"The department of commerce assembles here the forces designed by Congress to advance the interests of industry and trade through experimental research, the dissemination of knowledge and the administrative vigilance it stimulates for the progress of America upon land and sea and in the air and thereby speeds the nation in the march of mankind."
This quote is on the top of the Herbert Hoover Building in Washington, DC. Built in 1932, these words, carved in stone, express a commitment to research and knowledge, otherwise known as evidence. Although it is not uncommon to find these ideas in Washington, DC, this quote was particularly surprising because the Hoover Building is the Department of Commerce, devoted to business and trade. Statements about knowledge, research, and evidence are commonly found in libraries, museums, and monuments. It is notable that evidence was a critical component to the business community almost 100 years ago.
Last December, President Trump signed the Foundations for Evidence Based Policymaking Act of 2018. The law requires federal agencies "to develop evidence-based policy and evaluation plans and designate Evaluation Officers, Statistical Officials and Chief Data Officers to support and implement those new requirements" (Social Security Administration, 2019). This law was an actual bipartisan effort jointly sponsored by then House Speaker Paul Ryan (R-WI) and Senator Patty Murray (D-WA). Motivated by many aspects of how public policy is made, common cause was found in the need for timely, reliable, high-quality, relevant, and accessible evidence to make effective public policy.
The critical nature of evidence to decision making is familiar ground for clinicians. Evidence is the unifying language of interdisciplinary practice. We share the commitment to research, the dissemination of knowledge, and the application of evidence in practice for all decisions. We are well versed in forming questions, evaluating what is known, grading the reliability of the evidence, testing and applying evidence. This expertise is invaluable to policy makers and an opportunity for nursing to engage in public policy.
The universal support for this legislation signals the value of evidence and the opportunity for experts in the fields impacted by policy to be active. Speaking at an event shortly after the passing of this law, Dr. Adam Gamoran, President of the William T. Grant Foundation, posed that the core challenge to the use of evidence is rarely the lack of evidence. But that "evidence use depends on the relationships between evidence producers and consumers of evidence and the intermediaries who knit them together."
In clinical practice, the patient is often the intended user of evidence. Nurses play a critical role as the intermediary "knitting them together." We understand practice guidelines, dietary restrictions, medication orders, and many other forms of evidence. We are largely responsible for ensuring the patients understand and can use this evidence. We build our relationships to maximize our ability to utilize evidence. This expertise is critical to the use of evidence in public policy, particularly the laws and regulations about our work.
Nurses remain a largely unknown source of expertise in policy meetings, particularly at the federal level. There are many reasons for this but one of the most significant is that nurses are unsure how to be helpful. Acting as an intermediary between evidence producers and users is one place we can be helpful. We can apply our expertise with evidence and relationship building to public policy. We can think of policy makers and regulators as partners in decision making much as we do with our care teams. We can build relationships and develop trust with legislators the same way we do with patients. We can impact our patients and communities in far reaching ways by being active problem solvers for the public good. Solving problems and helping people-isn't that why you became a nurse?
Peanut Allergy Protection Limited After Oral Immunotherapy
NIH: Peanut is one of the most common food allergies nationwide. Previous studies have shown that peanut oral immunotherapy (OIT) can desensitize adults and children and prevent life-threatening allergic reactions. OIT involves ingesting small, controlled amounts of peanut protein over time.
To help determine the optimal duration and dose for OIT, a team led by Drs. Stephen Galli and Kari Nadeau at Stanford University carried out a three-year study with 120 participants, aged 7 to 55, who were diagnosed with peanut allergy. Results were published in the Lancet.
While otherwise avoiding peanut throughout the trial, 95 participants received gradually increasing daily doses of peanut protein (up to 4 grams). Twenty-five received a similar-looking placebo made of oat flour. After two years, the researchers assessed the participants' peanut tolerance with a food challenge: gradually increasing the amount of peanut in a controlled environment.
The researchers found 83% of participants who received peanut OIT passed the challenge without an allergic reaction, while only 4% on the placebo did. Those who passed the challenge were randomly assigned to receive either a reduced dose of peanut protein of 300 milligrams daily or to stop OIT altogether and take the oat flour placebo instead. One year later, only 37% of participants on the reduced peanut dose could still tolerate a 4-gram dose of peanut at a food challenge-and only 13% of those taking the placebo did so. These results confirmed most participants didn't maintain peanut desensitization after stopping or reducing OIT.
"We hope that, with more research, blood tests can help us predict who may respond to OIT treatment," says Dr. Alkis Togias of NIAID's Division of Allergy, Immunology and Transplantation. "Future studies will also focus on identifying the optimal OIT regimens to maintain protection from serious allergic reactions."
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