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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

0 Download5 Pages / 1,182 Words

Course Code: 3034PHM
University: Griffith University

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Country: Australia

Question
Topic is prevention of ventilator pneumonia in ICU patients this is a evidence based research firstly tell how ventilator pneumonia is an issue in ICU then how it will prevent by using evidence based practice.
Answer
Introduction
Ventilator associated pneumonia (VAP) is a common nosocomial infection in the ICU that is associated with increased morbidity, mortality and medical cost. It is type pneumonia where symptoms of fever, altered white blood count and sputum changes are seen following 48-72 hours of endotracheal intubation (Kalanuria, Zai & Mirski, 2014). Hence, the condition is most likely to be found in mechanically ventilated patients and it increases burden for critical care nurses. In response to this issue, the main purpose of the paper is to discuss how ventilator pneumonia as an issue in the ICU and identify the research article that provides the strongest evidence to prevent the issues. The description of best evidence is provided following the steps of the EBP process.
Rational for EBP as an issue in ICU practice
VAP is regarded as an undesirable condition in ICU patient because it increases length of stay in the intensive care unit and prolongs duration of ventilator support. The rate of VAP in hospital varies due to diagnostic criteria and knowledge of nurses in preventing the condition. Barriers and facilitator to managing VAP in the ICUs may also vary because of factors like communication between staffs, education and knowledge related to VAP, guideline awareness, management process for VAP and appropriate use of technology (Safdar et al., 2016). Another issue for nurse is that variety of preventive measures has been recommended for preventing VAP Eom et al. (2014), however the effectiveness of these intervention needs to be confirmed by means of evidence based practice process.
Preventing VAP through the EBP process:
Evidence based practice (EBP) is regarded as a process that can support nurses to address gap in patient care and achieve better health outcome for patient. By engaging in the process of the judicious use of current best evidence related to practice issue and integration of the evidence with patient values and clinical expertise, optimal care can be provided to patients (Hall & Roussel, 2016). This paper is concerned with the practice issue of prevention of VAP in ICU. The six steps of the EBP process that can help to identify the best evidence that supports prevention of VAP in the ICU are as follows:
Asking a clinical guiding question:
The best research articles for prevention of VAP in ICU can be retrieved by ICU nurse by first developing a clinical guiding question. The PICO question for the use of VAP can be as follows:
Which preventive measures (intervention) are most useful in the prevention of VAP (outcome) in ICU patients (population)?
Searching for the best evidence
Keywords from the clinical question can be used to search for relevant articles related to the practice issue. Terms like preventive measures and VAP, VAP prevention and ICU patients and prevention for VAP can be used to retrieve relevant articles. The articles can be searched from different databases and search engines like Google Scholar. The search for articles related to the prevention of VAP revealed implementation of VAP bundle approach as the most effective approach to prevent VAP as it includes variety of interventions to reduce the incidence of VAP. The Institute for Healthcare Improvement (IHI) developed the bundle and it includes all interventions necessary for VAP prevention such as elevation of head of bed (30°- 45°), daily sedation, stress ulcer prophylaxis and breathing trials (Hellyer et al., 2016). Kalanuria, Zai and Mirski (2014) revealed that high compliance rate of about 95% is necessary to achieve best results for patients. Hence, in accordance with these results, articles reporting about adherence to VAP bundle and its outcomes were analysed. The research study by Mohamed (2014) and Eom et al. (2014) were found to provide the best evidence regarding the effectiveness of VAP bundle in prevention of VAP. This was because Mohamed (2014) evaluated both compliance rate as well as effectiveness related outcomes and Eom et al. (2014) conducted a multi-centre study.
Critically appraising the evidence
To determine whether the research evidence selected is the best one to be applied in clinical practice, it is necessary to evaluate the strength, weakness, reliability, validity and applicability of the research evidence. This can be done by analysing the research aim, methodology and rigor in research design. Any kinds of bias that affects study results should also be analysed. Mohamed (2014) is found as a reliable evidence because it gave both after and before intervention results and the most vital factor of compliance to the bundle was also analysed. Furthermore, validated criteria and was used to measure outcomes. Eom et al. (2014) revealed the applicability of the intervention because of multi-centre evaluation.
Integrating the evidence with clinical expertise
To integrate the chosen evidence into practice, it will be necessary for nurse to determine the changes needed to implement the EBP decision. ICU nurse can consult with care providers regarding the intervention and they can take special skill trainings to effectively implement the intervention.
Evaluating the outcome of the EBP practice decision
After implementation of the identified intervention, it will be necessary for nurse to analyse the outcome of the intervention and determine whether expected outcomes were achieved or not. If expected outcome is not achieved, then it is necessary to identify the cause behind and make changes in care planning accordingly.
Disseminating the findings
Based on the experience of implementing best practice evidence using the EBP process, a nurse can disseminate the evidence to colleagues within the organization so that events like VAP can be prevented in the future.
Conclusion:
The paper summarized the process of identifying the best intervention to prevent VAP in ICU using the EBP process. In response to the issue of prolonged hospital stay and increased health care cost, the VAP bundle was identified as the best preventive step to reduce incidence of VAP. The critical appraise process and the steps needed to properly integrate the evidence with clinical expertise revealed VAP bundle as a solution to reduce VAP in ICU patients.
References:
Eom, J.S., Lee, M.S., Chun, H.K., Choi, H.J., Jung, S.Y., Kim, Y.S., Yoon, S.J., Kwak, Y.G., Oh, G.B., Jeon, M.H. and Park, S.Y., 2014. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. American journal of infection control, 42(1), pp.34-37.
Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers.
Hellyer, T. P., Ewan, V., Wilson, P., & Simpson, A. J. (2016). The Intensive Care Society recommended bundle of interventions for the prevention of ventilator-associated pneumonia. Journal of the Intensive Care Society, 17(3), 238–243. https://doi.org/10.1177/1751143716644461
Kalanuria, A. A., Zai, W., & Mirski, M. (2014). Ventilator-associated pneumonia in the ICU. Critical care, 18(2), 208.
Mohamed, K.A.E., 2014. Compliance with VAP bundle implementation and its effectiveness on surgical and medical sub-population in adult ICU. Egyptian Journal of Chest Diseases and Tuberculosis, 63(1), pp.9-14.
Safdar, N., Musuuza, J. S., Xie, A., Hundt, A. S., Hall, M., Wood, K., & Carayon, P. (2016). Management of ventilator-associated pneumonia in intensive care units: a mixed methods study assessing barriers and facilitators to guideline adherence. BMC Infectious Diseases, 16, 349. https://doi.org/10.1186/s12879-016-1665-1

