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Nurses' long hours endanger patient health, study says

Hospitals and nursing homes are endangering patients by allowing or requiring nurses to work more than 12 hours a day, the National Academy of Sciences said Tuesday.

Such long hours cause fatigue, reduce productivity and increase the risk they will make mistakes that harm patients, the academy said in a report commissioned by the federal government.

Donald Steinwachs, chairman of the health policy department at Johns Hopkins University, said fatigue was a "major cause of mistakes and errors" in hospitals and nursing homes. Steinwachs was chairman of the panel of 18 experts who conducted the study.

The report said many nurses and nursing assistants worked more than 12 straight hours, with some working shifts of 16 hours.

To reduce "error-producing fatigue," the report said, state officials should ban nurses from working more than 12 hours in any 24-hour period or more than 60 hours a week.

The report, from the academy's Institute of Medicine, said, "Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, decreases energy, diminishes attention to detail, and otherwise contributes to errors."

Many hospitals and nursing homes have too few nurses to take proper care of patients, the panel said. Hospital intensive care units should have one licensed nurse on duty for every two patients, the report said. Nursing homes should have one registered nurse for every 32 patients and one nursing assistant for every 8{ patients.

Panel chairman not sold on breast implant sales

WASHINGTON _ In a highly unusual move, the chairman of a government advisory panel that reluctantly backed resuming sales of silicone gel breast implants is urging federal health officials and lawmakers to disregard that advice.

"I really have a lot of angst" about the panel's vote, said Dr. Thomas Whalen of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. "I felt morally compelled _ it sounds corny, but morally compelled _ to do something about it."

Silicone gel implants were highly popular until 1992, when fears that leaking silicone caused serious diseases prompted the Food and Drug Administration to end routine sales. One manufacturer wants an end to the ban, arguing silicone implants have been exonerated of causing serious diseases like cancer or lupus.

FDA advisers recommended 9-6 resuming the sale of implants but only under strict conditions, including additional safety tests and warnings to recipients about lingering safety questions and the frequent need for repeated operations because of painful scar tissue and other problems.

The FDA said it had received and would consider Whalen's comments.

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