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Systematic reviews and meta-analysis are two methods used for evaluating evidence. Reliable and accurate evidence is necessary in promoting positive patient outcomes. Systematic reviews rely on a comprehensive and reproducible approach that focused on a single clinical issue with clear objectives. This method is used to reduce bias by identifying, appraising, and synthesizing all relevant studies from a quantitative or qualitative analysis that led to a more reliable and accurate conclusion (Uman, 2011). The studies can take months to seven years to complete. Systematic review is considered an evidence-based resource.

Meta-analysis involves the statistical process of analyzing and combining results from multiple different studies (Ahn & Kang, 2018). This method is use in studies from quantitative analysis with conflicting results to develop a more precise estimate of the outcomes (Ahn & Kang, 2018). Meta-analysis is a subset of a systematic review. It is difficult, time-consuming and considered an evidence-based resource.

Develop a Power Point presentation regarding CHF (Congestive Heart Failure).

1-What is CHF?

2-Pathophysiology 

3- Risk Factors.

4-Diagnostic Testings 

5-Assessment findings, sign and symptoms of CHF

6-Difference between left sided heart failure and right sided heart failure

7-Treatment, medication

8- Patient education, before being diagnose with the disease and after being diagnosed  

two separate answer

Describe the evaluative criteria (indicators or variables) to be addressed in answering each evaluation question. Describe the research approaches to be used to answer each question and why they are appropriate to the evaluation questions posed. Describe in specific detail how data will be collected related to each of your evaluative criteria/indicators. Discuss exactly how the data be collected, when, and by whom. Describe any data collection tools in terms of their development and appropriateness in answering the evaluation questions. Provide information on validity and reliability of tools, if available. Explain why the data collection methods are appropriate to the research approach, type of data, and purpose of the evaluation.Describe how you will analyze the data, including specific statistical tests to be used. Include dummy data tables if applicable to show how you will display your findings.

The question is about opioid abuse in the emergency department. Specifics to come

Mr. E is a pleasant, 70-year-old, black, male

Source: Self, reliable source

Subjective:

Chief complaint: “I urinate frequently.”  

HPI:  Patient states that he has had an increase in urination for the past several years, which seems to be worsening over the past year. He estimates that he urinates clear/light yellow urine approximately every 1.5-2 hours while awake and is up 2-4 times at night to urinate. He states some urgency and hesitancy with urination and feeling of incomplete voiding. He denies any pain or blood. Denies any head trauma. Denies any increase in thirst or hunger. He denies any unintentional weight loss.

Allergies: NKA

Current Mediations:

Multivitamin, daily

Aspirin, 81 mg, daily

Olmesartan, 20 mg daily

Atorvastatin, 10 mg daily

Diphenhydramine, 50 mg, at night                                                                                                                   

Pertinent History: Hypertension, hyperlipidemia, insomnia

Health Maintenance. Immunizations: Immunizations up to date

Family History: No cancer, cardiac, pulmonary or autoimmune disease in immediate family members

Social History: Patient lives alone. He drinks one cup of caffeinated coffee each morning at the local diner. He denies any nicotine, alcohol or drug use. 

ROS: Incorporated into HPI

Objective:

VS – BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 195 lbs, height: 70 inches.

Mr. E is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age.

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop

Respiratory: Clear to auscultation 

Abdomen: Bowel sounds positive. Soft, nontender, nondistended, no hepatomegaly           

Neuro: CN 2-12 intact                                                                                                                        

Renal/prostate: Prostate enlarged, non-tender. No asymmetry or nodules palpated

Labs:

