Using Recipes: Sugar In The Jelly

I like to cook.  When I first started, I would diligently follow the recipes exactly as printed.  My kitchen cupboards hold a variety of measuring cups and spoons that attest to this.  Over time, as I became more familiar with the chemistry of cooking and became surer of myself, the need to follow the instructions so closely waned.  Accurate measuring became an “eyeball” event. Ingredient substitution became
commonplace, mostly because I did not have the item that was called for but sometimes just because I wanted to try something else.  While some things did not turn out so well, overall most of my attempts worked.  But there are some things you learn you just cannot alter.  Shortening the time in a water bath is risky business if you are canning food.  There is no substitute for sugar in the making of jelly.  Cakes won’t rise if you don’t put in baking powder.

And so it is with those pesky treatment guidelines.  Sometimes you can bend them a bit – maybe you don’t ask every patient about smoking cessation.  But a lot of the guidelines make a lot of sense and are like the sugar in the jelly – you can’t replace them.

In one study, patients who received an ACE inhibitor or an ARB at discharge were about half as likely to be readmitted as those who did not receive one (Mechcatie, 2014).  And while clinicians all know the danger of clots from atrial fib, a retrospective study at Northwestern University in Chicago revealed that 40% of patients with atrial fibrillation leave the hospital without a prescription for stroke prevention medication (Otto, 2014).

Given the penalties that are now in place for readmission rates and the need to reduce costs, ignoring guidelines may no longer be the wisest course of action.

References

Mechcatie, E. (2014, April). ARB, ACEI at Discharge Curb Heart Failure Readmissions. Cardiology News, V. 12, p. 1.

Otto, A. (2014, March 31). Quality Gap In Atrial Fibrillation Care Significant. Internal Medicine News.