Please respond to the discussions below done by others seperately and reference each in APA format
Discussion 1 by osheka:-
Why was the study done
This was a retrospective study to determine the length of time once the patient enters the emergency department during a vaso-occlusive crisis to the initiation of analgesia. The study cites the American Pain Societies recommendation for treatment of acute pain related to vaso-occlusive crisis with enteral analgesia within 15-30 minutes of entering the emergency department (ED) (Inoue et al., 2016, pp. 221).
What is the sample size? Size can and should vary according to the nature of the study. Since determining a valid minimum sample size in a single study can be difficult, taking into account multiple studies is beneficial.
The sample size was male and female pediatrics less and 18 and adults greater than 18 over a 7-year period, that presented to the ED between January 2007 and December 2013.
The answer to this question alone should not remove a study from the appraisal process.
Are instruments of the variables in the study clearly defined and reliable? Make sure the variables were consistently applied throughout the study and that they measured what the researchers said they were going to measure.
The study separated children and adults but the variable were consistent throughout the study.
How was the data analyzed?
Make sure that any statistics are relevant to the clinical question.
The data was organized per year during the 7 year period through chart review. The chart compared number of patients per year, number of visits per year, time to first medication, and initial pain score in both adults and children. The study also compared how gender was affected.
Were there any unusual events during the study? If the sample size changed, for example, determine whether that has ramifications if you wish to replicate the study.
Although there were no unusual events during this study, it is noteworthy because of the longevity. Although the study is hypothesis driven and provides only descriptive results.
How do the results fit in with previous research in this area? Make sure the study builds on other studies of a similar nature.
As stated previously this was a long-term study that evaluated how well emergency room providers following evidenced based recommendations provided for the treatment of sickle cell patients during vaso-occlusive crisis. Since it was a 7-year study, with a large sample size that included both adults and children and both genders.
What are the implications of the research for clinical practice? Ask whether the study addresses a relevant and important clinical issue.
This study recognized there may be some bias in initiation and treatment for females during vaso-occlusive crisis, as they tended to report higher pain scores but had longer enteral analgesia initiation times than men in the study with lesser pain scores.
Reference
Inoue, S., Khan, I., Mushtaq, R., Sanikommu, S., Mbeumo, C., LaChance, J., … Sanikommu, S. R. (2016). Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease. Annals of Hematology, 95(2), 221. Retrieved from https://search-ebscohost-com.southuniversity.libpr…
Discussion 2 by Luz 6999:-
Why was the study done? Make sure the study is directly relevant to the clinical question.
This study was done to explore how female patients with a breast cancer diagnosis conducts physical activity (PA) during adjuvant (treatment given after surgery) chemotherapy treatment.
What is the sample size? Size can and should vary according to the nature of the study. Since determining a valid minimum sample size in a single study can be difficult, considering multiple studies is beneficial.
The sample size for the study involved sixteen women diagnosed with breast cancer and who were actively participating in a supervised 16-week PA intervention program during adjuvant chemotherapy treatment (Backman, Browall, Sundberg, Wengstrom, 2016).
The answer to this question alone should not remove a study from the appraisal process.
Are instruments of the variables in the study clearly defined and reliable? Make sure the variables were consistently applied throughout the study and that they measured what the researchers said they were going to measure.
Yes, the variables in the study were clearly defined as all the patients in the study were patients with breast cancer. All the patients were receiving the same kind of chemotherapy, which was producing all of the same adverse side effects, for all the participants.
How was the data analyzed?
The data in this study was analyzed inductively with content analysis (Backman et al, 2016)
Make sure that any statistics are relevant to the clinical question.
Were there any unusual events during the study? If the sample size changed, for example, determine whether that has ramifications if you wish to replicate the study.
Symptom burden, time and lack of motivation were reported as barriers to continuing PA program during the treatment. If I was going to replicate this study, I would have made some changes, which would include coaching, mentoring and direct follow-up with the patients through the use of the healthcare providers, which would include nurses, nurse practitioners, and doctors.