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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

0 Download2 Pages / 428 Words

Course Code: 3034PHM
University: Griffith University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:
Describe the steps of the evidence-based research process and the importance of using them.
 
In the initial stages of an EBP project, where do nurses in your specialty (Nursing informatics and technology) go to locate sources of information that help them to determine whether or not a practice problem is appropriate for an evidence-based practice change proposal.
 
Include two specific sources on information in your discussion
Answer:

Steps of the evidence-based practice process and their importance
Evidence-based practice process (EBP) refers to judicious use of the recent best proves in making decisions about the health care of a patient. The EBP keep nurses updated. This proves are acquired from clinical evidences from various researches. It has various advantages. For instance, providing the best care available. Hence, improved patient outcome is one of their main aims.  We are going to discuss the EBP steps one by one.
Ask a clinical guiding question
This is where the practitioner assesses the patient (Rubak, Sandbæk, Lauritzen, Borch-Johnsen, & Christensen, 2009) . The patient presents his physical or mental symptoms. The practitioner then designs an appropriate query that takes in consideration the symptoms of the patient. This is so that the practitioner provides the best options to the patient. Therefore, the patient is the source of the information.
Search for the best evidence
After the enquiry the practitioner then looks for resources from databases. PubMed, MEDLINE and CINAHL are best resources for nurses. Those databases use MeSH subject headings as the official terms to describe concepts related to medical articles.
Critically appraise the evidence
Depending on the results of step 2, this process may vary. In this step you evaluate the results of study how they relate to the patient’s case. In case you have found analyses of primary resources then validation will be provided in the analysis.
Integrate the evidence with one’s clinical expertise
In this step, the nurse makes judgement on patient’s case using his previous experience. Given EBT is customer-centered, patient preferences and cost of treatment should be considered in order to give patients best option (McLeod, Southam?Gerow, Tully, Rodriguez, & Smith,2013)
Evaluate the outcomes of the EBP practice decision
In this step, the nurse returns the discussion to the patient. The nurse engages the patient to give him the best medication.
Disseminate the outcome
This is a self-evaluation step. The practitioner examines his proficiency on his work.
References
McLeod, B. D., Southam?Gerow, M. A., Tully, C. B., Rodriguez, A., & Smith, M. M. (2013). Making a case for treatment integrity as a psychosocial treatment quality indicator for youth mental health care. Clinical Psychology: Science and Practice, 20(1), 14-32.
Rubak, S., Sandbæk, A., Lauritzen, T., Borch-Johnsen, K., & Christensen, B. (2009). General practitioners trained in motivational interviewing can positively affect the attitude to behaviour change in people with type 2 diabetes: One year follow-up of an RCT, ADDITION Denmark. Scandinavian journal of primary health care, 27(3), 172-179.

