Jacob Molyneux, senior editor/blog editor, Author at Off the Charts

Critical Care: Where’s the Evidence for Central Venous Pressure Monitoring?

Editor’s note: This post is by Anne Dabrow Woods, MSN, RN, CRNP, who is AJN‘s publisher and chief nurse and publisher of Wolters Kluwer Health Medical Research. It was originally published on the blog of Lippincott’s Evidence-Based Practice Network.

I read with interest the article “Central Venous Pressure Monitoring: Where’s the Evidence?” (purchase required for nonsubscribers) in the January issue of AJN. It’s part of a series called Critical Analysis, Critical Care, which will appraise the evidence regarding common critical care practices. So much of what we do in nursing is not based on evidence but on how we have always done things in practice—or on research that was not credible.

This article looks at the evidence supporting the use of central venous pressure (CVP) monitoring alone to guide treatment decisions for patients. According to the article, a 2008 systematic review by Marik and colleagues concluded that CVP is not an accurate indicator of intravascular volume, nor is it an accurate predictor of fluid responsiveness (whether a patient will respond to a fluid bolus with an increase in stroke volume). The authors of the AJN article critically appraised the evidence and determined the following:

The relationship between intravascular volume and CVP is a weak relationship and clinicians should not use CVP to estimate a patient’s intravascular volume.
The absolute CVP value or a change in CVP should not be used to predict a change in the stroke volume or cardiac index.
There is not an absolute CVP value […]
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Jacob Molyneux, senior editor/blog editor2016-11-21T13:10:59-05:00January 13th, 2012|nursing perspective, nursing research|0 Comments

Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

What’s new in health care news this week?

Diabetes everywhere. There’s an entire Health Affairs issue devoted to the topic of “Confronting the Growing Diabetes Crisis.” It looks at many interrelated issues, such as the personal financial burden of having diabetes over the course of a lifetime, whether it’s best to put scarce health care resources into focusing on prevention or treatment, models for community-based lifestyle programs for those with type 2 diabetes, the positive effects of the Affordable Care Act on giving those with diabetes access to affordable health insurance and crucial care, genetic factors related to type 2 diabetes, and a great deal more. Inevitably, many of the articles focus on type 2 diabetes, which is so closely linked to America’s obesity epidemic.

Joint studies. SmokeCartel reported this week on a large government study showing that, whatever one believes about marijuana’s psychological effects or the efficacy of its various medical uses, long-term marijuana smoking—at least one joint per day, every day of the year—does not impair lung function or contribute to the development of COPD. Will this change anyone’s mind about whether this drug is evil, a panacea for all ills, or somewhere in between? Probably not.

Unreported harm. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services issued a report last week stating that only 14% of medical errors and other events that harm Medicare patients were reported by hospital employees. The report calls for improving reporting systems and the […]

Jacob Molyneux, senior editor/blog editor2017-07-10T16:46:39-04:00January 12th, 2012|Nursing|6 Comments

Nurses Know

It happened back in 1976, but I still remember the sound of the distant ambulance. Why was I lying in the grass and the weeds? Hadn’t I been in the car, driving home from the Visiting Nurse Association along the country road?

So begins the January Reflections essay, “Nurses Know.” By Lois Gerber, it’s one patient’s vivid story of the many crucial roles that nurses played in her care—and it’s free, so have a look and let us know what you think. For those of you who write or who think you have a strong story to tell about nurses, nursing, or some aspect of health care, Reflections submission guidelines can be found here.—JM, senior editor/blog editor

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:02-05:00January 6th, 2012|nursing perspective|1 Comment

Year-End Take: A Hopeful Trend in U.S. Health Care?

Less Is Sometimes More
A hopeful trend that’s gained some serious momentum this year—and may be connected to both the recession and some provisions of the Affordable Care Act—is that we’re beginning to question whether we really need quite so many tests and drugs. By ‘we’ I mean researchers, some journalists, some nurses and physicians, and of course patients. The answers aren’t always clear, and there’s plenty of room for disagreement on many such issues, but at least we’re asking the right questions more often, rather than retreating in fear and simply hurling around the word “rationing”:

Who really benefits from prostate and breast cancer screening and who is more likely to be harmed, and why? When are you too young or too old to be likely to benefit from a certain type of screening? When does aggressive care at the end of life cease to make sense? Are we confusing a risk factor with a disease, an association with causation, relative risk with absolute risk?

Does that drug you see relentlessly marketed in advertisements during breaks in the network news actually help you? Which physicians are being paid as consultants in support of various drugs, tests, or treatments, and does this compromise their objectivity? And so on. The latest example of this kind of analysis I’ve stumbled across can be found here: “Disease Creep: How We’re Fooled Into Using More Medicine Than We Need.”

The Many Faces of Nursing
So, that’s […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:11:06-05:00December 27th, 2011|health care policy, nursing perspective|3 Comments

Top 10 (New) AJN Posts of 2011

Some of our posts, like this one from 2009 (“New Nurses Face Reality Shock in Hospitals–So What Else Is New?”) keep getting found and read. They remain as relevant today as they were when we posted them. Our top 20 posts for the year (according to reader hits, that is) include several others like this: “What Is Meaningful Use? One Savvy Nurse’s Take”; “Is the Florence Nightingale Pledge in Need of a Makeover?”; “Do Male Nurses Face Reverse Sexism?”; “Are Nursing Strikes Ethical? New Research Raises the Stakes”; and “Workplace Violence Against Nurses: Neither Inevitable or Acceptable.”

But putting aside these contenders (why do so many of them have questions in their titles?), here are the top 10 (again, according to our readers) new posts of 2011, in case you missed them along the way. Which doesn’t mean that these are (necessarily) our best posts, or a representative sample, or that many others didn’t hit home for various subgroups of readers.

While we all get a little tired of lists by this time in the year, we don’t really use them an awful lot here at Off the Charts. So please indulge us this once, and thanks to everyone who wrote, read, and commented on this blog in 2011.—Jacob Molyneux, AJN senior editor/blog editor

1. “Notes of a Student Nurse: A Dose of Reality,” by Jennifer-Clare Williams

2. “Placenta Facebook Photos: Nurse and […]