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[email protected] AJN M March 2009 M Vol. 109, No. 3 19

Rapid response teamsreduce preventable in-hospital deathssome of

the time. Research hasnt conclu-sively shown that theyre effec-tive in lowering cardiac arrestand mortality rates outside the

ICU. Now a large prospectivecohort study conducted by Chanand colleagues at a tertiary hos-pital in Kansas City, Missouri,has found that they dontimprove rates of cardiac arrestor death hospital-widethat is,both inside and outside the ICU.

A rapid response team con-sists of ICU personnel who canbe summoned to assess and treatany patient outside the ICU whoshows signs of deterioration and

who may be at risk for cardiacarrest or death. Team makeupvaries but often includes one ormore ICU nurses, a respiratorytherapist, and a physician whocan be called upon when needed.

Since the Institute for Health-care Improvement (IHI) made theimplementation of rapid responseteams one of the six strategies inits 100,000 Lives Campaign in2004 (and carried over as one of12 interventions in its more ambi-tious 5 Million Lives Campaign in2006) to reduce preventabledeaths in hospitals, initiatives pro-moting the use of such teams havebeen taken up by major founda-tions and accrediting agencies, aswell as hundreds of hospitals.

But little is known about thecost-effectiveness of rapid responseteams, and until now their effec-tiveness had only been studiedoutside the ICUnot in the hospi-

tal as a whole. Concerned that aprimary action of rapid response

teams is to transfer patients to theICU, and that cardiac arrestsin the ICU were not included inrecent studies, Chan and col-leagues examined hospital-widecardiac arrest and mortality ratesbefore and after the implementa-

tion of a long-term (20-month)rapid response team.The team in the study con-

sisted of two ICU nurses, a respi-ratory therapist, and an ICUphysician. During the 20 monthsof the study, the team was calledon 376 times. Cardiac arrestrates were 11.2 per 1,000 admis-sions before implementation ofthe rapid response team and 7.5afterward; after adjusting forvariables, the reduction was not

significant. Nor did unadjustedhospital-wide mortality ratesmeaningfully change after theintervention, with rates of 3.22per 100 admissions before theintervention and 3.09 after theintervention.

Should support of rapidresponse teams be reevaluated?IHI vice president Joe McCannonsays that although the organiza-

Do Rapid Response Teams Save Lives?This strategy seems like a no-brainerbut a study suggests that clinicians take a second look.

News Director: Maureen Shawn Kennedy, MA, RNE-mail: [email protected]

NewsCAPNewsCAPDrug-resistant temporal lobe epilepsy patients may live longer after anteriortemporal lobe resection than with medical management, concluded a December3, 2008, report inJAMA. A simulation model incorporating seizure status, surgi-cal complications, and patients quality-of-life data indicated that surgery wouldconfer an average increase in lifespan of five years, or 7.5 quality-adjusted life-

years, as compared with medical therapy. The model predicted that after oneyear, 71.9% of postsurgery patients would have no disabling seizures (comparedwith 8% of patients taking medication) and less than a 6% chance of relapse per

year (compared with a 25.4% chance of relapse in patients taking medication).The American Academy of Neurology advises that not every nonresponder is acandidate for surgery; medical evaluation is necessary.

tion is always interested in newevidence, the IHI still believesthat rapid response teams andother early detection strategiesare important for addressingthis problem.

The study authors suggest that

secondary effects of having rapidresponse teams may be as impor-tant as the primary outcomes theymeasured. Noting that a sizablenumber of patients who survivedtheir initial rapid response teamintervention subsequentlyobtained [do not resuscitate] sta-tus during their hospital stay, theauthors speculate that rapidresponse teams may not bedecreasing [cardiac arrest] rates asmuch as catalyzing a compassion-

ate dialogue of end-of-life careamong terminally ill patients.The authors also call for moreresearch into the best compositionof rapid response teams, theirmost appropriate use in hospitals,and the optimal triggers forrapid response team activation.