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“Evidence Based Practice.” My Assignment Help, 2020, https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/health-care-of-a-patient.html.

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My Assignment Help. ‘Evidence Based Practice’ (My Assignment Help, 2020) accessed 18 December 2021.

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3034PHM Evidence Based Practice

.cms-body-content table{width:100%!important;} #subhidecontent{ position: relative;
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3034PHM Evidence Based Practice

0 Download2 Pages / 428 Words

Course Code: 3034PHM
University: Griffith University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:
Describe the steps of the evidence-based research process and the importance of using them.
 
In the initial stages of an EBP project, where do nurses in your specialty (Nursing informatics and technology) go to locate sources of information that help them to determine whether or not a practice problem is appropriate for an evidence-based practice change proposal.
 
Include two specific sources on information in your discussion
Answer:

Steps of the evidence-based practice process and their importance
Evidence-based practice process (EBP) refers to judicious use of the recent best proves in making decisions about the health care of a patient. The EBP keep nurses updated. This proves are acquired from clinical evidences from various researches. It has various advantages. For instance, providing the best care available. Hence, improved patient outcome is one of their main aims.  We are going to discuss the EBP steps one by one.
Ask a clinical guiding question
This is where the practitioner assesses the patient (Rubak, Sandbæk, Lauritzen, Borch-Johnsen, & Christensen, 2009) . The patient presents his physical or mental symptoms. The practitioner then designs an appropriate query that takes in consideration the symptoms of the patient. This is so that the practitioner provides the best options to the patient. Therefore, the patient is the source of the information.
Search for the best evidence
After the enquiry the practitioner then looks for resources from databases. PubMed, MEDLINE and CINAHL are best resources for nurses. Those databases use MeSH subject headings as the official terms to describe concepts related to medical articles.
Critically appraise the evidence
Depending on the results of step 2, this process may vary. In this step you evaluate the results of study how they relate to the patient’s case. In case you have found analyses of primary resources then validation will be provided in the analysis.
Integrate the evidence with one’s clinical expertise
In this step, the nurse makes judgement on patient’s case using his previous experience. Given EBT is customer-centered, patient preferences and cost of treatment should be considered in order to give patients best option (McLeod, Southam?Gerow, Tully, Rodriguez, & Smith,2013)
Evaluate the outcomes of the EBP practice decision
In this step, the nurse returns the discussion to the patient. The nurse engages the patient to give him the best medication.
Disseminate the outcome
This is a self-evaluation step. The practitioner examines his proficiency on his work.
References
McLeod, B. D., Southam?Gerow, M. A., Tully, C. B., Rodriguez, A., & Smith, M. M. (2013). Making a case for treatment integrity as a psychosocial treatment quality indicator for youth mental health care. Clinical Psychology: Science and Practice, 20(1), 14-32.
Rubak, S., Sandbæk, A., Lauritzen, T., Borch-Johnsen, K., & Christensen, B. (2009). General practitioners trained in motivational interviewing can positively affect the attitude to behaviour change in people with type 2 diabetes: One year follow-up of an RCT, ADDITION Denmark. Scandinavian journal of primary health care, 27(3), 172-179.

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Cite This Work
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MLA
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Vancouver

My Assignment Help. (2020). Evidence Based Practice. Retrieved from https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/health-care-of-a-patient.html.

“Evidence Based Practice.” My Assignment Help, 2020, https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/health-care-of-a-patient.html.

My Assignment Help (2020) Evidence Based Practice [Online]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/health-care-of-a-patient.html[Accessed 18 December 2021].

My Assignment Help. ‘Evidence Based Practice’ (My Assignment Help, 2020) accessed 18 December 2021.

My Assignment Help. Evidence Based Practice [Internet]. My Assignment Help. 2020 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/3034phm-evidence-based-practice/health-care-of-a-patient.html.

