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IOM Report Urges Expanding Role of Nurses
Gastroenterology and Hepatology News Richard Peek and K. Rajender Reddy, Section Editors
IOM Report Urges Expanding Role of Nurses
A
report from the Institute of Medicine (IOM) in October 2010 urges policy makers to remove policy barriers that hinder nurses—particularly advanced practice registered nurses such as Certified Registered Nurse Anesthetists (CRNAs)—from practicing to the full extent of their education and training. The IOM consensus report asserts that “expanding the role of nurses in the U.S. healthcare system will help meet the growing demand for medical services.” Titled “The Future of Nursing: Leading Change, Advancing Health”; (available: http://www.iom.edu/ Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health. aspx), the IOM report was released in the wake of research published in peer-reviewed health journals that confirmed the safety and cost effectiveness of nurse anesthetists. A study published in the August 2010 issue of Health Affairs examined nearly 500 000 individual cases in states that had removed the federal physician supervision requirement
New Test Measures DNA Methylation Levels to Predict Colon Cancer
A
n investigational DNA methylation test could alter the screening landscape for colorectal cancer, according to data presented at the American Association for Cancer Research special conference on Colorectal Cancer: Biology to Therapy, held October 2010 in Philadelphia. Only 60% of adults age ⱖ50 have undergone the recommended colorectal cancer screening, according to the Centers for Disease Control and Prevention. Dr. David Ahlquist, professor of medicine and a consultant in gastroenterology at the Mayo Clinic in Rochester, Minnesota, said
for nurse anesthetists between 2001 and 2005. In 2001, the Centers for Medicare and Medicaid Services allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by CRNAs. By 2005, 14 states had exercised this option. The study conducted by Research Triangle Institute found patient outcomes did not differ between the states that do not require physician supervision and states that do. Further, the study confirmed that there are no differences in patient outcomes when anesthesia services are provided by CRNAs, physician anesthesiologists, or CRNAs supervised by physicians (See Health Affairs 2010;29:1469 –1475). Another study by the Lewin Group appeared in the May/June issue of Nursing Economics. This research considered the different anesthesia delivery models in use in the United States today, including CRNAs acting solo, physician anesthesiologists acting solo, and various models in which a single anesthesiologist di-
rects or supervises 1– 6 CRNAs. The results show that CRNAs acting as the sole anesthesia provider cost 25% less than the second lowest cost model. Alternatively, the model in which 1 anesthesiologist supervises 1 CRNA is the least cost-efficient model [Nursing Economics 2010;28(3)]. CRNAs are anesthesia professionals with 7– 8 years of education and training related to their specialty, including a 4-year bachelor’s degree in nursing, ⱖ1 year of experience as a registered nurse in an acute care setting, and a master’s degree from a 24to 36-month nurse anesthesia educational program. In addition, CRNAs must fulfill continuing education requirements every 2 years to remain certified to practice. By 2025, a doctorate of nursing anesthesia practice will be required for entry into the profession. The IOM report was prepared by its committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which consists of physicians, nurses, academicians, and other health care representatives.