Jacob Molyneux, senior editor

Chan PS, et al.JAMA 2008;300(21);2506-13.


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dentiality; and preparation ofproviders. It can be found atwww.nap.edu/catalog.php?record_id=12063.

According to Bearinger, themajority of health care providerswho work with adolescentsbelieve theyre ill equipped to do

so. As an example, the reportcited one survey of 520 nurseswho worked with adolescents,more than a quarter of whomidentified substantial gaps in theirknowledge of such common teenhealth issues as depression, eatingdisorders, and violence. In addi-tion, says Bearinger, nearly twothirds felt inadequate to addressthe needs of gay, lesbian, andbisexual adolescents or to counselteens on pregnancy options.

Part of the problem is regula-tory. With the exception of pedi-atric and family medicine, sheexplains, theres currently norequirement that curriculum con-tent or accreditation, licensure, orcertification exams deal with ado-lescent health. The NRCIOM

report calls for regulatory bodiesand agencies funding training pro-grams to address such deficiencies.

Even with adequate prepara-tion, however, providers arehard pressed to promote com-prehensive adolescent carewithin a system that neither fos-

ters nor funds coordination ofprimary and specialty care. TheNRC and IOM recommend thatproviders and the federal, state,and private systems that supportthem develop interdisciplinaryadolescent health care services.In such endeavors, Bearingersuggests, nurses may be particu-larly well suited to provide lead-ership. Nurses, she says, moveseamlessly between mental,physical, and psychosocial health

and are prepared to create solu-tions for coordinating systems.

Echoing many of the sameconcerns as the NRCIOMreport is the policy statementfrom the American Academyof Pediatrics (AAP) (http://pediatrics.aappublications.org/cgi/content/full/123/1/191), whichaddresses the deleterious effectsof underinsurance on adolescentaccess to preventive, reproduc-tive, and behavioral health care.The AAP identified the followingproblems: benefits are not wellmatched to adolescent needs;nearly 40% of adolescent healthcare expenditures are paid out ofpocket; and within Medicaidrisk-based managed care sys-tems, capitation rates covering13-to-18-year-olds are substan-tially lower than those coveringyounger and older patients,which effectively penalizes

the physicians who see them.Maribeth Maher

For the 42 million adoles-cents living in the UnitedStates, health care is

highly fragmented and poorlycoordinated, according to a newreport issued by the NationalResearch Council (NRC) andthe Institute of Medicine (IOM).

Were missing opportunities torespond to critical issues of youngpeople that may have a long-lasting impact on their healthand well-being, says Linda H.Bearinger, a professor at theUniversity of Minnesotas Schoolof Nursing, director of the uni-versitys Center for AdolescentNursing, and the only nurse onthe 20-member IOM committee.The report, Adolescent HealthServices: Missing Opportunities,

which focuses on the health careneeds of people ages 10 to 19,highlights five areas in whichimprovements are necessary: pri-mary care coordination; diseaseprevention, health promotion,and behavioral health; communityinvolvement; protection of confi-

20 AJN M March 2009 M Vol. 109, No. 3 ajnonline.com

Its Not Easy Being TeenHealth care providers arent trained to handle common adolescent issues such as as depression andeating disorders.

NewsCAPNewsCAP

Nearly 50% of college-aged youths had a psychiatric disorder within the pastyear, but fewer than 25% sought treatment for it. Such were the findings of ananalysis of the 20012002 National Epidemiologic Survey on Alcohol andRelated Conditions published in the December 2008 issue of the Archives ofGeneral Psychiatry. Investigators analyzed the responses of 5,092 19-to-25-year-oldsmore than half of whom had not attended college in the past year. Amongcollege students, the most prevalent psychiatric disorders involved alcohol use dis-orders (20.4%), followed by personality disorders (17.7%). Among those whodidnt attend college, personality disorders were most prevalent (21.6%) followedby nicotine dependence (20.7%). The prevalence of mood and anxiety disorderswas also high in both groups. In light of the high prevalence of psychiatric disor-ders and the low percentage of youths seeking treatment, greater efforts todevelop intervention programs are needed.