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Introduction
Advanced Professional Nurses (APNs) consist of nurses who are registered with proper training and have the required certificates that help them give healthcare skills in their place of work. APNs are very important since they make sure that those who need their attention are well attended to with accordance of each person’s needs (Sheer & Wong, 2008). The scarcity of healthcare experts, there is a reason to set …
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Answer:
Introduction
Electroconvulsive therapy (ECT) is the deliberate inducing of a modified generalized seizure in an anaesthetized patient under medically-controlled conditions to produce a therapeutic effect (Kavanagh & McLoughlin, 2009). To achieve this, an electric charge is passed through the brain between two electrodes that are placed on the scalp of the anaesthetized patient. Electroconvulsive therapy is used to cause changes in…
Read
More
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Australia Surry Hills Medical Healthcare University of New South Wales 

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Country: Australia

Answer:
Introduction
In Australia, the MHN reports that most cases of chronic mental illness are due depression: either socially or economically associated (Reich, 2015). Also, the bipolar condition and schizophrenia disorder have been on the increase up to the early 2000s after which the federal government is liaising with the MHN, and the state governments intervened through regulation of Medicare safety net and Medicare Levy (Dzipora and A…
Read
More
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ITC542 Internetworking With TCP/IP
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Introduction
The The results of the Gallup’s Annual Honesty and Ethical Standards poll (DEC20, 2016) showed that nursing the most trusted profession for the 15th year all way. Trust is a firm belief, of the character, strength or truth of someone of something according to Merriam-Webster (1828). For a person to be trusted by anyone, he must have portrayed a particular character, trait, or individual strength. The character is also …
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3034PHM Evidence Based Practice

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3034PHM Evidence Based Practice

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Course Code: 3034PHM
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Question:
Write a literature review on neonatal seizure.
Answer:

Introduction
The treatment processes for neonatal seizures are quite limited within 2 to 4/1000 in North American births, which is not up to the level of expectancy of experts, and paediatric doctors around the world as neonatal seizures are quite common. Nearly 19 to 58/1000 infants are born with less than 1500 grams of birth weight (Slaughter Patel and Slaughter 2013). However, different new antiepileptic medications are introduced almost every year to treat the infants. As per the experts, besides new antiepileptic the necessity of treatment is also as important as the process of treatment required for a certain newborn infant. The most common medication used by experts are Phenobarbital and phenytoin/fosphenytoin which have efficiency of approximately 50% which is way to less than required effectiveness. The main concerns related to this medication process are the side effects, interaction of the medication with the patient body, continuous monitoring of the blood flow level besides the consequences of potential negative neurodevelopment. However, according to different reports, the increment in the usage of antiepileptic medications is the result of these limitations of phenytoin and phenobarbital. As per the research and analysis of different expert neurologists on the other hand, nearly 73% of levetiracetam and/ or topiramete in the treatment of neo natal seizures are used in treatment of neonatal seizures because of their less adverse effects and the easiness of usage.
Search Strategy
To develop the database for this research (see appendix 1) different databases like Medline, PubMed Central, NCBI and Google Scholar are used. To complete the research, ample time is important to ensure the significance of the work and the results obtained from this. 22 qualitative research papers were approved which are summarized in Appendix 2. The study consists of systematic analysis and meta-synthesis review techniques. The three most predominant themes immerged in the literature review in this paper have been formulated as the subdivisions of this study paper to develop it. The three recurring themes will be debated in the next sections of this paper.
Main body
Pharmacological treatment
To perform this research nearly 557 articles had been identified from the MEDLINE database by the team of researchers. The whole texts of the rest of the 64 articles have been reviewed. During this, the abstract and the titles of the manuscript are eliminated, as they do not serve the purpose of paper analysis. After the analysis of these articles and the references involved with them 14 additional articles are taken to review. After the analysis of total 78 full texts with 16 research papers involving investigations with EEG (electro encephalogram) to diagnose seizure and treatment observations are taken in considerations as they are fulfilling the required criteria (Slaughter Patel and Slaughter 2013). 

