Are we measuring what we need to measure?

Optimal treatment for patients with chronic pain remains elusive. A growing international consensus advocates evidence-based practice with assessment of clinical outcomes to improve the process and outcome of care. Clinical decision making about treatment options for an individual patient should include the patient's clinical presentation, available evidence, and patient preferences. Treatment should then be monitored and outcomes of treatment assessed. Although the placement of clinical decision making on a scientific, often quantitative basis as opposed to a subjective, impressionistic approach makes intuitive sense, the question is whether we have been measuring what we need to measure to practice evidence-based practice when we consider the current available evidence on pain management? The methods of synthesis of available evidence are still in development. Much of the evidence, although having internal validity, has limited external validity and is difficult to apply to the individual patient. Patients with chronic pain are a heterogeneous group, and different interventions may be indicated for different subgroups of patients. Various methods are being developed to better match patients with treatment. Little information exists on patient preferences, or how best to measure these. Information on how health care providers make clinical decisions is also scarce. Outcome measurement has come a long way and core domains to be measured have been established. Establishing normative data is a next main goal. Important methodologic and practical challenges remain to formulate evidence that can be applied to the individual patient with chronic pain.     

Error reporting in the emergency department: do we do what we say we do?

BACKGROUND:

The Joint Commission accreditation manual contains standards in improving organization performance related to report and review of patient care issues causing unexpected harm. In spite of regulations mandating reporting, it remains inconsistent, varying by provider type and hospital. Our purpose was to determine current attitudes, knowledge, and practice of error reporting among emergency department (ED) providers.

METHODS:

We administered a survey assessing ED staff practice regarding error reporting. Questions involved reporting of errors in which the practitioner was directly involved, errors the practitioner observed, and general awareness of reporting mandates. We also questioned individuals regarding fear of repercussions for reporting.

RESULTS:

Fifty-two surveys were returned. For most errors, providers were more likely to tell their supervisor about the issue than to tell the patient. Seventeen percent of respondents did not think that referring errors for review was their job. Only 31% of respondents were aware of standardized institution-wide pathways to report errors. Any respondent who was aware of the institution-wide pathway also felt responsibility for error reporting. Thirty-three percent of the respondents were concerned about negative repercussions from reporting errors. In querying the hospital reporting system, 263 cases were referred for quality issues over the previous year, 51% of them were referred by nurses, 27% by medical technicians (MTs), 2% by mid-level providers (MLPs), 1% by physicians, and 19% by other personnel.

CONCLUSION:

Although most of the ED staff are responsible for patient safety, most are not aware of systems available to assist in reporting, and even many do not utilize those systems.KEY WORDS: Error reporting, Quality assurance, Medical error     

Neurorehabilitation: are we doing all that we can?

Occupational therapists have many intervention tools available for working with clients having a neurological injury; however, some of the most innovative and effective methods have not gained acceptance by many clinicians. Emerging research and new technologies provide occupational therapists with a multitude of treatment strategies and novel devices, but incorporation of those tools into clinical practice appears to be limited by the time necessary to learn about the intervention, educational requirements associated with implementation, or lack of awareness regarding the evidence supporting the use of such tools. Strategies to combat this trend include educating clinicians on evidence-based methods for neurological rehabilitation, aligning academics with practitioners to translate evidence into practical treatment strategies, and accepting that occupational therapy can use these innovations as a means toward state-of-the art, occupation-based practice.     

Was Feuerbach right: are we what we eat?

Food and stress are powerful modulators of the body-mind connection, which is imbalanced in obese individuals. Why do we choose chocolate over an apple when overworked and stressed, and why does comfort food make us feel better? Two independent studies in the JCI, one in this issue, home in on the role of stress on gut hormones and food choices and, conversely, on the effect of the intestinal system on modulation of brain activity by sadness. These studies broaden our understanding of the ties between food and mood and underscore promising targets for obesity treatments.     

Glycemic variability: should we and can we prevent it?

Diabetes is characterized by glycemic disorders that include both sustained chronic hyperglycemia and acute glucose fluctuations. There is now cogent evidence for the deleterious effects of sustained chronic hyperglycemia that results in excessive protein glycation and generation of oxidative stress. The role of glucose variability from peaks to nadirs is less documented, but there are many reasons to think that both upward (postprandial) and downward (interprandial) acute fluctuations of glucose around a mean value activate the oxidative stress. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of dysglycemia (i.e., A1C, fasting and postprandial glucose, as well as glucose variability). All the therapeutic agents that act on postprandial glucose excursions seem of particular interest for reducing the latter parameter (i.e., the glucose instability). Particular attention should be paid to such emerging therapeutic agents as the glucagon-like peptide 1 agonists and the dipeptidyl peptidase (DPP)-IV inhibitors that act through the incretin pathway.     

Nursing memoirs: why do we do what we do?

According to Black, Deeny and McKenna, "defining what nurses do, and why, has been the endeavour of many researchers" (1997). With the events of 9-11, many people have spent recent months reflecting on that which constitutes their focus, evoking memories from the past. In the aftermath of 9-11, nurses have likewise stopped to reconsider why we do what we do. The purpose of this article is to examine what nursing literature says about why nurses do what they do and share the findings in the context of my own story as a nurse.     

Healing is who we are ... and who are we?

Yavapai Regional Medical Center (YRMC) has created, developed, embraced, and shared its vision of a total healing environment. The management/leadership team identified the values of respect, integrity, accountability, commitment, and quality as norms of behavior to reach YRMC's vision. This article describes how senior management at YRMC supports and reinforces the healing process as part of their everyday work life, resulting in better patient care and an improved bottom line. Nursing executives know that healing is the mantra of caregiving and the foundation of nursing itself. It is an invitation to each employee to invite his/her soul to work, which allows all employees to partner with nursing to become caregivers for each other. Understanding the transformation at YRMC begins with reading and listening to the stories that follow of the experiences and talents of the employees. Others are encouraged to use our model by first recognizing the positive talents and experience of staff members and then telling and retelling the stories that come from these experiences. We believe this will enhance the current healing in your organization and improve your environment "one conversation at a time," as it happened at YRMC. Yavapai Regional Medical Center is proud of its accomplishments. We wish to share our story and journey so that each nurse executive can be inspired to develop and live his/her own vision to create this healing environment.     

Shall we dance？

一个男人，28岁结婚，30岁时有了孩子，40岁买了属于自己的房子，然后呢?