Test Name

Result

Units

Reference Range

Color

Yellow

Yellow

Clarity

Clear

Clear

Bilirubin

Negative

Negative

Specific Gravity

1.011

1.003-1.030

Blood

Negative

Negative

pH

7.5

4.5-8.0

Nitrite

Negative

Negative

Leukocyte esterase

Negative

Negative

Glucose

Negative

mg/dL

Negative

Ketones

Negative

mg/dL

Negative

Protein

Negative

mg/dL

Negative

WBC

Negative

/hpf

Negative

RBC

Negative

/hpf

Negative

Lab

Pt’s Result

Range

Units

Sodium

137

136-145

mmol/L

Potassium

4.7

3.5-5.1

mmol/L

Chloride

102

98-107

mmol/L

CO2

30

21-32

mmol/L

Glucose

92

70-99

mg/dL

BUN

7

6-25

mg/dL

Creat

1.6

.8-1.3

mg/dL

GFR

50

>60

Calcium

9.6

8.2-10.2

mg/dL

Total Protein

8.0

6.4-8.2

g/dL

Albumin

4.5

3.2-4.7

g/dL

Bilirubin

1.1

<1.1

mg/dL

Alkaline Phosphatase

94

26-137

U/L

AST

25

0-37

U/L

ALT

55

15-65

U/L

Pt’s results

Normal Range

Units

WBC

9.9

3.4 – 10.8

x10E3/uL

RBC

4.0

3.77 – 5.28

x10E6/uL

Hemoglobin

11.5

11.1 – 15.9

g/dL

Hematocrit

35.0

34.0 – 46.6

%

MCV

85

79 – 97

FL

MCH

28

26.6 – 33.0

Pg

MCHC

34

31.5 – 35.7

g/dL

RDW

14

12.3 – 15.4

%

Platelets

220

150 – 379

X10E3/uL

PSA

5.4

0-4.0

ng/mL

Assessment:

Diagnosis: Benign prostatic hyperplasia, ICD-10: N40.1

Please answer the following:

For the sake of this case study, the patient has confirmed BPH and prostate cancer has already been ruled out. Hence, please document your prescribed treatment plan for this patient (i.e. don’t state “refer to urology”).

1. What is your treatment plan (include specific dosage and frequency)? Why did you choose this treatment plan? Do you change any of his current medications?  In your answer, please describe, briefly, the pharmacodynamics (1 point) and pharmacokinetics (1 point) of your treatment choice and how they influenced your decision. Does the patient have any comorbidities that influenced your choice as well (1 point)? 

       Three months later, the patient notes improvement, but no resolution of symptoms. What would be your next prescribed treatment option (1 point)?

1. Document the education you would provide for this patient, specific to the prescribed medication. Please include information pertinent to the patient (2 points) and common potential adverse effects (2 points).

TEACHER VERY STRICT PLEASE FOLLOW ALL INSTRUCTIONS 

During this course, you will learn the components of a research study. Each week you will learn components of the research process through your readings and application of the knowledge gained to published research articles. At the end of the course, you will complete a review of a nursing research article utilizing all of the components of the research process.

Using the Week 2 research template, identify the research components, listed on the template, as you begin to examine research studies. Review your two assigned articles and address each of the following criteria:

• Identify and describe
  • The problem
  • Purpose
  • Hypothesis or research questions of each study.
• Discuss the significance of the research to nursing practice.
• Identify two details to support the research as qualitative or quantitative.
• NOTE: If a component is not addressed, the student receives a zero for that component.

Article Assignments

Students with the last name beginning with M-Z

Jenson, H., Maddux, S., Waldo, M. (2018). Improving oral care in hospitalized non-ventilated patients: Standardizing products and protocol. MEDSURG Nursing 27(1), 38-45

Turk, M., Fapohunda, A., & Zoucha, R. (2015). Using photovoice to explore Nigerian immigrants’ eating and physical activity in the United States. Journal of Nursing Scholarship, 47(1), 16-24. doi: 10.1111/jnu.12105

Cite all sources in APA format.

Submission Details

Write a 6 page research paper about Obesity and Weight Management Programs.

Answer the following questions:

– What causes obesity?

– How can obesity affect our health?

– Can obesity shorten life expectancy?

Include an introduction and a conclusion.

3 references within the last 5 years.

APA style.

 Discuss a problem or issue in your clinical setting that you have encountered since the outbreak of the COVID-19 pandemic that would be appropriate for  an evidence based project(EBP) project and formulate a researchable question using the PICOT format.  Use APA format avoid the use of direct quotes 

 I work in the Emergency ROOm

Use APA format avoid the use of direct quotes.  I will only accept direct word match less than 20 words in the correct format “……..”( author, year , p#).

Initial post no less than 250 words. 1 page only

PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:

1). ZERO (0) PLAGIARISM

2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS

3). PLEASE SEE THE FOLLOWING ATTACHED RUBRIC DETAILS. 

Thank you.  

If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?

These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.

In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.

To Prepare:

• Review the Resources and select one current national healthcare issue/stressor to focus on.
• Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.

 Write a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.  

Discussion: Searching Databases

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

• Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
• Review the Resources for guidance and develop a PICO(T) question of interest to you for further study.