Painter and his team focused on the phenobarbital and phenytoin and their research work is the only one in this field in 1999. After this research study, a trail with 59 patients were arranged. In this trail, patients were given a level of 25mg/l Phenobarbital and 3 mg/L of phenytoin in addition to an alternative medication in case the process fails. EEG of the patients were performed continuously. The effectiveness of the phenobarbital and phenytoin were obtained as the seizures came in control of 43% for both matured and premature infants. The results were obtained in both the cases with phenobarbital and phenytoin (P=1) which is nearly 45% with a seizure ratio controlled by these medications is 57:62 respectively for P=0.67. Therefore, the results obtained shows that both of the medications are equally effective with no adverse side effects for the infants. This significant development is considered as the cause of seizure reduction up to 80% relative to complete seizure cessation, this rate of efficiency improved to 80% and 72% respectively. The observations of adverse effects are almost none. However, the patients were shuffled for better research; still the research of Painter and his team consists of some insignificant restraints. The research is carried on only single centre with expert physicians, well aware EEG technicians to carry out the observation and research method. The usage of disparity among groups and the only single-blinded regarding baseline characteristics was present.
In 2004, boylan and his team had performed a research on randomised trial of lidocaine versus a benzodiazepine dip after the failure of Phenobarbital. During the research, the experts performed EEG of the patients continuously. Lidocaine was used at a dosage at a rate of mg/kg then infused at a rate of 2 mg/kg/hr. 60 micrograms/kg of midazolam were dozed after 150-300 micrograms/kg/hr infusion. In addition to this Clonazepam, dosing has been used. The statistical analysis required for this research was prevented due to the major restriction of its small size. There are certain cases, which were randomized including five cases to lidocaine group, 6 to benzodiazepines (3 for midazolam, 3 for clonazepam). The responses varied with each other. Benzodiazepine groups came up with no responses and in case of lidocaine, 3 out of 5 patients responded to the treatment. In the second case, among 3 patients one had 80% seizure reduction and two were seizure free. It is clear that from the results that the neurodevelopment among patients were very poor for over the period of a year for the research. However, no adverse effects were noticed in a short period. Particularly the 50% of the patients under observation responded to the phenobarbital, which is consistent with the reports of Painter and his team.
A research on second-line midazolam usage after up to 40 mg/kg phenobarbital to a historical phenobarbital and or phenytoin treated neonatal seizure patients by the team of Castro-Condeet in 2005. Continuous EEG was done for multiple hours then intermittent EEG at an interval of 24-hours was done to assure no seizure reversion occurs. Midazolam was administered up to twice at a rate of 150 mg/kg when required at a rate of 60-1080 mg/kg/hr injection. The dosage is way to higher than the dosage used by Boylan and his team in 2004 or any other expert team for that matter. The midazolam rate brought remarkable response of 100%. The seizures were totally controlled within an hour for nearly 10 to 13 patients in the treatment group. However, no gap differences of any year has been observed in case of neurodevelopmental results. If the results are compared  between group 1 with no responders (seizures continued even after administration of phenobarbital or phenytoin) and the 2ndgroup which is treated with midazolam, surprisingly the number of patients assessed as normal after treatment showed significant differences in terms of percentage in favour of midazolam. As the difference contains the previous troop, the results are considered to be biased as of the changed practice between this time period which is not related to midazolam. In numerical view, it has seen that in every 4 out of 13 infants have decreased consciousness as side effects for nearly 10 to 15 minutes further leading to midazolam bolus hypertension with multisystem organ failure because of acute hypoxic-ischemic injury (HIE). Tin case of 2 infants the conditions are not related to midazolam administration.
After dosage of  40mg/kg of  phenobarbital and /or IV diazepam or lorazepam in a single dosage, the comparison between second and third line treatment with lidocaine versus midazolam for mature and premature babies with neonatal seizure cases has been conducted by Shany and his team in 2007. The research also consists of the historical cohort based on the hypoxic-ischemic encephalopathy of such cases. The Amplitude based EEG has been conducted on the students continuously. The 2mg/kg of lidocaine dosage was administered at a rate of 4-6 mg.kg.hr infusion. Midazolam was also injected at a rate of 60-200 mg.kg/hr without loading as a dosage. This group of patients in the first case responded up to 77% however, there were 50% cessation with the seizure activity rate less than 6 hours. The second group showed 50% response with a seizure activity rate also less than 6 hours of completion of cessation. The non-responders were passed by the alternative medication agents leading towards the overall response consists of 81% lidocaine and 67% of midazolam with no adverse effects in this short period. The comparative investigation was limited due to the absence of midazolam loading dose.
After that about 20 infants were treated with lidocaine (dosing protocol: 2 mg.kg load, 6mg/kg/hour for 12 hours then 2 mg/kg/hours for again 12 hours.) prospectively. Malingre and his team develop the process in 2006. The research work is significant after the failure of phenobarbital and either midazolam or clonazepam. The reduction in the seizures was noticed at 76% with 52% with seizure cessation. The aim of this research was to minimize the cardiac effects with an optimal lidocaine dosing. The dose was reduced following this research from 6 mg/kg/hour for 6 hours versus up to 12 hours.). This gave a similar response rate of 78% affectivity with no adverse result notices.
Another research is done on the usage of levetiracetam of 10-20 mg/kg load with a rate of 80 mg/kg/hour divided twice daily leading to 45mg/kg/hour everyday among 23 neonates in comparison with phenobarbital and phenytoin. The research is conducted by Abend and his team in 2011. Result of this research shows a reduction of 50% in the number of seizures treated by levetiracetam recorded among 35% neonates. No adverse effects had been noticed. It is stated in the discussion that with the passage of time some of the seizures may have been secondary.
Another research is done by reviewing 22 patients acquiring first and second line levetiracetam of 10-50 mg/kg intravenous load at an infusion rate of 50 mg/kg/hour. The result of this research showed 86% reduction in seizure cessation. 100% improvement was recorded in case of 7 patients among 22 which is 32% after the heavy dosage. The side effect was noticed in one patient it was just an irritability, which was cured by following pyridoxine supplement.