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22 AJN M March 2009 M Vol. 109, No. 3 ajnonline.com

Researchers found that cancerrecurred in 29 women in the ther-apy group and in 33 women inthe assessment-only group. Themedian time to disease recurrencein the therapy group was 2.8years; in the control group it was2.2 years. Of those in the therapygroup, 24 died of the disease (the

median survival time being 6.1years) and of those in the assess-ment-only group, 30 died (themedian survival time being 4.8years). Multivariate analysesshowed that the patients in thetherapy group had a 50% lowerrisk of breast cancer recurrenceand a 68% lower risk of deathfrom breast cancer than patientsin the assessment-only group.

These findings confirm theearlier work of David Spiegel of

Stanford University, who foundthat cancer patients participationin support groups increased the

length and quality of their lives.According to Pamela J. Haylock,interim executive director of theAssociation for Vascular Accessand a cancer care consultant, fewhave been able to duplicate hisresults. Finally were seeing sim-ilar findings, says Haylock, whohas hosted retreats for breast

cancer patients. Women withbreast cancer tell us they likefinding people who are goingthrough or have gone through asimilar experience.

Researchers have warned ofthe relationship between stressand health for some time; in thisstudy, women who focused onstress reduction and took partin daily muscle relaxation exer-cises had even better results thanothers in the therapy groups.

Tammy WorthAndersen BL, et al. Cancer 2008;113(12):3450-8.

Women with breast can-cer who participated ingroup therapy for 11

years were 56% less likely todie of the disease and 45% lesslikely to have their cancer return,according to a recent study.

Researchers followed 227women surgically treated for

breast cancer, half of whom par-ticipated for one year in therapygroups; the other half receivedonly assessments. Therapyincluded muscle relaxation, prob-lem solving, strategies for increas-ing exercise and lowering fatintake, learning to communicateassertively, and coping withadverse effects of treatment. Thegoals of therapy were to improvethe quality of patients lives andhealth behaviors (diet, exercise,

and smoking cessation), reducestress, and facilitate treatmentand follow-up.

Group Therapy Benefits Patients with Breast CancerA focus on relaxation and exercise improves results.

NewsCAPSNewsCAPS

Generic cardiovascular drugs and their brand-nameequivalents produce similar results, reported a systematicreview and metaanalysis of 47 studies in the December 3,2008, issue ofJAMA. The review analyzed trials publishedfrom 1984 (when the Food and Drug Administration first

approved generics) to 2008. Analyses indicated that brand-name drugs werent superior to their generic equivalents in 10of 11 diuretic trials, seven out of seven -blocker trials, five ofseven calcium channel blocker trials, five of five warfarin tri-als, and two of two statin trials, among others. Meanwhile,more than half (23 of 43) of editorials written during the sameperiod advised against using generic drugs.

Weight training is better than aerobic exercise forchronic lower back pain, according to a report in theMarch issue of theJournal of Strength and ConditioningResearch. In addition to gaining strength and flexibility, sub-jects with chronic lower back pain who used free weights

and weight-bearing exercise equipment showed a 60%improvement in pain, disability, and quality of life. But theircounterparts who worked out on treadmills or elliptical train-ers showed no significant improvements. Both groups exer-cised three times weekly for 16 weeks.

Unlicensed persons cannot give insulin to school chil-dren in California, ruled a state court in November 2008.This ruling upheld Californias Nursing Practice Act, whichprohibits people other than nurses from administeringinsulin. Although the case focused on delegation of insulin,its really about who has control over nursing practice inpublic health arenas, according to Amy Garcia, executivedirector of the National Association of School Nurses.The question is whether a school district can override theNursing Practice Act because of convenience or cost, shesaid. This ruling upholds the tradition that the NursingPractice Act guides nursing practice. M

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