental and financial costs associated with waste disposal and its public health impact, many hospitals are adopting environmentally friendly practices that reduce waste production and offer equally effective, yet less expensive alternatives. Reprocessing of medical equipment is one such practice that has gained popularity in recent years and has led to major cost savings across several medical disciplines. In this commentary, we seek to take a closer look at the practice of reprocessing, explore the evidence surrounding its safety, and suggest implications of reprocessing for medical centers.
From the speech:
Today, I will:
• Describe the struggles of American businesses and workers as they confront
the harsh realities of today's economy.
• Explain why the upheaval of the U.S. economy did not begin during the
Great Recession of 2008-2010 and why it will not disappear when the
economy recovers later this decade.
• Explain why millions of Americans have been working scared for more than
a decade and with good reason.
• Outline an agenda of common-sense actions to help employees, employers,
educators, and government policymakers respond to/manage current and
future labor markets.
See also:
- Presentation
- The Labor Market, Then and Now: Changing Realities in the 21st Century
A new survey found that the abuse nurses confront on the job often goes unreported.
]]>The 400 American households with the highest incomes also have enjoyed a much faster pace of income growth than the vast majority. And, because tax rates applied to their income have fallen by a third, their after-tax incomes grew substantially faster than their pre-tax incomes. The figure looks at inflation-adjusted pre-tax and after-tax income growth for the 400 top-income families between 1992 and 2007, based on new data recently released by the Internal Revenue Service. It shows that while pre-tax income grew by a staggering 409% over that 15-year period, after-tax income increased even more, by 476%.
]]>From the abstract:
Amid growing concern about childhood obesity, the United States spends billions of dollars on food assistance: providing meals and subsidizing food purchases. We examine the relationship between food assistance and body mass index (BMI) for young, low-income children, who are a primary target population for federal food programs and for efforts to prevent childhood obesity. Our findings indicate that food assistance may unintentionally contribute to the childhood obesity problem in cities with high food prices. We also find that subsidized meals at school or day care are beneficial for children's weight status, and we argue that expanding access to subsidized meals may be the most effective tool to use in combating obesity in poor children.
Arsenic, Other Deadly Pollutants Found in Water From Additional Sites in DE, FL, IL, IN, MD, MI, MT, NC, NM, NV, PA, SC, TN and WV; Toxic Metals Found at Levels Up to Nearly 150 Times Federal Limits
The case for the federal Office of Management and Budget (OMB) to stop sitting on a delayed Environmental Protection Agency (EPA) coal-ash site contamination rule is even stronger than it first appeared to be, according to a major new report from the Environmental Integrity Project (EIP) and Earthjustice. The analysis by EIP and Earthjustice identifies 31 additional coal-ash contamination sites in 14 states, which, when added to the 70 in the EPA's justification for the pending rule, brings the total of coal-fired power plant waste storage sites with poisoned water to 101.
With data showing arsenic and other toxic metal levels in contaminated water at some coal-ash disposal sites at up to 145 times federally permissible levels, the EIP/Earthjustice report identifies 31 coal-ash waste sites where groundwater, wetlands, creeks, or rivers have been polluted with "wastes (that) contain some of the earth's most deadly pollutants, including arsenic, cadmium, lead, selenium, and other toxic metals that can cause cancer and neurological harm (in humans) or poison fish." The 31 sites are located in the following 14 states: Delaware (1); Florida (3); Illinois (1); Indiana (2); Maryland (1); Michigan (1); Montana (1); Nevada (1); New Mexico (1); North Carolina (6); Pennsylvania (6); South Carolina (3); Tennessee (2); and West Virginia (2).
]]>The brief's key findings are:
Health care costs loom as a major risk for retirees, with nursing home care as the real wild card.
A typical couple at age 65 can expect to spend over its remaining lifetime:
-$197,000 with a 5-percent risk of exceeding $311,000, excluding nursing home care; or
-$260,000 with a 5-percent risk of exceeding $570,000, including nursing home care.
Households need to figure out how to handle such risk.
See also:
- Abstract
- Working Paper
From the abstract:
Background: Hospitals face increasing pressure to lower cost of care while improving quality of care. It is unclear if efforts to reduce hospital cost of care will adversely affect quality of care or increase downstream inpatient cost of care.
Conclusions: The associations are inconsistent between hospitals' cost of care and quality of care and between hospitals' cost of care and mortality rates. Most evidence did not support the "penny wise and pound foolish" hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of care.
See also:
Decreasing Hospital Costs While Maintaining Quality: Can It Be Done?
State and local government workers are much more likely to get hurt on the job than private sector workers, according to a new report from the Labor Department.
Among workers in the private sector, there were 113 nonfatal occupational injuries and illnesses per 10,000 full-time workers in 2008. In state and local government, the incidence rate was 170 cases and 195 cases per 10,000 employees, respectively.
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