Cooling Method

Therapeutic hypothermia is a powerful and clinically accessible treatment for neonatal hypoxic-ischemic encephalopathy or HIE. Various animal quantitative researches have shown that this type of hypothermia treatment can diminish seizures and epilepsies action in the setting of hypoxia-ischemia. However, recent clinical information in human babies has been proving different from this. Three observational quantitative studies demonstrated a diminished frequency and seriousness of seizures among neonates with HIE who were treated with therapeutic hypothermia. Furthermore, two quantitative research studies demonstrated a much lower burden for the electrographic seizures by EEG observing: (1) among neonates with direct encephalopathy and (2) subsequent to representing severe mind damage on MRI. In addition this, in cohort studies, neonates were treated with therapeutic hypothermia and as a result it was found to have blood vessel ischemic stroke on
MRI having a much lower probability of seizure when contrasted with those neonates with stroke who were not given cooling treatment. Interestingly, meta-examinations of randomized controlled trials of cooling therapy for neonatal HIE have neglected to demonstrate a relationship between cooling therapy and diminished seizures. The potential effects of epileptogenic impacts of cooling therapy possess critical clinical ramifications. Since some of the seizure, medicines have restricted viability in infants and hence, may prove harmful.
The connection between cooling therapy and the combined occurrence of seizures was inspected by examining neonate’s cohorts either with seizures who were admitted to various health centers previously o rafter the start of the cooling treatment. Among the enrolled infants incorporated into the study nearly 151 were getting treatment for hypothermia.  The seizure monitoring in study subjects who were born before the onset of the cooling therapy were mainly at discreation of all appointed treating physician, however, on the other hand, cooled newborns were having continuous monitoring both with conventional video EEG as well as amplitude-integrated EEG. It was done from time of admission until completion of the rewarming treatment after giving therapeutic hypothermia. All the cooled infants suffering from direct encephalopathy substantially were much less prone to suffer from either electrographic or clinical seizures compared with the non-cooled babies (the cooled ones: 26 % vs. the non-cooled: 61%, P<0.001). However, there was still no distinction in risks of seizures mainly among the infants having extreme encephalopathy' As the observation of ceaseless EEG was performed closely by hypothermia, it was most probably possible that the recurrence of EEG seizure was more or less under-evaluated in non-cooled amass whenever checking was more constrained and at the tact of the treating doctor. Management of Underlying causes According to quantitative findings of - a study, neonatal period (the initial 28 days of life) has the highest frequency of seizures over the life expectancy at 1.8 to 3.5 for every 1,000 live births. The most widely recognized reason for neonatal seizures is hypoxic-ischemic Encephalopathy, which happens in around 1 to 2 for each 1,000-1ive births. In the neonates, a wide scope of central nervous system and systematic disorders can give rise to neonatal seizures. Evaluation of cause and treatment normally happens simultaneously. The most basic need is distinguishing treatable reasons underlying seizures, including metabolic disturbances (hypocalcaemia, hypo glycaemia and hypomagnesaemia) as well as inflammation due to infection attack. The overwhelming reason is to some degree due to the neonate basic setting. A detailed quantitative investigation from a tertiary care referral neonatal ICU was done in which around 66% were found to be related to hypoxic-ischemic encephalopathy and cerebrovascular disarranges In spite of the fact that the term baby is at high hazard for seizures, it is progressively perceived that seizures can be a major issue for the preterm newborn children. A recent quantitative study of extremely low birth-weight children in Israel was analyzed showing a general rate of neonatal seizures of around 5'6%' A much younger male sex, gestational age, along with other major foundational (such as sepsis) and neurological comorbidities (either intraventricular drain or periventricular (leukomalacia) were  all considered as autonomous indicators of neonatal seizures. Newborn children with complex innate coronary illness are at high hazard for seizures in the perioperative period. Different but less common reasons for neonatal seizures incorporate formative irregularities, natural mistakes of digestion, and other hereditary disorders that are examined in detail in reference studies Antiepileptic  Drug Therapy(AED) Thorough assessment of the adequacy of antiepileptic drugs treatment in neonates is very challenging. In perspective