By Day 3 of Week 4 USE THE TOPIC MEDICATION ERRORS

Post your PICO(T) question, the search terms used, and the names of at least two databases used for your PICO(T) question. Then, describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

Required Readings

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 2, “Asking Compelling Clinical Questions” (pp. 33–54)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 55–92)

Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80. https://doi.org/10.18438/B8WS5N
Note: You will access this article from the Walden Library databases.

Library of Congress. (n.d.). Search/browse help – Boolean operators and nesting. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010a). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79
Note: You will access this article from the Walden Library databases.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Note: You will access this article from the Walden Library databases.

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Searching for the evidence. American Journal of Nursing, 110(5), 41–47. doi:10.1097/01.NAJ.0000372071.24134.7e
Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Nursing. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981

Walden University Library. (n.d.-c). Evidence-based practice research: CINAHL search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp

Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp

Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search help. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp

Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing? Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670

Walden University Library. (n.d.-i). Systematic review. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

THIS IS AN EXAMPLE

A Clinical Question

            The best way to form clinical question is in the form of PICO(T)  (Ask: Write a focused clinical question, 2020). I have done such a thing and have found that the question formulation and changes to it were not as challenging as finding research related to the question.

The Question:

            (P) In the hospital or clinical acute care setting, (I) is a 2 person double-check of insulin, (C) compared to a single person double-check of 5 rights, (O) more effective in the improvement of (01) insulin medication errors, (02) nurse satisfaction during a (T) 30-day term of observation?

Databases Used

            The Walden University database was used to search databases for nursing. Of those available Science Direct, CINAHL, and Cochrane, and PubMed were used. Background questions were first asked to get a sense of what has been studied in this area. It was important to understand when and why this practice first started to determine the relevance of data acquired and to determine how recently we needed to search. Then, foreground questions began to form until finally the PICO(T) question.

            During the background question period, the terms ‘double-check’ became the preferred terminology for the practice I wished to study. So using this ‘double-check’ in the PubMed database, 244 articles were found but not all pertained to my topic. Changing the text to be included only in the title or abstract, the same result achieved. Adding ‘medication errors’ reduced the yield to 21 results. At this level, the evidence is available on the basic topic of using the double-check to prevent all medication errors and relates often to high-risk medications. However, I want to know about the labor-intensive practice of using a 2 nurse double-check for subcutaneous injection of insulin. Adding a level of inquiry which includes insulin, this yielded 2 studies. One from 1983, and one from 2009. Neither of which addresses the current question other than provides background for why the practice may exist in the first place. Changing terms to highlight ‘insulin double-check” yielded two results, both relevant, and one is the most current and referred to peer-reviewed study on this topic.

Affecting Rigor and Effectiveness

            To improve the effectiveness and rigor of a database search one much identify proper and strong keywords in the question or relating to the question. Use filters to find peer-reviewed data first. Use filters for the type of study if possible, including systematic studies, and work your way down the pyramid for strength of research available. If the question is somewhat original, there may not be much evidence. This is the case here. Other filters and Boolean operator’s include dates of publication, with the last 5 years preferred as ‘current’, using ‘and’ and ‘or’ and ‘not’ to include or exclude words in the title, abstract, text, or any part of the article or work.

References

Ask: Write a focused clinical question. (2020). Retrieved from Northern Arizona University: https://libraryguides.nau.edu/c.php?g=665927&p=4682772

Berdot, S., & Sabatier, B. (2018). Medication errors may be reduced by double-checking method. Evidence Based Nursing, 18(21), 67. doi:10.1136/eb-2018-102901

Chua, G., Lee, K., Peralta, G., & Heng Chi Lim, J. (2019). Medication Safety: A Need to Relook at Double-Checking Medicines? Asia-Pacific Journal of Oncology Medicine, 6(3), 246-252. doi:10.4103/apjon.apjon_2_19

Modic, B., Alber, N., Bena, J., Yager, C., Cary, T., Zhiyuan, S., . . . Kissinger, B. (2016). Does an Insulin Double-Checking Procedure Improve Patient Safety? JONA: The Journal of Nursing Administration, 46(3), 154-160. doi:10.1097/NNA.0000000000000314

Sentinel event alert: High-alert medications and patient safety. (1999, November). The Joint Commission: https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/sea_11pdf.pdf?db=web&hash=CA29CB641C8749521733A05716852A1F

Westbrook, J., Ling, L., Raban, M., Woods, A., Koyama, A., Baysari, M., . . . White, L. (2020, August). Associations between double-checking and medication administration errors: a direct observational study of pediatric inpatients. BMJ Quality and Safety. doi:10.1136/bmjqs-2020-011473