Trends For RNs, Case Managers, Disease Managers, Life Care Planners and Legal Nurse Consultants

Trend #1 Demographics

By the time the Baby Boom generation reaches the age of 65 between 2010 and 2030, the elderly population is going to make an enormous impact on health care expenditures.  Approximately 20 per cent of U.S. citizens will be elderly by 2030.

Trend #2 Evidence-based Medicine (EBM)

Evidence–based Medicine, treatment and practice guidelines that have been scientifically validated, are increasingly being used and incorporated in best practices.

Trend #3 Population- based Medicine (PBM)

Health planners throughout the U.S. have begun studying their membership, as well as stressing early detection, early intervention and disease management.

Members are being grouped into disease-specific populations and the process is being called care management. Health plans identify those conditions (high risk disease-specific populations) as the greatest consumers of healthcare dollars.

Trend #4 Technology - Nanotechnology

Future manufacturing technology will make most products lighter, stronger, cleaner, less expensive and more precise. Medical applications of nanotechnology are increasing in therapeutics, devices, and diagnostics.  

Trend #5 The Consumer Movement

Consumers are increasingly getting involved in their own healthcare and taking more responsibility for their own health and risk behaviors.

Trend #6 Healthcare Policy

Keeping informed of changes in healthcare policy will promote our own professional best practices and provide a vision of the future healthcare landscape.

Building a Trend Kit for the Future*1.  The Case Manager 2004, Volume 15, Issue 5, Pages 56-60 L. Husted

Highlight: Technology- Nanotechnology Trends

Nanotechnology is a rapidly evolving field that crosses scientific disciplines with applications in biology, medicine, physics, materials science, chemistry, and earth science. Scientists and engineers now have the capability of working on a molecular level. This is a scale so small, a nanoscale, it is invisible to the human eye. New tools such as the atomic force microscope allow scientists to do manipulations at the smallest of scales—the nanometer.

One nanometer is one-billionth of a meter or only 3 to 4 atoms wide.  Just to give you an idea of how small that is, a human hair is about 80,000 nanometers wide.

Nanotechnology builds things one atom or molecule at a time using programmed nanoscopic robot arms.  Taking advantage of the chemical properties of atoms and molecules, in other words, how they stick together, nanotechnology has the potential of constructing molecular devices that have exceptional properties. Atoms can be manipulated one at a time and placed exactly where needed to produce the desired structure.

The past five years, the National Cancer Institute has supported research on nanodevices that may detect and pinpoint the location of cancer at its earliest stages, deliver anticancer drugs specifically to malignant cells, and determine if these drugs are effective in killing malignant cells. Companies are currently developing medications that will effectively target tumor cells without killing the healthy tissue around it.  For example, American Pharmaceutical Partners and American BioScience have received FDA acceptance of New Drug Application for Abraxane in the treatment of metastatic breast cancer.

Other medical applications of nanotechnology are already on the market. Take coronary stents, for example.  Stents that were initially developed to treat blocked coronary arteries used to be made of bare metal. After about six months, approximately 30 to 35 percent of arteries with implanted stents would become narrowed or blocked again (restenosed) due to the build up of scar tissue.

To address the problem of restonosis different solutions were sought. Pharmacologic advances ushered in a new way of dealing with the development of scar tissue. Moving away from bare metal or purely mechanical devices of the 1990’s, stents were coated with drugs known to interrupt the biological processes that caused restenosis. Some stents were imbedded in a thin polymer for time-release. Now, by adding a drug that is released from within special polymers placed on the stent, the rate of restenosis drops to between 5 and 10 percent, thereby reducing or preventing the need for open heart surgery. Two medicated stents or drug-eluting stents with FDA approval for sale in the U.S. are Taxus, by Boston Scientific, and Cypher, by Cordis.  We can thank advances in nanotechnology for these wonders.

Since cardiovascular disease and cancer are the two leading causes of death in the U.S., drug-eluting stents and anticancer drugs can change the course of our lives. See how nanotechnology is already impacting our future!

Linda Husted, MPH, RN   September 18, 2005