of the difficulties characteristic in behavioral findings, incorporation of the constant EEG observing can be referred to as a quality level for investigations of the therapeutic efficiency. A consensus exists that as of now the anticonvulsants used are regularly ineffectual for the treatment of neonatal seizures (Sanker and Painter 2005). Painter and associates' in 1999 quantitative investigation revealed that in babies with EEG-affirmed seizures, the loading doses for both phenobarbital and phenytoin were similar but deficiently viable, and that either of these alone controlled seizures in less than the half. Moreover, variable viabilities has been reported for midazolam as the second line of pharmaceutical. Lidocaine is a viable treatment for neonatal seizures; however, issues related to the heart danger have restricted broad reception of this in infants. A similarly imperative quantitative finding regarding AED treatment in neonates was whether treatment as fruitful method of treatment for seizures justified. In encephalopathy newbom children, the seizures unexpectedly wind down before the finishing of first 7 days of life; in spite of the fact that it is obscure whether continuation of AED treatment is of advantage, this practice is very normal. Quantitative investigations of early-life anticonvulsant treatment on both psychological as well as neurological improvement are constantly confounded by numerous reasons for neonatal seizures, and it will be important to formulate thorough methodologies for the generally homogeneous clinical populaces for such examinations. Discussion Proving a technique to be the best with 100% positive result in case of treating seizure is not possible as a very few proof about the finest treatment for natural seizure in medicine is available. One out of two scattered trails, which have been conducted for this research was worthy and big enough to give numerical analysis. There are only few more researches available with potential of non-scattered study by experiments and two legions of demonstrations done before this research. Those papers also provide thorough study on effects of different types of treatment methods for neonatal seizures. The description of the first exposure seizing infants related to novel medications was revolutionary in terms of the historical cohort of neonatal seizure treatment. However, hazards and advantages are very lesser known as per recent data about anti-epileptic drugs comprising the scarcity of control or comparability group. Even after different study suggesting against phenobarbital, it has been found from different research papers that the first line of medication should be phenobarbital. This is because it is included as RCT, which is the first line treatment of neonatal seizure. As in animals, it is the most analyzed anti-epileptic drug, which makes it historically precedent for neonates. It has also been found that the proof of the impact of phenobarbital on futuristic neonatal neurodevelopment is very little. In addition, the U.S Food and Drug Administration (FDA) have put bindings on the usage, which includes no approval of usage of such drugs in communities with large number of patients. The reasons of such bindings is not clear. However, in other researches, Phenobarbital was been considered as a better medication for neonatal antiepileptic, even though Painter and his team gave equal importance to phenytoin. The probability of side effects, capricious metabolism in neonates besides the requirement of continuous monitoring blood flow level are the major reasons, which suggest the opposite of this. There are treatments, which are not that much responsive to Phenobarbital for neonatal seizures and can be used as second-line treatment includes Levetiracetam, Phenytoin/fosphenytoin, and Lidocaine. Although there is no comparison within the same structural study in two different studies. It has been observed that Levetiracetam has minimized the seizure. It is recommended for all age groups and does not require any type of blood observations. Therefore, for this research, as per the stipulations of Lidocaine and fosphenytoin/phenytoin, it has been considered as the second line of medication. However, it is not recommended as there are not many thorough studies done taken in regards to the first moth life cycle especially. If the usage is compulsory at any circumstances, it is not recommended to use more than 40-50 mg/kg bolus in line. This is also recommended by the team of Khan. It has been found from the study that this measurement shows continuous progress. In addition, neonatal seizures are related to the morbidity and mortality. Hypoxic-ischemic encephalopathy (HIE) is a widely recognized cause behind seizures in beizuresabies. Neonatal models using cooling therapies for animals show better results to diminish seizures and epileptic-form among hypoxia-ischemia, however information from human examinations have poor results. In this regard,discoveries of