2. Effective Care Resources


2.1: The U.S. Effective Health Care Program

  • The U.S. Department of Health and Human Services (HHS), Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program website: effectivehealthcare.ahrq.gov,  The National Clearinghouse Guidelines at guidelines.gov site that was managed by AHRQ was closed due to insufficient funding July 16, 2018.  An archive list is available with original links, the titles can be looked up to find the original source provider. The Clearinghouse screened medical practice guidelines for quality and offered summaries and other commentary. I made some copies and will add links as it is organized. Here are the basic categories of primary source guidelines:


Guideline Summary Categories included 15 areas of medical practice:

  1. Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . 23 files : Cardiology [archive list]
  2. Critical Care  . . . . . . . . . . . . . . . . . . . . . . . 24 files : Critical Care [archive list]
  3. Emergency Medicine   . . . . . . . . . . . . . 39 files : Emergency Med [archive list]
  4. Family Practice . . . . . . . . . . . . . . . . . . . . 170 files : Family Practice [archive list]
  5. Geriatrics  . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 files : Geriatrics [archive list]
  6. Infectious Diseases . . . . . . . . . . . . . . . . . 24 files : Infectious Disease [archive list]
  7. Internal Medicine . . . . . . . . . . . . . . . . . . 158 files : Internal Med [archive list]
  8. Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  47 files : Nursing [archive list, 7/16/18]
  9. Obstetrics & Gynecology  . . . . . . . . . .  50 files : Ob & Gyn [archive list, 7/16/18]
  10. Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 files : Oncology [archive list]
  11. Orthopedic Surgery . . . . . . . . . . . . . . . . . 24 files : Orth. Surgergy [archive list]
  12. Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 files : Pediatrics [archive list]
  13. Physical Medicine & Rehabilitation . 28 files : Phys Med & Rehab [archive list]
  14. Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 files : Psychiatry [archive list]
  15. Surgery  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 files : Surgery [archive list, 7/16/18]

  • The U.S. Effective Health Care Program reviews research articles on a  variety of medical and health related topics and provides research summaries for consumers, clinicians & policymakers on the topics: [2

2.2: The American Red Cross

  • The American Red Cross website:  redcross.org/participantmaterials 
  • The non-profit organization offers training courses on a variety of health and safety topics. Their course guides are available for purchase in print form or available for free download in pdf form. Topics include: 

  1. Administering Emergency Oxygen; 
  2. Babysitter’s Training;
  3. Basic Life Support for Healthcare Providers;
  4. Bloodborne Pathogens Training; 
  5. CPR/AED for Professional Rescuers (CPRO); 
  6. First Aid, CPR and AED (Spanish versions available); 
  7. Life-guarding;
  8. Wilderness and Remote First Aid.

  • A pdf of the Swimming and Water Safety Manual (2009) by the American Red Cross organization is also available on their website. redcross.org/SwimmingWaterSafety.pdf
  • The American Red Cross training for water safety instructors includes basic boating safety information however more frequent boaters would benefit from a more focused course such as those offered by the U.S. Coast Guard. 

2.3: The U.S. Coast Guard & Boating Safety

A few safety tips at the most basic level - not intended to replace a boating safety course: 

  1. ALWAYs bring life-preservers or other flotation devices in case of a boating accident. Seat cushions in many small water craft are designed to float and may serve in place of a life jacket or other fitted life preserver. Wood and fiberglass float so debris from an accident might float. Whether you can find your life preserver, a seat cushion, or floating piece of debris by the time you need it, is something only Davy Jones may know - so wear your life preserver and if you are the captain of your ship - make your passengers wear theirs too.        My father served in the military and his rule for the car and canoe was that the ship doesn’t move until it is fully prepared - oil, gasoline, windshield wiper fluid, and safety belts fastened for all riders in a car, and life preservers on for everyone in the canoe. We canoe-primitive camped from young ages - like backpacking except with a canoe to haul the stuff between campsites, so easier than backpacking. It was fun. We also all attended swimming classes at the local YMCA starting in the wading pool with bubble floats designed for babies and toddlers. - Everyone can benefit from feeling safe in the water, fears can be overcome with the help of an instructor and practice: "Why you should learn how to swim - it could save your life": (usnews); YMCA, Find your "Y", for locations of a YMCA near you: (YMCA)         When I was a parent driving my own little ones around in a car my father shared his reasoning with me regarding the seatbelt rule - of course the car would "go" without someone’s seatbelt being fastened, at that time. Now seatbelts are automated and cars actually will not work without the driver and passenger seatbelts in place - my father was ahead of his time. Anyway, he said the driver is the most important person to have wear a seatbelt because the driver has to maintain control of the car in case of an accident and there is not time to fasten a seatbelt in most/many types of car accidents - having since tested that theory, I do fasten my seatbelt whenever driving or riding in a car,even if it isn’t an automated seatbelt, but he convinced me at the time to develop better habits since I had such precious cargo on board (his grandkids). He had a firm policy and he stuck with it and shared it, knowing that gravity works, often at speeds faster than your reaction time.
  2. If your boat does start to sink or is sinking - don't swim to it. For reference, in case you missed it, see the movie The Titantic. The survivors are the ones who swam away from the sinking ship. Like water swirling around a drain, the sinking ship pulls whatever is in the water nearby along down with it due to the turbulence in the water.
  3. Mixing alcohol and water sports can be lethal - you may not care about taking the risk for yourself but do you want to feel responsible if your actions result in someone else being harmed?
  4. If you are out on the water and a lightning storm appears on the horizon - don't panic, and do start paddling for shore - the nearest shoreline if the storm is already upon you. You are probably better off in the boat than in the water, especially if you are wearing rubber soled boat shoes or tennis shoes and are sitting on a plastic seat cushion. Metal is a danger in a lightning storm but so is the large body of water surrounding your boat. If you are in the water and lightning is about to strike, take a deep breath and duck under water - good luck. Fish survive because they are under the surface: (sciencenetlinks.com/zapping-fish)

2.4: Recreational Vehicle Safety Programs

Land bound outdoor recreational vehicles can also be dangerous and safety programs for snowmobiling and other off road vehicles likely exist. 

