Evidence-Based Assignment

Epidemic obesity and type 2 diabetes in Asia

Who is the target audience?

As I read this, I think there are at least two target audiences: the public health department of the government and the regular population of Asia.

Does the article provide statistics from any of the original research?

Yes. This article is a review of 113 different articles. It provided some of the statistics of the original research. From these statistics, the author concluded that Asians have higher body fat then European origin as the same BMI level, and have higher prevalence of type 2 diabetes. People in Asia develop diabetes at a lower degree of obesity and at younger ages, suffer longer with chronic diabetic complications, and die sooner that those in developed countries. And Asians have a strong genetic susceptibility to type 2 diabetes, characterized by early B-cell failure and prominent central obesity.

How is the evidence relevant to your current level of practice?

Healthcare professionals in the US tend to use BMI to determine if the individual is overweight or obese. BMI is a good indictor to predict individual at risk of type 2 diabetes, hypertension, and coronary artery disease and so on. But as a group of Asians, the indicator has to be used differently. This article provided some evidence of BMI <>30kg/m2. So healthcare practice need to be individualized. This affects our health teaching to patient. As for Asians, even BMI<25kg/m2, there are still needs for better lifestyle and weight control and exercises.

Any indication the evidence is being utilized in your current or other clinical setting?

As so far, I did not see any practice utilizing this evidence in clinical setting I was involved. I am a Asian, my BMI is 23.4kg/m2 which considered normal by the WHO standard, and healthcare personals around me all were saying that my body’s size is perfect even I knew I need to keep exercises and watch my diet fat. I am glad I read this article so that I can use it on my future practice.

Reference:

Yoon, Kun-Ho, Lee, Jin-Hee, Kim, Ji-Won, Cho, Jae Hyoung, Choi, Yoon-Hee, Ko, Seung-Hyun, Zimmet, Paul, San & Ho-Young. (2006). Epidemic obesity and type 2 diabetes in Asia. Lancet 2006, 368, pp. 1681-1688.

Professional Communication

Week 9
Professional Communication

One day on Sunday, I went to work at 11:00 AM. I found a order which was timed for 04:00 AM. And there was another order for the same pt. And same test timed as 12:00 PM. I asked the morning shift tech what was going on. She told me that someone put the timed order together with the 12:00 Pm one on the top of the other one. Since 12:00 PM was far early to due, she did not check the order and went to do all the routine orders for the day. Once she finished the routine and had chance to check the timed orders, she found out the 04:00 AM one at 09:00 AM. She knew that was night shift’s responsibility to do the 04:00 AM test, and it was already far behind and the coming 12:00 PM one was almost due. She did not know what to do with the 04:00AM one and let it sit there.

Since it was already 11:00 AM, I took those two orders and went to the floor to talk to the nurse who cared of the pt. I want to know the rational for the timed orders and also want to know what the nurse want me to do since we already missed the correct timed one for 04:00. The nurse did not know the rational of the timed orders and did not want to find out. She told me “that is a incident report” and also told me that I could do the 12:00 one at 11:30 to cover these two orders. I end up to fill an incident report and did the 12:00 order as the nurse directed.

In this event, there couple of communication errors between healthcare professionals can be improved.

The first, since the error already be made by the night shift tech, the morning shift tech could check the timed order before going her routine. The timed order always is a priority, that is why you want to check it first so that you will not miss anything. That way, the error would be caught earlier at 06:30 and could be corrected earlier if there was a significant need for the timed order.

The second, the two mistakes already happened, when the morning tech found out the error at 09:00, she should directly go to the floor get the test done and talk to the nurse what happened and fill out a incident report. That still would be better than doing nothing.

The third, it is true that a missed test should be a incident report, but it is also important to know the rational for the timed test. Sometimes it is important because pt. was taking special medications which need to be monitored by ECG. But sometimes it was just the ward clerk’s mistake for putting the orders in that way. As a nurse, she should be able and have the responsibility to know the rational. But the nurse I communicated with indicated that she was “too busy” to help me to find out. And I am not suppose to look on pt. Chart as a tech. but following orders. That order was put in by different floor, and the pt. was moved to other floor after the order was put in. That was why I really want to know the rational, also, that was why the nurse did not know. But she could find it by checking the doctor’s original orders.

I am guessing no harm done of the event. But effective communication could make the situation better.