recent examinations exhibited a diminished seizure number in infants with direct HIE treated with hypothermia. This research also confirms to clinical trial information that showed that infants with encephalopathy could benefit the most from therapeutic hypothermia (Gano et al., 2014). Furthermore, more study is required to reveal the components that underline the decreased risks of seizures related with cooling therapy in babies with HIE, and the potential risks of epileptogenic for hypothermia in other clinical settings (Silverstein and Jensen, 2007). In spite of the fact that, many researches and innovations of procedures are now available for neonatal seizures. Numerous functional difficulties must be routed to smoothen the clinical trials of AEDs in neonates. Involving consistent EEG checking into clinical investigations of neonatal seizure treatment is an overwhelming task. However, it will likewise be fundamental to survey AED effectiveness with different treatments (such as instigated hypothermia) in newborn children. The criteria involved in this research do not include any articles as treatment options, which comprise of Phenobarbital coma and status epileptics for infants. Resultantly it cannot be used as reasons about the recommendation of the trail of phenobarbital in effected infants who have not responded to our pharmacological therapies. Conclusion and Recommendation The research is conducted on the review of popular research works depicting different treatment method for neonatal seizure with respect to antiepileptic medication. The aim of this research is to bring out the most suitable method of them. The data used for this research is topiramate in neonates is quite low. The adaptation of the futuristic approach includes the seizure diagnosis and verification of cessation via amplitude-integrated EEG can be considered one of the most effective of all. The focus of this method is on the condition of the patient and etiologist. Irregular but controlled experimentation showed better results with medications without any side effects. However financing such researches is a major concern for any researchers. The collaboration of different neonatal care units of different hospitals is also necessary for such researches, as this will help in financing of the projects. In addition to this, the collaboration will ample the statistical power of data collection and help to cope with the difficulties of reports related to the enrolled neonates in medical experiments of antiepileptic and offer a minimal amount of protective means for treatment and randomization. A detailed group formation for patients is necessary to enlist details of those infants whose parents have denied randomization for different researches. This is why collaboration of different centres with networks to ensure funding and permission to perform tests on neonatal seizure medication. On the other hand, this will help the researchers to use large amount of statistical and medical reports and analyse more data to ensure more accuracy of the research. The success rate of the research will be more than conducting research on patients of a single centre. Subject: Management of Neonatal Seizures Search Time Frame: 1999-2018 Selected databases & Sources: PubMed Central (Results 20/saved 15) Google scholar (Results 45/saved 8) Springer (Results 2/1 ) Elsevier (Results 5/saved 2) Range of search terms: Synonyms: epilepsy, fits, newborn/infants, treatment Acronyms: AED, HIE, EEG, FDA Other search terms: women, mother, neurological problem, epilepsy, causes, management, short and long term effects, recommendations. Examples of Boolean terms and Truncation: Neonatal seizures AND management Neonatal seizures AND lived experiences  Neonatal epilepsy AND management Treatment, OR recommendations AND Neonatal seizures   Inclusion criteria English language papers Full text papers Relevant grey literature Primary research articles Relevant review and discussion papers Exclusion criteria Research papers that require purchasing prior to viewing Papers not available in full text Unpublished studies Free Membership to World's Largest Sample Bank To View this & another 50000+ free samples. Please put your valid email id. E-mail Yes, alert me for offers and important updates Submit  Download Sample Now Earn back the money you have spent on the downloaded sample by uploading a unique assignment/study material/research material you have. After we assess the authenticity of the uploaded content, you will get 100% money back in your wallet within 7 days. 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The advantages of larger MTU is:
They are appropriate for handling the transfer of the larger amount of the data that is set over the longer distance.
There is no major fragmentation important for fast delivery and few lost datagrams.
The advantages are for small MTU:
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Introduction
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