My Scope of Practice: Evidence-based Medicine in Prime Time

  When a medical topic becomes a plot line for a prime-time television series, you can be sure it is making news beyond the usual healthcare circles. A recent episode of ER addressed evidence-based medicine. The new emergency department chief, eager to streamline and standardize in an effort to improve outcomes, urged staff to embrace evidence-based practice. For the lay or non-scientific person, the question of evidence-based medicine may seem simplistic – who wouldn’t want to follow a protocol that has been proven successful? The bigger query is, What is the basis for that protocol?   The quest for ensuring a sound evidence base is creating a number of “champions,” many of them wound care practitioners and interdisciplinary researchers. This month, they also are Ostomy Wound Management authors. Guest Editor Kath Bogie, DPhil, is a biomedical engineer who focuses on translational research in the prevention and treatment of chronic wounds. Dr. Bogie currently holds appointments with the Louis Stokes Cleveland Department of Veterans Affairs Medical Center as a Senior Research Scientist and with the Department of Orthopaedics at Case Western Reserve University School of Medicine as a Senior Research Associate. Her current research incorporates multidisciplinary teams, including biomedical engineers, electrical engineers, clinicians, biologists, and statisticians, to investigate novel approaches to wound care through both clinical and basic science studies. Together with Chester H. Ho, MD, Dr. Bogie developed the concept underlying the conference, Evidence-based Practice in Wound Care, with the goal of bringing together other researchers and clinicians to discuss state-of-the-art wound care research that can be immediately translated into clinical practice.

  Dr. Ho, Chief, Spinal Cord Injury, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, and Assistant Professor, Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, has received several awards for his research, including the Case Western Reserve University Department of Physical Medicine and Rehabilitation Chairman’s Award for Research, the Department of Veterans Affairs Federal Executive Board Wings of Excellence Award, and the Veterans Health Administration Health Care Leadership Institute Executive Career Field Participant award. His insightful, evidence-based changes to facility protocol are yielding positive outcomes for his patients.

  Dan Berlowitz, MD, MPH, is Director of the Center for Health Quality, Outcomes and Economic Research, Bedford VA Hospital; Professor at Boston University Schools of Public Health and Medicine; and a past-president of the National Pressure Ulcer Advisory Panel. His clinical background is in geriatrics and he has had extensive experience working in long-term care settings. Among his research interests are studies on assessing and improving the quality of pressure ulcer care. These activities have required a detailed understanding of the pathophysiology of pressure ulcers and how they can be best prevented.

  Laura Edsberg, PhD, is Director, Natural and Health Sciences Research Center, and Director, Center for Wound Healing Research, Daemen College, Amherst NY. In addition to her numerous research activities focusing on the histology of wounds, Dr. Edsberg is a member of the Editorial Board of Ostomy Wound Management.

  Steven I. Reger, PhD, CP, is the Director of the Rehabilitation Technology section of the Department of Physical Medicine and Rehabilitation at the Cleveland Clinic. He is also an educator and advisor to advanced training programs for nurses, graduate biomedical and rehabilitation engineering students and residents in orthopedic and plastic surgery. He lectures on soft tissue physiology, biomechanics, and the prevention and treatment of pressure ulcers; has authored or co-authored more than 200 scientific publications; and was awarded five patents. His research interests are load transfer through soft tissues, prevention of low back pain, healing of pressure ulcers by functional electrical stimulation, and computer aided design of body supports.

  Vinoth K. Ranganathan, MS, MBA, is a Program Manager in the Department of Physical Medicine and Rehabilitation at the Cleveland Clinic. As a former member of the Department of Biomedical Engineering at the Cleveland Clinic Foundation for 5 years, he focused on research related to changes in cognitive and motor functions with ageing, arthritis, improving muscle strength using non-traditional means such as imagery, and studying central nervous system using electrophysiological methods.

  Vinod Sahgal, MD, is the Chairman of the Department of Physical Medicine and Rehabilitation in the Division of Post Acute Medicine at the Cleveland Clinic. He is also the first holder of the Robert, Eleanore and Kathy Risman Chair and Professorship in Medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, and Professor of Physical Medicine and Rehabilitation at the Ohio State University School of Medicine, Columbus, Ohio. His research interests include the histochemistry and morphology of human muscles, the control of muscle activation by electro-stimulation for pressure ulcer healing, the relationship between muscle activation and related cortical potentials, and the neural mechanism of chronic fatigue measured by joint force surface EMG-related cortical potentials with EEG and functional MRI. He has authored and co-authored nearly 400 scientific articles and presentations. He was the recipient of the James A. Brady Award from the Illinois Head Injury Association. His clinical activities range from myopathic dysfunction to brain, spinal cord, and stroke injury rehabilitation.

  Gayle E. Reiber, MPH, PhD, VA Career Scientist in the Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, is a Professor in the Departments of Health Services and Epidemiology at the University of Washington. Dr. Reiber is responsible for the HSR&D PhD Post-doctoral training program at VA Puget Sound Health Care System and is a core scientist in the VA RR&D Center of Excellence for Limb Loss, Prevention and Prosthetics Engineering. Her major research interests are diabetes, diabetes self-management, and the prevention and treatment of lower-limb wounds. In addition to research on wound care and systems of care, she is directing research on prosthetic use in Operation Enduring Freedom, Operation Iraqi Freedom, Desert Storm, and Vietnam amputees.

  This impressive multidisciplinary group is protecting and defending, as well as creating, a sound foundation on which to build practice. In the often murky arena of chronic wounds, this requires dispelling and supporting, as needed, centuries of accumulated – or, in some situations, gaping abysses in – knowledge. One thing is certain: the need for evidence-based medicine is a prime-time concern, a critical factor in providing good wound care that must be addressed. These professionals are going above-and-beyond the call of duty in their scope of practice.

My Scope of Practice is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ. This article was not subject to the Ostomy Wound Management peer-review process.