  • At a state level, the Michigan Department of Natural Resources offers a training program for volunteers to be certified as Recreational Safety Instructors. michigan.gov/dnr 

2.5: Effective Care Guidance for Residential Facilities

  •  A pdf from the Alzheimer’s Association, alz.org, Dementia Care Practice Recommendations for Assisted Living and Nursing Homes. [7
  • An infographic from casey.org. titled Elements of Effective Practice for Children and Youth Served by Therapeutic Residential Care. [9
  • A review: Effectiveness and Implementation of Evidence-Based Practices in Residential Care Settings, by Sigrid James, PhD, MSW, Qais Alemi, MPH, MBA, and Veronica Zepeda, BA. [11
  • An Executive Summary regarding the effective use of psychiatric residential facilities and the best practices to look for when assessing a facility is available in a pdf: Appropriate and Effective Use of Psychiatric Residential Treatment Services by Dave Ziegler, Ph.D. for Jasper Mountain. [12

2.6: Putting Safety First Can Mean Recognizing Limits

Effective self care can involve learning both the recommendations from research and others’ experiences and learning to recognize internal signals from the body – queasy stomach, wobbly walk, slurred speech, — give the keys to the bartender or close friend and sleep it off. 

Excess alcohol may also cause a depressed mood or a more aggressive mood so recognize that violence or self injury in oneself or a friend may be more of a risk when under the influence of alcohol. Sleeping it off is the safest strategy because coffee or other methods suggested for rapid sobering up have not been found to be truly effective. Roughly, it takes the body about one hour to process an ounce equivalent of hard liquor (5-6 ounce wine, 12 ounce beer) so if it was a twelve pack, then plan ahead and call in absent from the next day’s work, and then maybe turn off the phone to prevent making any other unfortunate calls. 

 Effective self care can serve as a safety warning when someone recognizes that what they are feeling is similar to what they felt in their body during a previous experience that had negative consequences. An example would be the medications Xanax or Valium, or other benzodiazepines, which may be prescribed as an anti-anxiety medication, however they affect the brain and body very similarly to alcohol and taking a benzodiazepine medication when also drinking alcohol can make the “drunk” symptoms much worse.

  • More information on benzodiazepine addiction: webmd.com

One of the topics reviewed by the U.S. Effective Health Care Program is on alcohol use disorder and medications that have been used in research trials for treating adults with the condition: Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings,  effectivehealthcare.ahrq.gov 

2.7: Play it safe. Learn from the experts & avoid unnecessary risks.

And mixing alcohol and other drugs is a risk, even without a recreational vehicle.

I have never been much of a fan of alcoholic beverages. Just one or two drinks can affect my balance and I prefer good balance and being able to spin and dance for a natural thrill, rather than drinking for a "buzz."

  • My own interest in best practices and effective care started early, during childhood. 
  • My first job as a teenager was as a water safety instructor, life guard and camp counselor for groups of children at a summer camp. 
  • In order to qualify for the position I had previously spent many hours of my life going to swimming classes each year. I enjoyed them and slowly advanced up through the levels of training and tests of skill and knowledge until eventually I achieved certification as a water safety instructor and swimming lifeguard - two different sets of training and testing, and it also required CPR certification and training with a different organization. I had to understand and remember safety and emergency procedures in real life training drills for a variety of scenarios and repeat them under timed test conditions.
  • All the training helped me perform better as a lifeguard and water safety instructor for the children at the summer camp during normal routine and during emergency situations. Summer storms can roll in rapidly and if you are out in the middle of the lake in a metal boat then you need to get to shore quickly and calmly.
  • In an emergency, panic is not helpful in oneself or as a role model for others. 
  • Fortunately we all got to shore safely. It helped me stay calm leading a small group on my own, to have first been part of a larger group with other more experienced camp counselors guiding the group through a dangerous situations.

Happily I've never been in a situation where I had to try to save a drowning person,

 but I am still prepared to jump in the deep end if a situation calls for it. 

  • However if possible, first I would also ask someone to call 911 and look for a life preserver, and I would probably have kicked off my shoes and jacket at the same time. 
  • Having experienced the training situations I know that every advantage can help in a dangerous situation and bulky clothing or backpacks would be a disadvantage in the water, especially with a struggling person who might be panicking.

Recognizing that a risk exists allows strategies to be developed to better cope with the risk, or to help prevent the risk from occurring. Learning from the experience and reliable research of others can help save time and lives, and can be more cost effective than paying for the research independently, or worse - having to learn the hard way by experiencing an accident or emergency firsthand. 

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. 
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert

Continue Reading: Patient Advocacy

Instinct & Policy; Resources

Table of Contents

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  • Chapters and Glossary section summaries & links, and a link for the book version of this site, Instinct & Policy: Effective Care and Best Practices for Promoting Health and Preventing Harassment and Discrimination. 

Table of Contents

2. Links & References

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 Links and Reference footnotes for Chapter 1: About Effective Care

2. Links & References.pdf

Glossary & Resources

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  • Definitions of terms and the resources & therapy techniques from the various sections gathered in one location for convenience with some additional topics and material for background detail not covered elsewhere.  

Glossary & Resources