Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients’ families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families’ satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = −2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = −2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit’s team works together.

Trichorrhexis nodosa is a disorder of the hair shaft in which there is a distinctive response to injury. The hair is fragile and on examination regularly spaced pale 'node-like' swellings may be observed. It may affect normal hair following excessive or repeated trauma, or may occur after minimal trauma if there is an inherent defect in keratin synthesis causing abnormally brittle hair. The diagnosis can be readily made clinically and confirmed microscopically. Treatment is aimed at reducing trauma. We describe a case of localized trichorrhexis nodosa in a patient with otherwise apparently normal hair.

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Reviews developments, strengths and challenges in evidence-based spiritual care practice (EBSCP) using a hermeneutical method which compares and interprets a variety of written texts. EBSCP originated from evidence-based medicine (EBM) developed at McMaster University and was adopted as evidence-based practice (EBP) by multiple professional disciplines. EBSCP was first addressed in Canada and American spiritual care researchers in the US have since advanced EBSCP. Questions are raised about processes of integrating EBSCP in a Canadian context as well as areas for future research.

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