Can We Talk?: Lessons Learned by Communicating

On August 23, our local newspaper, Commercial Appeal, published an article that caught my eye. The article, “Bedsore Know-How is Lacking,” briefly summarized an article published on the same day in the Journal of the American Medical Association (Reddy M, Gill, S, Rochon P. Preventing pressure ulcers: a systematic review. JAMA. 2006;296:974–984). The JAMA article presented evidence that American medicine knows very little about how best to prevent pressure ulcers. As a nursing professional who has encountered medical professionals with a less than solid grasp of the pressure ulcer concept, my first thought was positive — physician peers finally had acknowledged the reality of their information gap regarding pressure ulcers.
That was not quite the thrust of the actual article. The authors reported that the science used to support efforts to prevent and treat pressure ulcers was sadly deficient. This opinion was based on the assumption that randomized controlled trials (RCTs) are the only way to validate a scientific platform. After reviewing 59 RCTs, the authors concluded that the current science supporting pressure ulcer prevention and treatment was sorely inadequate.
Unwilling to easily accept such profound criticism of what I had thought was evidence-based pressure ulcer care — even though it appeared in a prominent medical journal — and despite the fact that recent American Heart Association/American College of Cardiology guidelines on peripheral arterial disease are based almost exclusively on expert opinion — I wondered if RCTs are universally considered the “Holy Grail” of science. I sent the JAMA article abstract to several wound care gurus to alert folks to the article, as well as to (hopefully) generate some discussion. Because of the quantity of articles available, we all are at times guilty of stockpiling but not reading our pile of journals, no matter how strategically placed. But a discussion, email or otherwise, can facilitate an expeditious sharing of concepts, ideas, experiences, and insights.
Much to my delight, Dr. Barbara Braden and others with a great deal of industry expertise answered my query. Dr. Braden explained the reasons why RCTs provide the strongest possible evidence, but also acknowledged why they are not always practical, offering alternative research options that consider common sense and the credo to “do no harm.” She weighed levels of evidence for me. She traced the research history of one of the examples I had cited of a “common sense” conclusion. Most gratifying, she thanked me for initiating the discussion.
Bottom line, when we read something interesting or encounter, first-hand, an interesting case or nugget of information, we need to share because there is no limit to knowledge or resources. I received a valuable lesson about research by querying folks about an article that raised my hackles. Can we talk? We sure can!
This article was not subject to the Ostomy Wound Management peer-review process.