[NP-Clinical] UTI/lactobacillis

[Dena]

Priscilla-

Hope your yogurt worked to chill. Sounds like you needed it! My post was
certainly NOT an attack on you or anyone else. The two questions I posed
were out of curiosity alone (I DID mention that, didn't I??? Did you miss
that line???).

 

YOU did use evidence for your clinical decision-making... although,
obviously, it was early evidence and further evidence didn't support it. So,
question #1 was, will you continue to use Probiotics for vag discharge
despite the new evidence based on the fact that you don't feel it will hurt
and that future evidence might support it someday? Or will you go back to
pharmaceutical treatments which you believe may not be in the best interest
of the patient? What does one do when their own personal philosophy, or your
patient's, might not pan out scientifically? 

 

And, although YOU may keep current with research and evidence-based
practice, not everyone does-as we have seen by occasional responses on this
listserve alone. Question #2 was asking what NPs may base their clinical
decisions on if not evidence? This is simply curiosity on my part after
reading articles on the NP informational needs and clinical decision-making.
As I mentioned, I PERSONALLY use EBP/CPGs to guide my practice-and always
have. That's how I was taught and have never done it any other way so I'm
curious to know what factors others might take into consideration. I
certainly realize that my philosophy and the way I practice is NOT the only
way things are done (maybe when I finally become the Supreme Goddess of the
World, I will mandate that everything think and do like me, but that will
probably still be a few years down the road <G>)- so I am trying to broaden
my horizons and explore how others think and what they do. How do we arrive
at our decisions-- what are the different thought processes and paths we
take to arrive at them?

Dena Galler

 

  _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Priscilla Merrill
Sent: Monday, May 07, 2007 9:12 AM
To: 'NP Clinical'
Subject: RE: [NP-Clinical] UTI/lactobacillis

 

I have only recommended probiotics to women with recurrent BV as initial
studies (learned at NPACE workshop at GYN talk) looked promising.

The post seems a bit alarmist to me.  A big difference between trying a food
product versus some of the very scary meds that studies touted as "safe and
effective" to then go on and kill many a patient.  Take Vioxx for instance.
Remember these studies are done by pharmaceutical companies with vested
interests.  I just think we need to look at all sides of the issues.  We
can't put "medicine" in a tidy box.  Evidence is not perfect and YES, I do
use CPG's and am very conscientious in "doing no harm" but look at how
studies have not panned out as perfect.  What about the whole women's health
initiative.  These studies were reputable and we DID base our practice on
them.  Never were breast cancer rates so high, not to mention deaths from
PE's.  Science is always evolving and we constantly need to keep up.  As
soon as we think we have answers, "research" changes it again.

So, playing Devil's Advocate, I don't use supplements lightly but the early
evidence was supportive enough for one of our major NP leaders to tout it in
a workshop.

That's what's good about studies.  WE always evolve and learn from changing
findings.  We all know there's no big money behind supplements, yet fish
oil/omega's have gotten a very positive rap finally.

I felt I had to defend myself as a willy-nilly renegade off to harm my
patients. Now I'll eat a yogurt and chill.  LOL.

 

Priscilla Merrill FNP

 

  _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Dena
Sent: Monday, May 07, 2007 11:14 AM
To: 'NP Clinical'
Subject: RE: [NP-Clinical] UTI/lactobacillis

 

Out of curiosity:

To those using them, will you continue to RX probiotics in light of the fact
that studies don't support their use in certain situations? And how did one
decide initially to order them for vag discharge in the first place without
evidence of efficacy?

 

And, if evidence isn't used for clinical decision making, what ARE NPs
basing their practice decisions on? In this day of evidence-based medicine,
hopefully practitioners aren't basing their decisions on antidotal hear-say,
what might have worked in the past, simply because "that's the way it's
always been", or, worse yet, "this sounds like an interesting concept-let's
just try it". As EBP is repeatedly beat over our heads, hopefully we start
to critically appraise the literature, Clinical Practice Guidelines, and our
own decision making patterns (albeit unwillingly, involuntarily,
begrudgingly, and in my own case, hostily). Personally, for my own safety
and self-preservation, and in light of the fear of harming a patient and of
malpractice issues, I doubt that I ever order something these days that
isn't in a CPG, regarded as the accepted gold standard, and based on
evidence. Not only am I hoping that this should result in better and safer
patient outcomes but will also, hopefully, protect me if I'm ever called on
in a court of law to defend my clinical decisions. I'm a risk-taker in many
aspects of my life and always have been-but not in my professional practice
where it may adversely affect others. How do others practice and make their
decisions?

Dena Galler

 


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