much of that low rate may be due to inconveniences associated with conventional approaches. “There is definitely an incentive and legitimate justification to be designing a screening approach that is user friendly, affordable and has the ability to detect pre-cancers,” said Ahlquist. “The noninvasive stool DNA test we have developed is simple for patients, involves no diet or medication restriction, no unpleasant bowel preparation, and no lost work time, as it can be done from home. Positive tests results would be followed up with colonoscopy.” The test that Ahlquist et al evaluated is under development by Exact Sciences, a molecular diagnostics company in Wisconsin. The assay, which is
not yet approved by the US Food and Drug Administration, detects tumorspecific DNA alterations in cells that are shed into the stool from precancerous or cancerous lesions. In this first clinical validation study presented at the American Association for Cancer Research conference and included 1100 patients, the researchers detected 64% of precancerous adenomas ⬎1 cm and 85% of cancers. Furthermore, cancers and precancerous adenomas were detected equally well on both sides of the colon. Colorectal cancer rate detection was 87% for cancers considered to be in the most curable stages (stages I–III) and 69% for the most advanced stage (stage IV). Further clinical trials are planned for next year. GASTROENTEROLOGY 2011;140:5–7
IOM Report Urges Expanding Role of Nurses
A
report from the Institute of Medicine (IOM) in October 2010 urges policy makers to remove policy barriers that hinder nurses—particularly advanced practice registered nurses such as Certified Registered Nurse Anesthetists (CRNAs)—from practicing to the full extent of their education and training. The IOM consensus report asserts that “expanding the role of nurses in the U.S. healthcare system will help meet the growing demand for medical services.” Titled “The Future of Nursing: Leading Change, Advancing Health”; (available: http://www.iom.edu/ Reports/2010/The-Future-of-NursingLeading-Change-Advancing-Health. aspx), the IOM report was released in the wake of research published in peer-reviewed health journals that confirmed the safety and cost effectiveness of nurse anesthetists. A study published in the August 2010 issue of Health Affairs examined nearly 500 000 individual cases in states that had removed the federal physician supervision requirement
New Test Measures DNA Methylation Levels to Predict Colon Cancer
A
n investigational DNA methylation test could alter the screening landscape for colorectal cancer, according to data presented at the American Association for Cancer Research special conference on Colorectal Cancer: Biology to Therapy, held October 2010 in Philadelphia. Only 60% of adults age ⱖ50 have undergone the recommended colorectal cancer screening, according to the Centers for Disease Control and Prevention. Dr. David Ahlquist, professor of medicine and a consultant in gastroenterology at the Mayo Clinic in Rochester, Minnesota, said
for nurse anesthetists between 2001 and 2005. In 2001, the Centers for Medicare and Medicaid Services allowed states to opt out of the requirement for reimbursement that a surgeon or anesthesiologist oversee the provision of anesthesia by CRNAs. By 2005, 14 states had exercised this option. The study conducted by Research Triangle Institute found patient outcomes did not differ between the states that do not require physician supervision and states that do. Further, the study confirmed that there are no differences in patient outcomes when anesthesia services are provided by CRNAs, physician anesthesiologists, or CRNAs supervised by physicians (See Health Affairs 2010;29:1469 –1475). Another study by the Lewin Group appeared in the May/June issue of Nursing Economics. This research considered the different anesthesia delivery models in use in the United States today, including CRNAs acting solo, physician anesthesiologists acting solo, and various models in which a single anesthesiologist di-
rects or supervises 1– 6 CRNAs. The results show that CRNAs acting as the sole anesthesia provider cost 25% less than the second lowest cost model. Alternatively, the model in which 1 anesthesiologist supervises 1 CRNA is the least cost-efficient model [Nursing Economics 2010;28(3)]. CRNAs are anesthesia professionals with 7– 8 years of education and training related to their specialty, including a 4-year bachelor’s degree in nursing, ⱖ1 year of experience as a registered nurse in an acute care setting, and a master’s degree from a 24to 36-month nurse anesthesia educational program. In addition, CRNAs must fulfill continuing education requirements every 2 years to remain certified to practice. By 2025, a doctorate of nursing anesthesia practice will be required for entry into the profession. The IOM report was prepared by its committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which consists of physicians, nurses, academicians, and other health care representatives.
much of that low rate may be due to inconveniences associated with conventional approaches. “There is definitely an incentive and legitimate justification to be designing a screening approach that is user friendly, affordable and has the ability to detect pre-cancers,” said Ahlquist. “The noninvasive stool DNA test we have developed is simple for patients, involves no diet or medication restriction, no unpleasant bowel preparation, and no lost work time, as it can be done from home. Positive tests results would be followed up with colonoscopy.” The test that Ahlquist et al evaluated is under development by Exact Sciences, a molecular diagnostics company in Wisconsin. The assay, which is
not yet approved by the US Food and Drug Administration, detects tumorspecific DNA alterations in cells that are shed into the stool from precancerous or cancerous lesions. In this first clinical validation study presented at the American Association for Cancer Research conference and included 1100 patients, the researchers detected 64% of precancerous adenomas ⬎1 cm and 85% of cancers. Furthermore, cancers and precancerous adenomas were detected equally well on both sides of the colon. Colorectal cancer rate detection was 87% for cancers considered to be in the most curable stages (stages I–III) and 69% for the most advanced stage (stage IV). Further clinical trials are planned for next year. GASTROENTEROLOGY 2011;140:5–7