How do the results fit in with previous research in this area? Make sure the study builds on other studies of a similar nature.
This study’s findings should fit with previous research, of which I found in this respective area of study. Furthermore, this study presents more data not only as how PA decreases the adverse side effects of the treatments, but how a structured PA program can produce a positive impact on how patients with cancer perceive their state of health.
What are the implications of the research for clinical practice? Ask whether the study addresses a relevant and important clinical issue.
The implications of the research for clinical practice showed that it was possible to exercise despite increasing symptom burdens from treatment. Furthermore, that a PA program was perceived as a tool that supported health processes and gave the female patients a feeling of getting respite from the illness (Backman et al., 2016). This study addresses a very relevant and important clinical issue that is seen in the oncology field with patients receiving treatment. One class of the patient that are mostly affected by chemotherapy’s adverse side effects and anxiety are the younger females’ patients diagnosed with breast cancer. Patients with depression and higher anxiety levels experience more symptoms from cancer treatments (Faller et al., 2016). If patients are able to find empowerment, motivation, and independence in a physical activity program does reduce their level of anxiety and depression and consequently the experience of adverse side effects related to chemotherapy treatments. Many patients during chemotherapy treatments suffer from anticipatory nausea and vomiting when they arrive at the oncology office or increase fatigue related to feeling depressed due to a new medical diagnosis (Faller et al., 2016)
References
Backman, M., Browall, M. Syndberg, C.J., & Wengstrom, Y. (2016). Experiencing health–physical activity during adjuvant chemotherapy treatment for women with breast cancer. European Journal of Oncology Nursing, 21, 160-167. Retrieved from https://www.sciencedirect.com/science/article/pii/S1462388915300302
Faller, H., Weis, J., Koch, U., Brähler, E., Härter, M., Keller, M., … & Reuter, K. (2016). Perceived need for psychosocial support depending on emotional distress and mental comorbidity in men and women with cancer. Journal of Psychosomatic Research, 81, 24-30. Retrieved from https://www.sciencedirect.com/science/article/pii/…
Discussion 3 by charlotte 6440:-
As a family nurse practitioner you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having a difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills.
References
Garner, D. (2014). Assessment of an eating disorder. Retrieved from
https://www.edreferral.com/assessment
Harrington, B. (2015). Initial Evaluation, Diagnosis, and Treatment of Anorexia Nervosa and Bulimia Nervosa. Retrieved from https://www.aafp.org/afp/2015/0101/p46.html
Discussion 4 by Sonya 6440:-
As a family nurse practitioner, you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills.
Be sure to address the following in your plan of care: pharmacological and non-pharmacological (OTC) interventions, labs, follow up, teaching, and referrals.
Pharmacological and non-pharmacological (OTC) interventions: Usually, the first medication recommendation to treat eating disorders is anti-depressant medication. Three meals a day and Ensure with 3 meals. Labs would include CBC, CMP, EKG, TSH, T3, T4, TIBC, Ferritin, Lactic acid, UA, LFT, PT/INR. Pt will need to follow up in clinic in 1 week. The Provider will notify her parent of any abnormal lab findings. Will consider admission based on lab and condition of patient. Pt and parent will be advised that no prescriptions for weight loss will be provided and that if her condition does not improve, she will face life-threatening challenges. Pt will need to start therapy. Provided list of counselors and psychiatrists.
References
Campbell, K. & Peebles, R. (2014). Eating disorders in children and adolescents: State of the art review. In Pediatrics 134(3). Retrieved on 3/27/2019 from https://pediatrics.aappublications.org/content/134/3/582
Cowden, S. (2017). The SCOFF questionnaire to screen for eating disorders. Retrieved on 3/27/2019 from https://www.verywellmind.com/the-scoff-questionnai…
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